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Case Details (Sorted by Age)

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VAERS ID:366047 (history)  Vaccinated:2009-11-02
Age:18.0  Onset:2009-11-02, Days after vaccination: 0
Gender:Female  Submitted:2009-11-02, Days after onset: 0
Location:Vermont  Entered:2009-11-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP010AA0UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Asked to lie down immediately, pale, Trendelenburg, cool cloth. Known to have fainting spells. No breakfast, just got up.

VAERS ID:366156 (history)  Vaccinated:2009-10-29
Age:18.0  Onset:2009-11-04, Days after vaccination: 6
Gender:Female  Submitted:2009-11-09, Days after onset: 5
Location:Texas  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PHENERGAN PO prn
Current Illness: Morning sickness-nausea
Preexisting Conditions: Pregnancy 1st trimester PMH: none Allergies: PCN, Morphine
Diagnostic Lab Data: Labs: CBC, neutrophils high Dx studies: transvaginal US no FHT
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP010AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Abortion spontaneous, Full blood count, Neutrophil count increased, Ultrasound scan abnormal, Uterine dilation and curettage
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: Miscarriage/D and C.11/10/2009 MD and hospital records for 11/4 and 11/5-2009. Patient nine weeks pregnant, transvaginal US noted no FHT. Scheduled for D&C 11/5/2009. DC DX S/P suction D&C.

VAERS ID:366167 (history)  Vaccinated:2009-11-07
Age:18.0  Onset:2009-11-08, Days after vaccination: 1
Gender:Female  Submitted:2009-11-09, Days after onset: 1
Location:Colorado  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: none
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: rash Rt temple to neck, facial swelling. continues to have above sx @ 11/09/09 12:00 PM

VAERS ID:366215 (history)  Vaccinated:2009-11-07
Age:18.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Male  Submitted:2009-11-09, Days after onset: 2
Location:California  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Takes Advair daily via inhaler for Asthma. No adverse respiratory events experienced during episode.
Current Illness: No
Preexisting Conditions: History of asthma, on daily inhaler
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Approx. 2 hrs after H1N1 injection, developed rash on both upper arms from shoulder to elbow, upper back and under chin. Took po benedryl at pharmacy (approx. 20 mg liquid), with sx. subsiding in approx 15 min, but returning at 11:15 PM (itching only). Took another 10 mg. dose of benedry, with sx. resolving and not returning.

VAERS ID:366221 (history)  Vaccinated:2009-09-23
Age:18.0  Onset:2009-09-24, Days after vaccination: 1
Gender:Male  Submitted:2009-11-09, Days after onset: 46
Location:Indiana  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED  IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Muscular weakness, Musculoskeletal pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Pain in shoulder 1st day after injection, peaked at 1 week, continued since then and increased over last 3 days. Painful motion, especially abduction/elevation of shoulder, weakness of ratator cuff, no direct nerve injury, but poss. auto-immune phenomenon like Parsonage-Turner syndrome. Onset of Sx over period of 1-14 days, improved for 12 weeks, reacurred and worsened about 11-01-09. Sought care beginning 11-06-09. Sx weakness and pain in left arm, especiall with abduction of arm. No readness, swelling, nodules, masses, no redness or warmth. Left supra-spinatous muscle atrophy in supraspinous fossae, pain wit ext. rotation and abduction. Referred to sports medicine physician. Last exam 12-03-09: Feels tight in should with abduction $g90 degree, supraspinatous atrophy, weakness, and pain. 1+= infraspinatinatous weakness, referred for physical therapy.

VAERS ID:366415 (history)  Vaccinated:2009-11-06
Age:18.0  Onset:2009-11-09, Days after vaccination: 3
Gender:Male  Submitted:2009-11-10, Days after onset: 1
Location:Illinois  Entered:2009-11-10
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen Klonopin Miralax
Current Illness: None
Preexisting Conditions: Neuromuscular Respiratory Failure Neuromuscular Degenerative Disease NOS Cerebral Palsy PMH: progressive spastic quadriplegia, respiratory failure, neuromuscular disease, aspiration pneumonia, dysphasia, ALS, kyphosis, scoliosis.
Diagnostic Lab Data: ECG / Resp monitoring DX studies: CXR: increased density compatible with pneumonia of L lung.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101276060IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bronchoscopy, Chest X-ray abnormal, Dyspnoea, Electrocardiogram, Influenza, Laryngoscopy, Pneumonia, Pyrexia, Tracheostomy
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Swine Flu Symptoms. High grade fever 102.00. Inability to breathe. Treated with ibuprofen fever reducer and empiric inhaler usage. 12/07/09 and 12/31/09 MR and DC summary received for 11/12/09-12/22/09. Elective tracheostomy. Pt tolerated procedure well. Pt with pneumonia of L lung base. Pt improved and discharged home in stable condition. 12/31/09 Consult received for DOS 12/14/09. F/U visit after elective tracheostomy. Pt breathing comfortably. Wound healing well. Flexible laryngoscopy and bronchoscopy: Bronchoscopy showed: no distal obstructions and patent main stem bronchi.

VAERS ID:366448 (history)  Vaccinated:2009-11-05
Age:18.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic inflammatory demyelinating polyneuropathy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Feeling hot, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient c/o feeling hot, nauseous, and like he was going to faint while in waiting area, after receiving H1N1, brought to cot in clinic area, pt pale, EMT called, message left for mother. Evaluated by EMT, refused transport.

VAERS ID:366507 (history)  Vaccinated:2009-11-02
Age:18.0  Onset:2009-11-04, Days after vaccination: 2
Gender:Female  Submitted:2009-11-10, Days after onset: 6
Location:Kentucky  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ORTHO TRICYCLEN
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500758P0IN 
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Had H1N1 2 days ago (nasal vaccine) feels weak and vomited x 3 today. Nausea resolved. No vomiting for 7 hours.

VAERS ID:366989 (history)  Vaccinated:2009-08-18
Age:18.0  Onset:2009-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 86
Location:Texas  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TX090076PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2915AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0581X1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: I GAVE IMMUNIZATION AND ON 2ND SHOT, I ASKED ARE YOU OK AND SHE WAS ALREADY PASSING OUT OR FAINTING. ADMINISTERED O2 AND SMELLING SALTS-DID NOT FALL OR INJURE SELF-MOM AT SIDE.

VAERS ID:367002 (history)  Vaccinated:2009-11-11
Age:18.0  Onset:2009-11-11, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Low Fever of 99.0 F
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Cough, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Fever of 102 F. Achy. Chills. Sore Throat. Cough.

VAERS ID:367062 (history)  Vaccinated:2009-11-12
Age:18.0  Onset:2009-11-12, Days after vaccination: 0
Gender:Male  Submitted:2009-11-13, Days after onset: 1
Location:Kansas  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: HTN
Preexisting Conditions: HTN; VSD with repair
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500781P0IN 
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Nasal inflammation, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Facial erythema, swelling, itching, nasal passage swelling.

VAERS ID:367099 (history)  Vaccinated:2009-08-11
Age:18.0  Onset:2009-09-10, Days after vaccination: 30
Gender:Male  Submitted:2009-11-13, Days after onset: 64
Location:Illinois  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PCN 11/18/09 DC sum and medical records received for dates 9/10/09 to 9/19/09. PMH: PCN allergy
Diagnostic Lab Data: GBS 11/18/09 DC sum and medical records received for dates 9/10/09 to 9/19/09. Diag/Labs: LP(-), MRI (+)sinusitis, blood work WNL.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500619P4IN 
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB162CA   
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3043AA   
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURAC52B041CA   
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETHD0191   
Administered by: Military     Purchased by: Unknown
Symptoms: Areflexia, Ataxia, Blood product transfusion, Blood test normal, Diarrhoea, Eyelid ptosis, Guillain-Barre syndrome, Lumbar puncture normal, Muscular weakness, Nasopharyngitis, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging abnormal, Paraesthesia, Paresis, Sinus congestion, Sinusitis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Noninfectious diarrhoea (narrow)
Write-up: Motor Paresis: 10-Sep-09. 11/16/09: Medical Center contact information provided. 11/18/09 DC sum and medical records received for dates 9/10/09 to 9/19/09. DC DX: GBS. Secondary DX: sinusitis. Chief Pt. c/o tingling in feet, hands, weakness in abdominal muscles. Pt. states unable to exercise. Sx began x3 days ago. Ptosis of rt. eye began 1 day ago. Sinus congestion noted x5 days ago then improved. Diarrhea x1 wk ago, now resolved. Pt states was given a "peanut butter shot" 8/4 which is standard for recruits. Pt unable to run, do push-ups, or sit-ups. Pt states feet feeling as "if they are about to fall asleep". Admitted for progression of sx. Assessment: ptosis rt. eye, areflexia, nerve conduction test abnormal-preserved latencies, ataxic, reflexes were present in AM and absent in PM. IVIG started. Pt improved at dc. 12/10/09 Outpatient Medical Records received for DOS 09/22/09 Pt. requesting return to full duty; reports feeling better DX: Guillain-Barre syndrome, resolved.

VAERS ID:367112 (history)  Vaccinated:2009-11-04
Age:18.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:Mississippi  Entered:2009-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/S IV; SOLUMEDROL; PHENERGAN; IV BENADRYL 11/4/09; O2; ATIVAN IV x 2
Current Illness: Lethargic/vomiting
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: ABG''s, PO2 103 IV, O2, EKG, glucose 141. Labs: CBC, Neutophils high, Lymphs low, CMP, Gl ucose high, Ua norm, urine drug screen neg, HCG neg DX studies: EKG wnl
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS10127606 UNUN
Administered by: Other     Purchased by: Public
Symptoms: Anxiety, Blood gases, Blood glucose increased, Convulsion, Depressed level of consciousness, Drug screen negative, Electrocardiogram, Full blood count, Hyperventilation, Lethargy, Lymphocyte count decreased, Metabolic function test, Nausea, Neutrophil count increased, PO2 increased, Pallor, Pregnancy test negative, Rash macular, Shock, Somatoform disorder, Tremor, Urine analysis normal, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Received H1N1 vaccine at school after N 15 min observation went to bathroom was rash, lethargic, vomiting, pale, awake but not alert. N/V, SOB with shock like symptoms. 911 called, to hospital via ambulance. Rash-slightly splotching, anxious. Returned to ER @ 5:48 pm w c/o seizure x 1hr- "flopping in bed, shaking all over" evaluated by ER MD - Hyperventilation - Tx with IV ATIVAN x 2. Referred to mental health and evaluated in ER. D/C 1:20 a.m. 11/05/09 Dx Psychogenic Resp Syndrome" 12/7/2009 ED records for 11/4/2009, patient admitted with ?seizure activity, hyperventilating and shaking all over. Tx IV Ativan, Solu-Medrol and Phenergan, DC DX Hyperventilation syndrome

VAERS ID:367121 (history)  Vaccinated:2009-11-04
Age:18.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:Mississippi  Entered:2009-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data: BP
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101276060UNUN
Administered by: Other     Purchased by: Public
Symptoms: Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow)
Write-up: Received H1N1 vaccine @ school. School nurse called to gym-pt c/o "allergic reaction" EMS called 9:52. Pt tx with EPINEPHRINE, IV fluids, BENADRYL IV, O2. Improved in route to ER. No rash noted by nurse. Improved d/c home.

VAERS ID:367133 (history)  Vaccinated:2009-11-13
Age:18.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 0
Location:Pennsylvania  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin
Current Illness: unknown
Preexisting Conditions: No known drug allergies. Pt is 26 weeks pregnant
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP013AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug exposure during pregnancy, Face injury, Fall, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt Received H1N1 vaccine. While standing at check out counter she passed out, fell forward, struck her face (rt side) and chin on the counter then fell down onto buttocks landing in a sitting position.

VAERS ID:367249 (history)  Vaccinated:2009-11-12
Age:18.0  Onset:2009-11-12, Days after vaccination: 0
Gender:Male  Submitted:2009-11-13, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500801P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hyperhidrosis, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Near faint, pale, sweaty. Reclined, rest for 1 hr, discharged by physician.

VAERS ID:367254 (history)  Vaccinated:2009-11-11
Age:18.0  Onset:2009-11-12, Days after vaccination: 1
Gender:Female  Submitted:2009-11-13, Days after onset: 1
Location:Louisiana  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER   RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (broad)
Write-up: I got the vaccine in my right shoulder, the morning after I woke up and my hip was very sore and throbbing. When I got out of bed and stood up it became a sharp pain. I took I.B Profurien but it did not help. The throbbing is still going on today and I am a little worried because I got the shot in my shoulder not my hip.

VAERS ID:367435 (history)  Vaccinated:2009-11-13
Age:18.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 0
Location:Pennsylvania  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1013263P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Electrocardiogram normal, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Patient was have difficulty breathing after getting to vaccine. Unable to take in breath. Gave EPI-PEN 0.3mg in Rt thigh. Improvement. 911 called and sent to ER.

VAERS ID:367400 (history)  Vaccinated:2009-11-14
Age:18.0  Onset:2009-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-11-15, Days after onset: 1
Location:South Carolina  Entered:2009-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acne medication
Current Illness: nasal drainage which was thought to be allergies
Preexisting Conditions: Augmentin; cephalosporin drugs; seasonal allergies; repaired pectus excavatum 12-08; tympanoplasty 3-09 resulting in mild continual tinnitus
Diagnostic Lab Data: EKG;Chest Xray and bloodwork
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood test, Chest X-ray, Dizziness, Dyskinesia, Electrocardiogram, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 2 episodes of dizziness and fainting with the second episode having seizure type activity

VAERS ID:367411 (history)  Vaccinated:2009-11-14
Age:18.0  Onset:2009-11-14, Days after vaccination: 0
Gender:Female  Submitted:2009-11-15, Days after onset: 1
Location:New Jersey  Entered:2009-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Diarrhea 6x / vomit 12x. Dehydration.

VAERS ID:367508 (history)  Vaccinated:2009-10-21
Age:18.0  Onset:2009-10-21, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 26
Location:Pennsylvania  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinusitis
Preexisting Conditions: At time of vaccination it was not known patient was pregnant
Diagnostic Lab Data: n/a
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500757P IN 
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Pregnant patient given H1N1 live intranasal vaccine.

VAERS ID:367531 (history)  Vaccinated:2009-11-02
Age:18.0  Onset:2009-11-03, Days after vaccination: 1
Gender:Male  Submitted:2009-11-14, Days after onset: 11
Location:Virginia  Entered:2009-11-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DUONEB; ZITHROMAX; ADVAIR
Current Illness: Mild bronchitis without fever
Preexisting Conditions: Asthma; obesity; depression. 11/17/09: Discharge Summary recieved for dates of service 11/4/09 to 11/7/09. PMH: Asthma, obesity, borderline type 2 diabetes mellitus and depression with a history of suicidal ideations. Allergy to Penicillin.
Diagnostic Lab Data: WBC = 23.4 with 76 P, 10 Band, 8 L; Influenza A +; Bld culture-negative. 11/17/09: Discharge Summary recieved for dates of service 11/4/09 to 11/7/09. Labs and diagnostics: Urine culture-no growth, blood culture-no growth. CXR-WNL. WBC 23.4 (H), RBC 5.34 (H), MCV 76.3 (L), MCH 25.5 (L), Sodium 133 (L), Segs 76 (H), Lymph 8 (L), # Neut 20.1 (H). UA protein-trace (H), urobilinogen 2.0 (H). Glucose 119 (H).
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA0IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3251BA0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB327AA1IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0622X0IMLL
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Asthma, Band neutrophil percentage, Blood culture negative, Blood glucose increased, Blood sodium decreased, Bronchitis, Cellulitis, Chest X-ray normal, Chest pain, Chills, Cough, Crepitations, Culture urine negative, Decreased appetite, Diabetes mellitus, Dyspnoea, Erythema, Fatigue, Granulocyte count increased, Headache, Influenza, Influenza serology positive, Injection site cellulitis, Injection site erythema, Injection site pain, Injection site swelling, Leukocytosis, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin decreased, Mean cell volume abnormal, Musculoskeletal stiffness, Nausea, Neutrophil count increased, Neutrophil percentage increased, Oropharyngeal pain, Oxygen saturation normal, Pneumonia, Protein urine, Pulmonary congestion, Pyrexia, Red blood cell count increased, Rhonchi, Sinusitis, Skin warm, Tachypnoea, Urobilin urine present, Viral infection, White blood cell count increased
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Developed rigors, fever, pneumonia (+) Influenza A, as well as L thigh swelling, redness pain c/w cellulitis -$g hospitalized for pulmonary status as well as IV Abx. 11/17/09: Discharge Summary recieved for dates of service 11/4/09 to 11/7/09. Final Dx: Influenza A-Rule out H1N1, Bronchitis with clinical right middle lobe pneumonia, asthma exacerbation-improved, resolving chest pain, possible LVH on echocardiogram-r/o LVH, boarderline diabetes mellitus, left thigh cellulitis, leukocytosis with left shift-sepsis ruled out. Assessment: Dx. in office with viral syndrome and frontal sinusitis and treated with Zithromax for 7 days and prednisone for 5 days. Returned to the office with c/o two weeks of congestion, chills, HA, productive cough RUQ and LUQ abdominal pain, decreased appetite and sore throat and diagnosed with bronchitis with decreased apical breath sounds and probable influenza. On date of admission presented with c/o substernal chest pain and SOB, fever, headache, neck and back stiffness, fatigue and nausea. Rigors, decreased R sided breath sounds and a respiratory rate of 34 were noted. Cultures obtained and pt. placed on IV fluids with Levaquin IV and Tamiflu, Advair, Singulair and ceftin. Nebulizer tx. Q 6 hrs, increased to Q 4 hrs. SpO2 remained 98-100% on room air. Temp. ranged from 98.0 to 102.8. Lungs with RML rhonchi and crackles. Prednisone therapy initiated. C/o increased L thigh pain at injection site of Pneumovax with erythema and warmth to touch. Rocephin and warm compresses initiated. Discharged on 11/7 on 2500 kcal ADA diet, warm compresses to L thigh 3 x daily.

VAERS ID:367792 (history)  Vaccinated:2009-11-03
Age:18.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Male  Submitted:2009-11-16, Days after onset: 13
Location:New Mexico  Entered:2009-11-16
Life Threatening? No
Died? Yes
   Date died: 2009-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: gingivitis. dental care provided 10/29/2009
Preexisting Conditions: PMH: loose teeth, gum pain and bleeding, hit head when young.
Diagnostic Lab Data: OMI results not available at this time however chest xray showed enlarged heart, no pulmonary effusion
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500781P IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Aspiration, Blood pressure, Cardiac arrest, Chest X-ray abnormal, Death, Endotracheal intubation, Hypertrophic cardiomyopathy, Myocardial fibrosis, Poor dental condition, Pulmonary congestion, Pulse absent, Resuscitation, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow)
Write-up: Patient had sudden cardiac arrest and had CPR from onset, was picked up by EMS and transported to hospital and pronounced dead at approx 11:30 PM. 12/16/09 Report of death received for 11/03/09. Decedent fell on the floor while in a social gathering. No pulse, CPR performed by school nurse for 10 mins until EMS came. Decedent had emesis while compressions were performed. EMS started ACLS, intubation, 3 IV lines, 4 Epi, 3 Atropine and 1 amp Bicarb. Sinus rhythm established 1 time, but lost. CPR unsuccessful. Decendent pronounced dead. 12/16/09 Autopsy results revealed no visible internal signs of trauma. All systems autopsy: normal. Teeth in poor condition. Cardiovascular system: myocardium: focal areas of fibrosis, atrial; bulges in atrial and ventricular muscular fee walls, interventricular septum 3cm thick. Pathologist opinion: Hypertrophic cardiomyopathy (790gr). Heart severely congested and lungs heavy with possible aspiration. 12/24/09 Toxicology report received. This report showed that no drugs were used. 01/04/09 Medical/dental record received for DOS 10/29/09. Debridement performed. Anesthesia used. Moderate to heavy generalized bleeding. Tx: Chlorhexidine gluconate oral rinse. DX: Gingivitis, periodontal disease.

VAERS ID:367802 (history)  Vaccinated:2009-11-13
Age:18.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 3
Location:Michigan  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500805P IN 
Administered by: Other     Purchased by: Public
Symptoms: Feeling abnormal, Headache, Nausea, Pallor, Posture abnormal, Somnolence, Speech disorder
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: About 25-40 min after receiving H1N1, student returned to imm. area c/o nausea, feeling groggy, HA. Alert, oriented to time, place, person, speech slow. Slouching in chair, pale, 110/64, P 92, R 16. Guardian notified to come to school. Child monitored x approx 60 min., did not worsen, did not improve, did not want to be evaluated in local walk-in, got out of chair abruptly and left.

VAERS ID:367993 (history)  Vaccinated:2009-11-10
Age:18.0  Onset:2009-11-11, Days after vaccination: 1
Gender:Female  Submitted:2009-11-11, Days after onset: 0
Location:Pennsylvania  Entered:2009-11-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP015AA0IMUN
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3167BA0IMUN
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: dizziness 11/11/09 and 11/10/09 upon awakening in am, nausea 11/10/09 upon awakening in am.

VAERS ID:368005 (history)  Vaccinated:2009-11-06
Age:18.0  Onset:2009-11-07, Days after vaccination: 1
Gender:Male  Submitted:2009-11-10, Days after onset: 3
Location:Virginia  Entered:2009-11-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EFFEXOR XR
Current Illness: None
Preexisting Conditions: Depression
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102045P10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash erythematous, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Raised red rash with itching on waist line, torso and arms. Mother states talked with PMD and was told reaction to vaccine. Was advised to give Benadryl by PMD.

VAERS ID:368132 (history)  Vaccinated:2009-11-04
Age:18.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:Tennessee  Entered:2009-11-17, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': TN09033
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500754P0IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Vision blurred, Visual field defect
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Reports onset of blurred peripheral vision and intense headache approx 1 1/2 hrs after administration of vaccine. Advised per clinic coordinator to take TYLENOL or ADVIL and lay down. Go to dr. or hosp if no relief. Telephone call to client at 12:30pm Mon 11/4/09 & ask outcome. She said she took a friend''s migraine med. (name unknown) and she was now feeling well.

VAERS ID:368152 (history)  Vaccinated:2009-11-11
Age:18.0  Onset:2009-11-11, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:North Carolina  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: PMH: PMD, PPD, abn pap, migraine, scabies.
Diagnostic Lab Data: Patient is pregnant at 22 weeks.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS100738020IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Cough, Dizziness, Drug exposure during pregnancy, Feeling of body temperature change, Foetal hypokinesia, Viral infection
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)
Write-up: Received vaccine H1N1 at 15:00 and developed lightheadedness, dizziness, chills later that evening, hot and cold all over, occas. cough x 48 hours. 12/9/09 Medical records received. Prenatal records. EDC: 2/10/10. OV 11/13/09 Pt c/o decreased fetal movement, dizzy, lightheaded after vax. DX: viral illness.

VAERS ID:368217 (history)  Vaccinated:2009-11-14
Age:18.0  Onset:2009-11-16, Days after vaccination: 2
Gender:Male  Submitted:2009-11-16, Days after onset: 0
Location:Pennsylvania  Entered:2009-11-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data: None.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00549611A UNRL
Administered by: Other     Purchased by: Public
Symptoms: Lymphadenopathy
SMQs:
Write-up: Slight swelling of gland right axilla on waking, resolved several hours later.

VAERS ID:368232 (history)  Vaccinated:2009-11-09
Age:18.0  Onset:2009-11-10, Days after vaccination: 1
Gender:Female  Submitted:2009-11-17, Days after onset: 7
Location:Oklahoma  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00649611A0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash on arms, back, abdomen and legs. pt went to the ER and received a tapering does of prednisone 30 mg a day for 2 days and then 20 mg a day for 2 days then 10 mg a day for 2 days. also recommended over-the-counter med every 6 hours (ER report does not state what OTC med she was supposed to get)

VAERS ID:368710 (history)  Vaccinated:2009-11-19
Age:18.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 0
Location:New York  Entered:2009-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pregnant
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500779P0IN 
Administered by: Private     Purchased by: Public
Symptoms: Contraindication to vaccination, Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: On 11/19/09, patient received H1N1 nasal spray vaccine. After administration, it was noted she is pregnant, EDC 5/16/10. She and her mother were advised of the wrong vaccine given; CDC contacted and her obstetrician notified. 11/23/2009 OB-GYN records indicate pregnant patient EDC 5/16/10 exposed to vaccine, no sx noted at present

VAERS ID:369193 (history)  Vaccinated:2009-11-20
Age:18.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Female  Submitted:2009-11-20, Days after onset: 0
Location:Colorado  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Mantoux Test Sanofi Pasteur Lot # C3150AA Left Forearm. Any other medications or adverse events previously are unknown.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500721P IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Incontinence, Nervousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Following the administration of seasonal flumist, Gardasil, and PPD Mantoux test, patient became faint, pale, shaky, and incontinent. She did not lose consciousness or fall. Patient assisted to lie down with feet elevated, drink two juice boxes, cool rags placed on forehead and neck. Within 2 minutes, patient returned to normal color, and no longer was faint or dizzy. Paitient instructed to sit in chair and remain seated for 15 minutes prior to leaving clinic. Upon leaving clinic, patient continued to be free of dizziness or faintness, and kept normal coloring.

VAERS ID:369264 (history)  Vaccinated:2009-11-19
Age:18.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-11-22, Days after onset: 3
Location:Washington  Entered:2009-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data: Urine test; results normal
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500760P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Dizziness, Urine analysis normal
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Severe abdominal pain lasting about two hours; dizziness. Required emergency room visit.

VAERS ID:369358 (history)  Vaccinated:2009-11-23
Age:18.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 0
Location:Virginia  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None per pt
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0455Y0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blindness, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt became faint, sweaty, and "I cannot see". Immediately seated pt with head down - water and crax and peanut butter given as she felt better. BP 78/50. P60. Had pt recline. BP 80/50. P-52. Pt had very little breakfast.

VAERS ID:369377 (history)  Vaccinated:2009-11-12
Age:18.0  Onset:2009-11-13, Days after vaccination: 1
Gender:Male  Submitted:2009-11-23, Days after onset: 10
Location:Texas  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Born with AVM of Great Vein of Galen, Shunt placed at 3-4 months old, RSV at 5 months, AVM hemorrhaged at 6 months, stroke at 6 1/2 months, coil embolization of the AVM at 7 months, several shunt revisions before age 8, was on seizure medication till age 12 when doctors weined him off, no seizures in last 10 years 11/25/09 DC summary and hosp. records received for dates 11/13/09 t
Diagnostic Lab Data: CT scans showed no bleeding, EEG, and all tests performed at Medical Center 11/25/09 DC summary and hosp. records received for dates 11/13/09 to 11/16/09 Diag/Labs: EEG abn-rt.temporal epileptic discharges, EKG(-), blood cult(-), urine c
CDC 'Split Type':
Vaccination
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1009220IJRA
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98441PIA0IJLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abnormal behaviour, Aphasia, Blood culture negative, Computerised tomogram normal, Convulsion, Culture urine negative, Electrocardiogram normal, Electroencephalogram, Electroencephalogram abnormal, Endotracheal intubation, Intensive care, Mechanical ventilation, Respiratory failure, Speech disorder, Status epilepticus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad)
Write-up: Teachers reported strange actions (trying to eat puzzle, talking incoherently then not talking all, acted as if eevrything in slow motion), took to ER where actions were same, had a large seizure at 3:30-4:00pm, admitted to icu, placed on ventilator, started having small trembling seizures, placed on seizure & sedations meds, seizure cycles were broken around 1:00 am on 11/14/2009. 11/25/09 DC summary and hosp. records received for dates 11/13/09 to 11/16/09. DX: seizure, respiratory failure, epilepsy. Pt presented w/ status epilepticus and respiratory failure, was intubated in ER, seizure resolved w/ med tx. Pt returned to what is patients baseline norm. Upon dc pt stable. Parent states received H1N1 vax this day. Assessment once admitted noted to be febrile, all tests (-).

VAERS ID:369603 (history)  Vaccinated:2009-11-20
Age:18.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Female  Submitted:2009-11-21, Days after onset: 1
Location:California  Entered:2009-11-23, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Slight URI no fever or respiratory problems other than runny nose
Preexisting Conditions: Spina bifida with hydrocephalus(VP shunt, neurogenic bowel/bladder), chronic renal failure, Latex and food allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP024AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Cough, Crying, Emotional distress, Erythema, Lethargy, Swelling face, Swollen tongue, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: In first 10-15 min after : upset, slight cough,crying and rubbing eyes became lethargic. 20 min after : lips, ears, around eyes, face in general swelled up/red. 25 min. after : tongue swollen, wheezing heard with stethoscope. No cyanosis or change in vital signs during observation after Diphenhydramine (20ml) given 20 min. after injection). 25-50 min. after: facial and tongue swelling slowly decreased, no wheezing. 75 min. after: Dad took her to ER.

VAERS ID:369652 (history)  Vaccinated:2009-11-20
Age:18.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Female  Submitted:2009-11-20, Days after onset: 0
Location:Florida  Entered:2009-11-24, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102126P1A UNUN
Administered by: Public     Purchased by: Public
Symptoms: Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 8:30 client arrived/received H1N1 vaccine. 9:20 client c/o itching all over - no wheezing not at this time, alert x5. Fiance called will pick-up client and stay with her. 9:30 BENADRYL 50 mg IM Rt arm no wheezing. 9:50 home with fiance.

VAERS ID:369702 (history)  Vaccinated:2009-11-09
Age:18.0  Onset:2009-11-09, Days after vaccination: 0
Gender:Male  Submitted:2009-11-19, Days after onset: 10
Location:Minnesota  Entered:2009-11-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol; HUMALOG; LANTUS; METFORMIN; BYETTA
Current Illness: Untreated uncontrolled DM2, depression
Preexisting Conditions: DM2 - Insulin dep. diabetes since age 8, htn, obesity, depression, ADD
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP021AA0IJLA
Administered by: Private     Purchased by: Unknown
Symptoms: Blood glucose increased, Hypoaesthesia, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Immediate onset of nausea after vaccine admin. Within 2-3 hrs L upper arm and L upper leg numbness, tingling "like it fell asleep". Duration 2 days at time of visit. No evidence of CVA/M/or other cause. However, blood sugar remains high 200''s.

VAERS ID:369728 (history)  Vaccinated:2009-11-09
Age:18.0  Onset:2009-11-13, Days after vaccination: 4
Gender:Female  Submitted:2009-11-16, Days after onset: 3
Location:Connecticut  Entered:2009-11-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None Known
Current Illness:
Preexisting Conditions: 11/25/09 Hospital records received for date 11/14/09 PMH: anxiety
Diagnostic Lab Data: 11/25/09 Hospital records received for date 11/14/09Diag/Labs:CXR(-), urine(-). 11/30/09 ER records received for date 11/13/09 Diag/Labs: BUN 27(H), ALT 37(H), albumin 5.1(H), AST 49(H), CPK 531(H), CBC diff abnormal.
CDC 'Split Type':
Vaccination
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00249611A0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Alanine aminotransferase increased, Anxiety, Aspartate aminotransferase increased, Blood albumin increased, Blood creatine phosphokinase increased, Blood test normal, Blood urea increased, Chest X-ray normal, Chest pain, Convulsion, Dizziness, Dyspnoea, Dyspnoea exertional, Echocardiogram normal, Electrocardiogram ambulatory normal, Electrocardiogram normal, Headache, Heart rate abnormal, Heart rate increased, Nausea, Palpitations, Stress echocardiogram, Urine analysis normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad)
Write-up: Was vaccinated with H1N1 on 11/9/09. On 11/13/09 pt had experienced irregular HR, went to ER, had EKG, bloodwork, urine, and more. All normal, also CXR WNC then on 11/14, had "convulsions/seizure" witnessed by hockey team members. Went to ER had EKG, again normal. Pt believes reaction to shot. Has HX of: family members with multiple medical hX. Father MVP / bro MVP and hole in heart / closed on own, no surgery. PGM died age 50 (CAD) PGF sudden dead (MI). 11/25/09 Hospital records received for date 11/14/09. DX: dyspnea acute.Presented to ER w/ c/o HA, nausea, chest pain, SOB, increased HR, anxiety. 11/25/09 Medical records received for date 11/17/09. Holter monitor report: NSR. Stress echo report: negative. Cardiac echo: negative. 11/30/09 ER records received for date 11/13/09. DX: palpitations Chief c/o palpitations, dizziness, SOB. Pt states worse w/ exertion. Assessment: WNL.

VAERS ID:369810 (history)  Vaccinated:2009-11-11
Age:18.0  Onset:2009-11-12, Days after vaccination: 1
Gender:Female  Submitted:2009-11-17, Days after onset: 5
Location:Pennsylvania  Entered:2009-11-24, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Migraine headaches
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP015AA0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Cheilitis, Lip pain, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Vaccinated - 4pm 11/11. Awakened with swollen lips next couple mornings. Lips painful, irritated. Started 11/12 9:30 a.m.

VAERS ID:369893 (history)  Vaccinated:2009-11-23
Age:18.0  Onset:2009-11-24, Days after vaccination: 1
Gender:Female  Submitted:2009-11-24, Days after onset: 0
Location:New Jersey  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: No noted
Preexisting Conditions: No PMH, NKA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS 0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Fever of 102 degrees with sore throat.

VAERS ID:369921 (history)  Vaccinated:2009-11-19
Age:18.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 0
Location:Ohio  Entered:2009-11-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)
Write-up: 4:52 arrived complaining of tightness in chest.

VAERS ID:369961 (history)  Vaccinated:2009-10-28
Age:18.0  Onset:2009-10-29, Days after vaccination: 1
Gender:Male  Submitted:2009-11-24, Days after onset: 26
Location:New York  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP007AA0IMRA
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA275AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Onset of urticarial rash on trunk and LUE. Had resolved by 10-30-2009.

VAERS ID:369987 (history)  Vaccinated:2009-11-05
Age:18.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-24, Days after onset: 19
Location:New York  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA275AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Rash papular
SMQs:
Write-up: Fine papular rash on upper chest.

VAERS ID:370080 (history)  Vaccinated:2009-11-18
Age:18.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-25, Days after onset: 7
Location:Ohio  Entered:2009-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Latex allergy (non-latex gloves were utilized during the vaccination;no bandaid was applied)
Diagnostic Lab Data:
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP025AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Injection site erythema, Injection site haematoma, Injection site pain, Injection site rash, Streptococcal infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Within one hour of vaccination began having headache that lasted several days. Within 2 hours of vaccination began having painful bruising of arm where received injection from elbow to shoulder and red-raised rash covering area. Rash, bruising and pain lasted approximately one week. Did not see a physician for this, however was diagnosed with strep on 11/23/09.

VAERS ID:370099 (history)  Vaccinated:2009-10-22
Age:18.0  Onset:2009-11-20, Days after vaccination: 29
Gender:Female  Submitted:2009-11-23, Days after onset: 3
Location:Tennessee  Entered:2009-11-25, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Medroxyprogesterone
Current Illness: none
Preexisting Conditions: Migraines
Diagnostic Lab Data: none
CDC 'Split Type':
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500754P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pain, Photophobia
SMQs:, Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Patient complains of severe headache on 11-20-09 at 4:00 am with throbbing pain in head and sensitive to light. Patient states OTC TYLENOL or MOTRIN would not stop pain. Headache lasted 5 1/2 hours. Pt has appt with clinic 11-25-09 at 9:00 am for evaluation. C/O headache 4 hrs/day after FLUMIST given.

VAERS ID:370278 (history)  Vaccinated:2009-11-20
Age:18.0  Onset:2009-11-21, Days after vaccination: 1
Gender:Male  Submitted:2009-11-26, Days after onset: 5
Location:D.C.  Entered:2009-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Sick~Influenza (H1N1) (Influenza (H1N1) (UNKNOWN MANUFACTURER))~1~18.67~Patient
Other Medications: Doryx. On a side note I would like to know if other people are experiencing some of the same side effects. Thanks.
Current Illness: No.
Preexisting Conditions: Allergic to Amoxicillin and Penicillin
Diagnostic Lab Data: I have still not recovered and I have been sick for five days with no end in sight.
CDC 'Split Type':
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.UNKOWN1IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Eye swelling, Headache, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: I woke up with my eyes swollen and a massive headache. The problems progressed throughout the day, my stomach started to hurt and my whole body ached. Eventually my throat started hurting. I have been sick since the 21st and today is now the 26th, I now have a 101 (f) fever but it has been jumping around from 102 (f) (at the highest) to 98.5 (lowest).

VAERS ID:370368 (history)  Vaccinated:2009-11-15
Age:18.0  Onset:0000-00-00
Gender:Male  Submitted:2009-11-28
Location:Oklahoma  Entered:2009-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: military would not say
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Influenza
SMQs:
Write-up: My son went into the military. He was forced to take the shots or face prison. Within 12 hours he came down with the flu. While in formation he asked the 60 other inductees which had received the flu from the shots and by a raise of hands more than half had come down with the flu. Some has since been hospitalized and have not returned. It''s been 2 weeks.

VAERS ID:370397 (history)  Vaccinated:2009-11-25
Age:18.0  Onset:2009-11-25, Days after vaccination: 0
Gender:Male  Submitted:2009-11-29, Days after onset: 4
Location:Washington  Entered:2009-11-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WA
Vaccination
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IJRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Lymphadenopathy, Oropharyngeal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Had a mild fever close to 100 on day one as well as a sore throat. Day two had a 102 fever most of the evening and a sore throat all day. Day four, felt weak and then vomited. Still has a sore throat. The sore throat includes a swollen gland on the left side. After vomiting he felt much better but still has the sore throat. We have been treating with ibuprofen and Tylenol. Alternating the medications every 4 to 6 hours or as needed.

VAERS ID:370771 (history)  Vaccinated:2007-12-19
Age:18.0  Onset:2008-07-12, Days after vaccination: 206
Gender:Female  Submitted:2009-08-25, Days after onset: 409
Location:Kentucky  Entered:2009-12-01, Days after submission: 98
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA 60 mg daily
Current Illness: Well child visit
Preexisting Conditions: Seasonal allergic Rhinitis PMH: Seasonal allergies Rhinitis Allergies: NKDA
Diagnostic Lab Data: 07/17/08 Cat Scan chest negative Labs: CBC, CMP, Uric acid, LDH, Anticardiolipin AB all WNL, PT elevated Dx studies: CT chest normal, Doppler study RUE abnormal + for DVT
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.1266U2IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood lactate dehydrogenase, Blood uric acid normal, Cardiolipin antibody negative, Chest X-ray normal, Computerised tomogram normal, Deep vein thrombosis, Feeling cold, Feeling hot, Full blood count normal, Hyperaesthesia, Lymphadenitis, Metabolic function test, Oedema peripheral, Paget-Schroetter syndrome, Pain in extremity, Paraesthesia, Prothrombin time prolonged, Thoracic outlet syndrome, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: 07/12/2008 presented to doctor office with hx 5 days of "Right arm aching/swelling". Diagnosis? Rt. axillary adenitis placed on KEFLEX 500 mg tid. No known Hx trauma. Has sensation to touch/heat/cold etc.; yet "tingly". Dx DVT and Paget Schroetter syndrome Aug 08. I called Mom this evening to discuss further her question regarding patient''s Gardasil vaccine series and her n/o blood clot. Patient has had something called Paget Schroetter syndrome which is a subset of thoracic outlet syndrome. This is usually due to inadequate space for the subclavian vein to run through at the shoulder due to anatomic variations in the 1st rib and clavicle (thus causing blood clot) or can also be from anterior scalene hypertrophy from repetive UE use. Patient used to participate in karate so this possibly may have put her at risk for this. I also reviewed office visit notes. I also reviewed the time course of patients Gardasil vaccines. Her initial visit here for RUE swelling was 6-7 mos following her 3rd Gardasil vaccine. I researched Gardasil and blood clots over the weekend and most of the alleged cases of causality are in clots that occurred within days to weeks following Gardasil vaccine. I reviewed this w/Mom and advised that, given the cause of patient''s clot being an anatomic etiology, and the fact that her Gardasil series was several months prior to her blood clot, I don''t think the two are related. However I again emphasized that we may never know the true answer and I am only relating my observations based on my research into Paget Schroetter Syndrome and Gardasil/blood clots. Mom said she was relieved to hear this, I think she was experiencing alot of guilt for having patient complete the Gardasil series, in light of the complications patient has had from surgery for the aforementioned syndrome ( had a pneumothorax as a complication from surgery to remove part of a rib to make room for her R subclavian vessel). I also disc''d the VAERS reporting service and advised that we would submit patient info to them which may help eventually establish causality or otherwise down the road when they look at Gardasil. 12/1/2009 PCP and Specialist records from 7/2008 to 9/2009. Patient with c/o''s sudden onset RUE swelling and pain. Tx''d initially with po ABX, Doppler + for DVT and placed on anticoagulant therapy. Patient had extensive surgery 6/2009, scalenectomy, brachial plexus neuroplasty, first rib resection and anteriolysis of subclavian artery. Patient had complication post op: pnemothorax. Dx''d with Paget Schroetter syndrome

VAERS ID:370930 (history)  Vaccinated:2009-11-20
Age:18.0  Onset:2009-11-21, Days after vaccination: 1
Gender:Male  Submitted:2009-12-01, Days after onset: 10
Location:New Jersey  Entered:2009-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: possible viral illness, afebrile
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102125P10IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Asthenia, Headache, Pain
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: stomach ache, body aches, headache, afebrile, low energy.

VAERS ID:371124 (history)  Vaccinated:2009-12-02
Age:18.0  Onset:2009-12-02, Days after vaccination: 0
Gender:Male  Submitted:2009-12-02, Days after onset: 0
Location:Kentucky  Entered:2009-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500761P2IN 
Administered by: Other     Purchased by: Public
Symptoms: Headache, Musculoskeletal stiffness, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Stiffness, headache, fever (99.3), nauseated. Fever (98.7) 20 minutes later

VAERS ID:371477 (history)  Vaccinated:2009-11-24
Age:18.0  Onset:2009-11-24, Days after vaccination: 0
Gender:Female  Submitted:2009-11-27, Days after onset: 3
Location:New Jersey  Entered:2009-12-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3062AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1087Y1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 11/27/09 Pt called to report injection sites red hot and sore and itches. Since rec''d Vaccine 11/24/09. Pt came into office 11/27/09 4pm. Reddened areas warm to the touch noted Right arm 5cm x 4.5cm; Left arm 6.5cm x 7cm (localized) / Assessed by NPC.

VAERS ID:371662 (history)  Vaccinated:2009-12-01
Age:18.0  Onset:2009-12-04, Days after vaccination: 3
Gender:Female  Submitted:2009-12-05, Days after onset: 1
Location:Colorado  Entered:2009-12-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever blisters~HPV (no brand name)~1~17.58~Patient
Other Medications:
Current Illness: none
Preexisting Conditions: cashews, pistachios
Diagnostic Lab Data:
CDC 'Split Type':
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0  
Administered by: Public     Purchased by: Public
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Tingling of fingers, hands.

VAERS ID:371920 (history)  Vaccinated:2009-11-19
Age:18.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Male  Submitted:2009-12-07, Days after onset: 18
Location:Ohio  Entered:2009-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Blood glucose 90 at office
CDC 'Split Type': odh
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood glucose normal, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: School clinic. Pt. developed dizziness about 20 mins after h1n1 immunization. Symptoms had lasted a few hours before presenting to MD''s office. Symptoms improved rapidly.

VAERS ID:371934 (history)  Vaccinated:2009-10-22
Age:18.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-12-07, Days after onset: 46
Location:Massachusetts  Entered:2009-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Reflux oesophagitis, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Received 2nd GARDASIL 1-3-08 & vomited every day or every other day for 6 months - saw GI with no finding - received 3rd on - 10-22-09 & started to vomit again.

VAERS ID:372057 (history)  Vaccinated:2009-12-01
Age:18.0  Onset:2009-12-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Arizona  Entered:2009-12-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pt wearing immobilizer brace to L LE and using crutches 2/2 knee injury
Diagnostic Lab Data:
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0313Y0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Head injury, Injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncopal episode approx 10 mins s/p vaccine at check out desk. + trauma to head-immediate return to consciousness. Symptomatic care with ice, snack, H2O. Normal vital signs and neuro exam after 30 mins observation.

VAERS ID:372121 (history)  Vaccinated:2009-11-30
Age:18.0  Onset:2009-12-01, Days after vaccination: 1
Gender:Female  Submitted:2009-12-08, Days after onset: 7
Location:Minnesota  Entered:2009-12-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC 'Split Type':
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: She received the H1N1 flu nasal mist. She began coughing and looking ill the next day; continued for several days, then got much worse after 5-6 days. Fever rose to about 100, coughing persisted. She is better now (after 7 days) but still has a persistent, frequent cough.

VAERS ID:372306 (history)  Vaccinated:2009-12-02
Age:18.0  Onset:2009-12-02, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Wisconsin  Entered:2009-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Influenza (Seasonal) (no brand name)~UN~17.00~Patient
Other Medications: Lamotrigine
Current Illness: None
Preexisting Conditions: Depression
Diagnostic Lab Data:
CDC 'Split Type':
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Nausea, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: My daughter broke out in welt-like hives 2 hours after an H1N1 nasal innoc. Hives were across her knees and were gone by the next day but she had severe nausea for 2 days.

VAERS ID:372358 (history)  Vaccinated:2009-12-04
Age:18.0  Onset:2009-12-07, Days after vaccination: 3
Gender:Female  Submitted:2009-12-09, Days after onset: 2
Location:New York  Entered:2009-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102127910SCRA
Administered by: Unknown     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: development of rash on chest and shoulders

VAERS ID:372393 (history)  Vaccinated:2009-12-07
Age:18.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Female  Submitted:2009-12-09, Days after onset: 2
Location:Virginia  Entered:2009-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies: Penicillin, dust, animal hair
Diagnostic Lab Data:
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP044AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Nausea, Throat irritation
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Reported to school nurse that she developed headache, nausea, and throat "felt funny." No medical evaluation. Returned to school on 12/8/09.

VAERS ID:372422 (history)  Vaccinated:2009-12-09
Age:18.0  Onset:2009-12-09, Days after vaccination: 0
Gender:Male  Submitted:2009-12-09, Days after onset: 0
Location:California  Entered:2009-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1013264P0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Laceration, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Student apparently fainted few minutes after recieving the vaccine. He was unresponsive for a few seconds but later recovered. He gave his name & place where he''s at. He sustained a small cut (R) cheek area. Neuro signs OK. 911 was called at 10:06. Father was notified by phone. Student taken to Hospital via Fire Department ambulance around 10:25 AM.

VAERS ID:372426 (history)  Vaccinated:2009-12-08
Age:18.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Female  Submitted:2009-12-09, Days after onset: 1
Location:New York  Entered:2009-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1013266P IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eye swelling, Headache, Immediate post-injection reaction, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Immediate headache, periorbital itching and swelling. c/o of itching all over. No localized reaction at injections site. Given Solu-medrol and Benadryl in ambulance.

VAERS ID:372454 (history)  Vaccinated:2009-09-22
Age:18.0  Onset:2009-10-03, Days after vaccination: 11
Gender:Male  Submitted:2009-12-09, Days after onset: 67
Location:California  Entered:2009-12-09
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No PMH: sulfa
Diagnostic Lab Data: MRI, EKG, Cat Scan, Spinal Tap Diag/Labs: CBC abnormal, CT(-).
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3203AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, CSF immunoglobulin increased, CSF protein increased, Computerised tomogram normal, Diplopia, Dizziness, Electrocardiogram, Full blood count abnormal, Gait disturbance, Guillain-Barre syndrome, Hypoaesthesia, Lumbar puncture abnormal, Nuclear magnetic resonance imaging, Paraesthesia, Vision blurred
SMQs:, Haematopoietic leukopenia (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Glaucoma (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (broad)
Write-up: disgnosed GuillainBarre Syndrome

VAERS ID:372875 (history)  Vaccinated:2009-12-04
Age:18.0  Onset:2009-12-11, Days after vaccination: 7
Gender:Male  Submitted:2009-12-11, Days after onset: 0
Location:Wisconsin  Entered:2009-12-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98432P1 IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB312AA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURD01910IMRA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Woke up this morning with itchy, red rash on arms which has progressed to his legs and trunk. Took BENADRYL and applied SOLARCAINE. Denies difficulty breathing. Referred for medical evaluation today. Mother participated in phone conversation.

VAERS ID:373079 (history)  Vaccinated:2009-11-24
Age:18.0  Onset:2009-11-24, Days after vaccination: 0
Gender:Female  Submitted:2009-11-30, Days after onset: 6
Location:Virginia  Entered:2009-12-14, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC 'Split Type':
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.J00840P0IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0312Y1IMUN
Administered by: Public     Purchased by: Public
Symptoms: Fall, Head injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Received HPV and H1N1 vaccine. RN accompanied client to bill pay and told to wait 15 min before leaving. Client fell while waiting at bill pay and hit back of head on floor. Unresponsive approx 30 sec BP 118/78, P64, R16. Waited at HD about 40 min - ER with friend. No Rx at ER.

VAERS ID:373123 (history)  Vaccinated:2009-12-11
Age:18.0  Onset:2009-12-11, Days after vaccination: 0
Gender:Male  Submitted:2009-12-11, Days after onset: 0
Location:Michigan  Entered:2009-12-14, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: none
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP031AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Felt nauseous and dizzy after receiving vaccine (IM) Hx of fainting after immunizations.

VAERS ID:373182 (history)  Vaccinated:2009-12-03
Age:18.0  Onset:2009-12-06, Days after vaccination: 3
Gender:Male  Submitted:2009-12-14, Days after onset: 8
Location:Virginia  Entered:2009-12-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Diagnostic Lab Data: Electrolytes - chem st
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102129P10IJRA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Blood electrolytes, Dyskinesia, Hypoaesthesia oral, Laboratory test
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 12/5/09 complaint of involuntary hand movements, tongue no movement, abdominal pain. Rx PREDNISONE, ATARAX. Treatment in emergency dept, 12/5/09 and 12/6/09.

VAERS ID:373290 (history)  Vaccinated:2009-12-10
Age:18.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Female  Submitted:2009-12-14, Days after onset: 4
Location:Massachusetts  Entered:2009-12-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102137P1 IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Vasovagal syncope hit head. Transported to ED.

VAERS ID:373674 (history)  Vaccinated:2009-12-10
Age:18.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Female  Submitted:2009-12-16, Days after onset: 6
Location:Massachusetts  Entered:2009-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI; Omega 3 fatty acid; Iron
Current Illness: None
Preexisting Conditions: Post-concussive syndrome
Diagnostic Lab Data: Nl CBC / diff, UA, ESR
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102137P10IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3240AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Back pain, Differential white blood cell count, Full blood count, Pain, Red blood cell sedimentation rate, Urine analysis
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: 10 hrs after injection, sharp, shooting pain arose in lower back.

VAERS ID:374085 (history)  Vaccinated:2009-12-16
Age:18.0  Onset:2009-12-16, Days after vaccination: 0
Gender:Female  Submitted:2009-12-17, Days after onset: 1
Location:Pennsylvania  Entered:2009-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No - c/o exacerbation of seasonal allergies
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP031AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: 0755 Student presented pale c/o nausea since last night. Student states she feels if she eats anything she will vomit. Student allowed to rest x 30min without relief. Parent notified student dismissed to home 0900.

VAERS ID:374087 (history)  Vaccinated:2009-12-16
Age:18.0  Onset:2009-12-16, Days after vaccination: 0
Gender:Unknown  Submitted:2009-12-17, Days after onset: 1
Location:Pennsylvania  Entered:2009-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROVENTIL inhaler
Current Illness: No
Preexisting Conditions: Asthma KADRU
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP031AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 1150 Student presented with nausea. Reports nausea started last night, vomited x 1 last night. Allowed to rest with relief. Returned to class 1230.

VAERS ID:374388 (history)  Vaccinated:2009-11-27
Age:18.0  Onset:2009-11-30, Days after vaccination: 3
Gender:Female  Submitted:2009-12-21, Days after onset: 21
Location:Mississippi  Entered:2009-12-21
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRSA in blood cultures MRI Brain 12/6/09 Bilateral cavernous sinus thrombosis, bilateral superior ophthalmic vein thrombosis. The MRV is otherwise within normal limits with widely patent dural venous sinuses and deep cerebral venous structures.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500782P IN 
Administered by: Other     Purchased by: Public
Symptoms: Blindness unilateral, Blood culture positive, Cavernous sinus thrombosis, Computerised tomogram abnormal, Eye swelling, Headache, Malaise, Nuclear magnetic resonance imaging brain abnormal, Periorbital cellulitis, Skin lesion, Staphylococcal bacteraemia, Visual impairment, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, venous (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Ocular infections (narrow), Hypersensitivity (narrow)
Write-up: Patient had immunization for H1N1 via nasal device at school and noted a nasal skin lesion 2 days after immunization. She began having a headache as well as general malaise and eventually saw a providor at another facility. She was told she had MRSA and was treated with Tamiflu as well. At day 8 after her immunization she noted vision changes, swelling of her left eye and severe headaches and presented to the ER. She eventually was noted to have cavernous sinus thrombosis, peri-orbital cellulitis and MRSA bacteremia which required an extended hospital stay. The patient also is now premenently blind in her left eye and is being discharged from the hospital today with close follow-up. I am the attending physician on record for the patient.

VAERS ID:374616 (history)  Vaccinated:2009-12-02
Age:18.0  Onset:2009-12-02, Days after vaccination: 0
Gender:Female  Submitted:2009-12-02, Days after onset: 0
Location:Rhode Island  Entered:2009-12-22, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500832P0IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Feeling cold, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: 5 minutes after receiving nasal mist student felt dizzy, coldness in her ears and then diaphoretic. Rested x 20 minutes. States something has happened to her when she gave blood & when she had her wisdom teeth removed.

VAERS ID:375075 (history)  Vaccinated:2009-12-17
Age:18.0  Onset:2009-12-18, Days after vaccination: 1
Gender:Male  Submitted:2009-12-21, Days after onset: 3
Location:Ohio  Entered:2009-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Folic acid; Tetracycline; Colazal
Current Illness: None
Preexisting Conditions: Crohn''s Disease
Diagnostic Lab Data: Testicular U/S
CDC 'Split Type':
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP031AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erectile dysfunction, Hypoaesthesia, Muscular weakness, Scrotal pain, Testicular disorder, Ultrasound testes
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Fertility disorders (narrow)
Write-up: Patient described numbness of both legs and groin beginning 12 hours after vaccine admin. He also lost sensation to penis and was unable to have an erection for 4 days and counting.

VAERS ID:375141 (history)  Vaccinated:2009-12-22
Age:18.0  Onset:2009-12-23, Days after vaccination: 1
Gender:Female  Submitted:2009-12-28, Days after onset: 5
Location:Ohio  Entered:2009-12-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: History of nose bleeds as child. Nose surgery in 2000.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500823P0IN 
Administered by: Other     Purchased by: Other
Symptoms: Burning sensation, Condition aggravated, Dyspepsia, Epistaxis, Rash, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific dysfunction (narrow), Hypersensitivity (narrow)
Write-up: Patient woke up about 9 am with a nose bleed and stomach burning. Called the ER for advice and was instructed to come to ER if symptoms worsened. Patient developed rash on arms and burning sensation on her face on 12/27 and went to ER for treatment. She was diagnosed with an acute reaction to the H1N1 vaccine and prescribed hydrocortisone cream. She did not fill the Rx but used some hydrocortisone cream she had at home.

VAERS ID:375193 (history)  Vaccinated:2009-12-28
Age:18.0  Onset:2009-12-28, Days after vaccination: 0
Gender:Female  Submitted:2009-12-29, Days after onset: 1
Location:Pennsylvania  Entered:2009-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: YAZ
Current Illness:
Preexisting Conditions: Fatigue; Depression
Diagnostic Lab Data:
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.1013Y2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Pain, Paraesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Patient c/o tongue feeling weird after shot c/o nausea 1/2-10 after shot. Also c/o body aches rest of day. About 7 hrs after she received the shot, she had tongue swelling. Parents gave BENADRYL & swelling resolved. No resp distress/no difficulty swallowing.

VAERS ID:375268 (history)  Vaccinated:2009-12-08
Age:18.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Female  Submitted:2009-12-08, Days after onset: 0
Location:Ohio  Entered:2009-12-29, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sore throat, nasal congestion
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10UNRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Lightheaded, hot. Sent to nurse office to call mom.

VAERS ID:375346 (history)  Vaccinated:2009-12-08
Age:18.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Male  Submitted:2009-12-08, Days after onset: 0
Location:Ohio  Entered:2009-12-29, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: No
CDC 'Split Type':
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER102129P1 IJUN
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Injection site warmth
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Shot-hot and dizzy.

VAERS ID:375362 (history)  Vaccinated:2008-03-04
Age:18.0  Onset:0000-00-00
Gender:Female  Submitted:2009-12-28
Location:Kentucky  Entered:2009-12-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CORTEF; SEROQUEL; ZOLOFT
Current Illness: Depression; Insomnia; Fatigue
Preexisting Conditions:
Diagnostic Lab Data: thyroid function test, 03/??/08, results not provided; EPSTEIN-BARR virus, 03/18?/08, positive
CDC 'Split Type': WAES0912USA02352
Vaccination
Manufacturer
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HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Epstein-Barr virus infection, Epstein-Barr virus test positive, Fatigue, Thyroid function test
SMQs:
Write-up: Information has been received from a physician concerning an 18 year old female patient with fatigue, depression and insomnia who was vaccinated with the first, second and third dose of GARDASIL on 06-AUG-2007, 06-NOV-2007 and 04-MAR-2008 respectively. Concomitant therapy included ZOLOFT, SEROQUEL and maybe CORTEF. The physician reported that after the third dose vaccination with GARDASIL, the patient experienced chronic fatigue and EPSTEIN-BARR syndrome. The physician also reported that about two weeks after the vaccination, on approximately 18-MAR-2008, the patient was diagnosed with EPSTEIN-BARR syndrome. Thyroid test( results not provided) and EPSTEIN BARR test were performed. The EPSTEIN-BARR test was positive. The patient sought medical attention in the office. It was reported that the patient was unable to attend her last semester of high school due to fatigue. At the time of the report the patient had not recovered. All telephone attempts to obtain follow-up information have been unsuccessful. The patient''s chronic fatigue and EPSTEIN BARR syndrome were considered to be disabling by the physician. Additional information has been requested.

VAERS ID:375371 (history)  Vaccinated:2009-12-18
Age:18.0  Onset:2009-12-18, Days after vaccination: 0
Gender:Female  Submitted:2009-12-22, Days after onset: 4
Location:Pennsylvania  Entered:2009-12-29, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL XR
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0672Y1IMUN
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Injection site pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Beginning about 6 to 7 hours after administration developed pain radiating from right arm from injection site, fingers of right hand became swollen. Swelling persisted into 12/22 with decreased strength of hand. Hand returned to normal 12/23 but still pain upper arm at site of injection.

VAERS ID:375526 (history)  Vaccinated:2009-12-28
Age:18.0  Onset:2009-12-29, Days after vaccination: 1
Gender:Female  Submitted:2009-12-30, Days after onset: 1
Location:Indiana  Entered:2009-12-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies
Preexisting Conditions: Denies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1163Y1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Induration, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Client reports she had varicella and HPV immunizations given in L arm on 12-28-09. On Tues. approx 9 PM, bandaids removed and noticed redness. Pain in back of upper arm; above elbow is sore also. States has hard knot, size of 3" circle towards back of arm. Itching also in area of bandaids.

VAERS ID:375728 (history)  Vaccinated:2009-12-08
Age:18.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Female  Submitted:2010-01-04, Days after onset: 27
Location:Texas  Entered:2010-01-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: DID NOT TELL ANYONE THAT SHE DID NOT FEEL WELL
Preexisting Conditions: NOT KNOWN
Diagnostic Lab Data: LUMBAR PUNCTURE-CLEAR, NEGATIVE. MRI-NEGATIVE.
CDC 'Split Type': TX20090106PU
Vaccination
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102130410IMLA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Asthenia, Bacteria urine, Blood creatine phosphokinase normal, CSF culture negative, CSF protein normal, CSF test normal, Computerised tomogram normal, Dizziness, Dysstasia, Full blood count, Headache, Hypoaesthesia, Hypoaesthesia facial, Influenza serology negative, Lumbar puncture normal, Lymphocyte percentage decreased, Muscular weakness, Myalgia, Myopathy, Neutrophil percentage increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging normal, Pain, Paraesthesia, Polyneuropathy, Post lumbar puncture syndrome, Scan brain, Vaccination complication, Viral infection, Vision blurred, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Haematopoietic leukopenia (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: DIZZINESS, NUMBNESS IN ARMS AND LEGS, INTERMITTENT. HAD NUMBNESS IN JAW AT ONE TIME. HEADACHE.

VAERS ID:375774 (history)  Vaccinated:2009-12-22
Age:18.0  Onset:2009-12-23, Days after vaccination: 1
Gender:Female  Submitted:2010-01-01, Days after onset: 9
Location:Maryland  Entered:2010-01-04, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVAIR 115/21; XOPENEX BID; NEXIUM 40 mg BID; ZYRTEC; SINGULAIR; AUGMENTIN 875 BID 12/15-$g12/29
Current Illness: Sinusitis; ? GERD 530.1
Preexisting Conditions: Chronic sinusitis; asthma (non-allergic); s/p low normal IgG; CECLOR allergy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP027AB0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Headache, Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: "Pt states 4 days of all over headache and about an hour also c/o a neck pain"; stiff neck

VAERS ID:375955 (history)  Vaccinated:2010-01-04
Age:18.0  Onset:2010-01-05, Days after vaccination: 1
Gender:Male  Submitted:2010-01-05, Days after onset: 0
Location:Minnesota  Entered:2010-01-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0527Y0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large redness at injection sight and a circling around arm. Phone call from parents at approx. 1:40pm. Asked that patient come in so we could look at presenting symptoms. Above noted what was seen.

VAERS ID:376055 (history)  Vaccinated:2009-12-07
Age:18.0  Onset:2009-12-08, Days after vaccination: 1
Gender:Female  Submitted:2010-01-06, Days after onset: 29
Location:Missouri  Entered:2010-01-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Diagnostic Lab Data: unknown
CDC 'Split Type':
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IJUN
Administered by: Other     Purchased by: Public
Symptoms: Aphonia, Back pain, Cough, Crepitations, Dyspnoea, Nasal congestion, Rhinorrhoea, Skin warm, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: The next day after getting H1N1 vaccine caller started getting shortness of breath, "wheeziness in lungs" with crackling, stuffy/runny nose, loss of voice, also she stated" back hurt really bad this morning". She also had a cough she described as "somewhat dry and productive". She has felt warm, but she hasn''t checked her temperature. Numerous attemtps were made to contact the caller, numerous messages were left, no return calls were received, no further information is available.

VAERS ID:376223 (history)  Vaccinated:2010-01-07
Age:18.0  Onset:2010-01-07, Days after vaccination: 0
Gender:Female  Submitted:2010-01-07, Days after onset: 0
Location:Pennsylvania  Entered:2010-01-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, advair, singulair, differin, zyrtec, clindamycin, iron, multi vitamin, and tri sprantic
Current Illness: none
Preexisting Conditions: allergies and asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0 RA
Administered by: Unknown     Purchased by: Public
Symptoms: Apnoea, Fear, Heart rate increased, Mental disorder
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow)
Write-up: Freaked out mentally. Thought that my mom and aunt were trying to kill me and was yelling for help continuously. Couldn''t breathe and 2 hours after that still had heartrate of 100 +. Lasted 4 hours+. Took an albuterol treatment.

VAERS ID:376523 (history)  Vaccinated:2010-01-07
Age:18.0  Onset:2010-01-07, Days after vaccination: 0
Gender:Female  Submitted:2010-01-09, Days after onset: 2
Location:Arizona  Entered:2010-01-11, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.100440SCLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Has redness, no pus, at site of vaccination. Rec: ice pack and 1% HC cream. Told this is not uncommon.

VAERS ID:376809 (history)  Vaccinated:2010-01-04
Age:18.0  Onset:2010-01-04, Days after vaccination: 0
Gender:Female  Submitted:2010-01-13, Days after onset: 9
Location:Arizona  Entered:2010-01-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: light headed~HPV (no brand name)~3~17.00~Patient
Other Medications:
Current Illness: Light headed, vomiting, then passed out, then convulsed in chair. Within 60 seconds, she woke and was feeling fine. She ate a popcicle, water, and walked out of there fine.
Preexisting Conditions: None.
Diagnostic Lab Data: Going to Doctor Fri. Jan. 15 at 1:00pm to see what was the problem. I have not grasped the severity of my daughters event until today.
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 3  
Administered by: Other     Purchased by: Private
Symptoms: Convulsion, Dizziness, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Light headed, vomit, passed out, convulsed all within 60 seconds. She woke up feeling fine, ate a popcicle, water and walked out fine.

VAERS ID:376940 (history)  Vaccinated:2009-12-15
Age:18.0  Onset:2009-12-15, Days after vaccination: 0
Gender:Female  Submitted:2009-12-15, Days after onset: 0
Location:Kentucky  Entered:2010-01-14, Days after submission: 30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500834P0IN 
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Erythema, Malaise, Nausea, Rash papular
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Pt came back @ 11:40 am after flu vaccination with c/o "lightheadedness and sick to stomach". After 35 minutes pt had red, splotchy spots on chest and red ears. No itching, no wheezes, at 1:01 pm, pt c/o difficulty taking deep breath. O2 24 min per NC applied. Pt sent to ER via EMS with mom accompanying her. 12/15/09: 5:05 pm spoke to family member stated pt doing better and is on her way home from ER.

VAERS ID:377129 (history)  Vaccinated:2010-01-18
Age:18.0  Onset:2010-01-18, Days after vaccination: 0
Gender:Female  Submitted:2010-01-18, Days after onset: 0
Location:Louisiana  Entered:2010-01-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline for acne
Current Illness:
Preexisting Conditions: Anxiety
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y2UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dyskinesia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 09:04 AM-Turned to find patient lying on her side/back-unresponsive with arms jerking, lasted approximately 4 seconds. Pt. sat up immediately and was AAO x 3.

VAERS ID:377519 (history)  Vaccinated:2010-01-11
Age:18.0  Onset:2010-01-11, Days after vaccination: 0
Gender:Female  Submitted:2010-01-19, Days after onset: 8
Location:Florida  Entered:2010-01-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Syncope
Diagnostic Lab Data: blood pressure, 01/11/10, 80/40 mmHg
CDC 'Split Type': WAES1001USA00988
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1131X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Condition aggravated, Convulsion, Grand mal convulsion, Hyperhidrosis, Hypotonia, Loss of consciousness, Neurological examination normal, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from an advanced registered nurse practitioner concerning an 18 year old female patient with history of fainted in the past after seeing needles who on 11-JAN-2010 was vaccinated with a first 0.5 ml dose of GARDASIL. The nurse practitioner reported that "as she was withdrawing the needle from the patient''s arm, she went limp and went back on exam table, then seized loss of consciousness, came to conscious and reported seizure activity. She left in ambulance to a hospital (stayed in hospital was unknown) and she was stable. Neurological evaluation was negative. Follow up information has been received from an advanced registered nurse practitioner concerning the patient on 11-JAN-2009 was vaccinated with the first dose of GARDASIL (Lot # 661954/1131X), 0.5 ml, IM. The patient did not received any concomitant vaccinations at that time. When the registered nurse withdrew the GARDASIL needle from the patient. the patient became limp and had a tonic- clonic seizure with loss of consciousness that lasted about 60 seconds. The patient regained consciousness and had another tonic- clonic seizure with loss of consciousness that lasted about 40 seconds. The patient regained consciousness and was pale and diaphoretic. Oxygen was administered and the patient''s blood pressure was 80/40. The paramedics were called to the office and the patient was transported to the Emergency Room (ER) at a hospital. At the time the patient refused intravenous (IV) therapy. Blood laboratory tests were drawn in the ER and the patient fainted. The patient regained consciousness and recovered. The patient was not admitted to the hospital; she was kept in the hospital for one hour and was sent home. On 12-JAN-2010 during a conversation with the registered nurse the patient reported that she had recovered. The patient had a scheduled appointment to see the advanced registered nurse practitioner on 14-JAN-2009 for routine physical. Upon internal review tonic-clonic seizure was considered an other important medical event. Additional information is not expected.

VAERS ID:377731 (history)  Vaccinated:2010-01-21
Age:18.0  Onset:2010-01-21, Days after vaccination: 0
Gender:Female  Submitted:2010-01-21, Days after onset: 0
Location:Kentucky  Entered:2010-01-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pt is pregnant - 3rd trimester
Diagnostic Lab Data: Pt is pregnant in 3rd trimester
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3188AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Drug exposure during pregnancy, Pregnancy, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Hypersensitivity (narrow)
Write-up: Itching and rash arms, chest, back 20 mins after seasonal flu vaccination. Treated w/BENADRYL 25 mg PO.

VAERS ID:377757 (history)  Vaccinated:2010-01-19
Age:18.0  Onset:2010-01-19, Days after vaccination: 0
Gender:Female  Submitted:2010-01-21, Days after onset: 2
Location:Michigan  Entered:2010-01-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth-control
Current Illness: none (no)
Preexisting Conditions: trees; dander; dust; allergies per pt.
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3263AA0IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1257Y0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0870Y1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3064AA0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: hot/sweaty. popped ears, dizzy

VAERS ID:377984 (history)  Vaccinated:2010-01-21
Age:18.0  Onset:2010-01-21, Days after vaccination: 0
Gender:Female  Submitted:2010-01-24, Days after onset: 3
Location:Missouri  Entered:2010-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wal-zyr
Current Illness: no
Preexisting Conditions: Mild asthma hx. seasonal allergies, allergic to amoxicillin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER  ID 
Administered by: Unknown     Purchased by: Other
Symptoms: Dizziness, Fatigue, Feeling abnormal, Headache, Mobility decreased, Muscular weakness, Nausea, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Patient experienced nausea, sore throat, muscle weakness, it was an effort to move, sore throat, severe headache lightheaded, "just didn`t feel right and very tired starting that afternoon

VAERS ID:378107 (history)  Vaccinated:2009-11-12
Age:18.0  Onset:2009-11-19, Days after vaccination: 7
Gender:Male  Submitted:2010-01-04, Days after onset: 46
Location:North Carolina  Entered:2010-01-25, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: nasal congestion
Preexisting Conditions: childhood h/o using Inhalers, nebulizers occasionally
Diagnostic Lab Data: 01 Dec 2009 1213. C-Reactive Protein 0.2mg/dL. Creatine Kinase SERUM 143 U/L. Troponin T Cardiac SERUM <0.010 ng/mL. Creatine Kinase MB SERUM 3.4 ng/ML. ESR BLOOD 1 mm/hr. WBC BLOOD 10.9x10(3)/mcL.RBC BLOOD 4.91x10(6)/mcL. Hemoglobin BLOOD 15.3 g/dL. Hematocrit BLOOD 43.0%. MCV BLOOD 87.6 fL. MCH BLOOD 31.2 pg. MCHC BLOOD 35.6 g/dL. RDW CV BLOOD 12.4%. Platelets BLOOD 205x10(3)/mcL. MPV BLOOD 11.2fL. Neutrophils BLOOD 7.6x10(3)/mcL. Neutrophils BLOOD 69.9%. Lymphocytes BLOOD 2.6x10(3)/mcL. Lymphocytes BLOOD 23.8%. Monocytes BLOOD 0.4x10(3)/mcL. Monocytes BLOOD 4%. Eosinophils BLOOD 0.2x10(3)/mcL. Eosinophils BLOOD 1.7%. Basophils BLOOD 1%. Basophils BLOOD 0.1x10(3)/mcL. 12/1/09 PA AND LATERAL CHEST: An azygous fissure is seen. The lungs ar
CDC 'Split Type':
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Dose
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500741P   
Administered by: Military     Purchased by: Military
Symptoms: Chest pain, Dyspnoea, Laboratory test normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: SM developed intermittent chest pain and SOB starting on the 19 of Nov with a very brief episode and then no recurrence until 25th Nov. Chest pain not related to exertion. SM is noting SOB with climbing stairs and during PT.

VAERS ID:378228 (history)  Vaccinated:2010-01-12
Age:18.0  Onset:2010-01-12, Days after vaccination: 0
Gender:Female  Submitted:2010-01-13, Days after onset: 1
Location:Minnesota  Entered:2010-01-26, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies- Flexeril; Penicillin; bees; dogs; (per consent form)
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102139P10IMRA
Administered by: Other     Purchased by: Other
Symptoms: Chest discomfort, Feeling hot, Nasopharyngitis, Nausea, Pharyngeal oedema, Pruritus, Pyrexia, Rash, Scratch, Skin warm
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 9am vaccine-Novartis (lot #102139P1) administered. 10:15 am ED reports hot face and neck with itching-scratching area. Administered Benadryl 50mg po- No SOB, oriented, steady ambulation. 10:25 am ED "nauseous", itching continues, legs and arms "hot"- no rash observed to extremities-face and neck red from continuous scratching. 10:35 am arms and legs itching, No resp difficulty. Additional Benadryl 50mg po given. Is dizzy. NO SOB. 10:45 ER notified of plan to transport. Dr ordered & administered epinephrine 0.3mg IM due to distance to hosp and transport by family. New c/o SOB. 10:50 am transport to hospital by grandfather.

VAERS ID:378395 (history)  Vaccinated:2009-11-23
Age:18.0  Onset:2009-12-01, Days after vaccination: 8
Gender:Female  Submitted:2010-01-26, Days after onset: 56
Location:Washington  Entered:2010-01-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SPIRONOLACTONE
Current Illness: None
Preexisting Conditions: No allergies. Medical condition = Acne
Diagnostic Lab Data: Lesion punch biopsy = hypersensitivity (leukocytoclastic) vasculitis
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Other
Symptoms: Hypersensitivity, Laboratory test, Leukocytoclastic vasculitis
SMQs:, Angioedema (broad), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: Hypersensitivity or Leukocytoclastic Vasculitis

VAERS ID:380248 (history)  Vaccinated:2007-10-03
Age:18.0  Onset:2007-10-03, Days after vaccination: 0
Gender:Female  Submitted:2010-01-07, Days after onset: 827
Location:Oregon  Entered:2010-01-27, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness:
Preexisting Conditions: It was reported that the subject has a possible penicillin allergy. There is no history of adverse events following previous vaccinations.
Diagnostic Lab Data:
CDC 'Split Type': A0774219A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB437CA1 LA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was reported by a healthcare professional and described the occurrence of stomach cramps in a 18-year-old female subject who was vaccinated with Engerix B (GlaxoSmithKline). There were no concurrent medications. On 3 October 2007 the subject received 2nd dose of Engerix B at at 20 mcg in the left arm. On 3 October 2007, less than one day after vaccination with Engerix B, the subject experienced severe stomach cramps. It was not known how long the cramps lasted, but they reportedly resolved. The healthcare professional considered the event was possibly related to vaccination with Engerix B.

VAERS ID:380266 (history)  Vaccinated:2009-04-10
Age:18.0  Onset:2009-04-13, Days after vaccination: 3
Gender:Female  Submitted:2010-01-07, Days after onset: 269
Location:Utah  Entered:2010-01-27, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions:
Diagnostic Lab Data: unk
CDC 'Split Type': A0780174A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 1UNUN
Administered by: Private     Purchased by: Private
Symptoms: Anaemia
SMQs:, Haematopoietic erythropenia (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of antigenemia in a 18-year-old female subject who was vaccinated with ENGERIX B (Glaxosmithkline). On 10 April 2009 the subject received 2nd dose and ENGERIX B (20 mcg, unknown). On 13 April 2009, 3 days after vaccination with ENGERIX B, the subject experienced antigenemia. On 13 April 2009, her blood tested positive for hepatitis B surface antigen. Her blood had not been redrawn at the time of reporting, so it was unknown if it has resolved. The nurse believed that that subject received the 20 mcg dose. At the time of reporting the outcome of the event was unspecified. The healthcare professional considered the event was probably related to vaccination with ENGERIX B.

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