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Case Details (Sorted by Age)

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VAERS ID: 500633 (history)  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-08-19
Onset:2013-08-20
   Days after vaccination:1
Submitted: 2013-08-26
   Days after onset:6
Entered: 2013-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J002304 / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1308USA010494

Write-up: This spontaneous report as received from a nurse refers to a 5 year old female patient. On 19-AUG-2013 the patient was vaccinated with PROQUAD (lot # J002304, exp 22-AUG-2014). On 20-AUG-2013, the patient experienced local reactions, large, swollen, red area, about size of an egg on the thigh after receiving PROQUAD. Patient was seen in the office on 21-AUG-2013 and received BENADRYL 25 mg as treatment. The outcome of the adverse event was unknown. Additional information has been requested.


VAERS ID: 500670 (history)  
Age: 5.0  
Gender: Female  
Location: Colorado  
Vaccinated:2013-08-19
Onset:2013-08-20
   Days after vaccination:1
Submitted: 2013-08-21
   Days after onset:1
Entered: 2013-08-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / 5 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015644 / 1 RL / SC

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

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

Write-up: Thigh had a local reaction, red, warm. Swollen - approx 12cm by 10cm. Appt with a provider 2 days later. No treatment but to rest a few days.


VAERS ID: 500683 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2013-08-19
Onset:2013-08-21
   Days after vaccination:2
Submitted: 2013-08-22
   Days after onset:1
Entered: 2013-08-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

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

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:

Write-up: Rash typical of varicella.


VAERS ID: 500692 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2013-08-06
Onset:2013-08-27
   Days after vaccination:21
Submitted: 2013-08-27
   Days after onset:0
Entered: 2013-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254AA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J004174 / 0 RL / SC

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

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

Write-up: Onset of vesicular rash consistent with varicella, against which he was immunized 3 weeks before.


VAERS ID: 500734 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2013-08-20
Onset:2013-08-22
   Days after vaccination:2
Submitted: 2013-08-22
   Days after onset:0
Entered: 2013-08-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / 0 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS JR737 / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J004172 / 1 LL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD placed 8/20/13
Current Illness: None noted
Preexisting Conditions: Unspecified asthma; Constipation
Diagnostic Lab Data: Erythema right thigh
CDC Split Type:

Write-up: Presented to clinic 8-22-13 with erythema to right thigh.


VAERS ID: 500819 (history)  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:2013-08-26
Onset:0000-00-00
Submitted: 2013-08-28
Entered: 2013-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS 9AB77 / 4 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 47350 / 4 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Full blood count, Injection site swelling, Nausea, Ultrasound scan, X-ray
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

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: CBC; X-Ray; and US
CDC Split Type:

Write-up: Swollen R thigh and knee. No fever. Nausea when woke up yesterday.


VAERS ID: 500829 (history)  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2013-08-26
Onset:2013-08-27
   Days after vaccination:1
Submitted: 2013-08-28
   Days after onset:1
Entered: 2013-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B187AA / 0 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J000199 / 0 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mother reports none
Current Illness: Parent report none
Preexisting Conditions: Parent report none
Diagnostic Lab Data:
CDC Split Type:

Write-up: L upper arm reddened/ warm approx 4 x 5 cm X 1/2 mm height. Child had received 2 vaccines 1 s/c; 1 IM on 8/26/13. Child was very anxious; moving and tightening arm while mother held her. Treatment: prescribed by NP Tylenol q 6 h ATC 3-4 days. Cool compresses qid X 10 minutes until redness clears. PHN will follow up with 2 phone calls to mother over next 7 days. Mother will call PHN if s/s worsen.


VAERS ID: 500853 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-08-12
Onset:2013-08-13
   Days after vaccination:1
Submitted: 2013-08-28
   Days after onset:15
Entered: 2013-08-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3957AA / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site rash, Injection site reaction, Local reaction, Pyrexia, Rash, Rash vesicular, Urticaria, Varicella virus test
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL 12.5 mg/5 ml Q6 hrs
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Varicella IgG and IgM antibody screen
CDC Split Type:

Write-up: 8/12/13 Vaccine administered. 8/13/13 Localized rxn injection site rash and welt right thigh. 8/15/13 Fever 102F. Few spots vesicular on trunk and face. 8/21/13 Fever and vesicles inc.


VAERS ID: 500878 (history)  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-08-03
Onset:2013-08-04
   Days after vaccination:1
Submitted: 2013-08-29
   Days after onset:25
Entered: 2013-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4214BA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1028 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H013042 / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H019446 / 1 LL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: TX130025PU

Write-up: Pain and redness in upper thighs, hot to touch, and swollen.


VAERS ID: 500883 (history)  
Age: 5.0  
Gender: Male  
Location: Utah  
Vaccinated:2013-08-28
Onset:2013-08-29
   Days after vaccination:1
Submitted: 2013-08-29
   Days after onset:0
Entered: 2013-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B225BA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001012 / 0 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Inflammation, Local swelling, Pain in extremity, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Red, raised, hot to touch, non-painful, circle of inflammation on left anterior thigh. Approximate size is 1 3/4 inch in diameter. Fever in the morning of 101.2 degrees F. Child complains that his "leg hurts." Encouraged mom to continue Tylenol as needed. Mark with a pen the edge of redness. If symptoms worsens or any new symptoms occur to contact pediatrician.


VAERS ID: 501054 (history)  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2013-08-13
Onset:2013-08-30
   Days after vaccination:17
Submitted: 2013-08-30
   Days after onset:0
Entered: 2013-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Rash erythematous, Rash maculo-papular, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Red/pink maculopapular rash on anterior and posterior trunk. No vesicles noted. Mild discomfort or itching. Rash is most prevalent on anterior trunk. No fever or signs of illness present. Pt''s brother with a few very similar lesions to trunk without any other symptoms. Varicella vaccine given on 8/13/2013 with other routine immunizations. Rash is most consistent with varicella.


VAERS ID: 501142 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2013-08-26
Onset:2013-08-27
   Days after vaccination:1
Submitted: 2013-08-28
   Days after onset:1
Entered: 2013-08-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B187AA / - LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H017433 / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020587 / 1 LL / UN

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

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: None
CDC Split Type:

Write-up: Developed redness, warmth, no drainage at the site of injection.


VAERS ID: 501155 (history)  
Age: 5.0  
Gender: Female  
Location: Maine  
Vaccinated:2013-08-21
Onset:2013-08-22
   Days after vaccination:1
Submitted: 2013-08-23
   Days after onset:1
Entered: 2013-08-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020254 / 0 LL / UN

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

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:

Write-up: Patient c/o itchy raised red rash 24 hours after receiving varicella vaccine.


VAERS ID: 501176 (history)  
Age: 5.0  
Gender: Male  
Location: Delaware  
Vaccinated:2013-08-19
Onset:2013-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2013-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B235AA / 0 LA / IM

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

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:

Write-up: Patient received DTAP/IPV on left arm. 48 Hs c/o develop swollen and redness on site in small blisters, on site of injection. Today the arm is swollen, mild redness. He had no fever or breathing difficulties.


VAERS ID: 501213 (history)  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:2013-08-19
Onset:2013-08-20
   Days after vaccination:1
Submitted: 2013-08-30
   Days after onset:10
Entered: 2013-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B164AA / 0 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Throat irritation, Tic
SMQs:, Dyskinesia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; Probiotic
Current Illness: None
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a tic-within-24 hours of vaccine. Juts chin out/clears throat - worse at night. Bad headache after 2 days of vaccination.


VAERS ID: 501345 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2013-08-27
Onset:2013-08-29
   Days after vaccination:2
Submitted: 2013-08-30
   Days after onset:1
Entered: 2013-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015643 / - LA / UN

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

Life Threatening? No
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:

Write-up: Mom noticed the reaction yesterday 8/29/13 around 6:00 PM red, warm and swelling. Pt. got PROQUAD on the left arm on 8/27/13. Reaction''s measurements 20 x 30 mm.


VAERS ID: 501678 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-08-20
Onset:2013-08-20
   Days after vaccination:0
Submitted: 2013-08-30
   Days after onset:10
Entered: 2013-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J002317 / - UN / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1308USA011500

Write-up: This spontaneous report as received from a licensed practical nurse (L.P.N) concerning to a 5 year old male patient with none drug reactions/allergies and none pertinent medical history. On 20-AUG-2013, the patient was vaccinated with VARIVAX (Merck) (dose, frequency, concentration and route of administration were not provided), lot number J002317, subcutaneous. There were no concomitant medications. On 20-AUG-2013, 12 hours later after vaccination; the patient experienced rash pruritic that appeared on the inner thigh and then spread from there to unspecified locations of the body. No laboratory studies were reported. On an unknown date the patient was given acetaminophen (manufacturer unknown) and hydrocortisone (manufacturer unknown ) as treatment for the event. No further information was available. At the time of this report the outcome of rash pruritic was unknown. The causality between the adverse event and the vaccine was unknown. Additional information has been requested.


VAERS ID: 501211 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2013-08-27
Onset:0000-00-00
Submitted: 2013-08-27
Entered: 2013-09-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1340 / - LL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B087CB / - RL / IM

Administered by: Private       Purchased by: Other
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)

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

Write-up: Pt. was accidentally vaccinated with BOOSTRIX instead of DAPTACEL for a kindergarten physical. Pt. with mother. No reaction noted after staying 15 min. after injection.


VAERS ID: 501374 (history)  
Age: 5.0  
Gender: Male  
Location: Maryland  
Vaccinated:2013-08-16
Onset:2013-08-18
   Days after vaccination:2
Submitted: 2013-08-26
   Days after onset:8
Entered: 2013-09-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4452AA / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1281 / - LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J002308 / 0 RL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Seasonal allergies only; followed by ENT for tonsillar hypertrophy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received vaccines on 8-16-13 as part of a well visit. On the evening of 8-18-13, pt''s left upper thigh, where vaccines were administered, swelled, becoming red, hard, and warm to the touch. Seen at ER, dx''ed with cellulitis as a reaction to the vaccine, put on KEFLEX 10 day course. Had a follow-up appt at our office on.


VAERS ID: 501350 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-08-22
Onset:2013-08-28
   Days after vaccination:6
Submitted: 2013-09-03
   Days after onset:6
Entered: 2013-09-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4454AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. J000722 / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J005177 / 0 LL / IM

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

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

Write-up: Fever, seizure 6 days after vaccines given. ER in ambulance. Given VERSED and monitored. Discharged from ER - no other findings.


VAERS ID: 501401 (history)  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2013-08-23
Onset:2013-08-23
   Days after vaccination:0
Submitted: 2013-08-26
   Days after onset:3
Entered: 2013-09-04
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B235AA / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J00233 / - LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Erythema, Induration, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Worsening redness, tenderness and induration - 6cm x 6cm at time of visit 3d later. Afebrile.


VAERS ID: 501403 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2013-08-14
Onset:2013-08-17
   Days after vaccination:3
Submitted: 2013-08-22
   Days after onset:5
Entered: 2013-09-04
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4378AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J10581 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014978 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J000150 / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site reaction, Pyrexia, Rash, Streptococcus test positive, Urine analysis normal, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Urinalysis (-); Strept test (+)
CDC Split Type:

Write-up: Rash, fever 3 days after vaccine. Urticarial rash on right leg.


VAERS ID: 501409 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2013-08-13
Onset:2013-08-14
   Days after vaccination:1
Submitted: 2013-09-04
   Days after onset:21
Entered: 2013-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / 4 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H021357 / 1 LA / SC

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

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

Write-up: Grandma phoned in AM with concerns of swelling in L thigh, "hard lump" and warm to touch. Called PCP, PCP advised to call where vaccines were admin. Called back in PM to say swelling incresed down to client''s knee. Took to Urgent care 08/15/13 PM. Treated with antibiotics, Benadryl, Advil, and ice packs. Symptoms improved 08/16/13 AM.


VAERS ID: 501414 (history)  
Age: 5.0  
Gender: Male  
Location: Maryland  
Vaccinated:2013-09-04
Onset:2013-09-04
   Days after vaccination:0
Submitted: 2013-09-04
   Days after onset:0
Entered: 2013-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014977 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020671 / 1 RL / SC

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Lethargy, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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:

Write-up: PT W/ EMESIS, ERYTHEMATOUS FACE + LETHARGY AFTER 4 Y/O VACCINATION. EPIPEN JR GIVEN @ 1000, BENADRYL + PREDNISONE ALSO GIVEN. WITHIN 15MIN LETHARGY WAS IMPROVING. PT WAS MONITORED WITH PULSE OX + VITALS FOR 3 HOURS. DISCHARGED HOME WITH EPIPEN STEROIDS, + ANTIHISTAMINES. STABLE OF BASELINE AT DISCHARGE.


VAERS ID: 501537 (history)  
Age: 5.0  
Gender: Male  
Location: Georgia  
Vaccinated:2013-08-17
Onset:2013-08-18
   Days after vaccination:1
Submitted: 2013-08-19
   Days after onset:1
Entered: 2013-09-04
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4383AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1284 / 4 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H017432 / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J000192 / 2 LA / SC

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

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: GA1312

Write-up: Mother called stating child had a mild rash and swelling of the glands behind ears, neck and the cheeks. Instructed caregiver to take pt to ER.


VAERS ID: 501519 (history)  
Age: 5.0  
Gender: Female  
Location: Ohio  
Vaccinated:2013-08-16
Onset:2013-08-17
   Days after vaccination:1
Submitted: 2013-09-05
   Days after onset:19
Entered: 2013-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H018949 / - - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J001647 / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Serum sickness
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: METROHEALTHESP201259083

Write-up: Ot serum react d/t vacc on 2013-08-17.


VAERS ID: 501763 (history)  
Age: 5.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2013-09-04
Onset:2013-09-04
   Days after vaccination:0
Submitted: 2013-09-06
   Days after onset:2
Entered: 2013-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4363AA / 4 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH898AB / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1281 / 4 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Vaccination site erythema, Vaccination site warmth
SMQs:

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:

Write-up: (L) leg vaccine site red on 9-4-13 3:00 pm outlined by mom spread today (9-5-13) warm to touch. Cellulitis-afebrile 20x20 cm area - Rx AUGMENTIN.


VAERS ID: 501775 (history)  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2013-08-29
Onset:0000-00-00
Submitted: 2013-09-06
Entered: 2013-09-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 3 LA / UN

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

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

Write-up: Clinic had issue with refrigerator, staff was initially told vaccines were okay to administer but later notified that small subset was not viable. No adverse symptoms in patient.


VAERS ID: 501844 (history)  
Age: 5.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2013-08-30
Onset:2013-08-31
   Days after vaccination:1
Submitted: 2013-09-09
   Days after onset:9
Entered: 2013-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B196CA / 4 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB690BA / 0 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. J003478 / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017438 / 1 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None-But client is very hungry that time
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The next day after getting the vaccination - client developed high fever up to 102 degrees Farenheit and L deltoid became swollen, red and very hot to touch. Mom gave her Motrin and fever only last for 1 day. Soreness last 2-3 days and child able to go to school. 9/3/13 Tuesday of follow up call today and Mom verbalized she is doing great!


VAERS ID: 501887 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2013-09-05
Onset:2013-09-07
   Days after vaccination:2
Submitted: 2013-09-09
   Days after onset:2
Entered: 2013-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254BA / 0 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001053 / 0 RA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID
Current Illness: None
Preexisting Conditions: Hashimoto''s thyroiditis; Eczema
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2 d after MMRV administered pt developed redness at injection site; 3 d after inj erythema, pallor increased from elbow to shoulder with sl itching at site; No vesicles no fever; 9/9/13: decreased pallor/decreased erythema; site improving.


VAERS ID: 501936 (history)  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:2013-09-03
Onset:2013-09-05
   Days after vaccination:2
Submitted: 2013-09-09
   Days after onset:4
Entered: 2013-09-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS T5LP9 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. J002504 / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J003704 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Body temperature increased, Oral candidiasis, Rash generalised
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: 9/3/2013 MMR and VZV given. 9/5/13-9/6-/13 Temp of 104.1, rash on neck and body thrush to tongue. Reported by Mom. 9/7/13 ER visit and treatment.


VAERS ID: 501941 (history)  
Age: 5.0  
Gender: Unknown  
Location: Indiana  
Vaccinated:2013-08-29
Onset:2013-08-29
   Days after vaccination:0
Submitted: 2013-09-10
   Days after onset:12
Entered: 2013-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1121AA / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1309USA001529

Write-up: This spontaneous report was received from a healthcare worker who refers to a 5 year old patient of unknown gender. On 29-AUG-2013 the patient was vaccinated with an expired dose of M-M-R II lot # 671320/1121AA (rHA), expiration date 17-JUL-2013. No adverse effect reported. The outcome and action taken were not reported. Additional information has been requested.


VAERS ID: 501955 (history)  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:2013-08-20
Onset:2013-08-21
   Days after vaccination:1
Submitted: 2013-09-10
   Days after onset:20
Entered: 2013-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B235AA / 4 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H02850 / 1 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Allergic reaction-given antibiotics Bactrim; possible protein allergy to vaccine
CDC Split Type: TX130028PU

Write-up: Swelling of Left arm at site and down arm next day. Large swelling behind arm where Proquad given. Patient experienced heat coming from site and was taken to emergency room. Emergency Dr. advise to tell us.


VAERS ID: 501981 (history)  
Age: 5.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2013-09-10
Entered: 2013-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1309USA000332

Write-up: This spontaneous report was received from a physician assistant via company representative who refers to a 5 year old patient of unknown gender. The physician assistant reported that on an unknown date the patient was vaccinated with a dose of GARDASIL (dose, route and lot # were not reported). The outcome and action taken were not reported. Additional information has been requested.


VAERS ID: 502050 (history)  
Age: 5.0  
Gender: Male  
Location: New York  
Vaccinated:2013-09-06
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2013-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B008 / 5 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H011898 / 2 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J003712 / 2 UN / SC

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

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:

Write-up: Pt was here for a M. V vaccine order was in EMR. Correct vaccines were given. But when immz record was pulled up to be printed, it was noted pt had already had those vaccines in 10-4-12. MMR-Varicella-Kinrix. Dr was advised. No adverse effect was noted.


VAERS ID: 502126 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2013-08-22
Onset:2013-08-22
   Days after vaccination:0
Submitted: 2013-09-11
   Days after onset:20
Entered: 2013-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221AB / 0 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015792 / 0 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle aches, right arm red hot and hard at injection site.


VAERS ID: 502223 (history)  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-08-13
Onset:2013-08-29
   Days after vaccination:16
Submitted: 2013-09-06
   Days after onset:8
Entered: 2013-09-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2174 / 0 - / IN

Administered by: Private       Purchased by: Unknown
Symptoms: Computerised tomogram normal, Dyskinesia, Eye movement disorder, Facial paresis, VIIth nerve paralysis
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Ocular motility disorders (narrow)

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 (Asthma in past, not recent)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right facial weaknesss (Bell''s Palsy) onset 8/29/12. Seen in ED, had normal CT, treated with oral prednisolone. Seen my office 9/6/13, mildly improved per parent, still with (now mild) right facial weakness (eyebrow and eye movement improved, right side of mouth stiff and not movng well). Improved, expected to recover eventually.


VAERS ID: 502508 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2013-09-03
Onset:2013-09-04
   Days after vaccination:1
Submitted: 2013-09-14
   Days after onset:10
Entered: 2013-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 2029689 / 1 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Eye swelling, Gait disturbance, Induration, Injection site pain, Injection site swelling, Oedema, Tenderness, Weight bearing difficulty
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms included left thigh swelling, point tenderness, reduced weight bearing tolerance leading to a limp. By Thursday night at 8:00 PM left eye swelling, hard edema and extreme tenderness to passive range of motion were present. 25mg tablet of Benadryl given along with 7.5 ml of children''s ibuprofen. Repeated dosage the following morning at 6:30 A.M leading to significant symptom improvement by early afternoon.


VAERS ID: 502520 (history)  
Age: 5.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2013-08-09
Onset:2013-09-06
   Days after vaccination:28
Submitted: 2013-09-14
   Days after onset:8
Entered: 2013-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Skin ulcer, Staphylococcal infection, Varicella post vaccine
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data: Still has them at current time, doctors dont know what to do, was told by the hospital that it will go away eventually.
CDC Split Type:

Write-up: Got chicken pox from her second dose. HUGE sores and infection. Caused staph. Hospital prescribed Keflex. Problem is that she has to have a DTAP shot again (one on 8/9 also) but shes sick now and school says "its the law". May be forced to keep her out, but the school says they will call cops.


VAERS ID: 502669 (history)  
Age: 5.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2012-10-17
Onset:2012-10-21
   Days after vaccination:4
Submitted: 2013-09-16
   Days after onset:330
Entered: 2013-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA603AA / 7 LA / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Electroencephalogram, Epilepsy, Grand mal convulsion, Laboratory test
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cold sx, afebrile
Preexisting Conditions: None
Diagnostic Lab Data: EEG, lab work, etc
CDC Split Type:

Write-up: Grand mal seizures. No hx of seizures in family or patient. Patient diagnosed w/epilepsy with no know cause.


VAERS ID: 502679 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2013-09-10
Onset:2013-09-10
   Days after vaccination:0
Submitted: 2013-09-13
   Days after onset:3
Entered: 2013-09-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B182BA / 4 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1382 / 3 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J003534 / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram head normal, Head injury, Headache, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; Probiotics
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Head CT as above.
CDC Split Type:

Write-up: Syncope -$g head injury with HA and vomiting -$g sent to ER for head CT (neg).


VAERS ID: 502981 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-09-14
Onset:2013-09-17
   Days after vaccination:3
Submitted: 2013-09-18
   Days after onset:1
Entered: 2013-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2174 / 0 - / IN

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

Life Threatening? No
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: Unknown / Dr assessment.
CDC Split Type:

Write-up: Patient developed welps 72hrs after vaccination w/ FLUMIST. Dr at Urgent Care believed it was due to FLUMIST. Treated with Prednisone 5mg/5ml 1 tsp. QID x 3 days. Spoke with mom today and patient is "perfectly fine".


VAERS ID: 502995 (history)  
Age: 5.0  
Gender: Male  
Location: New York  
Vaccinated:2013-08-23
Onset:2013-08-24
   Days after vaccination:1
Submitted: 2013-09-13
   Days after onset:20
Entered: 2013-09-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00672 / 2 RA / UN

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

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

Write-up: Child seen 8/29/13 by CNP for lingering hives on R upper arm. Reaction began 8/24/13 by mom''s report as redness and swelling from shoulder to elbow. Now no swelling but scattered welts. No signs of infection.


VAERS ID: 503047 (history)  
Age: 5.0  
Gender: Male  
Location: Unknown  
Vaccinated:2013-08-26
Onset:2013-08-27
   Days after vaccination:1
Submitted: 2013-09-18
   Days after onset:22
Entered: 2013-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / SYR

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Anaphylactic reaction, Condition aggravated, Eczema, Hypersensitivity, Oedema mouth, Pharyngeal oedema, Pruritus, Psychomotor hyperactivity, Swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Akathisia (broad), Oropharyngeal allergic conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin
Current Illness: Casein allergy; Eczema
Preexisting Conditions: There were no concomitant vaccinations. The consumer reported that the subject''s eczema normally flares up when he receives a vaccination, but not to the point it did this time. On follow up, the mother reported that the subject was "severely allergic to bovine casein."
Diagnostic Lab Data: UNK
CDC Split Type: A1040922A

Write-up: This case was reported by a consumer (the subject''s mother) and described the occurrence of allergic reaction in a 5-year-old male subject who was vaccinated with INFANRIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. Concurrent medical conditions included eczema. Concurrent medications included Vitamin. On 26 August 2013 at 14:00 the subject received unspecified dose of INFANRIX (details unknown). On 27 August 2013 (in the morning), 1 day after vaccination with INFANRIX, the subject experienced allergic reaction. The consumer reported that the subject''s eczema "normally flares up when he has a vaccine but not to the point it did this time". It was not specified whether the allergic reaction corresponded to the eczema flare up, or if other events had occurred. The consumer reported that a healthcare provider was consulted regarding the events. At the time of reporting, the allergic reaction was improved and the outcome of the eczema flare up was unspecified. Follow up was received on 29 August 2013. The case has been upgraded to serious. On follow up, the mother reported that the subject was "severely allergic to bovine casein." The mother reported that the subject "recently had an injection of INFANRIX" and reported anaphylactic reactions "to it". The mother reported "it to her physician but was not satisfied with his response." A physician or other health care professional has not verified this report. Additional information was received on 29 August 2013 from the mother. The mother stated that 1 day after vaccination with INFANRIX, the subject experienced anaphylactic reaction, hives, "hive-like itching", swollen (described as "swollenness"), swollen mouth, swollen throat, hyperactive (described as "became very hyper"), and feeling hyper (agitated) (described as "very ''hyper'' and or agitated"). The outcome of all events were unknown. A physician or other health care professional has not verified this report.


VAERS ID: 503070 (history)  
Age: 5.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2013-08-06
Onset:2013-09-13
   Days after vaccination:38
Submitted: 2013-09-13
   Days after onset:0
Entered: 2013-09-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B22SBA / 0 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Ear discomfort, Emotional distress, Hallucination, Hyperaesthesia, Muscle tightness, Ocular hyperaemia, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient developed tightness in ears, neck, and throat after the shot. The next day she had fever to 104 degrees 5:40 PM, red eyes, skin sensitivity, hallucinations, and became distraught. Symptoms resolved by 8/8/13.


VAERS ID: 503141 (history)  
Age: 5.0  
Gender: Female  
Location: Virginia  
Vaccinated:2013-09-11
Onset:2013-09-12
   Days after vaccination:1
Submitted: 2013-09-13
   Days after onset:1
Entered: 2013-09-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4452AA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1281 / 3 RL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015623 / 0 RL / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site reaction, Injection site warmth, Pallor
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)

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:

Write-up: 5 in x 5 in area of erythema (blanchable) and warmth around injection site (right ant. thigh).


VAERS ID: 503246 (history)  
Age: 5.0  
Gender: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2012-12-13
Submitted: 2012-12-14
   Days after onset:1
Entered: 2013-09-20
   Days after submission:279
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Expired drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2012SE94003

Write-up: A report has been received from a Health Professional concerning a 5 year old, Female subject, who had been receiving Nasal FLUMIST. FLUMIST started on an unknown date. The reporter stated that expired FLUMIST was given to the patient which started on 13-DEC-2012. The outcome of the event of EXPIRED FLUMIST GIVEN is unknown. The report was considered non-serious.


VAERS ID: 503269 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2012-09-29
Onset:2012-12-31
   Days after vaccination:93
Submitted: 2013-01-04
   Days after onset:4
Entered: 2013-09-20
   Days after submission:258
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2025 / - - / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Influenza A virus test positive
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE01353

Write-up: A report has been received from a Health Professional concerning a 5 year old, Male subject, who had been receiving Nasal FLUMIST. FLUMIST started on 29-Sep-2012. The patient experienced POSITIVE FOR INFLUENZA A which started on 31-Dec-2012. The outcome of the event of POSITIVE FOR INFLUENZA A is unknown. The report was considered to be non-serious.


VAERS ID: 503290 (history)  
Age: 5.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2013-01-12
Onset:2013-01-13
   Days after vaccination:1
Submitted: 2013-01-14
   Days after onset:1
Entered: 2013-09-20
   Days after submission:248
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2154 / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Influenza, Influenza A virus test positive, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE02877

Write-up: A report has been received from a Health Professional concerning a 5 year old, Male subject, who had been receiving Nasal FLUMIST. FLUMIST started on 12-Jan-2013. The patient experienced FEVER and TESTED POSITIVE FOR FLU A which started on 13-Jan-2013. The outcome of the event of FEVERF and TESTED POSITIVE FOR FLU is unknown. The report was considered to be non-serious.


VAERS ID: 503291 (history)  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2013-01-10
Submitted: 2013-01-10
   Days after onset:0
Entered: 2013-09-20
   Days after submission:252
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Expired drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE02583

Write-up: A report has been received from a Pharmacist concerning a 5 year old, Male subject, who had been receiving Nasal FLUMIST. FLUMIST started on an unknown date. The reporter stated that they had accidentally given expired doses of FLUMIST on 10-Jan-2013. The outcome of the event of GAVE EXPIRED DOSES OF FLUMIST is unknown. The report was considered to be non-serious.


VAERS ID: 503297 (history)  
Age: 5.0  
Gender: Male  
Location: Unknown  
Vaccinated:2012-08-29
Onset:2013-01-07
   Days after vaccination:131
Submitted: 2013-01-24
   Days after onset:17
Entered: 2013-09-20
   Days after submission:238
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2107 / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Influenza A virus test positive
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy Medications; PROVENTIL; FLONASE; NASONEX
Current Illness: Multiple allergies; Asthma
Preexisting Conditions:
Diagnostic Lab Data: Tested Positive for Influenza A
CDC Split Type: 2013SE02406

Write-up: A report has been received from a health professional. The report concerns a 5 year old patient of unknown gender. The patient''s concurrent diseases included allergies and asthma. Concomitant medications included Allergy Medications, Salbutamol Sulfate, Fluticasone Propionate and Mometasone Furoate. On 29-Aug-2012, patient received nasal FLUMIST. The patient tested positive for influenza A on 07-Jan-2013. The patient recovered from the event of tested positive for Influenza a on an unspecified date. The reporter was considered to be non-serious by the reporter. Summary of follow-up information received by AstraZeneca/MedImmune 24-Jan-2013 from health professional: Outcome of event was updated from unknown to recovered. Concomitant drug and concomitant diseases were added. Corrected report 29-Jan-2013: Manufacturer of suspected drug added. Reporter''s type med rep was added. Corrected report on 01-Mar-2013: event coding changed, narrative updated.


VAERS ID: 503301 (history)  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:2013-08-26
Onset:2013-09-15
   Days after vaccination:20
Submitted: 2013-09-20
   Days after onset:5
Entered: 2013-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J004174 / 1 RA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Redness/fever~Measles + Mumps + Rubella (MMR II)~1~2.00~Patient|Redness/fever~Tdap (Adacel)~1~2.00~Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Whole body rash. Chicken pox outbreak. Fever.


VAERS ID: 503321 (history)  
Age: 5.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2013-09-12
Onset:2013-09-12
   Days after vaccination:0
Submitted: 2013-09-20
   Days after onset:8
Entered: 2013-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH898AC / - LA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: In clinic to rule out cardiac issues- came to clinic complaining of chest pain and fatigue with activity. Cardiologist impression after examination: Impression: I believe he is normal from a cardiac standpoint. Some children at this age complain of pain when they are really feeling a fast heart rate so attention to his heart rate with any events would be a good idea but I do not think this is likely to be the case.
Preexisting Conditions: Adverse and Allergic Drug Reactions: azithromycin Structured Problems: Functional heart murmur
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initial onset at 130 PM: Dr. reported to me that patient''s mom had called reporting a reaction to the flu shot. Patient has hives all over their body. Dr. advised mom to treat with Benadryl and to take patient to PCP''s office. Patient was not reported to have any signs of respiratory distress. I called mom who stated that he was seen by his pcp and that the Benadryl was effective. Mom states PCP has not advised any other treatment of reaction. Mom states patient gets flu shot every year and that this is the first time the patient has had a reaction. Mom understands to call back if she has any other questions or concerns. Continued symptoms reported at 330P: 2013/09/12 15:42: Called mom, she stated they were in the PCP office when he was given the Benadryl and the hives did get better. They have now returned and they are cover more of his body. Mom stated they are on the way to ER. Told mom that if she can she may want to call her PCP to make them aware. Mom verbalized understanding. Patient presented at ED at: 1612: Treatment there: Treatments Rendered: prednisolone oral soln: Orapred 35 mg po stat; ranitidine oral syrup: Zantac 35 mg po stat; hydroxyzine hcl: Atarax 9 mg po stat. Prescriptions Written: prednisolone sodium phosphate 25 mg/5 mL (5 mg/mL) Oral Soln;Dispense: 35 milliliters; Refills: 0; Substitution: YesPrescription Type: Standard epinephrine 0.15 mg/0.15 mL (1:1,000) IM Pen Injector (Also Known As Adrenaclick); Dispense: 2 injectors; Refills: 0; Substitution: Yes Special Instructions: inject into lateral thigh if difficulty breathing, syncope/hypotension, altered mental status, profuse diarrhea/abdominal pain. Prescription Type: Standard diphenhydramine 12.5 mg/5 mL Elixir; Dispense: 240 milliliters; Refills: 0; Substitution: Yes Prescription Type: Standard hydroxyzine 10 mg/5 mL (5 mL) Syrup; Dispense: 75 milliliters; Refills: 0; Substitution: Yes. Prescription Type: Standard famotidine 40 mg/5 mL Oral Susp (Also Known As Pepcid); Dispense: 30 milliliters; Refills: 0; Substitution: Yes. Prescription Type: Standard. Please followup with the below contact(s): Please followup with your primary care provider in: 1-2 days. Discharged at 17:56 on 9/12.


VAERS ID: 503367 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2012-10-01
Onset:2012-10-01
   Days after vaccination:0
Submitted: 2012-12-16
   Days after onset:76
Entered: 2013-09-20
   Days after submission:277
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Cough, Pneumonia, Sinusitis
SMQs:, Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2012SE95065

Write-up: A report has been received from a Pharmacist concerning a 5 year old, Female subject, who had been receiving Nasal FLUMIST. FLUMIST started during Oct-2012. The patient experienced pneumonia, cough and sinusitis which started during Oct-2012. The patient recovered from the event of pneumonia and cough on an unspecified date and the outcome of the event of sinusitis is unknown. The report was considered to be non-serious.


VAERS ID: 503458 (history)  
Age: 5.0  
Gender: Male  
Location: Alabama  
Vaccinated:2013-09-17
Onset:2013-09-19
   Days after vaccination:2
Submitted: 2013-09-20
   Days after onset:1
Entered: 2013-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B225BA / - LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB551AA / 1 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J002931 / - LA / SC

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

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

Write-up: (L) deltoid area was swollen, hot to touch and painful. MD prescribed antibiotics for cellulitis.


VAERS ID: 503415 (history)  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:2013-09-09
Onset:2013-09-09
   Days after vaccination:0
Submitted: 2013-09-22
   Days after onset:13
Entered: 2013-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2124 / 0 - / IN

Administered by: Unknown       Purchased by: Other
Symptoms: Abasia, Aphasia, Asthenia, Computerised tomogram head, Dyskinesia, Fear, Gait disturbance, Laboratory test, Loss of control of legs, Nuclear magnetic resonance imaging brain
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levocarnitine and trileptal.
Current Illness: N/a
Preexisting Conditions: Beta Ketothiolase deficiency
Diagnostic Lab Data: She had CT and MRI of her brain. She was sedated for the MRI. She had to have IV fluids while NPO and has several labs ran.
CDC Split Type:

Write-up: Lost control of her arms and legs, stumbling, couldn''t walk, arms jerking, legs jerking. She was able to talk and was scared because she couldn''t make her arms and legs stop moving. After two weeks she still seems a bit weaker than before.


VAERS ID: 503869 (history)  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:2013-09-17
Onset:2013-09-18
   Days after vaccination:1
Submitted: 2013-09-24
   Days after onset:6
Entered: 2013-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH890AB / 3 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Local swelling, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Asthma
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Child presented with hives over her trunk and face, also some swelling to her hands and feet. She was wheezing but not labored.


VAERS ID: 503893 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-09-20
Onset:2013-09-21
   Days after vaccination:1
Submitted: 2013-09-24
   Days after onset:3
Entered: 2013-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 4LCP9 / 2 LA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin; Albuterol Sulfate; Flonase; Singulair; Pulmicort
Current Illness: No
Preexisting Conditions: Asthma, Allergies to egg white, soy, milk, peanuts, animal dander, wheat and Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm is swollen, red and painful.


VAERS ID: 504069 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2013-09-24
Onset:2013-09-24
   Days after vaccination:0
Submitted: 2013-09-25
   Days after onset:1
Entered: 2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2186 / 3 - / IN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J14061 / 4 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J006162 / 0 RA / SC
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 9F527 / 0 LA / IM

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

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

Write-up: Physician order in EHR for DTap, nurse administered Tdap. Pt tolerated vaccination without incident - mother made aware of incorrect vaccination having been administered. Advised to monitor for side effects.


VAERS ID: 504076 (history)  
Age: 5.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2011-07-13
Onset:2011-07-13
   Days after vaccination:0
Submitted: 2013-09-25
   Days after onset:805
Entered: 2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1309USA005515

Write-up: This spontaneous report as received from a Licensed Practical Nurse refers to a 5 year old patient. The patient was administered first dose of VARIVAX (Merck) 0.5 milliliter, subcutaneous (lot number and expiry date were not reported) and M-M-R II (lot number, expiry date, route and dose were not reported) prior to the 12 month birthday on 06-FEB-2007. The second dose of both VARIVAX (Merck) (lot number, expiry date, route and dose were not reported) and M-M-R II (lot number, expiry date, route and dose were not provided) was administered on 13-JUL-2011. No adverse effects reported. Additional information has been requested.


VAERS ID: 504229 (history)  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-09-13
Onset:2013-09-14
   Days after vaccination:1
Submitted: 2013-09-26
   Days after onset:12
Entered: 2013-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254BA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH907AB / - LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J005179 / 1 LL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. On Abx for URI. Well child exam
Preexisting Conditions: None
Diagnostic Lab Data: CBC - done 9/16/13 - NL.
CDC Split Type:

Write-up: 9/13/13- No reaction 15 min. after injection (R) upper thigh red (swollen). 9/14/13 - 9pm - Went to E/R. Dg with cellulitis. Prescribed BACTRIM BID X 7 days and Ibuprofen TID. 9/15/13 - 11am - Went to another E/R - Redness and swelling (R) ant upper thigh. Given ROCEPHIN 1000mg IM and Cephalexin 250mg QID x 10 days. 9/16 - F/u w Dr. Redness 10 x 10 cm - no cellulitis. Reaction to vacc. Cool compress.


VAERS ID: 504589 (history)  
Age: 5.0  
Gender: Female  
Location: Illinois  
Vaccinated:2013-09-13
Onset:2013-09-14
   Days after vaccination:1
Submitted: 2013-09-27
   Days after onset:13
Entered: 2013-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS F37NC / 4 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J001177 / 1 RA / SC

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

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:

Write-up: 9/16/13 Mother reported 2 day hx of (L) arm swollen to double normal size and redness down to elbow. No fever. Had given ibuprofen intermittently. Instructed to give ibuprofen q6hrs and ice pack prn. On 9/16/13 just redness persisting with 3" induration at injection site. 9/18/13 mother reported arm normal with no further complaints.


VAERS ID: 504667 (history)  
Age: 5.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2012-03-29
Onset:0000-00-00
Submitted: 2013-09-30
Entered: 2013-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1309USA013797

Write-up: This spontaneous report was received from a medical assistant refers to a patient of unknown age. On 17-MAR-2008, the patient was vaccinated with a first dose of VARIVAX (Merck)(lot number, expiry date and route was not reproted). On 29-MAR-2012, the patient was vaccinated with a second dose of VARIVAX (Merck), (lot number, expiry date and route was not reported). No adverse effect was reported. Additional information has been requested.


VAERS ID: 505001 (history)  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-09-27
Onset:2013-09-29
   Days after vaccination:2
Submitted: 2013-10-01
   Days after onset:2
Entered: 2013-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B267CA / - RL / UN
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BJ2013 / - - / IN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J004317 / - RL / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None (healthy)
Preexisting Conditions: None
Diagnostic Lab Data: Cellulitis
CDC Split Type:

Write-up: Pt return 3 days after vaccine was administered, complaining of redness that was worse the day before but was leaving a redness 10x12cm on (R) thigh/no tender/no /warm on touch. No fever/no sign of /no sign of . Receiving Tx for cellulitis.


VAERS ID: 505029 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2013-09-25
Onset:2013-09-25
   Days after vaccination:0
Submitted: 2013-09-26
   Days after onset:1
Entered: 2013-10-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 433F2 / 2 RA / IM

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

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

Write-up: Flu vaccine given around 5pm, woke from sleep with hives 9pm the same day. Came for appointment 9/26/13 (following day), still with moderate hives, BENADRYL PO prescribed. No SOB/wheezing.


VAERS ID: 505330 (history)  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:2013-09-30
Onset:2013-09-30
   Days after vaccination:0
Submitted: 2013-10-02
   Days after onset:2
Entered: 2013-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B267CA / - UN / IM
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2028 / - - / IN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. J003004 / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J003828 / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Cough, Flushing, Injection site reaction, Injection site swelling, Nasopharyngitis, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NASONEX
Current Illness: Cough/cold - mild URI
Preexisting Conditions: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right arm swelling, flushed. No c/o infection. KINRIX given (R) deltoid.


VAERS ID: 505357 (history)  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:2013-08-16
Onset:2013-09-12
   Days after vaccination:27
Submitted: 2013-10-02
   Days after onset:20
Entered: 2013-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4452AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1281 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood test normal, Convulsion, Gaze palsy, Tic
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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:
Diagnostic Lab Data: Bloodwork completed to r/o PANDAS
CDC Split Type:

Write-up: Tic appearing behavior-suspected to be seizure activity r/t immune response to DTaP vaccine. Had similar response for brief period of time after 15 month vaccines including DTaP. Activity was transient. Eye rolling.


VAERS ID: 505676 (history)  
Age: 5.0  
Gender: Male  
Location: Guam  
Vaccinated:2013-07-09
Onset:2013-07-10
   Days after vaccination:1
Submitted: 2013-07-11
   Days after onset:1
Entered: 2013-10-03
   Days after submission:84
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C43355AA / - RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / - RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0146456 / - LL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well child visit
Preexisting Conditions: Lymphadenitis; Acute tonsillitis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and redness of (R) thigh with fever since yesterday. It is located on the lower body and on the (R) thigh. It is described as acute. The color is described as erythematous. Pertinent findings include fever and denies itching. TYLENOL and BENADRYL ok. Warm or cold compresses.


VAERS ID: 505775 (history)  
Age: 5.0  
Gender: Male  
Location: Colorado  
Vaccinated:2013-09-24
Onset:2013-09-24
   Days after vaccination:0
Submitted: 2013-09-27
   Days after onset:3
Entered: 2013-10-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS C4452AA / 6 LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH900AD / - LA / UN

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

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:

Write-up: Erythma and edema of proximal (L) upper extremity. Tx with prednisone 1mg/kg burst x 3 days.


VAERS ID: 505791 (history)  
Age: 5.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2013-08-30
Onset:2013-10-03
   Days after vaccination:34
Submitted: 2013-10-04
   Days after onset:1
Entered: 2013-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2173 / 2 - / IN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J002931 / 0 UN / IM

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

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Maculopapular rash on cheeks and all over body.


VAERS ID: 506128 (history)  
Age: 5.0  
Gender: Male  
Location: Utah  
Vaccinated:2013-01-21
Onset:2013-01-22
   Days after vaccination:1
Submitted: 2013-09-30
   Days after onset:250
Entered: 2013-10-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / 0 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Drug administered at inappropriate site, Injection site oedema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: There were no other vaccinations administered on the same date. At the time of rpeorting, there were no concomitant medications or relevant medical history. It was unknown if there were any adverse events following previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A1009928A

Write-up: This case was reported by a healthcare professional (certified medical assistant) and described the occurrence of swelling injection site in a 5-year-old male subject who was vaccinated with KINRIX (GlaxoSmithKline). On 21 January 2013 the subject received 1st dose of KINRIX (.5 ml, unknown route, right thigh) and experienced vaccine administered at inappropriate site. The dose of KINRIX was administered in the right thigh when the preferred site of administration for KINRIX is the deltoid of the upper arm. In January 2013, within days of vaccination with KINRIX (up to and including 23 January 2013), the subject experienced swelling injection site. The certified medical assistant reported that the subject "swelled up at the injection site to mid knee cap." The subject was treated with prednisone. At the time of reporting the events were improved. Per the certified medical assistant, "the swelling is better but not resolved." The healthcare professional considered the events were probably related to vaccination with KINRIX. Follow up was received from the healthcare professional (certified medical assistant - CMA) on 21 May 2013. The CMA documented that on 22 January 2013, 1 day after vaccination with KINRIX, the subject experienced swelling injection site and injection edema (described as "edema, localized NOS"). The CMA reported these events resolved on 23 January 2013 and identified KINRIX as the suspect product. The CMA did not consider these events to be serious. The CMA also considered that the site of administration of KINRIX, right thigh, was appropriate for a 5 year old subject. The CMA documented that the vaccination series was not delayed or discontinued and that symptoms did not recur following subsequent administration. It was unknown if the subject experienced adverse events following previous vaccinations.


VAERS ID: 506134 (history)  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2013-04-19
Submitted: 2013-09-30
   Days after onset:164
Entered: 2013-10-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B213BA / - AR / UN

Administered by: Public       Purchased by: Public
Symptoms: Extensive swelling of vaccinated limb, Injection site pain, Injection site reaction, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A1022689A

Write-up: This case was reported by a healthcare professional (nurse) via a sales representative and described the occurrence of extensive swelling of vaccinated limb in a child of subject of unknown gender (kindergarten age) who was vaccinated with KINRIX (GlaxoSmithKline). On an unspecified date the subject received a dose of KINRIX (unknown route, unknown arm). At an unspecified time after vaccination with KINRIX, the subject experienced extensive swelling of vaccinated limb, welt injection site, injection site pain and injection site hot to touch. The nurse reported another case with adverse events after receiving KINRIX (A1022685A) and stated that this subject had "the exact same injection site reaction." The subject received the "kindergarten shot" of KINRIX and the subject''s "arm swelled up where they got the injection." The subject had a "large welt around the size of 3 by 5 inch wide" (76.5 by 127 millimeters). The welts were swollen and painful to the subject. The nurse also stated that the "welt was hot to touch." At the time of reporting the outcome of the events were unspecified. The nurse reported another case with KINRIX. See case A1022685A for details on the other case. The nurse stated that the subjects in both cases were unrelated and the events happened about 1 week apart. No specific dates were provided. Follow-up information was received on 04 June 2013 via healthcare professional, who is also the subject''s mother. She clarified that only one subject was involved and not two as previously reported. The subject received 0.5ml of KINRIX intramuscularly, vaccination date was not provided. The extensive swelling of vaccinated limb, welt injection site, injection site pain and injection site hot to touch started on 19 April 2013 and resolved on 25 April 2013. The subject has previously received PEDIARIX; this is the subject''s first time receiving KINRIX. The reporting healthcare professional considered the events probably related to vaccination with KINRIX. The events were not considered serious.


VAERS ID: 505967 (history)  
Age: 5.0  
Gender: Female  
Location: Maryland  
Vaccinated:2013-10-04
Onset:2013-10-04
   Days after vaccination:0
Submitted: 2013-10-07
   Days after onset:3
Entered: 2013-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BJ2109 / 0 - / IN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No known medications or previous reactions
Current Illness: No illness or known allergies to food or medications prior to administration of Flu-mist at school.
Preexisting Conditions: None reported
Diagnostic Lab Data: Lot # BJ 2109 - FluMist - Medimmune Exp 23 Dec 13 0.2ml IN
CDC Split Type:

Write-up: Parent picked up student at dismissal from school and noted bilateral upper arm raised welts/hives. Skin surrounding hives, warm to touch. Took child to clinic, however upon arrival hives disappeared. Hives reappeared later that evening and the next day 10/5/13 to other areas of the body. Benadryl given through the weekend.


VAERS ID: 505986 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2013-10-03
Onset:2013-10-04
   Days after vaccination:1
Submitted: 2013-10-07
   Days after onset:3
Entered: 2013-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH908AA / - RA / IM

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

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

Write-up: Patient is experiencing hives all over her body.


VAERS ID: 506328 (history)  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:2013-10-02
Onset:2013-10-04
   Days after vaccination:2
Submitted: 2013-10-08
   Days after onset:4
Entered: 2013-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
VARZOS: ZOSTER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration, Local swelling, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen left arm, redness, itching and hard hot area size of egg.


VAERS ID: 506513 (history)  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:2013-09-28
Onset:2013-09-28
   Days after vaccination:0
Submitted: 2013-10-08
   Days after onset:10
Entered: 2013-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Erythema, Local swelling, Pain in extremity, Rash erythematous, Rash macular, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Entire thigh became very swollen, hot, and red. Very painful. Swelling lasted approximately 72 hours, but blotchy red rash persists 9 days later.


VAERS ID: 506584 (history)  
Age: 5.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2013-09-30
Onset:2013-09-30
   Days after vaccination:0
Submitted: 2013-10-09
   Days after onset:9
Entered: 2013-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0491AE / 0 UN / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA002736

Write-up: This spontaneous report was received from a registered nurse refers to a 5 year old patient. On 30-SEP-2013, the patient was vaccinated with a first dose of an expired dose of PNEUMOVAX 23 (lot # 0491AE, expired date 15-SEP-2013). No adverse event was reported. Additional information is not expected.


VAERS ID: 506767 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2013-10-08
Onset:0000-00-00
Submitted: 2013-10-09
Entered: 2013-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / 0 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Exposure during pregnancy, Rash, Skin irritation, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: PCN - otherwise healthy.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt. came for vaccine. Was given Rotavirus. Needed IPV - mom said pt has rash on legs is irritable. She is 20 wks pregnant.


VAERS ID: 508117 (history)  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2013-10-01
Submitted: 2013-10-07
   Days after onset:6
Entered: 2013-10-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H011963 / - UN / SC

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

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: None
CDC Split Type:

Write-up: Seen in office for rash 10-4-13. Dx - Varicella. Had been sully immunized for varicella. VARIVAX vaccines 9-4-09, 11-27-12.


VAERS ID: 506939 (history)  
Age: 5.0  
Gender: Female  
Location: Maryland  
Vaccinated:2013-10-07
Onset:2013-10-10
   Days after vaccination:3
Submitted: 2013-10-11
   Days after onset:1
Entered: 2013-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH806AA / 2 RA / SYR
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H013182 / 1 LA / SYR

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Equate stool softener
Current Illness: No
Preexisting Conditions: Constipation
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever, limbs and extremities very hot to touch. IBP was given and shift of acetaminophen every 4 hours.


VAERS ID: 507157 (history)  
Age: 5.0  
Gender: Female  
Location: Virginia  
Vaccinated:2013-10-11
Onset:2013-10-12
   Days after vaccination:1
Submitted: 2013-10-13
   Days after onset:1
Entered: 2013-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. - / - - / IN

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

Life Threatening? No
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:

Write-up: Fever Chills Sneezing Running nose Headache Fever 102 Giving Motrin every 4 hours


VAERS ID: 507214 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-10-12
Onset:2013-10-13
   Days after vaccination:1
Submitted: 2013-10-14
   Days after onset:1
Entered: 2013-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4698CB / - RA / IM

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

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:

Write-up: Swollen from injection site to right above elbow hot, red and painful.


VAERS ID: 507245 (history)  
Age: 5.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2013-10-09
Onset:2013-10-09
   Days after vaccination:0
Submitted: 2013-10-09
   Days after onset:0
Entered: 2013-10-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BJ2014 / 1 - / IN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J004160 / 1 LA / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Flushing, Lip swelling, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: CP ? int asthma no problems in 1 yr+ ? of diagnosis.
Diagnostic Lab Data:
CDC Split Type: CT201305

Write-up: 5-10 min. post FLUMIST / Varicella developed agitation, hives, flushing, lip/nose swelling Sat''s stable 98-100% no resp distress required EPIPEN, BENADRYL, Prednisolone.


VAERS ID: 507290 (history)  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-01-15
Onset:2013-10-15
   Days after vaccination:273
Submitted: 2013-10-15
   Days after onset:0
Entered: 2013-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BJ2013 / - - / IN

Administered by: Private       Purchased by: Public
Symptoms: Activities of daily living impaired, Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Received FluMist Quadrivalent this AM in office. Mother called stating received a call from child''s school (child went to school) approx. 45 minutes after vaccine received. School stated child was sweating profusely and was dizzy. Mother went to school to get child and bring to office for recheck. Mother stated child was pale but got better on ride to office. Child was normal at office (maybe slightly pale).


VAERS ID: 507648 (history)  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2013-10-01
Onset:2013-10-02
   Days after vaccination:1
Submitted: 2013-10-04
   Days after onset:2
Entered: 2013-10-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BJ2012 / 0 - / IN

Administered by: Private       Purchased by: Private
Symptoms: Eye swelling, Nasal congestion, Oedema mouth, Pharyngeal oedema, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal allergic conditions (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Patient woke the morning after getting the FLUMIST (16hrs) with swollen eyes, nasal passages, mouth, throat localized mucous membranes, nose, mouth with slight wheezing remote history Reactive Airway Disease. Used BENADRYL.


VAERS ID: 508309 (history)  
Age: 5.0  
Gender: Female  
Location: Unknown  
Vaccinated:2013-08-06
Onset:2013-08-22
   Days after vaccination:16
Submitted: 2013-10-15
   Days after onset:54
Entered: 2013-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / - LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Blister, Full blood count normal, Injected limb mobility decreased, Injection site reaction, Rash, Rash maculo-papular, Red blood cell sedimentation rate normal, Streptococcus test negative
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis; Drug hypersensitivity
Preexisting Conditions: Amoxicillin, Urticaria
Diagnostic Lab Data: Complete blood count, (22-AUG-2013): Normal; Erythrocyte sedimentation, (22-AUG-2013): Normal; Antistreptolysin-O test, (22-AUG-2013): Normal
CDC Split Type: WAES1309USA012745

Write-up: This spontaneous report as received from a physician refers to a 5 year old female patient with amoxicillin (oral) allergy (body hives). No pertinent medical history was reported. On 06-AUG-2013 the patient was vaccinated with PROQUAD injection, (subcutaneous, 0.5 ml, in the left arm, dose number and lot number unknown). Other suspect therapies included IPV (Sanofi) in her left leg and DTAP (GlaxoSmithKline) in her left thigh. No concomitant medications were reported. On 22-AUG-2013 the patient sought medical attention at an unspecified emergency room for a sore left knee and a maculopapular rash with bullae down both legs. The results of Complete Blood Count (CBC), erythrocyte sedimentation rate (ESR and antistreptolysin-0 test (ASO) titer drawn on 22-AUG-2013 were normal. The patient was treated with a short course of oral steroids (manufacturer unspecified) begun on an unspecified date. Patient was treated and released from emergency room and not admitted. On 23-AUG-2013 the patient was seen at Physician''s office for a follow up visit. The physician reported that the rash had improved and the patient''s range of motion for left knee had improved. On 28-AUG-2013 the patient sought medical attention again at an unspecified emergency room for left hip pain. Patient was released from emergency room and not admitted to the hospital. No treatment was reported for left hip pain. Physician reported that left hip pain improved and rash had resolved on an unspecified date within 36 hours of emergency room visit on 28-AUG-2013. No further information was reported. The patient was reported as recovered from the events on 30-AUG-2013. Additional information has been requested.


VAERS ID: 507393 (history)  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:2013-10-08
Onset:2013-10-08
   Days after vaccination:0
Submitted: 2013-10-11
   Days after onset:3
Entered: 2013-10-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4693DA / 2 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Chills, Pneumonia, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o of abd pain, fever and chills. Pt was admitted to hospital told due to flu vaccine. Mom states at discharge told had pneumonia and given ATB, steroids and albuterol for treatment. Doing good 10/11/13 per mom.


VAERS ID: 508030 (history)  
Age: 5.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2013-10-16
Onset:2013-10-16
   Days after vaccination:0
Submitted: 2013-10-16
   Days after onset:0
Entered: 2013-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH920AC / 0 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Abdominal pain upper, Dyskinesia, Gaze palsy, Lethargy, Seizure like phenomena, Urinary incontinence
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad)

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 reported
Preexisting Conditions: None reported
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: On 10-16-13 pt was given FLUZONE at approx 9:42 am. Shortly thereafter pt complained of his stomache hurting. He began having seizure like activity including jerking movements, loss of bladder control and eyes rolling to the back of the head that lasted about 15 sec. He then was lethargic but was able to answer questions appropriately. Vitals were monitored.


VAERS ID: 507739 (history)  
Age: 5.0  
Gender: Female  
Location: Idaho  
Vaccinated:2013-10-09
Onset:2013-10-10
   Days after vaccination:1
Submitted: 2013-10-17
   Days after onset:7
Entered: 2013-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. BH2090 / - - / IN

Administered by: Public       Purchased by: Public
Symptoms: Cough, Decreased appetite, Dyspnoea, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Child woke with high fever 103.1 complained of body aches. Day of 10/10/13 cough started, nasal drainage, sore throat, fever continued. 10/11-10/14 Wheezing, cough, vomiting, continued fever between 101.0 to 103.2 No appetite, sore throat, continued wheezing, shortness of breath. Child taken to hospital 10/17/13. Was instructed side effects can last 5 - 10 days after Flumist was administered.


VAERS ID: 507756 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2013-01-17
Onset:2013-09-16
   Days after vaccination:242
Submitted: 2013-10-17
   Days after onset:31
Entered: 2013-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B187AA / - LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH721AC / - LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0643AE / - RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H014271 / - LL / UN

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

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

Write-up: Painful rash along R arm dx as herpes zoster.


VAERS ID: 508638 (history)  
Age: 5.0  
Gender: Female  
Location: Unknown  
Vaccinated:2013-08-01
Onset:2013-08-01
   Days after vaccination:0
Submitted: 2013-10-18
   Days after onset:78
Entered: 2013-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J005179 / - UN / SYR

Administered by: Other       Purchased by: Other
Symptoms: Immediate post-injection reaction, Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA007832

Write-up: This spontaneous report was received from a nurse via company representative referring to a 5 year old female patient who in August 2013, vaccinated with PROQUAD (Merck) (lot # J005179, expiration date 03-NOV-2014). In A2013 the patient experienced developed a rash around the injection site. The outcome of developed a rash around the injection site was reported as recovered/resolved. {Additional information has been requested. / Additional information is not expected.} The nurse reported that the patient developed a rash around the injection site immediately after she received PROQUAD (Merck) in August 2013, and was given BENADRYL (dosage unspecified) in office and the rash went away the same day. Additional information is not expected.


VAERS ID: 508254 (history)  
Age: 5.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2005-10-25
Onset:2005-10-25
   Days after vaccination:0
Submitted: 2013-10-20
   Days after onset:2917
Entered: 2013-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1831AB / 0 UN / UN

Administered by: Unknown       Purchased by: Private
Symptoms: Anaphylactic reaction, Dyspnoea
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: N/a
Preexisting Conditions: Common variable immune deficiency
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had anaphylactic attack where couldn''t breathe. Administered Epi-pen.


VAERS ID: 508402 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2013-10-04
Onset:2013-10-05
   Days after vaccination:1
Submitted: 2013-10-17
   Days after onset:12
Entered: 2013-10-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS JP2HP / 0 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH906AB / 0 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J006872 / 0 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Fall, Skin warm, Tonic clonic movements, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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: There is no documented history at this time.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Morning after 5 year shots including KINRIX, PROQUAD, and FLUZONE, had used the bathroom and was washing hands went fell to floor and dad found "shaking". Eyes went "wide" per dad and then sat up and tried to get up. Dad is EMT and thought it was not trembling but more tonic/clonic. Lasted about 30 sec. After was not confused or disoriented and did not lose condense (but had just used bathroom before). Noted to feel warm but no fever when dad took temp minutes after episode. Observed by dad and felt to be stable. Had not had breakfast yet but had dinner night before. Past history and head injury few month before but had had no symptoms from head injury since is occurred but did have LOC at the time. Decided to monitor at home for now. Called later and did give Motrin just in case had fever. Ate pancakes and seems fine now.


VAERS ID: 508463 (history)  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-10-15
Onset:2013-10-17
   Days after vaccination:2
Submitted: 2013-10-21
   Days after onset:4
Entered: 2013-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 63HY5 / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J14061 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H018995 / 1 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Local redness at injection set~Vaccine not specified (no brand name)~UN~0.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None completed local reaction only
CDC Split Type:

Write-up: Pt developed R upper arm swelling, redness several days following vaccine administration. Parent treated with warm compress at home. PO Childrens Ibuprofen and office eval 2-3 days following onset SX. No fever. No systemic symptoms. Pt evaluated 10/15/13 by PA. PO Benadryl advised continue Ibuprofen, ice for local reaction.


VAERS ID: 508685 (history)  
Age: 5.0  
Gender: Female  
Location: Maryland  
Vaccinated:2012-04-06
Onset:2013-09-19
   Days after vaccination:531
Submitted: 2013-10-21
   Days after onset:32
Entered: 2013-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B187AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1321AA / 1 RL / SC

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

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:

Write-up: Wide spread papules, pustules and vesicular eruption concentrated on upper trunk, ear, neck, and upper arms.


VAERS ID: 508696 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2013-10-03
Onset:2013-10-13
   Days after vaccination:10
Submitted: 2013-10-21
   Days after onset:8
Entered: 2013-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPIPV: DTP + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER 90696 / - LA / ID
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 90710 / - LL / ID

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

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: Penicillin
Diagnostic Lab Data: Was given azithromycin and triamcinolone by new physician.
CDC Split Type:

Write-up: Fever between 101-103, Vomiting, Cough, Rash on face and neck. Lasted on and off for a week.


VAERS ID: 508829 (history)  
Age: 5.0  
Gender: Female  
Location: West Virginia  
Vaccinated:2013-10-08
Onset:0000-00-00
Submitted: 2013-10-09
Entered: 2013-10-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B213AA / 3 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001012 / 0 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H012043 / 1 LA / SC

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

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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10-8-13 Pt given MMRV (R) and varicella (L) at same visit to HD. 10-11-13 spoke with mom and understands vaccination error. Child asym. Mom and child''s school teacher will observe for increased fever and febrile seizure. On 10-8-13 pt came to clinic with parents for shots. In discussion with parents what shots were needed, ask questions about child''s health etc., explained to parents child could have MMRV which was MMR and varicella together in one shot or could have MMR and varicella in separate shots. Parents seemed undecided what they wanted so I said lets do MMR and varicella separate. Mother said that was what she wanted. I told RN we would do MMR and varicella separate. She got the immun from frig. Child was given immun. I have varicella and KINRIX. RN gave another immu which was supposed to be MMR. Earlier in the day a 10--13 RN gave a MMR prior to this pt. I had already gone over MMRV and MMR with her before this child ever arrived. On 10-9-13 secretary questioned me about the lot number of immu given to pt on 10-8-13. I checked lot number which was for MMRV. I reported this to director.


VAERS ID: 508848 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2013-10-03
Onset:2013-10-03
   Days after vaccination:0
Submitted: 2013-10-22
   Days after onset:19
Entered: 2013-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH899AB / - RA / UN

Administered by: Unknown       Purchased by: Other
Symptoms: Erythema, Fluid retention, Local swelling, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
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:

Write-up: Increased swelling and fluid retention, around the area of the upper arm, then spread down the arm, down the back and chest, turning bright red and hot. Caused fever and walking with right side lower than left. Arm and right side looked at least three to four times the size of the left arm and back.


VAERS ID: 508868 (history)  
Age: 5.0  
Gender: Female  
Location: Ohio  
Vaccinated:2013-10-01
Onset:2013-10-14
   Days after vaccination:13
Submitted: 2013-10-22
   Days after onset:8
Entered: 2013-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J004175 / - - / -

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: METROHEALTHESP20124683

Write-up: Convulsions NEC on 2013-10-14, clinician comment: unclear if this patient had a seizure or a syncope.


VAERS ID: 508960 (history)  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:2013-10-10
Onset:2013-10-10
   Days after vaccination:0
Submitted: 2013-10-22
   Days after onset:12
Entered: 2013-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH890AA / - RA / IM

Administered by: Military       Purchased by: Other
Symptoms: Hypersensitivity, Neck pain, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT RECEIVED VACCINE AND WAITED IN THE CLINIC WAITING ROOM FOR 15 MINUTES. AFTER LEAVING THE CLINIC THE PARENT OF THE CHILD RETURNED STATING HE THINKS HIS CHILD IS HAVING AN ALLERGIC REACTION DUE TO THE CHILD COMPLAING OF HIS NECK HURTING AND HE COULDNT PUT ON HIS SEALBELT. THE FATHER ALSO STATED HE EXPERIENCED SOME VOMITING IN THE CAR AND HE WAS VERY PALE.


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