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Case Details (Sorted by Age)

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VAERS ID:446119 (history)  Vaccinated:2011-11-17
Age:15.0  Onset:2011-11-17, Days after vaccination: 0
Gender:Female  Submitted:2011-12-20, Days after onset: 33
Location:Unknown  Entered:2011-12-22, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No pertinent medical history, drug reactions or allergies. The patient was vaccinated with a first dose of GARDASIL, Merck (lot number not reported) on 19 January 2010 and on 08 April 2010 was vaccinated with a second dose of GARDASIL, Merck (lot number not reported). There were no concomitant medications.
Diagnostic Lab Data:
CDC Split Type: 201112323
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4476AD2IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1317AA2IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blood test normal, Chest X-ray normal, Chest pain, Dizziness, Drug screen negative, Electrocardiogram normal, Fatigue, Haematology test normal, Hyperhidrosis, Metabolic function test, Metabolic function test normal, Syncope, Tremor, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Initial report was received on 15 December 2011 from another manufacturer (manufacturer control number WAES 1111USA02846). The following is verbatim from the report: "Information has been received from a physician concerning a 15 year old female patient with no pertinent medical history, drug reactions or allergies who on 19-JAN-2010, was vaccinated with a first dose of GARDASIL (lot number not reported), on 08-APR-2010 was vaccinated with a second dose of GARDASIL (lot number not reported) and on 17-NOV-2011 was vaccinated intramuscularly with a 0.5 ml third dose of GARDASIL (669795/1317AA, expiration date 13-OCT-2013). There was no concomitant medication. The physician reported that on 17-NOV-2011 the patient felt well after receiving the third dose until late in the evening 8 hours after vaccine administration the patient experienced syncope, dizziness, weakness, shakiness and chest pain. The patient was seen in the office the following day (on 18-NOV-2011) her blood pressure was 138/80 and she was sweaty. The patient was sent to the emergency room where work up (blood tests, chest X-ray, electrocardiogram (EKG) was performed and all results were normal. A urine drug screen was also performed (results not provided). The patient continued to feel tired dizzy and had a noticeable tremor of the right hand (BP 120/80). The physician inquired about recommendations regarding treatment for syncope, dizziness, weakness, shakiness and chest pain related to the third dose of GARDASIL given to the patient. At the time of the report the patient''s events persisted. No treatment was given for the events. A neurology consult was being requested. Follow up information has been received from the physician who reported that the patient was seen by a neurologist last week who felt that tremor might be related to the vaccine. The physician also reported that the patient was "back to normal"; the tremor resolved last Wednesday (23-NOV-2011), within 6 days of onset. Information was received from a physician and medical records concerning a 15 year old female (64.25 inches, 140 pounds) with no pertinent medical history, drug reactions or allergies who on 19-JAN-2010 was vaccinated with a first dose of GARDASIL (lot number not reported), on 08-APR-2010 was vaccinated with a second dose of GARDASIL (lot number not reported) and on 17-NOV-2011 was vaccinated intramuscularly with a 0.5 ml third dose of GARDASIL (669795/1317AA, expiration date 13-OCT-2013) into the left deltoid. Concomitant medication received on 17-NOV-2011 was a third dose of influenza vaccination (Sanofi-Pasteur) (Lot #U4476AD) intramuscularly into the left deltoid. On 17-NOV-2011, approximately eight and one half hours after receiving the vaccinations, the patient experienced dizzy, weak, tremor of upper extremity, and chest pain. On 18-NOV-2011, a chest x-ray, urinalysis, urine drug screen, comprehensive metabolic panel, and hematology profiles were all normal. The physician reported that the patient was recovered on 23-NOV-2011. Syncope, dizziness, shakiness, weakness, tired, sweaty, and chest pain were considered to be disabling by the physician. All available medical records will be provided upon request. Additional information has been requested." Note: the influenza vaccine, lot number U4476AD (invalid lot number), was reported by the other manufacturer as a sanofi pasteur product.

VAERS ID:446237 (history)  Vaccinated:2011-12-21
Age:15.0  Onset:2011-12-22, Days after vaccination: 1
Gender:Male  Submitted:2011-12-23, Days after onset: 1
Location:New York  Entered:2011-12-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4249AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain, Dizziness, Dyskinesia, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Patient developed jerky movement on 12/22/2011 after vaccination. He also c/o dizziness, nausea and mild abdominal pain.

VAERS ID:446470 (history)  Vaccinated:2011-12-29
Age:15.0  Onset:2011-12-29, Days after vaccination: 0
Gender:Male  Submitted:2011-12-29, Days after onset: 0
Location:California  Entered:2011-12-29
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: PERFORATION TYMPANIC MEMBRANE PERSONAL CONDITION OF SIGHT PROBLEM HEARING LOSS
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0840AA2IMLA
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainting for aprox. 30 sec. Treatment: lay teen down for 15 minutes and gave Apple juice.

VAERS ID:446533 (history)  Vaccinated:2011-12-30
Age:15.0  Onset:2011-12-30, Days after vaccination: 0
Gender:Male  Submitted:2011-12-30, Days after onset: 0
Location:Oklahoma  Entered:2011-12-30
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: None
Diagnostic Lab Data: Blood Pressure was taken and pulse ox. Both within normal limits.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YL2069 IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0804AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4032AA1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Cold sweat, Gaze palsy, Hyperhidrosis, Mydriasis, Pallor, Seizure like phenomena
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient turned pale, clammy and sweaty, Eyes rolled back in head and started drawing hands up to chest, Seizure like activity. Pupils were dilated.

VAERS ID:446740 (history)  Vaccinated:2011-10-11
Age:15.0  Onset:2011-10-11, Days after vaccination: 0
Gender:Female  Submitted:2011-11-23, Days after onset: 43
Location:Unknown  Entered:2011-12-30, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHEH2011US06968
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSX10125 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect drug dosage form administered
SMQs:
Write-up: Case number PHEH2011US06968 is an initial spontaneous report received from a nurse on 13 Oct 2011. This case refers to a 15-year-old female patient. She was vaccinated with MENVEO (batch number: X10125) intramuscularly on 11 Oct 2011. The pharmacist stated that this patient received only MenCWY-135 liquid conjugate vaccine component of MENVEO; she did not receive the MenA lyophilized conjugate vaccine component of MENVEO. No adverse event was reported at the time of this report.

VAERS ID:446742 (history)  Vaccinated:2011-10-03
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-23
Location:Unknown  Entered:2011-12-30, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHEH2011US06971
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect drug dosage form administered
SMQs:
Write-up: Case number PHEH2011US06971 is an initial spontaneous report received from a health care professional on 10 Oct 2011: This report refers to a female child. She was given only the CYW-135 liquid component MENVEO (batch number: unknown) intramuscularly on 03 Oct 2011. No other adverse event was reported.

VAERS ID:446749 (history)  Vaccinated:2011-07-18
Age:15.0  Onset:2011-07-18, Days after vaccination: 0
Gender:Male  Submitted:2011-11-23, Days after onset: 128
Location:Unknown  Entered:2011-12-30, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHEH2011US02399
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS090901 IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS  IMUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect drug dosage form administered
SMQs:
Write-up: Case number PHEH2011US02399 is an initial spontaneous report received from a nurse on 22 Aug 2011. This report refers to a male child. He was given only the CYW-135 liquid component MENVEO (batch number: 090901) intramuscularly on 18 Jul 2011. On the same day he was also vaccinated with BOOSTRIX (manufacturer and batch number: unknown) intramuscularly and varicella vaccine (manufacturer and batch number: unknown) subcutaneously. No other adverse reaction was reported.

VAERS ID:446710 (history)  Vaccinated:2011-12-20
Age:15.0  Onset:2011-12-20, Days after vaccination: 0
Gender:Female  Submitted:2012-01-04, Days after onset: 15
Location:Indiana  Entered:2012-01-04
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0718Z1SCUN
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site swelling, Oedema peripheral, Skin warm, Staphylococcal infection
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Received immunization on 12/20/11. States arm became red, warm and swollen that evening. The next day site became more painful, and swelling and redness increased. Went to the doctor the next day and was dx with secondary staph infection. Was given antibiotic IM and orally for 10 days.

VAERS ID:447059 (history)  Vaccinated:2011-08-30
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-01-09
Location:New York  Entered:2012-01-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seasonal allergies; Asthma
Diagnostic Lab Data: None warranted
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0992Z0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0996Z1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site atrophy
SMQs:
Write-up: Loss of subcutaneous tissue at site of injection, 1 inch in diameter of (L) arm.

VAERS ID:447079 (history)  Vaccinated:2012-01-06
Age:15.0  Onset:2012-01-08, Days after vaccination: 2
Gender:Female  Submitted:2012-01-09, Days after onset: 1
Location:California  Entered:2012-01-09
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: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0816AA1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling and itchiness.

VAERS ID:447102 (history)  Vaccinated:2012-01-06
Age:15.0  Onset:2012-01-06, Days after vaccination: 0
Gender:Female  Submitted:2012-01-10, Days after onset: 4
Location:Ohio  Entered:2012-01-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: C/o constipation
Preexisting Conditions: none
Diagnostic Lab Data: Abnormal EEG. Follow up neuro. and EEG to be done in 2 weeks.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0692AA2IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Convulsion, Electroencephalogram abnormal, Immediate post-injection reaction
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Right after injection. Child has seizure. Sent to the emergency room.

VAERS ID:447115 (history)  Vaccinated:2011-10-04
Age:15.0  Onset:2011-10-04, Days after vaccination: 0
Gender:Female  Submitted:2012-01-05, Days after onset: 93
Location:Ohio  Entered:2012-01-10, Days after submission: 5
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: The patient has no reported past medical history, is taking no concomitant medications and illness at the time of vaccination was denied. The patient had a TD nine years ago.
Diagnostic Lab Data: The patient had blood tests including "WBC and connective tissue" results not reported.
CDC Split Type: 201110871
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DECAVAC)SANOFI PASTEURU3421DA SYRLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Blood test, Facial pain, Fatigue, Feeling abnormal, Gait disturbance, Laboratory test, Lymphadenopathy, Mononucleosis heterophile test negative, Myalgia, Pain in extremity, Pallor, Pyrexia, Streptococcus test negative, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Initial report was received on 08 November 2011 from a health care professional with additional information received on 11 November 2011 from a consumer who is also the patient''s parent. A 15 year-old female patient with no reported past medical history had received on 04 October 2011 a left deltoid injection of DECAVAC, lot number U3421DA (route of administration not reported) and an unspecified amount of time later the day of vaccination, experienced leg pain, swollen lymph glands, left thigh muscle pain, paleness, fatigue, felt feverish (temperature was not taken or documented) and a feeling that the left side of the face was bruised with no overt sign. The patient was evaluated by a physician. Diagnostic tests included a negative strep test and a negative mono test. No treatments were prescribed. It was reported some signs and symptoms were resolving. No further information was available at the time of the report. The patient''s outcome was not recovered. Follow-up information was received on 30 December 2011 from a consumer who is also the patient''s parent who reported that the patient can not walk for long. Based upon this new information received, it was determined this case now meets seriousness criteria and it has been upgraded from non-serious to serious. According to the parent, the patient has been experiencing leg and muscle pain since October. The patient is an organist and has a difficult time with the pedals. The parent states that all other symptoms have resolved except the leg and muscle pain. The patient has been treated with acupuncture and has seen a chiropractor. The patient had not been on any medications but the patient underwent some "blood tests" including WBC and connective tissue (results were not reported). The patient has a referral to see a physiatrist. According to the patient''s mother, the patient was not hospitalized. No further information was available at the time of the event. The patient''s outcome was not recovered. Documents held by sender: none.

VAERS ID:447218 (history)  Vaccinated:2011-12-14
Age:15.0  Onset:2011-12-26, Days after vaccination: 12
Gender:Male  Submitted:2012-01-11, Days after onset: 16
Location:New Jersey  Entered:2012-01-11
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: Environmental allergies. Acne. RAD when young. Pneumonia x2. Multiple concussions.
Diagnostic Lab Data: We do not have hospital privileges at facility, so I do not have access to test results.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1359AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Headache, Influenza like illness, Laboratory test, Myalgia, Oropharyngeal pain, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: Flu-like symptoms for 2 weeks. Initially fever to 102. Persistent vomiting. Also had sore throat, headache, muscle aches, and diarrhea. Repeated evaluations have not revealed etiology. Was admitted to Medical Center 1/6/12.

VAERS ID:447315 (history)  Vaccinated:2012-01-11
Age:15.0  Onset:2012-01-11, Days after vaccination: 0
Gender:Female  Submitted:2012-01-13, Days after onset: 2
Location:New York  Entered:2012-01-13
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4055BA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: SWELLING AND PAIN LEFT DELTOID.

VAERS ID:447414 (history)  Vaccinated:2012-01-02
Age:15.0  Onset:2012-01-02, Days after vaccination: 0
Gender:Male  Submitted:2012-01-13, Days after onset: 11
Location:California  Entered:2012-01-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1201USA00865
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Loss of consciousness, Seizure like phenomena
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a physician concerning a 15 year old male who was vaccinated with his third dose of GARDASIL (Lot number not reported) on approximately on 02-JAN-2012. Subsequently, the patient experienced what appeared to be seizure-like activity. The physician stated that the patient lost consciousness and his body tensed; he might have "stopped breathing momentarily." The physician reported that he managed the patient accordingly, (intervention and monitored) and that the patient regained consciousness. Upon internal review seizure like activity was determined to be an other important medical event. This is one of the several reports received from the same source. Additional information has been requested.

VAERS ID:447435 (history)  Vaccinated:2012-01-06
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-01-11
Location:Texas  Entered:2012-01-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADHD; sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM100581IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Erythema, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swelling, severe itching, pain, cellulitis. BENADRYL 50 mg Q 6hrs.

VAERS ID:447558 (history)  Vaccinated:2011-06-10
Age:15.0  Onset:2011-06-10, Days after vaccination: 0
Gender:Female  Submitted:2011-06-10, Days after onset: 0
Location:Michigan  Entered:2012-01-18, Days after submission: 222
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB469AA1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0786Z2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainting within 5 minutes of receiving shots.

VAERS ID:447772 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2011-12-23
Gender:Female  Submitted:2012-01-20, Days after onset: 28
Location:Unknown  Entered:2012-01-23, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy NOS (LMP = Unknown)
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1111USA03703
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abortion, Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: Information has been received from a Nurse for the pregnancy registry for GARDASIL, concerning an approximately 15 year old female patient who on unspecified day was vaccinated with the third dose of GARDASIL (Lot #, dose and route not reported). The nurse reported that after the patient received the vaccine, she immediately reported to the nurse that she may be pregnant. The nurse stated that they were awaiting confirmation of the pregnancy. At the time of the report the outcome of the patient was unknown. Follow-up information has been received from a nurse reporting that the patient had an abortion on 23-DEC-2011. Upon internal review, abortion was considered to be an other important medical event. Additional information has been requested.

VAERS ID:448017 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2011-12-20
Location:New York  Entered:2012-01-23, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Concomitant medications were unknown. No relevant medical history. The subject''s mother was Hepatitis B antigen positive.
Diagnostic Lab Data: Hepatitis B antibody, negative; Hepatitis B antigen, negative
CDC Split Type: A0890089A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 2UNUN
Administered by: Private     Purchased by: Private
Symptoms: Hepatitis B antibody negative, Hepatitis B antigen, No therapeutic response
SMQs:, Lack of efficacy/effect (narrow)
Write-up: This case was reported by a physician and described the occurrence of not responding to therapy in a 15-year-old male subject who was vaccinated with ENGERIX B (GlaxoSmithKline), Hep B. On an unspecified date the subject received 3rd dose of ENGERIX B (.5 ml, unknown), 2nd dose of Hep B (unknown). On an unspecified date after vaccination series completion with ENGERIX B and Hep B, the subject experienced not responding to therapy. The physician reported the subject tested negative for hepatitis B antigen and antibody on a recent test. The subject completed the vaccination series "years ago", but the mother was antigen positive. Relevant test results included Hepatitis B antigen and antibody negative. The healthcare professional reported another case regarding ENGERIX B, see case A0890090A. Follow-up information was received on 16 November 2010 via physician who refused to be contacted. At the time of the report no other information was provided.

VAERS ID:448073 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Unknown  Submitted:2011-12-20
Location:Pennsylvania  Entered:2012-01-23, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0941289A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Hepatitis B antibody negative, Therapeutic response decreased
SMQs:, Lack of efficacy/effect (narrow)
Write-up: This case was reported by a physician via a sales representative and described the occurrence of decreased therapeutic response in a 15-year-old subject of unspecified gender who was vaccinated with ENGERIX B (GlaxoSmithKline). On unspecified dates the subject received 3rd dose, 2nd dose and 1st dose of ENGERIX B (infant series). At the age of 15, the subject was tested for antibodies to hepatitis B and the subject did not have detectable levels. This was considered to be decreased therapeutic response. The physician reported to the sales representative that this event occurred in about 15 to 20 percent of 15 year olds checked for hepatitis B antibodies.

VAERS ID:448078 (history)  Vaccinated:2011-08-23
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2011-12-20
Location:Texas  Entered:2012-01-23, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic Rhinitis; Sinusitis
Preexisting Conditions: There were no concomitant vaccinations or medications. The subject had not experienced adverse events following previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0944125A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB803BA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site irritation, Injection site pruritus, Injection site pustule, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of injection site blisters in a 25-year-old female subject who was vaccinated with ENGERIX B (GlaxoSmithKline). Concurrent medical conditions included allergic rhinitis and sinusitis. On 23 August 2011 the subject received 1st dose of ENGERIX B (1 ml, unknown route, right arm). On either 23 or 24 August 2011, within 24 hours after vaccination with ENGERIX B, the subject experienced injection site blisters, injection site pruritus and injection site irritation. The subject had a raised blister with pus at the injection site, which was the size of a pencil eraser. The healthcare professional reported that it itched and caused some irritation. At the time of reporting the events were improved.

VAERS ID:447968 (history)  Vaccinated:2011-12-14
Age:15.0  Onset:2012-01-01, Days after vaccination: 18
Gender:Female  Submitted:2012-01-25, Days after onset: 24
Location:Nebraska  Entered:2012-01-25
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: Allergic to BACTRIM; MRSA positive
Diagnostic Lab Data: TSH; Free T4; CBC; ESR; ANA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1397AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Antinuclear antibody, Blood thyroid stimulating hormone, Full blood count, Pain in extremity, Red blood cell sedimentation rate, Sensory disturbance, Swelling, Thyroxine free
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) arm & hand pain - "tearing" or "tightness" sensation - evaluated on 1-3-12 -$g swelling also. Received HPV #3 on 12-14-11 in left deltoid region. Symptoms started a few days prior to being seen in the office on 1-3-12.

VAERS ID:447983 (history)  Vaccinated:2012-01-16
Age:15.0  Onset:2012-01-17, Days after vaccination: 1
Gender:Female  Submitted:2012-01-18, Days after onset: 1
Location:Florida  Entered:2012-01-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Bicuspid aortic valve
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA13BB2IMRA
Administered by: Private     Purchased by: Private
Symptoms: Local swelling, Pain, Skin warm
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Area swollen, hot to touch very painful.

VAERS ID:448284 (history)  Vaccinated:2012-01-27
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2012-01-27
Location:New York  Entered:2012-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NYC1200004
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.152488 UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood glucose normal, Hypotension, Seizure like phenomena
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow)
Write-up: Patient had a seizure like event for 20 seconds with low blood pressure as well, normal glucose levels.

VAERS ID:448344 (history)  Vaccinated:2011-07-01
Age:15.0  Onset:2011-07-23, Days after vaccination: 22
Gender:Female  Submitted:2012-01-30, Days after onset: 191
Location:Pennsylvania  Entered:2012-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: She is suffering severe abdominal pain, to the point she is missing school. We have had 2 rounds of blood tests, ultrasound, xray and a gastroenterology appointments. This started after receiving the 2nd Gardasil shot and has continued to get worse with no reprieve. I know I am not the only mom that once had a healthy athletic teenage daughter who now can''t even function normally or without pain.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1SCLA
Administered by: Unknown     Purchased by: Other
Symptoms: Abdominal pain upper, Activities of daily living impaired, Aphagia, Blood test normal, Ultrasound scan normal, Weight decreased, X-ray normal
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe stomach pain, any other illness has been ruled out, all her blood tests have come back normal again, and xrays as well as ultrasound showed nothing. She has gone from a healthy teenage girl to missing school, coming home from school because of her pains. She has lost weight is unable to eat at times because the pain is so bad.

VAERS ID:448430 (history)  Vaccinated:2012-01-23
Age:15.0  Onset:2012-01-23, Days after vaccination: 0
Gender:Female  Submitted:2012-01-26, Days after onset: 3
Location:Florida  Entered:2012-01-31, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness; menorrhagia
Preexisting Conditions: Allergic MACROBID/Sulfa; Hx Depression
Diagnostic Lab Data: Patient was admitted to Hosp 1/24/12 and stayed overnight. Evaluated by neurology. No notes available.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0963AA2IMRA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Muscle twitching
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)
Write-up: 1-23-12 received 3rd GARDASIL in (R) deltoid. Around 5pm (same day) started with a slight twitch to (R) arm and then started jerking and she felt dizzy. Was seen at ER given 125mg steroid Methylprednisolone and 50mg IV Diphenhydramine and it stopped but started again early next day.

VAERS ID:448431 (history)  Vaccinated:2012-01-25
Age:15.0  Onset:2012-01-25, Days after vaccination: 0
Gender:Male  Submitted:2012-01-26, Days after onset: 1
Location:Ohio  Entered:2012-01-31, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA - Mother stated same s/s after 1st inj on 12-27-11 but did not report till this visit. Pt did receive DEPO PROVERA 150mg IM on 12-27-11 with 1st GARDASIL. Mother did request #2 be given.
Diagnostic Lab Data: MD visit on 1-26-12 felt it was flu or virus
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0692AA1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Feeling of body temperature change, Headache, Nausea, Vertigo, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: Immediately after leaving facility, pt got HA, later nausea & vertigo, vomiting. Hot & cold spells. Mother took daughter to MD - MD felt she picked up virus. Tx anti nausea. MD felt it was OK to receive last vaccine.

VAERS ID:448479 (history)  Vaccinated:2009-07-19
Age:15.0  Onset:2010-01-09, Days after vaccination: 174
Gender:Female  Submitted:2012-01-31, Days after onset: 752
Location:Florida  Entered:2012-01-31
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Nausea, right arm goes numb, loss of appetite, sleeps a lot, menstrual cycle changed, fainting, night sweats, problems with vision, problems with heart issues, cyst on one ovary and it burst and had to have surgery to have it removed, pain in her abdomen, pain in chest, shortness of breath, muscle pain, weakness in muscles, seems to get angry easier and faster.
Preexisting Conditions: none
Diagnostic Lab Data: She continues to have weakness, and other symptom that concern me.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Public
Symptoms: Abdominal pain, Anger, Asthenia, Cardiac disorder, Chest pain, Cyst rupture, Decreased appetite, Dyspnoea, Hypersomnia, Menstrual disorder, Muscular weakness, Myalgia, Nausea, Night sweats, Ovarian cyst ruptured, Surgery, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: We were at church and she had severe abdominal pains that sent us to the ER. She had a cyst that burst and had to have emergency surgery.

VAERS ID:449049 (history)  Vaccinated:2012-01-31
Age:15.0  Onset:2012-01-31, Days after vaccination: 0
Gender:Female  Submitted:2012-02-07, Days after onset: 7
Location:Texas  Entered:2012-02-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: asthma, galactorrhea, allergic rhinitis
Preexisting Conditions: asthma, allergy to Benadryl
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1261AA1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Chemical burns of eye, Dizziness, Eye swelling, Vaccination complication, Vision blurred, Visual impairment
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Blurred vision, dizziness. vision problems continued through night. Patient awoke the morning of 2-1-12 with eyes swollen shut. Mother took patient to ophthalmologist. Mother stated she was told by ophthalmologist, "it looks like she had a chemical burn on her cornea''s and that it may be an adverse reaction to the HPV vaccine". I have attempted to contact that ophthalmologist to obtain his records for diagnosis but have not been successful.

VAERS ID:449065 (history)  Vaccinated:2009-10-19
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-02-07
Location:Texas  Entered:2012-02-07
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500677P IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0672Y2IMUN
Administered by: Private     Purchased by: Private
Symptoms: Neurological symptom, Neuropathy peripheral
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)
Write-up: Reports of undiagnosed neurological neuropathy problems (per parent / patient).

VAERS ID:449098 (history)  Vaccinated:2012-02-07
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-02-08
Location:Iowa  Entered:2012-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB532AA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1524AA2IMRA
Administered by: Private     Purchased by: Private
Symptoms: Incorrect dose administered
SMQs:
Write-up: Pt received HepA #2 - adult dose instead of pediatric dose.

VAERS ID:449124 (history)  Vaccinated:2012-01-23
Age:15.0  Onset:2012-01-23, Days after vaccination: 0
Gender:Female  Submitted:2012-02-08, Days after onset: 16
Location:Wisconsin  Entered:2012-02-08
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: Azithromycin; Seasonal allergies; Prior urticaria
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1524AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema multiforme, Urticaria
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Shortly after receiving 1st HPV vaccine dose 1/23/12, developed diffuse hive-like rash, worsening despite antihist. Seen by allergist 1/26. Rash described as target like with features of erythema multiforme, requiring steroids.

VAERS ID:449151 (history)  Vaccinated:2012-02-03
Age:15.0  Onset:2012-02-03, Days after vaccination: 0
Gender:Female  Submitted:2012-02-03, Days after onset: 0
Location:New York  Entered:2012-02-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0477AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncope episode after administration of vaccine.

VAERS ID:449202 (history)  Vaccinated:2012-02-08
Age:15.0  Onset:2012-02-08, Days after vaccination: 0
Gender:Female  Submitted:2012-02-08, Days after onset: 0
Location:North Carolina  Entered:2012-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0040AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1311AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood pressure decreased, Pallor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Five minutes after receiving these 2 immunizations patient vomited, had decreased BP from 134/82 to 99/57, became pale. Symptoms resolved within one hour and patient discharged home with father.

VAERS ID:449309 (history)  Vaccinated:2012-02-03
Age:15.0  Onset:2012-02-04, Days after vaccination: 1
Gender:Male  Submitted:2012-02-06, Days after onset: 2
Location:Ohio  Entered:2012-02-10, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AB0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0692AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4008AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0768AA1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site vesicles, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 2/4/12. 8:30 am Red blistery area noted next to (R) deltoid upper injection site - c/o itching 2:30 pm. Rash noted from injection site across chest toward neck area 2/5/12- Rash darker red, itching continues 2/6/12 - rash remains with itching - 8:30 am - BENADRYL given 10:30 am - Rash fading, itching subsiding.

VAERS ID:449351 (history)  Vaccinated:2012-02-09
Age:15.0  Onset:2012-02-09, Days after vaccination: 0
Gender:Male  Submitted:2012-02-10, Days after onset: 1
Location:Mississippi  Entered:2012-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: on 02/02/2012 diagnosed with sinus infection
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 2  
Administered by: Public     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives in legs, hands chest, back,arms and privates.

VAERS ID:449355 (history)  Vaccinated:2011-12-22
Age:15.0  Onset:2011-12-27, Days after vaccination: 5
Gender:Female  Submitted:2012-02-10, Days after onset: 45
Location:California  Entered:2012-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NONE
Diagnostic Lab Data: WORK UP SO FAR NEGATIVE EXCEPT FOR ANEMIA AND A RIGHT OVARIAN CYST THAT HAS RESOLVED. APPT WITH GYN AND NEURO STILL PENDING.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0692AA2IMRA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Anaemia, Asthenia, Decreased appetite, Dizziness, Headache, Laboratory test abnormal, Nausea, Ovarian cyst, Pelvic pain, Tremor
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: WEAKNESS, ABDOMINAL/PELVIC PAIN, LOSS OF APPETITE, ANEMIA AT FIRST, THEN LATER HAD NAUSEA, WORSENING OF WEAKNESS, HEADACHE, DIZZINESS, THEN SHAKING EVENTS (GETTING WORKUP FOR POSSIBLE SEIZURES).

VAERS ID:449637 (history)  Vaccinated:2012-02-13
Age:15.0  Onset:2012-02-13, Days after vaccination: 0
Gender:Female  Submitted:2012-02-15, Days after onset: 2
Location:Kansas  Entered:2012-02-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG11451 SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1023AA SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4104BA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0831AA SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling and redness to left upper arm.

VAERS ID:449658 (history)  Vaccinated:2012-02-13
Age:15.0  Onset:2012-02-13, Days after vaccination: 0
Gender:Female  Submitted:2012-02-15, Days after onset: 2
Location:California  Entered:2012-02-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Chronic sinusitis
Preexisting Conditions: allergic rhinitis chronic sinusitis
Diagnostic Lab Data: Pneumococcal serology prior to vaccine- most were 0.2-0.8 ug/ml 2 serotypes were 1.2 1 serotype was 2.23
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Activities of daily living impaired, Chills, Headache, Hypersensitivity, Oedema peripheral, Pain in extremity, Pyrexia, Streptococcus test negative, Vaccination complication
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt c/o fever and chills. Was given Advil. Next AM woke up with HA, arm was sore and swollen "she couldnt even put a shirt on." Was given Aleve twice that day. 8pm, took pt to urgent care and was told that was allergic reaction to vaccine. Strep test was negative.

VAERS ID:449831 (history)  Vaccinated:2011-11-15
Age:15.0  Onset:2011-12-30, Days after vaccination: 45
Gender:Female  Submitted:2012-02-13, Days after onset: 45
Location:Texas  Entered:2012-02-20, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? Yes
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0692AA0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:449868 (history)  Vaccinated:2012-02-16
Age:15.0  Onset:2012-02-17, Days after vaccination: 1
Gender:Female  Submitted:2012-02-20, Days after onset: 3
Location:Washington  Entered:2012-02-20
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4022AA0SYRLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis
SMQs:
Write-up: Cellulitis at shot site.

VAERS ID:450115 (history)  Vaccinated:2012-02-21
Age:15.0  Onset:2012-02-21, Days after vaccination: 0
Gender:Male  Submitted:2012-02-23, Days after onset: 2
Location:West Virginia  Entered:2012-02-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Allergies to Milk and Dairy.
Diagnostic Lab Data: Taking to Doctor, 2/23/2012
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Fatigue, Headache, Night sweats, Oropharyngeal pain
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)
Write-up: Dizziness, Headache, Sore Throat, Night Sweats, Fatigue.

VAERS ID:450143 (history)  Vaccinated:2012-02-13
Age:15.0  Onset:2012-02-13, Days after vaccination: 0
Gender:Female  Submitted:2012-02-16, Days after onset: 3
Location:Arizona  Entered:2012-02-23, Days after submission: 7
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA113AA2UNLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal discomfort, Headache, Influenza like illness, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 02-13-12, approx. 10 hrs after HPV injection, client c/o nausea, abd. discomfort. Sl. fever & headache. Mom took child to urgent care on 02-14-12 (evening) she was told to take child to DCP the following morning. 02-15-12 mom states child is no better and now has "flu like symptoms". Advised to take child to PCP.

VAERS ID:450186 (history)  Vaccinated:2012-02-20
Age:15.0  Onset:2012-02-21, Days after vaccination: 1
Gender:Female  Submitted:2012-02-23, Days after onset: 2
Location:Washington  Entered:2012-02-23
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1570Z0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0334AA1SCUN
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 60 mm red area to injection site from 3 days ago. Area is warm to touch.

VAERS ID:450665 (history)  Vaccinated:2011-09-02
Age:15.0  Onset:2011-09-02, Days after vaccination: 0
Gender:Female  Submitted:2011-09-08, Days after onset: 6
Location:Oregon  Entered:2012-02-23, Days after submission: 168
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: MEDI0013539
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Feeling abnormal
SMQs:, Dementia (broad)
Write-up: A non-serious spontaneous report of felt kind of crummy has been received from a non health professional concerning a 15-year-old female, subsequent to FLUMIST. Neither medical history nor concomitant medications were reported. The patient received FLUMIST on 02-Sep-2011. On 02-Sep-2011, the patient felt kind of crummy. The outcome of the event was not resolved.

VAERS ID:450667 (history)  Vaccinated:2011-08-19
Age:15.0  Onset:2011-08-22, Days after vaccination: 3
Gender:Female  Submitted:2011-08-25, Days after onset: 3
Location:Texas  Entered:2012-02-23, Days after submission: 182
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: MEDI0013499
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501086P IN 
Administered by: Other     Purchased by: Other
Symptoms: Bronchiolitis, Dyspnoea, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: A non-serious spontaneous report of acute bronchitis has been received from a health professional concerning a 15-year-old female, subsequent to FLUMIST. Neither relevant medical history nor concomitant medications have been reported for this patient. The patient received FLUMIST on 19-Aug-2011. On 22-Aug-2011, the patient experienced labored breathing, wheezing and fever of 102 degrees F, subsequently she was diagnosed with acute bronchitis. The patient saw the physician on 24-Aug-2011 and was administered a breathing treatment with albuterol. The outcome of the event was unknown.

VAERS ID:450414 (history)  Vaccinated:2011-12-22
Age:15.0  Onset:2011-12-27, Days after vaccination: 5
Gender:Male  Submitted:2012-02-24, Days after onset: 59
Location:Pennsylvania  Entered:2012-02-27, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mycotic allergy; Pollen allergy; Smoke sensitivity; Asthma; Seasonal allergy
Preexisting Conditions:
Diagnostic Lab Data: diagnostic pathological, 01/06/12, site: skin right anterior lateral thigh-see below
CDC Split Type: WAES1201USA02656
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1490AA1IMRA
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis psoriasiform, Diagnostic procedure, Hyperkeratosis, Hyperplasia, Lymphocytic infiltration, Parapsoriasis, Pruritus, Rash erythematous, Rash generalised, Rash macular, Scab, Skin exfoliation, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Skin premalignant disorders (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 15 year old male patient who on 21-OCT-2011, was vaccinated with the first dose of GARDASIL (dose, route and lot number not reported). On 22-DEC-2011, the patient was intramuscularly vaccinated with the second 0.5 ml dose of GARDASIL, (lot number: 668262/0841AA). On 25-DEC-2011, the patient developed "pityriasis lichenoides". Lab diagnostic studies included punch biopsy on 06-JAN-2012. Treatment given for AE included steroid cream (manufacturer unknown). At the time of the report the patient''s status was unknown. Follow up information has been received from the responsible physician and medical records regarding a 15 year old male (height: 70.25 inches, weight: 182 pounds) with mild intermittent asthma, seasonal allergic reaction-pollen and allergies to smoke, mold extracts (molds and smuts) and pollen extracts, who on 22-DEC-2011 was vaccinated with the second dose of GARDASIL, (lot number: 1300AA/1490AA) [previously reported as 668262/0841AA] intramuscularly in his right deltoid. The responsible physician reported that there was no illness at the time of the vaccination. Medical records indicated that on 06-JAN-2012 at 16:00, the patient was seen by the responsible physician with an all over rash. The patient reported that "around Christmas", he noticed red spots on his right upper leg which had spread to his lower abdomen, back, axilla and arms. The patient reported that over the last few days scaling and scabs had occurred. The physician reported that the patient did receive a second dose of GARDASIL a few days prior to the rash starting. The patient also did have new laundry detergent late November 2011 (was using about a month prior to rash starting) but patient changed back and rewashed all clothes "without a problem". The physician reported the patient''s skin was warm and the noted rashes were 2-15 millimeter mild erythematous macular scaled lesions on the trunk and extremities. The physician''s assessment was abnormality of the skin. The cause was unknown-possible GARDASIL reaction. The patient then underwent a punch biopsy from the anterior, lateral, right proximal thigh and was prescribed ZYRTEC, oral, as needed and KENALOG 0.1% topical to be applied two times daily as needed. The patient was instructed to keep the wound dry, covered for 24-48 hours and clean thereafter. On 09-JAN-2012, the physician attempted to notify the patient''s parents that the biopsied specimen was sent for additional consultation. On 13-JAN-2012, the final surgical pathology consultation report was received. Noted on biopsy report was erythematous papular lesions on trunk started two days after GARDASIL vaccination, "no other known exposures." The diagnosis was: "skin, right anterior thigh-psoriasiform lichenoid dermatitis (see comment)." The sections demonstrated psoriasiform hyperplasia of the epidermis with overlying parakeratotic mounds, a superficial perivascular and somewhat band-like lymphocytic infiltrate and extravasated erythrocytes. A rare necrotic keratinocyte was present. Comment from the physician who interpreted the biopsy: "I favor a diagnosis of pityriasis lichenoides because of the psoriasiform lichenoid pattern, rare necrotic keratinocytes and extravasated erythrocytes. Pityriasis lichenoides is generally believed to be idiopathic but has been noted to occur after some infections. There are also rare reports of occurring after vaccination but I have been unable to find an association with human papilloma virus vaccine. The histological differential could less-likely include nummular dermatitis or other dermatoses." The responsible physician reported that five days after GARDASIL was administered, on 27-DEC-2011, the patient started with red spots on the right upper leg that spread to the trunk and arms with mild itching. There was partial response to triamcinolone. At the time of this report the patient''s condition was unknown. The responsible physician determined

VAERS ID:450885 (history)  Vaccinated:2012-02-24
Age:15.0  Onset:2012-02-24, Days after vaccination: 0
Gender:Female  Submitted:2012-03-01, Days after onset: 6
Location:Oregon  Entered:2012-03-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1397AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Malaise, Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: Patient c/o headache, tinnitus, and "not feeling well" x24 hrs after vaccine.

VAERS ID:450968 (history)  Vaccinated:2012-02-23
Age:15.0  Onset:2012-02-23, Days after vaccination: 0
Gender:Female  Submitted:2012-03-02, Days after onset: 8
Location:Florida  Entered:2012-03-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Migraine; Allergic rhinitis
Preexisting Conditions: Peanuts; Asthma; Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA2UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0420AA1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Anaphylactic reaction, Face oedema, Immediate post-injection reaction, Lip oedema, Pharyngeal oedema, Pyrexia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Immediate anaphylaxis after varicella administration. Facial/pharynx/lip edema, urticaria to face and trunk, vomited x1. Epi 0.5cc SC, albuterol neb with Epi, DECADRON 8mg IM, DEPO MEDROL 80mg IM within 3 mins of vaccine administration. Oral steroid and antihistamines x7 days. Reported fever night after vaccine.

VAERS ID:451038 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2011-09-29
Gender:Female  Submitted:2011-11-08, Days after onset: 40
Location:Florida  Entered:2012-03-05, Days after submission: 118
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: Hx of emotional issues; eye; ear; nose; throat issues (parent history)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B062AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: TDAP administered, mother called to report patient woke up 9-29-11 at 0300 complaining of nausea; fever vomited while talking to mom. At 0730 when I talked with mom the student was sleeping.

VAERS ID:451063 (history)  Vaccinated:2012-03-01
Age:15.0  Onset:2012-03-01, Days after vaccination: 0
Gender:Male  Submitted:2012-03-05, Days after onset: 4
Location:Virginia  Entered:2012-03-05
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:
Vaccination
Manufacturer
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Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3989AA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Fatigue, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Gradual onset body aches, fatigue w/fitful sleep that night, w/fever of 102F by patient report the next day, w/gradual, complete resolution of symptoms in 24 hours. No sequelae. Used OTC ibuprofen for symptom control.

VAERS ID:451120 (history)  Vaccinated:2012-03-01
Age:15.0  Onset:2012-03-01, Days after vaccination: 0
Gender:Female  Submitted:2012-03-05, Days after onset: 4
Location:Connecticut  Entered:2012-03-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None, here for CPE
Preexisting Conditions: Amoxicillin --$g erythema multiforme
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH438AB0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1524AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted after receiving flu & HPV #1. Felt foggy and had some odd behavior and ? mental status changes. Being worked up by neurologist.

VAERS ID:451214 (history)  Vaccinated:2012-02-21
Age:15.0  Onset:2012-02-23, Days after vaccination: 2
Gender:Female  Submitted:2012-03-02, Days after onset: 8
Location:Washington  Entered:2012-03-07, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Toe fungus
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1261AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Went to ER for hives 48 hrs after vaccine. Followed up office, still had hives, started on prednisone, ranitidine & loratadine, continue BENADRYL q 6 hrs PRN increased itching.

VAERS ID:451298 (history)  Vaccinated:2012-03-06
Age:15.0  Onset:2012-03-06, Days after vaccination: 0
Gender:Male  Submitted:2012-03-08, Days after onset: 2
Location:Georgia  Entered:2012-03-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Migraines
Preexisting Conditions: ADD with Hyperactivity, Asthma, type unspecified, Common Migraine, Camptodactyly, Classic migraine
Diagnostic Lab Data: Migraine
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AF8IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Muscle spasms, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted, Dizziness, awkward spasms of arms and legs for about an hour.

VAERS ID:451427 (history)  Vaccinated:2011-12-27
Age:15.0  Onset:2012-02-24, Days after vaccination: 59
Gender:Female  Submitted:2012-03-08, Days after onset: 13
Location:Kentucky  Entered:2012-03-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity
Preexisting Conditions: Migraine; Headache; Hypersensitivity
Diagnostic Lab Data: Electrocardiogram, Brain: normal; electroencephalography, normal; computed axial, normal
CDC Split Type: WAES1202USA04245
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0963AA0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Aphasia, Computerised tomogram head, Computerised tomogram normal, Condition aggravated, Convulsion, Electrocardiogram normal, Electroencephalogram normal, Migraine, Vision blurred
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from an office manager and a doctor of pharmacy concerning the pharmacist''s 15 year old daughter with drug allergy to CEFZIL and a history of migraine, headaches and allergies who on 27-DEC-2011 (also reported as 25-JAN-2012, by the pharmacist) was vaccinated IM with the first and only 0.5ml dose of GARDASIL (lot #670048/0963AA) (site not reported). No other vaccines were given concomitantly. Concomitant therapy included ZYRTEC as needed. The doctor of pharmacy reported that on 24-FEB-2012 (also reported as "last week"), the patient had her first migraine-induced seizure and was taken to ER. An electrocardiogram, electroencephalogram and computed tomography (CT) scan of the brain were normal. The patient was unable to walk, talk and her vision was blurred for several hours after the seizure. On 27-FEB-2012 the patient experienced her second seizure but with only blurred vision for a shorter period of time. The patient was prescribed TOPAMAX. A repeat CT scan and electroencephalogram were scheduled. The patient was scheduled to see a neurologist on 19-MAR-2012. The doctor of pharmacy did not consider the events to be disabling or life threatening. The physician''s office manager stated that she was not aware of the adverse event. At the time of the report, the patient''s outcome was unknown. Upon internal review, migraine-induced seizure and seizure were determined to be other important medical events. Additional information has been requested.

VAERS ID:451782 (history)  Vaccinated:2011-07-05
Age:15.0  Onset:2011-07-06, Days after vaccination: 1
Gender:Female  Submitted:2011-11-30, Days after onset: 147
Location:California  Entered:2012-03-09, Days after submission: 100
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: Not reported. From follow-up on 14/Sep/2011 the patient had a primary series of Tdap with the "last one 7/19/0" (entire year not reported). From follow-up received on 03/Nov/2011 the patient had received the last Tdap on 19/Jul/2000.
Diagnostic Lab Data: Not reported
CDC Split Type: 201104198
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4001AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3921BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0095AA1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Musculoskeletal stiffness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Initial report was received on 07 July 2011 from a consumer who is also the patient''s parent. A 15 year-old female patient with no reported past medical history had received an intramuscular injection of MENACTRA (lot number and site of administration not reported) on 05 July 2011 and the next morning woke up with a backache, stiff neck, fever and vomiting. According to the reporter, the patient''s "problems" were getting worse. The patient was not evaluated by a physician. Treatments were not reported. No further information was available at the time of the report. The patient''s outcome was not recovered. Follow-up information was received on 14 September 2011 from a health care professional. On 05 July 2011, the patient had received an intramuscular right deltoid injection of MENACTRA, lot number U4001AA, a dose one left deltoid injection of ADACEL, lot number C3921BA (route of administration not reported) and a second dose right arm deltoid injection of VARIVAX, Merck lot number 0095AA (route of administration not reported). The patient had no illness at the time of vaccination, no concomitant medications and had no history of adverse events following prior vaccinations. The patient had a primary series of Tdap with the "last one 7/19/0" (entire year not reported). The reporter had no additional information to provide at the time of the report. The patient''s outcome was recovered (date not reported). Follow-up information was received from a health care professional on 03 November 2011. The patient had been given the fifth dose of Dtap (also reported as Tdap) on 19 July 2000 (previously reported as "0"). The patient had received ADACEL IM (intramuscularly) and VARIVAX SC (subcutaneously). No further information was available at the time of the report. Outcome was recovered. Documents held by sender: none.

VAERS ID:451865 (history)  Vaccinated:2011-12-15
Age:15.0  Onset:2011-12-20, Days after vaccination: 5
Gender:Male  Submitted:2012-02-24, Days after onset: 66
Location:New York  Entered:2012-03-09, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No other vaccines were given on the same date as the HAVRIX. It was unknown if the subject had any adverse events following previous vaccinations. The subject''s healthcare provider was unsure of the subject''s history of adverse events.
Diagnostic Lab Data: UNK
CDC Split Type: A0959892A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB481AB1UNAR
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain, Dizziness, Headache, Muscle twitching, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: This case was reported by a healthcare professional (nurse) and described the occurrence of abdominal pain in a 15-year-old male subject who was vaccinated with HAVRIX (GlaxoSmithKline). Concurrent vaccination included HAVRIX;GlaxoSmithKline; unknown;unknown arm given on 12 December 2011; MENACTRA (non-gsk); non-GSK manufacturer;unknown;unknown given on 20 December 2011. Concurrent medications included clindamycin. On 15 December 2011 the subject received 2nd dose of HAVRIX (.5 ml, unknown route, unknown arm). The subject received a dose of HAVRIX on 12 December 2011 and 15 December 2011 with one dose given in the left arm and one dose given in the right arm. On 20 December 2011, 5 days after vaccination with HAVRIX, the subject experienced abdominal pain, nausea and on 21 December 2011 at 07:00, 6 days after vaccination with HAVRIX, the subject experienced muscle twitching, dizziness and headache. The healthcare provider was not sure if the adverse events were the cause of the appointment, but also reported that headache and nausea were the reason for the office visit. At the time of reporting the events were unresolved.

VAERS ID:451915 (history)  Vaccinated:2011-08-01
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2011-08-26
Location:Florida  Entered:2012-03-09, Days after submission: 196
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: Patient denied any concurrent illnesses, pre-existing medical history, allergies or use of other medications.
Diagnostic Lab Data: Not reported
CDC Split Type: 201106953
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0627AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0636AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3780AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1704Z1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Gait disturbance, Oropharyngeal pain, Pain in extremity, Pharyngitis
SMQs:, Agranulocytosis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Initial report was received 15 August 2011 from a health care professional. A 15-year-old female patient had received a first dose intramuscular right deltoid injection of MENACTRA, lot number U3780AA, and a first dose intramuscular right deltoid injection of VAQTA (manufacturer Merck), lot number 0627AA, and a first dose intramuscular left deltoid injection of GARDASIL (manufacturer Merck), lot number 0636AA, and a second dose subcutaneous left deltoid injection of VARIVAX (manufacturer Merck), lot number 1704Z on 01 August 2011. One to two days later, the patient complained of pain and difficulty walking in both legs which lasted approximately three days. These symptoms resolved (date not reported) and did not require a doctor''s visit. On 12 August 2011, the patient was seen by her physician with complaints of a sore throat and she was subsequently diagnosed with acute pharyngitis. The patient denied any concurrent illness or pre-existing medical conditions and she had not been taking any concomitant medications. It was unknown if the patient experienced any adverse events following prior vaccinations. Outcome for the event of pharyngitis was unknown at the time of the report. Documents held by sender: None.

VAERS ID:451555 (history)  Vaccinated:2012-02-24
Age:15.0  Onset:2012-02-24, Days after vaccination: 0
Gender:Female  Submitted:2012-03-12, Days after onset: 16
Location:New Jersey  Entered:2012-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1397AA2IMRA
Administered by: Private     Purchased by: Private
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted and fall down after 5 minutes of vaccination (GARDASIL).

VAERS ID:451741 (history)  Vaccinated:2012-03-13
Age:15.0  Onset:2012-03-13, Days after vaccination: 0
Gender:Male  Submitted:2012-03-13, Days after onset: 0
Location:Pennsylvania  Entered:2012-03-14, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None - well visit
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1441AA1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Hypoaesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Feeling dizziness with intermittent numbness of lips after receiving immunizations. No syncope. Vitals normal. Pt. alert and oriented.

VAERS ID:451800 (history)  Vaccinated:2006-06-12
Age:15.0  Onset:2012-02-25, Days after vaccination: 2084
Gender:Female  Submitted:2012-03-09, Days after onset: 13
Location:Virginia  Entered:2012-03-14, Days after submission: 4
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: The patient''s past medical history was reported as Attention Deficit Disorder (ADD) and hypothyroidism, and the patient was taking ADDERALL, (reported as ATAROL) and EFFEXOR medications concomitantly. The patient had no illness at time of vaccination and had no known drug allergies.
Diagnostic Lab Data:
CDC Split Type: 201202564
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bordetella test positive, Culture, Feeling abnormal
SMQs:, Dementia (broad)
Write-up: Initial case received from a healthcare professional on 01 March 2012. A 15-year-old female patient received an intramuscular injection of DTAP, manufacturer and lot number unknown, (site not reported) on 12 June 2006. The patient''s past medical history was reported as Attention Deficit Disorder (ADD) and hypothyroidism, and the patient was taking ADDERALL, (reported as ATAROL) and EFFEXOR medications concomitantly. The patient had no illness at time of vaccination and had no known drug allergies. The reporter stated that the now 21-year-old patient received DTAP (Tdap) at age 15 years, and now the patient has a possible case of pertussis. The patient was seen in the local emergency room (ER) on 25 February 2012, and culture results were pending. On 01 Mar 2012, the reporter stated that the patient''s nasal swab tested positive for pertussis. The patient did not require hospitalization, but was given an antibiotic. The patient was currently feeling better and without fever. The patient''s outcome was not recovered. Documents held by sender: None.

VAERS ID:451817 (history)  Vaccinated:2012-03-12
Age:15.0  Onset:2012-03-13, Days after vaccination: 1
Gender:Female  Submitted:2012-03-14, Days after onset: 1
Location:North Carolina  Entered:2012-03-14
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM101300IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 10mm induration at injection site.

VAERS ID:451872 (history)  Vaccinated:2012-03-14
Age:15.0  Onset:2012-03-15, Days after vaccination: 1
Gender:Female  Submitted:2012-03-15, Days after onset: 0
Location:New Mexico  Entered:2012-03-15
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB509BA1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness & tenderness, SL induration upper (R) deltoid at site of vaccine. See page 2 of fax for Dr note & treatment plan.

VAERS ID:452245 (history)  Vaccinated:2012-03-15
Age:15.0  Onset:2012-03-15, Days after vaccination: 0
Gender:Female  Submitted:2012-03-21, Days after onset: 6
Location:Maine  Entered:2012-03-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4033AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B078BA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Injection site swelling, Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 3/15/12 Pt given MENACTRA & Tdap. After that pt & mother noted localized redness. 3/21/12 pt now w/ warmth to rt deltoid, swelling & welts (8x6 cm) & (2cm). Left deltoid 3 welts - (6x3 cm), (5x3 cm) & (2 cm) - no warmth on left.

VAERS ID:452639 (history)  Vaccinated:2012-03-12
Age:15.0  Onset:2012-03-12, Days after vaccination: 0
Gender:Female  Submitted:2012-03-21, Days after onset: 9
Location:Ohio  Entered:2012-03-29, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data: Pt. was seen at ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Concussion, Fall, Head injury, Loss of consciousness, Neck pain, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad)
Write-up: Patient had syncopal episode in lobby striking her head on floor & had brief LOC. Transferred to ER per EMS due to neck pain/visual disturb. Evaluated & released to home & diagn. with mild concussion. Episode occurred 10 min. after injection.

VAERS ID:452981 (history)  Vaccinated:2012-03-28
Age:15.0  Onset:2012-03-28, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:2012-04-03
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: Asthma; AR
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Hallucination, visual, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Within 2-3 hr. developed pain in arm that vaccine was given; pain radiated down mid chest, pain midline, stay froze; visual hallucination "seeing spiders in the room".

VAERS ID:453156 (history)  Vaccinated:2012-04-05
Age:15.0  Onset:2012-04-07, Days after vaccination: 2
Gender:Male  Submitted:2012-04-08, Days after onset: 1
Location:Illinois  Entered:2012-04-08
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMRA
Administered by: Private     Purchased by: Other
Symptoms: Lymphadenopathy
SMQs:
Write-up: Axilla lymphadenopathy on the side of injection of Gardasil (right deltoid injection with right axilla lymphadenopathy).

VAERS ID:453335 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2012-03-28
Location:California  Entered:2012-04-11, Days after submission: 14
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: Unknown
Diagnostic Lab Data: Not reported
CDC Split Type: 201203414
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  SYRUN
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Cough, Headache, Nausea, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Initial report was received from a health care professional on 23 March 2012. A 15-year-old male patient had received an injection of MENACTRA (lot number, route, site and date of administration unknown) and an unspecified amount of time later experienced headache, congestion, cough, wheezing, nausea and joint aches. No further information was available at the time of the report. The patient''s outcome was not recovered. Documents held by sender: None.

VAERS ID:453392 (history)  Vaccinated:2010-10-19
Age:15.0  Onset:2010-10-23, Days after vaccination: 4
Gender:Male  Submitted:2012-04-11, Days after onset: 536
Location:Massachusetts  Entered:2012-04-11
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: Hx of allergic rhinitis and mild asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0886Z0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives 10/23/10.

VAERS ID:454101 (history)  Vaccinated:2012-04-17
Age:15.0  Onset:2012-04-17, Days after vaccination: 0
Gender:Female  Submitted:2012-04-21, Days after onset: 4
Location:Maryland  Entered:2012-04-21
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: Not recovered as of this point. Had a neurology appointment without definitive findings on 4/18, followed by an ultrasound and MRI significant for a blood clot, details not known at this time. She was treated and seen at Medical Center.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1745AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Hypoaesthesia, Nuclear magnetic resonance imaging, Oedema, Paraesthesia, Sensory loss, Ultrasound scan
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Noticed edema and tingling of "pins and needles" of right arm. The following day symptoms have changed to include numbness of the entire right hand with loss of strength and sensation.

VAERS ID:454237 (history)  Vaccinated:2012-04-21
Age:15.0  Onset:2012-04-21, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New Jersey  Entered:2012-04-24
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1397AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient developed dizziness & pallor 10 minutes after vaccination.

VAERS ID:454402 (history)  Vaccinated:2012-04-11
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-04-16
Location:Kentucky  Entered:2012-04-25, Days after submission: 9
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: Dysmenorrhea
Diagnostic Lab Data: PPD placed on 4-11-12 Lot C3762AB exp. 9-1-13
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1378AA1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Injection site erythema, Injection site pain, Injection site swelling, Pallor
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: On 4-13-12 redness, tender swelling over injection site. 4 cm area of pale blanching erythema and 3 cm induration no fluctuance.

VAERS ID:454508 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-04-26
Location:Vermont  Entered:2012-04-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Magnetic resonance, Brain: Conversion
CDC Split Type: WAES1204USA02620
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Amnesia, Conversion disorder, Convulsion, Headache, Injury, Loss of consciousness, Musculoskeletal chest pain, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a consumer concerning currently 15 year old female patient with no pertinent medical history and no drug reactions/allergies who on an unspecified date, was vaccinated with the second dose of GARDASIL (lot # and route not reported) 0.5 ml. There was no concomitant medication. Consumer reported that on an unspecified date, minutes after getting her second GARDASIL dose, the patient had a seizure and was taken to the emergency room (ER) of an unspecified hospital. They did a magnetic resonance imaging (MRI) of her brain and the diagnosis was a conversion, which was a misfiring of the electrons in her brain due to traumatic bodily injury. Since this happened, she had had headaches, passed out all the time. she had tingling in her hands and feet, blurry vision, pain in her rib area, and a loss of memory of the last three years. She went to an unspecified neurologist, who could not pin it to the vaccine. She had missed 55 days of school since the event started. The patient''s mother said that physician dismissed the idea that it was due to the vaccine, so she switched to an unspecified doctor in the same practice. The consumer had been to the emergency room (ER) multiple times. It was reported that the events occurred after reintroduction. It was also reported that these events were a significant disability. It was not know if the days of school the consumer missed were consecutive and if the patient was ever admitted to the hospital. At the time of the report, the patient''s outcome was unknown. Therapy with GARDASIL was discontinued after the events happened. Additional information has been requested.

VAERS ID:454755 (history)  Vaccinated:2012-04-23
Age:15.0  Onset:2012-04-23, Days after vaccination: 0
Gender:Female  Submitted:2012-04-25, Days after onset: 2
Location:Connecticut  Entered:2012-05-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1745AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Crying, Emotional disorder, Feeling abnormal, Grip strength decreased, Headache, Inappropriate affect, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: A few hrs after HPV #1 vaccine, pt was in school & developed uncontrollable shaking, laughing, then crying, then curled up in a ball on floor. She had no control over her emotions x 45 min. Pt''s dad observed this behavior. 4/24 Next day, pt felt like "in a fog"; again felt "shaky" & unable to hold a pencil; also devel. headache lasting until 4/25 -$g today felt WNL.

VAERS ID:454848 (history)  Vaccinated:2012-04-18
Age:15.0  Onset:2012-04-18, Days after vaccination: 0
Gender:Male  Submitted:2012-05-02, Days after onset: 14
Location:Maryland  Entered:2012-05-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1480AA1IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3935AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1794AA0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site joint pain
SMQs:, Arthritis (broad)
Write-up: Child reports "right arm, at shoulder still hurts where shot was given." Right deltoid is the site of a Tdap injection only.

VAERS ID:454893 (history)  Vaccinated:2012-04-26
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-04-27
Location:Arizona  Entered:2012-05-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1291AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt. got dizzy after 15 min of receiving vaccine.

VAERS ID:454913 (history)  Vaccinated:2012-04-26
Age:15.0  Onset:2012-04-26, Days after vaccination: 0
Gender:Female  Submitted:2012-04-27, Days after onset: 1
Location:West Virginia  Entered:2012-05-03, Days after submission: 6
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: CBC; CMP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB550CA0UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0636AA2UNLA
Administered by: Private     Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Full blood count, Metabolic function test, Pallor
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pale skin, chest pain, SOB.

VAERS ID:455206 (history)  Vaccinated:2010-12-20
Age:15.0  Onset:2011-02-11, Days after vaccination: 53
Gender:Female  Submitted:2012-05-08, Days after onset: 451
Location:Texas  Entered:2012-05-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: MRI, echo, EKG are all normal. Stomach sonogram was normal. Paps was abnormal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AB UNRA
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER0565Z0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3430AA UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3476AA UNRA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain lower, Abdominal pain upper, Back pain, Convulsion, Cystitis, Diarrhoea, Echocardiogram normal, Electrocardiogram normal, Fungal infection, Migraine, Nuclear magnetic resonance imaging normal, Oligomenorrhoea, Smear cervix abnormal, Syncope, Ultrasound scan normal, Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Fertility disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow)
Write-up: She started have long menstral cycles after the 1st shot like 3 weeks at a time. After the 2nd shot 7/14/2011. She begin have migranes about 2 weeks after the shot. Then in Sept. she begin having seizures. After the 3rd shot she now have fainting spells, lower abdominal pain, stomach pain, back pain, she now have UTI/bladder infection/yeast infection all the time. And also diarrhea.

VAERS ID:455209 (history)  Vaccinated:2012-05-07
Age:15.0  Onset:2012-05-07, Days after vaccination: 0
Gender:Female  Submitted:2012-05-08, Days after onset: 1
Location:Florida  Entered:2012-05-08
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: Attention deficit disorder
Diagnostic Lab Data: Flu test: Negative for Influenza A&B
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4137AA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Chills, Dizziness, Headache, Influenza virus test negative, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Fever 102, chills, headaches, dizziness, body aches, weakness generalized.

VAERS ID:455298 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2012-05-09
Location:Unknown  Entered:2012-05-10, Days after submission: 1
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: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES1205USA00747
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Brain operation, Vaccination complication
SMQs:
Write-up: Information has been received from a patient''s mother reporting about her 15 year old daughter, who on unknown date was vaccinated with the first dose of MMR II (lot#, dose and route not reported). Patient''s mother reported that her daughter on unknown date had a reaction to the first MMR II shot but she was fine after the second one. The patient had a brain surgery 1 and a half years ago. Upon internal review, brain surgery was consider to be an other important medical event. At the time of reporting the patient status was unknown. It was unknown if the patient sought medical attention. Additional information is not expected.

VAERS ID:455399 (history)  Vaccinated:2012-05-11
Age:15.0  Onset:2012-05-11, Days after vaccination: 0
Gender:Male  Submitted:2012-05-11, Days after onset: 0
Location:Pennsylvania  Entered:2012-05-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported or observed.
Preexisting Conditions: None reported or observed
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110660IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B080AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1067AA1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Pain in jaw, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving three vaccines, Tdap, Varicella, and Meningococcal, the patient stood up but not immediately and started to pass out. His father caught him and the father and I laid him flat on the floor. After about 5 seconds he opened his eyes and said what happened. His bp was 124/72. He said his left jaw area hurt but neither the father nor I saw his face come into contact with anything. He had had no food this morning before the vaccines. He drank a jucice box and felt better. He was initially pale but the color returned to his face. He was released to the care of his father.

VAERS ID:455755 (history)  Vaccinated:2012-05-13
Age:15.0  Onset:2012-05-13, Days after vaccination: 0
Gender:Female  Submitted:2012-05-17, Days after onset: 4
Location:Indiana  Entered:2012-05-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none listed
Preexisting Conditions: none listed
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB538BA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Incorrect dose administered
SMQs:
Write-up: Inappropriate dose given.

VAERS ID:456093 (history)  Vaccinated:2012-04-30
Age:15.0  Onset:2012-04-30, Days after vaccination: 0
Gender:Female  Submitted:2012-04-30, Days after onset: 0
Location:Connecticut  Entered:2012-05-23, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1860AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt received HPV #1. Seemed fine after vaccine was given. Told to wait in the waiting room for 15 min. If pt was ok she could leave after the 15 min, grandma was told. I went to waiting room to check on pt and she started to bend over, pt passed out in my arms, pt came to 20 sec later gave pt a drink & took BP walked back to Rm, layed down, retook BP it was in normal range. Dr came in 20 min later & checked pt and she seemed fine and was sent home after 15 min later.

VAERS ID:456463 (history)  Vaccinated:2012-05-21
Age:15.0  Onset:2012-05-21, Days after vaccination: 0
Gender:Female  Submitted:2012-05-23, Days after onset: 2
Location:New York  Entered:2012-05-29, Days after submission: 6
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: Had previous syncope few years ago after getting shot
Diagnostic Lab Data: ER - CAT; syncope; nasal laceration; Scan - nasal fracture
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA2IMAR
Administered by: Public     Purchased by: Public
Symptoms: Computerised tomogram abnormal, Dizziness, Epistaxis, Facial bones fracture, Fall, Laceration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Vestibular disorders (broad)
Write-up: Received GARDASIL #3 5/21/12 Mom in a hurry to leave for work, so they left right after the shot was given. On the way out of the elevator, client felt dizzy & she fell on the floor. Sustained a rugged laceration on nasal bridge & nose bleed. EMS took her to hospital.

VAERS ID:456465 (history)  Vaccinated:2012-05-21
Age:15.0  Onset:2012-05-21, Days after vaccination: 0
Gender:Female  Submitted:2012-05-30, Days after onset: 9
Location:Connecticut  Entered:2012-05-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: NKDA; (+) still''s murmur; (+) glasses
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt received HPV #1 at 1 yo physical. Approx 1-1 1/2 hrs after vaccine, pt started feeling lightheaded, nauseous, vomited, without temp went to ED - seemed better. Next day low grade temp, nausea, HA.

VAERS ID:456521 (history)  Vaccinated:2012-05-23
Age:15.0  Onset:2012-05-24, Days after vaccination: 1
Gender:Female  Submitted:2012-05-30, Days after onset: 6
Location:Kansas  Entered:2012-05-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110660IMRA
Administered by: Public     Purchased by: Private
Symptoms: Body temperature, Headache, Injection site erythema, Injection site induration, Neck pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Patient reports hardening and redness at injection site along with mild swelling to (R) forearm. Also report feeling like "I was running a temperature". Pt. denies checking temperature. Also reports headache and neck ache on 5/24/12.

VAERS ID:456588 (history)  Vaccinated:2012-05-22
Age:15.0  Onset:2012-05-23, Days after vaccination: 1
Gender:Male  Submitted:2012-05-24, Days after onset: 1
Location:Pennsylvania  Entered:2012-05-31, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Healthy
Preexisting Conditions:
Diagnostic Lab Data: Started KEFLEX QID x 10 d
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC4127AA3UNLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURH13402UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Warm, red deltoid 2" x 3" no fever.

VAERS ID:456765 (history)  Vaccinated:2012-05-09
Age:15.0  Onset:2012-05-09, Days after vaccination: 0
Gender:Female  Submitted:2012-05-09, Days after onset: 0
Location:Minnesota  Entered:2012-06-04, Days after submission: 26
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA117AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Altered state of consciousness, Feeling abnormal, Hyperhidrosis, Loss of consciousness, Nausea, Somnolence, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Left office - in car on way to school - felt hazy, nauseated and sweaty; passed out and had generalized shaking movements of extremities < 1 min.; sleepy - came around to full consciousness in 2 min. Returned to office; VSS/PE (-)/Pulse OX 95%.

VAERS ID:456879 (history)  Vaccinated:2012-06-06
Age:15.0  Onset:2012-06-06, Days after vaccination: 0
Gender:Female  Submitted:2012-06-06, Days after onset: 0
Location:Georgia  Entered:2012-06-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURG154110IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Oropharyngeal pain, Skin warm, Visual impairment
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Pt had visual disturbance, felt warm & throat pain. Pt was given BENADRYL 25 mg IM.

VAERS ID:457219 (history)  Vaccinated:2012-06-08
Age:15.0  Onset:2012-06-10, Days after vaccination: 2
Gender:Female  Submitted:2012-06-11, Days after onset: 1
Location:Maryland  Entered:2012-06-11
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: Allergy; AUGMENTIN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1229AA2IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4053AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3900AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 6/8/12 received immunizations. 6/10/12 developed fever, & hives on hands & feet,. Mom gave child BENADRYL. 6/11/12 called health dept. Symptoms gone 6/10/12.

VAERS ID:457248 (history)  Vaccinated:2012-06-07
Age:15.0  Onset:2012-06-07, Days after vaccination: 0
Gender:Female  Submitted:2012-06-12, Days after onset: 5
Location:Michigan  Entered:2012-06-12
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1332Y0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEUR64305AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dyskinesia, Fatigue, Feeling abnormal, Injection site pain, Injection site reaction, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt was very anxious about receiving vaccines. RN administered a Tdap IM in the deltoid of her left arm. Pt stated that it hurt. RN then administered an HPV an inch lower in the same arm. Pt stated that it didn''t hurt, it just felt weird. Pt then became very pale and stated that she was going to pass out. She was sitting upright in a chair. RN had her slide down and rest her head on the back of the chair. Pt then just turned her head and fainted for about 2 seconds. During this time her legs and arms straightend out. Her mom got a cool cloth. We assisted her to the floor where she laid for about 10 minutes. She then sat in the chair for another 5 minutes. Her color came back and she stated she felt exhausted, but fine. RN gave her cell phone number and instructions to go to the ER if any concerns. RN gave info on the imms given and where they where given. RN text pt the next morning and she stated that she had just finished basketball pracitce and was feeling fine.

VAERS ID:457550 (history)  Vaccinated:2012-06-08
Age:15.0  Onset:2012-06-14, Days after vaccination: 6
Gender:Female  Submitted:2012-06-15, Days after onset: 1
Location:Michigan  Entered:2012-06-15
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0131AE IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4021AE IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4051AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Well circumscribed areas of urticaria on bilateral arms and legs-specifically large areas on back of bilateral thighs, elbows, knees, lower legs above ankles.

VAERS ID:457525 (history)  Vaccinated:2011-08-03
Age:15.0  Onset:2011-08-08, Days after vaccination: 5
Gender:Female  Submitted:2012-01-05, Days after onset: 150
Location:Pennsylvania  Entered:2012-06-18, Days after submission: 164
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0691AA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Disturbance in attention, Hypoaesthesia, Paralysis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: On 8-3-11 received HPV #2. 5-7 days later c/o numbness in arms & lasted 2 weeks off & on. On 8-20-11 she collapsed - had complete paralysis in hospital for one week then transferred to another hospital. Has had concentration problems and faint problems since.

VAERS ID:457743 (history)  Vaccinated:2012-05-15
Age:15.0  Onset:2012-05-16, Days after vaccination: 1
Gender:Female  Submitted:2012-06-19, Days after onset: 34
Location:Texas  Entered:2012-06-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; Allergic rhinitis
Diagnostic Lab Data: Normal EKG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1745AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Electrocardiogram normal, Headache, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 12 hours after HPV #1 given, patient developed chest pain, wheezing and headache.

VAERS ID:457762 (history)  Vaccinated:2012-02-20
Age:15.0  Onset:2012-02-21, Days after vaccination: 1
Gender:Female  Submitted:2012-06-19, Days after onset: 118
Location:Unknown  Entered:2012-06-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type I DM; Reaction to Thimerosal in prior vaccination - Rash; Pregnant: No
Diagnostic Lab Data:
CDC Split Type: 2012032598
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0843AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Fatigue, Injection site cellulitis, Injection site erythema, Injection site pain, Injection site warmth, Oedema peripheral, Pain in extremity, Pyrexia, Swelling
SMQs:, Cardiac failure (broad), 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)
Write-up: This spontaneous report (initial receipt 05-Jun-2012) concerns a 15-year-old female patient, who had a medical history of type 1 diabetes mellitus and a reaction to Thimerosal in prior vaccination (type uncertain) which resulted in rash. Concomitant medication included NOVOLOG insulin via a pump. On 20-Feb-2012 the patient received INFLUENZA vaccination in her right deltoid (manufacturer and batch no. were not provided) and PNEUMOVAX 23 0.5 ml intramuscularly in her left deltoid. On 21-Feb-2012 the patient experienced left upper arm cellulitis, left arm pain and fatigue. Most of the patient''s left upper outer arm became erythematous, warm and very tender. She developed a fever of 100.7F. She was treated with oral AUGMENTIN and intramuscular (IM) ROCEPHIN. The next day the redness in upper arm improved but new redness and swelling developed in her clavicle and lower arm near elbow. The fever resolved. New areas of erythema would begin in the arm as other areas resolved. AUGMENTIN was stopped and OMNICEF was started. The erythema stopped spreading. Clindamycin was provided for methicillin-resistant staphylococcal aureus (MRSA) coverage. By 29-Feb-2012 the erythema and warmth had resolved. The pain persisted for another month or so. The outcome for the events was recovered. The patient was no longer receiving treatment. On 29-May-2012, the reporter provided PNEUMOVAX 23 as a suspect drug and INFLUENZA vaccination as a concomitant medication.

VAERS ID:457799 (history)  Vaccinated:2012-06-20
Age:15.0  Onset:2012-06-20, Days after vaccination: 0
Gender:Male  Submitted:2012-06-20, Days after onset: 0
Location:North Carolina  Entered:2012-06-20
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainting.

VAERS ID:457992 (history)  Vaccinated:2012-05-15
Age:15.0  Onset:2012-05-25, Days after vaccination: 10
Gender:Male  Submitted:2012-06-22, Days after onset: 28
Location:Missouri  Entered:2012-06-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Migraine
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1206USA02933
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Migraine, Partial seizures
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Information has been received from a consumer concerning her 15 year old son with no drug reactions/allergies and a history of migraine who on approximately 15-MAY-2012 was vaccinated with his first dose of GARDASIL (Lot# and route not reported). There was no concomitant medication. Consumer reported that approximately 10 days following the vaccination her son experienced migraine with a partial onset seizure. Consumer reported that while her son had a history of migraines, he had never experienced a partial onset seizure before. The patient did not seek medical attention. Subsequently, the patient recovered from migraine and partial onset seizure on an unknown date. Additional information has been requested.

VAERS ID:458161 (history)  Vaccinated:2012-06-26
Age:15.0  Onset:2012-06-26, Days after vaccination: 0
Gender:Male  Submitted:2012-06-26, Days after onset: 0
Location:Oregon  Entered:2012-06-26
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: Autism spectrum
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Fatigue, Headache, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Headache, very tired, feel asleep.

VAERS ID:458267 (history)  Vaccinated:2012-06-21
Age:15.0  Onset:2012-06-21, Days after vaccination: 0
Gender:Female  Submitted:2012-06-26, Days after onset: 5
Location:Nebraska  Entered:2012-06-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1726AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient fainted.

VAERS ID:458299 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2012-06-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IDUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age
SMQs:
Write-up: 15 year old female given intradermal influenza vaccine which is licensed for 19 and older. Was sent by her OBgyn to clinic under a program we have offering free flu to pregnant women/family members with out insurance to cover. Qualified for VFC and should have received IM flu vaccine.

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