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Case Details (Sorted by Age)

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VAERS ID:393077 (history)  Vaccinated:2010-07-14
Age:11.0  Onset:2010-07-15, Days after vaccination: 1
Gender:Female  Submitted:2010-07-16, Days after onset: 1
Location:Kansas  Entered:2010-07-19, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3098AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B047AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1435Y1SCRA
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: 7/16 Presents to HD with redness at of swelling on (R) mid upper arm. 16.5 x 11cm reddened area encircling 6.25 x 7 cm raised area cool pack applied to arm. Advised client''s father to notify PCP. Client afebrile. 7/19 decreased s/s.

VAERS ID:393095 (history)  Vaccinated:2010-07-12
Age:11.0  Onset:2010-07-13, Days after vaccination: 1
Gender:Female  Submitted:2010-07-19, Days after onset: 6
Location:North Carolina  Entered:2010-07-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergies to Cefzil and PCN
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3358BA1 LA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt called office with complaint of arm swollen, red, warm and painful to touch. Swollen area bigger than a 50 cent piece. Advised office visit. Pt seen on 07/13/2010 advised to use Benadryl and cool compresses if worsens or new symptoms needs to be seen. Pt. returned to office with increased swelling on 07/14/2010 seen by Dr pt treated with Prednisone 20mg BID X 5 days told to stop Benadryl and use Atarax 25mg every 6 hours as needed and Keflex 250 mg BID X 10 days. Told to call or return to clinic if new symptoms or worsens.

VAERS ID:393122 (history)  Vaccinated:2010-06-19
Age:11.0  Onset:2010-06-20, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:New Jersey  Entered:2010-07-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic conjunctivitis
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.01004 UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3102AA UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3098AA UNRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site swelling, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Nausea and fever, swelling at site 24 - 48 hours after vaccine administered.

VAERS ID:393126 (history)  Vaccinated:2010-07-15
Age:11.0  Onset:2010-07-15, Days after vaccination: 0
Gender:Female  Submitted:2010-07-19, Days after onset: 4
Location:Arizona  Entered:2010-07-19
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: Amoxicillin (hives)
Diagnostic Lab Data: CBC: WBC, 5400; 61% granulocytes; 27% lymphs; H/H, 14.0/42.2
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3081AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Fatigue, Full blood count, Granulocyte percentage, Haematocrit normal, Haemoglobin normal, Pyrexia, White blood cell count normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Low grade fever (99.2 degrees) on day of vaccine administration. Fever resolved but returned on 7/18/10 to 101 degrees. Fatigue present since vaccination (7/15/10-7/19/10).

VAERS ID:393131 (history)  Vaccinated:2010-07-14
Age:11.0  Onset:2010-07-16, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2010-07-19
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
TDAP: TDAP (ADACEL)SANOFI PASTEURU2937DA UNLA
Administered by: Private     Purchased by: Public
Symptoms: Body temperature increased, Chills, Dizziness, Erythema, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: 7 cm x 7 cm redness swollen. Hurt yesterday on hand notice today 7/16/10. Temp 99 degrees dizziness chills.

VAERS ID:393133 (history)  Vaccinated:2010-07-15
Age:11.0  Onset:2010-07-17, Days after vaccination: 2
Gender:Female  Submitted:2010-07-19, Days after onset: 2
Location:Georgia  Entered:2010-07-19
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 PASTEURU3090AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.11113Y1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Parents states "Saturday night child broke out. No fever. Rash-like whelps began from "head-to-toe." Mom gave child BENADRYL. Stopped and started again.

VAERS ID:393180 (history)  Vaccinated:2010-07-18
Age:11.0  Onset:2010-07-18, Days after vaccination: 0
Gender:Male  Submitted:2010-07-20, Days after onset: 2
Location:Kentucky  Entered:2010-07-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: just completed antibiotic treatment for streptococcal meningitis
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.98744080IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Erythema, swelling, induration, tenderness at injection site. High fever ($g 102), myalgias.

VAERS ID:393186 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-20, Days after vaccination: 0
Gender:Female  Submitted:2010-07-20, Days after onset: 0
Location:Arizona  Entered:2010-07-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies.
Preexisting Conditions: Denies.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAVAHB365AA1 LA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000010 RA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3357AA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0973Y1 RA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Hyperhidrosis, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Client became dizzy, diaphoretic. Client was escorted to a chair and fainted in the presence of two licensed nursing staff. No fall or injury. Cool compresses provided. Water to drink, which she vomited x 1. Reports not eating breakfast. Refused Orange Juice or crackers. Stayed for approximately 20 minutes after event. Recovered well. Escorted to PMV by RN and mother.

VAERS ID:393217 (history)  Vaccinated:2010-07-19
Age:11.0  Onset:2010-07-19, Days after vaccination: 0
Gender:Male  Submitted:2010-07-21, Days after onset: 2
Location:Georgia  Entered:2010-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Acute otitis externa
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB382AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3064AA0IMRL
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BB055AB5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Wound
SMQs:, Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: "11 x 10 cm indurated erythematous swelling of Rt. upper arm. Small puncture wound visible-no fluctuance or oozing" (Per provider note).

VAERS ID:393219 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-20, Days after vaccination: 0
Gender:Female  Submitted:2010-07-21, Days after onset: 1
Location:North Carolina  Entered:2010-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of vaccination
Preexisting Conditions: Patient has history of Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient complained of itching, redness, swelling around the injection site.

VAERS ID:393227 (history)  Vaccinated:2010-07-15
Age:11.0  Onset:2010-07-15, Days after vaccination: 0
Gender:Male  Submitted:2010-07-16, Days after onset: 1
Location:Virginia  Entered:2010-07-21, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB336BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1178Y0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3353AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Pallor, Trendelenburg position
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After client complained feeling lightheaded approx 3 min after receiving vaccines. Client became pale - did not lose consciousness. Client placed in Trendlenberg position and ice pack applied to forehead. Client offered apple juice and consumed by client. Client monitored 15 minutes and discharged from clinic ambulatory to home with mother.

VAERS ID:393276 (history)  Vaccinated:2010-07-16
Age:11.0  Onset:2010-07-17, Days after vaccination: 1
Gender:Female  Submitted:2010-07-21, Days after onset: 4
Location:Indiana  Entered:2010-07-21
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: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0245Z0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3102AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3382AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1410Y1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site nodule, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: SWELLING, HARD KNOT, ITCHING AT ADMINISTRATION SITE, REDNESS 2-3" DIAMETER; X3D; TOPICAL CORTISONE APPLIED, BENADRYL, ADVIL PO

VAERS ID:393320 (history)  Vaccinated:2010-07-14
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2010-07-19
Location:South Carolina  Entered:2010-07-22, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3100AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B049CA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.165AY IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction, red, hot to touch both deltoid areas swollen and painful.

VAERS ID:393385 (history)  Vaccinated:2010-07-15
Age:11.0  Onset:2010-07-16, Days after vaccination: 1
Gender:Male  Submitted:2010-07-17, Days after onset: 1
Location:California  Entered:2010-07-22, 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: None
Preexisting Conditions: ADHD.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3436AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B054BA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) arm swollen warm to touch from shoulder 2/3 down upper arm. Taking 1 OTC ALEVE q 12 hours.

VAERS ID:393411 (history)  Vaccinated:2010-07-21
Age:11.0  Onset:2010-07-22, Days after vaccination: 1
Gender:Female  Submitted:2010-07-22, Days after onset: 0
Location:Texas  Entered:2010-07-22
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB362AA IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0216Y IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3078AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3249AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1205Y IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Itchy, red elevated vaccine site. Not painful. Cool compresses and BENADRYL.

VAERS ID:393417 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-20, Days after vaccination: 0
Gender:Female  Submitted:2010-07-22, Days after onset: 2
Location:Nevada  Entered:2010-07-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Swelling at site
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1539Y0UNRL
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3337AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3035AA4UNLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (L) deltoid redness, swelling and pain after immunization local swelling.

VAERS ID:393421 (history)  Vaccinated:2010-07-16
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2010-07-21
Location:Arizona  Entered:2010-07-22, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS0907010IMRA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:393506 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-23, Days after vaccination: 3
Gender:Male  Submitted:2010-07-23, Days after onset: 0
Location:Georgia  Entered:2010-07-23
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: Chronic ITP in remission
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR 0SCLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS  IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Area of redness and swelling progressed to warm red area on upper back of right arm, no fever.

VAERS ID:393514 (history)  Vaccinated:2010-07-23
Age:11.0  Onset:2010-07-23, Days after vaccination: 0
Gender:Male  Submitted:2010-07-24, Days after onset: 1
Location:Michigan  Entered:2010-07-24
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. Cough at times since he was young
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blister, Contusion, Ecchymosis, Pain
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (broad)
Write-up: Ecchymosis began around 8pm left upper arm. Morning of 7/24/10 increased ecchymosis measuring 3inches X 3 1/2inches. Taken to urgent care facility around 1pm was told to ice the area and use Tylenol or Benadryl prn. by 7pm 7/24 fluid filled blisters started forming within the bruised area (blister area is about 1 inch the total of bruised area) c/o pain with palpation.

VAERS ID:393544 (history)  Vaccinated:2010-07-22
Age:11.0  Onset:2010-07-24, Days after vaccination: 2
Gender:Male  Submitted:2010-07-24, Days after onset: 0
Location:Massachusetts  Entered:2010-07-26, Days after submission: 2
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0002Z1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (L) deltoid area, warm to touch. 2 1/2" x 2 1/2" erythema, edema, painful to touch.

VAERS ID:393625 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-21, Days after vaccination: 1
Gender:Female  Submitted:2010-07-26, Days after onset: 5
Location:Indiana  Entered:2010-07-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None listed
Preexisting Conditions: None listed
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3064AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3357AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)
Write-up: Patient woke up with a 102.2 fever. Patient was very tired, weak and dizzy. Motrin helped symptoms and reduced the fever. Mother noted swelling at the injection site on Left arm.

VAERS ID:393637 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-21, Days after vaccination: 1
Gender:Male  Submitted:2010-07-26, Days after onset: 5
Location:Alabama  Entered:2010-07-26
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: Hx of asthma, ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3352AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1707Y1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient had increased soreness redness, swelling, pain on day after vaccine given limited to (L) deltoid area (LUE).

VAERS ID:393639 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-20, Days after vaccination: 0
Gender:Male  Submitted:2010-07-26, Days after onset: 6
Location:Michigan  Entered:2010-07-26
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: Penicillin allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000220IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063CA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Local reaction, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: (R) arm MCV and (L) arm Tdap on 7/20/10 went to ER that eve because shortness of breath. Discharged with diagnosis "local shot reaction". Localized hives on (L) arm at that time. Faded by AM.

VAERS ID:393651 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-20, Days after vaccination: 0
Gender:Female  Submitted:2010-07-22, Days after onset: 2
Location:Arizona  Entered:2010-07-26, Days after submission: 4
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
TDAP: TDAP (ADACEL)SANOFI PASTEURUF544AA1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large induration 2" diameter at site (warm, red swollen)

VAERS ID:393679 (history)  Vaccinated:2010-07-26
Age:11.0  Onset:2010-07-26, Days after vaccination: 0
Gender:Female  Submitted:2010-07-27, Days after onset: 1
Location:Illinois  Entered:2010-07-27
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB417BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0312Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3356BA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B046DA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Loss of consciousness, Sensation of heaviness
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient states felt dizzy after vaccinations given, patient was reclined and lost consciousness for approx 45 sec, weak and dizzy upon awakening, c/o heaviness feeling in extremities, assessed by EMS personel, f/u of pt been taken by mother to urgent care facility to be assessed.

VAERS ID:393683 (history)  Vaccinated:2010-07-22
Age:11.0  Onset:2010-07-22, Days after vaccination: 0
Gender:Female  Submitted:2010-07-27, Days after onset: 5
Location:Pennsylvania  Entered:2010-07-27
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 ASTHMA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB437BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.033120IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3431AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061CA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Bone pain, Muscle spasms, Pain in extremity
SMQs:, Dystonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Received 4 immun today. c/o bilat arm pain and spinal pain. DX: acute bilat deltoid muscle spasm S/P vaccine. TX: Motrin, heat, rest. F/U 2 days with PCP if no improv; return if sx worsen.

VAERS ID:393695 (history)  Vaccinated:2010-07-22
Age:11.0  Onset:2010-07-23, Days after vaccination: 1
Gender:Female  Submitted:2010-07-24, Days after onset: 1
Location:Arizona  Entered:2010-07-27, Days after submission: 3
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3061AA0UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B0401AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0161Z1SCUN
Administered by: Public     Purchased by: Public
Symptoms: Pain, Pain of skin, Skin warm
SMQs:
Write-up: On 7/23/10 approx 6PM clt stated "very painful" red bump to left arm. Clt denies fever or illness at time, clt did not need to seek med attention according to family. Clt presented to clinic today (7/24/10) with area of 25x20 mm red area, warm to touch and tender, no fever or illness noted today. Clt had full range of motion to (L) arm - Clt presented to seek med attention ASAP if symptoms persist/worsen; family verbalized understanding. Instructed to use cool compress if needed.

VAERS ID:393747 (history)  Vaccinated:2010-05-20
Age:11.0  Onset:2010-07-20, Days after vaccination: 61
Gender:Male  Submitted:2010-07-28, Days after onset: 8
Location:Florida  Entered:2010-07-28
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: EMG confirmed diagnosis of Guillain Barre. MRI demonstrated enhancement of nerve roots.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3030AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Areflexia, Electromyogram abnormal, Guillain-Barre syndrome, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Patient presented with five days of leg achiness, progressive upper and lower extremity weakness, areflexia, diagnosed with Guillain Barre Syndrome. Sensory symptoms first onset several weeks prior.

VAERS ID:393757 (history)  Vaccinated:2010-07-22
Age:11.0  Onset:2010-07-23, Days after vaccination: 1
Gender:Male  Submitted:2010-07-23, Days after onset: 0
Location:North Carolina  Entered:2010-07-28, 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:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B054BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.04672Z1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site discomfort, Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Discomfort, redness (R) arm at injection site.

VAERS ID:393762 (history)  Vaccinated:2010-07-22
Age:11.0  Onset:2010-07-23, Days after vaccination: 1
Gender:Male  Submitted:2010-07-23, Days after onset: 0
Location:North Carolina  Entered:2010-07-28, 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:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B054BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0472Z1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site discomfort, Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Discomfort, redness at injection site (R) arm.

VAERS ID:393796 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-22, Days after vaccination: 2
Gender:Female  Submitted:2010-07-23, Days after onset: 1
Location:Massachusetts  Entered:2010-07-29, 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: MIRALAX prn; BENADRYL prn
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0415Z0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3335AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC3352AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Bradycardia, Dizziness, Laboratory test normal, Mobility decreased, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: Child came in 6/24/10 for dizziness, went to ER -all tests normal. In for ROV - 7/20/10 - c/o dizziness on that day; rec''d MENACTRA, Tdap and Hep A. - returned 2 days later c/o fainting episodes that required at 911 call - denied h/a, c/o diff moving legs; bradycardia noted, racing heart. No previous hx, sent to Neurology.

VAERS ID:393820 (history)  Vaccinated:2010-07-19
Age:11.0  Onset:2010-07-19, Days after vaccination: 0
Gender:Male  Submitted:2010-07-20, Days after onset: 1
Location:Arizona  Entered:2010-07-29, Days after submission: 9
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 PASTEURU3069AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU2936BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Malaise, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: On 7/19/10 (day imms given) pt began c/o nausea and not feeling well approximately 7pm. Thurs AM about 5AM began vomiting till about 1230pm fever began about 1130AM Temp of 101. By 1610 that afternoon pt feeling some better, no nausea, no stomach ache, no emesis.

VAERS ID:393834 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-21, Days after vaccination: 1
Gender:Male  Submitted:2010-07-21, Days after onset: 0
Location:North Carolina  Entered:2010-07-29, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic to eggs as young child and later tolerated them
Diagnostic Lab Data: CBC; WBC: 5.0 K/uL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB431BA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3064AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061CA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0224Z1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Full blood count, Injection site erythema, Injection site warmth, White blood cell count normal
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, warmth surrounding site of Varicella shot. Treated with PREDNISONE 20mg po x1 x7days AZITHROMYCIN 250mg po x1 then po x1 x4 days and ZYRTEC OTC. 7/23/10 no redness today.

VAERS ID:393843 (history)  Vaccinated:2010-07-21
Age:11.0  Onset:2010-07-21, Days after vaccination: 0
Gender:Male  Submitted:2010-07-23, Days after onset: 2
Location:Kentucky  Entered:2010-07-29, Days after submission: 6
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: Pertussis
Diagnostic Lab Data: Physical assessment
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABA028A5UNLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash generalised, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Severe full body rash including palms of hands and feet. Extreme itching. Some swelling around rash site.

VAERS ID:393846 (history)  Vaccinated:2010-07-27
Age:11.0  Onset:2010-07-27, Days after vaccination: 0
Gender:Male  Submitted:2010-07-29, Days after onset: 2
Location:Indiana  Entered:2010-07-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None listed
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3053AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3448AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1109Y1SCRA
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Dizziness, Dysstasia, Fall, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Upon giving vaccinations, pt was standing for 5min before he fainted and fell to the floor. Pt came to and was oriented x3. Pt then threw up and began to feel dizzy again. Pt was unable to stand he was so weak. EMS was contacted and checked pt out. O2 was adminstered. Pt was cleared to go home.

VAERS ID:393887 (history)  Vaccinated:2010-07-27
Age:11.0  Onset:2010-07-28, Days after vaccination: 1
Gender:Male  Submitted:2010-07-29, Days after onset: 1
Location:Iowa  Entered:2010-07-29
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: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1751Y1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Area hot swollen and firm to touch per pt and mother-red on arm after vaccination went to camp and noted area on arm. Came to clinic and seen by provider given script for CEPHALEXIN, LORADINE, Ibuprofen.

VAERS ID:393897 (history)  Vaccinated:2010-07-27
Age:11.0  Onset:2010-07-27, Days after vaccination: 0
Gender:Female  Submitted:2010-07-29, Days after onset: 2
Location:Arizona  Entered:2010-07-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No. Mom reports child has a history of fainting.
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB365AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000010IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3357AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.097391SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Feeling abnormal, Immediate post-injection reaction, Loss of consciousness, Nausea, Pallor
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Just after receiving vaccine client c/o of feeling "weird and now everything is going black." Client lost consciousness momentarily for approximately 15 seconds and then was pale, nauseated and lightheaded after that. Used cold gel pack on back of client''s neck and forehead and client took sips of cold water. Client was sitting in chair leaning against her mother and supported by the nurse during episode. After approximately 20 minutes child recovered completely and left with mother.

VAERS ID:393898 (history)  Vaccinated:2010-07-27
Age:11.0  Onset:2010-07-27, Days after vaccination: 0
Gender:Female  Submitted:2010-07-29, Days after onset: 2
Location:Arizona  Entered:2010-07-29
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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000010IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3357AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.097391SCRA
Administered by: Public     Purchased by: Public
Symptoms: Cold sweat, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Child was waiting the prescribed 15 minutes in the lobby after MENVEO, when about 10 minutes into the wait she began to feel very nauseated, clammy, and dizzy. Child didnot lose consciousness. Used cold gel pack to back of child''s neck and forehead and gave her sips of cold water. Child felt better after about 10 minutes and was able to leave with mother another 10 minutes after that.

VAERS ID:393917 (history)  Vaccinated:2010-07-14
Age:11.0  Onset:2010-07-14, Days after vaccination: 0
Gender:Female  Submitted:2010-07-26, Days after onset: 12
Location:New York  Entered:2010-07-29, 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: The patient had no illness at the time of the vaccinations
Preexisting Conditions: The patient had no other vaccinations within 4 weeks. Her medical history included unspecified numerous allergies. No other pre-existing medical conditions or concomitant medications were reported.
Diagnostic Lab Data:
CDC Split Type: 201003918
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  IJUN
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  IJUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: Initial case was received on 19 July 2010 from the parent of the patient. A 11 year old female patient received an injection of MENACTRA (lot number not reported) and an injection of "another vaccine" (parent didn''t know what vaccine) on 14 July 2010. Within minutes the patient experienced an "anaphylactic reaction" (NOS). The mother stated her daughter was taken to the emergency room and received prednisone and several ''''IVs." The patient had no illness at the time of the vaccinations and had no other vaccinations within 4 weeks. Her medical history included unspecified numerous allergies. No other pre-existing medical conditions or concomitant medications were reported. The patient recovered from the "anaphylactic reaction" per reporter. Documents held by sender: None.

VAERS ID:393930 (history)  Vaccinated:2010-07-20
Age:11.0  Onset:2010-07-21, Days after vaccination: 1
Gender:Female  Submitted:2010-07-30, Days after onset: 9
Location:Texas  Entered:2010-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: LUMBAR SPRAIN, NO ACTIVE DISEASE
Preexisting Conditions: NO KNOWN PREVIOUS ALLERGIES OR CHRONIC CONDITIONS
Diagnostic Lab Data: NONE
CDC Split Type: TX20100075PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARILRIX)GLAXOSMITHKLINE BIOLOGICALS008921SCLA
Administered by: Unknown     Purchased by: Public
Symptoms: Erythema, Local reaction, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: LOCAL REACTION ON LEFT ARM. ERYTHEMA, WARMTH, AND 2"X2" AREA OF SWELLING. TREATED WITH MOTRIN AND ICE.

VAERS ID:393981 (history)  Vaccinated:2010-07-21
Age:11.0  Onset:2010-07-22, Days after vaccination: 1
Gender:Unknown  Submitted:0000-00-00
Location:California  Entered:2010-07-30
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: hives; angioedema after MMR.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3441BA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Headache, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Malaise, emesis, chills, frontal headache and fever beginning the day after vaccination.

VAERS ID:393982 (history)  Vaccinated:2010-07-28
Age:11.0  Onset:2010-07-28, Days after vaccination: 0
Gender:Male  Submitted:2010-07-29, Days after onset: 1
Location:Texas  Entered:2010-07-30, 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: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.066420IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3473AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3352AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, pain, itching at site of immunizations onset approx. 12 hrs after injections. At onset, Dr. advised BENADRYL: by mouth and ice to site. On 7/29/10, advised ZYRTEC and hydrocortisone to site.

VAERS ID:394006 (history)  Vaccinated:2010-07-30
Age:11.0  Onset:2010-07-30, Days after vaccination: 0
Gender:Female  Submitted:2010-07-30, Days after onset: 0
Location:California  Entered:2010-07-30
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1378Y1IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF484AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swollen, Pain, Redness on area.

VAERS ID:394038 (history)  Vaccinated:2010-07-29
Age:11.0  Onset:2010-07-29, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2010-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA - none reported by parent.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3044AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B036AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Gaze palsy, Immediate post-injection reaction, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Pt complained of dizziness, pt''s skin color was pale after Immunization administration and fainted, eyes rolled back. Med. assistance was requested thru 911. Pt admitted to hospital.

VAERS ID:394062 (history)  Vaccinated:2010-07-16
Age:11.0  Onset:2010-07-16, Days after vaccination: 0
Gender:Female  Submitted:2010-07-27, Days after onset: 11
Location:Arizona  Entered:2010-08-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None listed
Preexisting Conditions: None listed
Diagnostic Lab Data: none known
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3339AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Head injury, Malaise, 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: Client received MENACTRA at school based IZ clinic, approx. ten minutes later, child was sitting in a chair by mom in another area of the clinic, stated she "felt sick, fainted and fell on the floor, hitting right side of her head," child opened her eyes, was responsive and alert. EMS was called and child was taken to ER per parent request.

VAERS ID:394098 (history)  Vaccinated:2010-04-28
Age:11.0  Onset:2010-04-28, Days after vaccination: 0
Gender:Female  Submitted:2010-04-29, Days after onset: 1
Location:Colorado  Entered:2010-08-02, Days after submission: 95
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fainting; Nausea
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1684Y1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1318Y0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF500AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1434Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Immediate post-injection reaction, Loss of consciousness, Muscle contracture, Nausea
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), 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), Hypersensitivity (narrow)
Write-up: Pt. rec''d GARDASIL in left arm. Immediately following injection pt. passed out while sitting in chair and contracted her arms to chest. Pt. regained consciousness after 10 seconds then became nauseated but had no emesis. Breathing was assessed and pt. rec''d water and peanut butter crackers and rested for ten minutes.

VAERS ID:394125 (history)  Vaccinated:2010-07-27
Age:11.0  Onset:2010-07-29, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:Louisiana  Entered:2010-08-02
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3068AA IJLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Erythema and warmth surrounding injection site & induration centrally mild edema, (+) itching.

VAERS ID:394133 (history)  Vaccinated:2010-07-28
Age:11.0  Onset:2010-07-29, Days after vaccination: 1
Gender:Male  Submitted:2010-08-02, Days after onset: 4
Location:Florida  Entered:2010-08-02
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: ADD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3355AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0063Z1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, warmth, and raised at site. BENADRYL (12.5/5ml) 2 tsp by mouth for itching.

VAERS ID:394147 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Female  Submitted:2010-08-03, Days after onset: 0
Location:Massachusetts  Entered:2010-08-03
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.0565Z2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Immediate post-injection reaction, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Within 1 minute of receiving vaccine, pt. felt dizzy. Proceeded to vomit. Pt. laid down for 1/2hr. Upon sitting up pt. vomited again.

VAERS ID:394150 (history)  Vaccinated:2010-08-02
Age:11.0  Onset:2010-08-02, Days after vaccination: 0
Gender:Male  Submitted:2010-08-03, Days after onset: 1
Location:Arizona  Entered:2010-08-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: NONE DISCLOSED BY THE FAMILY
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB431BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1539Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3078AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B043BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hyperhidrosis, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: PT BECAME PALE, DIAPHORETIC, AND ALMOST PASSED OUT. B/P WAS 88/40 AND HER PULSE WAS 84. SHE RECOVERED WITHIN ABOUT 20 MIN.

VAERS ID:394159 (history)  Vaccinated:2009-09-03
Age:11.0  Onset:2010-06-20, Days after vaccination: 290
Gender:Female  Submitted:2010-07-29, Days after onset: 39
Location:New York  Entered:2010-08-03, 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: Allergy to Penicillin G Potassium
Diagnostic Lab Data: Positive Bordatella Pertussis test
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3355AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Bordetella test positive, Pertussis
SMQs:
Write-up: Tested positive for pertussis on sample collected 6/24/10. Exposed to confirmed case(s).

VAERS ID:394170 (history)  Vaccinated:2010-07-28
Age:11.0  Onset:2010-07-28, Days after vaccination: 0
Gender:Female  Submitted:2010-07-28, Days after onset: 0
Location:New York  Entered:2010-08-03, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS024520IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.056520IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR43465AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B042BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Nausea, Posture abnormal
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt. felt dizzy and nauseous and slumped down on the floor.

VAERS ID:394177 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Female  Submitted:2010-08-03, Days after onset: 0
Location:Louisiana  Entered:2010-08-03
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 CEFZIL AND ZITHROMAX
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS0907010IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061CA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.030821SCLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Chest discomfort, Hyperhidrosis, Injection site pain, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad)
Write-up: CHEST TIGHTNESS, TACHYPNEA, ABDOMINAL PAIN, PAIN AT INJECTION SITE, DIAPHORESIS

VAERS ID:394187 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Female  Submitted:2010-08-03, Days after onset: 0
Location:Texas  Entered:2010-08-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: Allergic to Tylenol
Diagnostic Lab Data: None needed.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB379BA0IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD054813IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0155Z1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3358BA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B042BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0027Z1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mother noticed raised red area above bandaid on back of left upper arm where varicella had been given. When bandaid removed by RN, a 1/2" by 1/4" raised red area surrounded by a 1" by 2" slightly raised red area, non-tender, and skin slightly warm to the touch were noted. When child asked if area itched, child responded "No". RN asked PNP to look at reaction. PNP looked at left upper arm, asked parent to stay in clinic waiting area for 15 minutes for observation of any further signs or symptoms. Only complaint while waiting was being sleepy. RN checked RP - 66 and regular. No changes in orientation, respiration, or skin color . RN present with parent and child in waiting area until 3:30 PM. While waiting, RN looked at other injection sites - 2 IM sites on each L and R deltoid and MMR site back of R upper arm. MMR site approximately 1/2" diameter flat red area. At approximately 3:10pm, with parent''s verbal permission, the CNS gave the child 2 tsp. Benadryl. At 3:30 RN and PNP looked at SQ sites: L SQ area much less red and raised. Never itched. R SQ area only pink. PNP wrote on child''s immunization record that child had local reaction to Varicella and MMR vaccines on 8/3/2010.

VAERS ID:394241 (history)  Vaccinated:2009-09-01
Age:11.0  Onset:2010-05-21, Days after vaccination: 262
Gender:Male  Submitted:2010-07-23, Days after onset: 63
Location:New York  Entered:2010-08-03, Days after submission: 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: Autism Spectrum Disorder
Diagnostic Lab Data: Bord. Pertussis, PCR positive
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3196AA IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2926AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3355AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Bordetella test positive, Pertussis, Vaccine breakthrough infection
SMQs:
Write-up: He had TDAP without issues 9/09 - but he developed PCR (+) Bordetella Pertussis 6/10.

VAERS ID:394279 (history)  Vaccinated:2010-07-19
Age:11.0  Onset:2010-07-21, Days after vaccination: 2
Gender:Male  Submitted:2010-07-30, Days after onset: 9
Location:Wisconsin  Entered:2010-08-04, Days after submission: 5
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: Premature had Asthma as infant
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3437AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3446AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0224Z1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Fatigue, Pyrexia, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swelling, fever, fatigue, hot to touch. Went ER 7/21/10.

VAERS ID:394287 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Male  Submitted:2010-08-04, Days after onset: 1
Location:Texas  Entered:2010-08-04
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 (VAQTA)MERCK & CO. INC.0267Y UNRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR  UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0071Z UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3017AA UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3448AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0413Z UNRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 21 x 20 area, 16 x 12 area both arm, red, raised, itching.

VAERS ID:394296 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-04, Days after vaccination: 1
Gender:Female  Submitted:2010-08-04, Days after onset: 0
Location:Colorado  Entered:2010-08-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3111DA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discomfort, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Edema noted around injection site this am by MOC. Mild discomfort when area touched. No redness or warmth noted around area.

VAERS ID:394306 (history)  Vaccinated:2010-08-04
Age:11.0  Onset:2010-08-04, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 0
Location:Florida  Entered:2010-08-04
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
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
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: Fainted few minutes after receiving vaccine for Tdap and Menactra.

VAERS ID:394322 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Male  Submitted:2010-08-05, Days after onset: 2
Location:Arizona  Entered:2010-08-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE MENTIONED BY FAMILY DURING ASSESSMENT
Preexisting Conditions: NONE MENTIONED BY FAMILY DURING ASSESSMENT
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB431BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1539Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3078AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B043BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0338Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Loss of consciousness, Pallor
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: PT STATED HE WAS GOING TO FAINT, TURNED PALE AND PASSES OUT. HIS VS WERE AS FOLLOWS: B/P 92/50 PULSE 88 RESP 14. USED AMMONIA AMPULE TO RISE HIM, LAID HIM ON THE FLOOR, ICE PACK TO BACK OF NECK. PT. RECOVERED WITHIN 15 MINUTES.

VAERS ID:394344 (history)  Vaccinated:2010-08-02
Age:11.0  Onset:2010-08-04, Days after vaccination: 2
Gender:Male  Submitted:2010-08-05, Days after onset: 1
Location:Louisiana  Entered:2010-08-05
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3068AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3049CA UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm red - swollen - warm to touch (Right arm).

VAERS ID:394388 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-04, Days after vaccination: 1
Gender:Female  Submitted:2010-08-05, Days after onset: 1
Location:Kansas  Entered:2010-08-05
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: NKDA; none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3045AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3083CA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1229Y1SCRA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness and arm felt hot yesterday, more redness and continues to feel hot to touch today.

VAERS ID:394405 (history)  Vaccinated:2010-03-25
Age:11.0  Onset:2010-03-27, Days after vaccination: 2
Gender:Female  Submitted:2010-07-26, Days after onset: 121
Location:Florida  Entered:2010-08-05, Days after submission: 10
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: No concomitant vaccinations. Relevant medical history was unknown. The subject had not experienced adverse events following previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0857520A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA088BC0IMAR
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Blood urine present, Diarrhoea, Flushing, Headache, Lethargy, Myalgia, Nausea, Pyrexia, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported by a physician via sales representative and described the occurrence of muscle pain in a 12-year-old female subject who was vaccinated with CERVARIX (GlaxoSmithKline). On 25 March 2010 the subject received 1st dose of CERVARIX (.5 ml ,unknown, unknown arm). On 27 March 2010, 2 days after vaccination with CERVARIX, the subject experienced severe muscle pain, joint pain, vomiting, diarrhea, facial flushing, fever, nausea, blurred vision, lethargy, headache and blood in urine. On 10 April 2010, the muscle pain, joint pain, vomiting diarrhea, facial flushing, fever, nausea, blurred vision, lethargy, headache and blood in urine were resolved. Follow-up information received from healthcare professional (the subject''s mother) on 13 May 2010: CERVARIX was administered intramuscularly. The events resolved on 11 April 2010 (previously reported as 10 April 2010). The immunisation series with CERVARIX was discontinued.

VAERS ID:394465 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Male  Submitted:2010-08-06, Days after onset: 3
Location:California  Entered:2010-08-06
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: ADHD, Asthma
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB437AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3441BA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: patient has rash on back and chest

VAERS ID:394505 (history)  Vaccinated:2010-07-19
Age:11.0  Onset:2010-07-21, Days after vaccination: 2
Gender:Male  Submitted:2010-07-21, Days after onset: 0
Location:California  Entered:2010-08-06, Days after submission: 16
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3076AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B049BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0161Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Inflammation, Pain in extremity, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: (R) arm 10 x 10 cm inflammation circumference (+) warm (+) swelling (+) painful. No Rx.

VAERS ID:394511 (history)  Vaccinated:2010-08-06
Age:11.0  Onset:2010-08-06, Days after vaccination: 0
Gender:Female  Submitted:2010-08-06, Days after onset: 0
Location:Utah  Entered:2010-08-06
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
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061CA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Fall, Loss of consciousness, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Fell off exam table and was shaking x 15-30 seconds. Then in elevator-passed out for 5 seconds.

VAERS ID:394583 (history)  Vaccinated:2008-07-07
Age:11.0  Onset:2009-07-09, Days after vaccination: 367
Gender:Male  Submitted:2010-07-29, Days after onset: 385
Location:Alabama  Entered:2010-08-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Temperature measurement, 101 F
CDC Split Type: WAES0909USA01022
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1679U UNUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Oedema peripheral, Pyrexia, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning a 11 year old male patient with many unspecified underlying problems who on 07-JUL-2008 was vaccinated with a dose of PNEUMOVAX (Lot # was 659921/1679U). On unknown date the patient experienced a fever of 101F, arm swelling and vomiting after receiving PNEUMOVAX. The patient was admitted to an unspecified hospital two days later on approximately 09-JUL-2009 for unknown numbers of days. At the time of the report, the patient recovered from the events. Additional information has been requested.

VAERS ID:395234 (history)  Vaccinated:2009-09-29
Age:11.0  Onset:2009-09-29, Days after vaccination: 0
Gender:Female  Submitted:2010-07-29, Days after onset: 303
Location:Unknown  Entered:2010-08-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0910USA00261
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0627Y1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information has been received from a nurse practitioner concerning an 11 year old female patient with asthma and no known allergies who in 2008, about 1.5 years ago was vaccinated with the first dose of PNEUMOVAX 23 (lot number not reported). On 29-SEP-2009 the patient was vaccinated with the second of PNEUMOVAX 23 (lot number 663888/0627Y). There was no concomitant medication. In the morning of 30-SEP-2009, the patient began to vomiting and the vomiting has recovered by the evening. The patient called the office. Additional information has been requested.

VAERS ID:395833 (history)  Vaccinated:2009-08-13
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2010-07-30
Location:Texas  Entered:2010-08-06, 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:
Preexisting Conditions: The patient had no pre-existing medical conditions, no concomitant medications and no known allergies.
Diagnostic Lab Data:
CDC Split Type: 201004039
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1130X0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2919AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU2933AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Initial case was received on 28 July 2010 from a healthcare professional. An 11 year old female received on 13 August 2009, a left deltoid intramuscular injection of ADACEL (reported lot number U29133 AA not valid for ADACEL, but is valid for MENACTRA), a right deltoid intramuscular injection of MENACTRA (lot number U2919AA) and a right deltoid intramuscular injection of GARDASIL (Merck lot number 1130X). The patient experienced numbness in both arms and legs since the vaccinations (onset date and time not specified). The patient had no pre-existing medical conditions, no concomitant medications and no known allergies. On 28 July 2010, the patient returned to the physician''s office for an annual exam, reported the numbness and stated the symptoms continued. Document''s held by sender: None.

VAERS ID:394613 (history)  Vaccinated:2010-08-02
Age:11.0  Onset:2010-08-02, Days after vaccination: 0
Gender:Female  Submitted:2010-08-09, Days after onset: 7
Location:Alabama  Entered:2010-08-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergy b cefzil
Diagnostic Lab Data:
CDC Split Type: AL1020
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA4IMLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Headache, Influenza like illness, Injection site rash, Nausea, Neck pain, Pain, Pain in extremity, Pyrexia, Sensation of heaviness
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Mom called and said pt. got Tdap here (clinic) yesterday about 3p. Almost 1 hr. later pt. c/o heaviness in legs, achiness, headache, pain in back neck, hands, feet, nausea- no vomiting, feels hot, claw marks on legs- no itching- Around noon today pt. said head, neck, back, hurt the most. Fever elevated 101.6- advised mom to take child to ER. About 6p yesterday mom took pt. to ER- no test done. They gave 1 dose of steroids in ER. Told mom to continue Benadryl, Tylenol, Motrin. Mom was told it was an allergy to something, had flu like symptoms, red bumps about 1-2 1/2 inches in diameter at inj. site.

VAERS ID:394663 (history)  Vaccinated:2010-08-05
Age:11.0  Onset:2010-08-05, Days after vaccination: 0
Gender:Male  Submitted:2010-08-06, Days after onset: 1
Location:Arizona  Entered:2010-08-09, 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: History of seizures-none in 2yrs
Preexisting Conditions: Seizures- but never with immunization
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1318Y0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Client received HPV and H1N1 about 1:30p.m. He was sitting up in a chair as per protocol after shots and was observed with his head down, not responding to verbal commands. He was assisted to the floor. VS WNL. He responded to command to squeeze hand, but could not open eyes or raise hand. O2 2L/NC applied. ? and arrived at 1:42p.m. Client then opened his eyes and became responsive. He left with his mother - no hospitalization.

VAERS ID:394677 (history)  Vaccinated:2010-08-04
Age:11.0  Onset:2010-08-06, Days after vaccination: 2
Gender:Female  Submitted:2010-08-09, Days after onset: 3
Location:Kansas  Entered:2010-08-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: none known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB427AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3083CA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0161Z1SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Client presented to the doctors office at 4pm Friday 8-06. Reported nausea, low grade fever, and approx. 10 cm of redness, swelling and warmth at the site of the varicella vaccination.

VAERS ID:394692 (history)  Vaccinated:2010-08-04
Age:11.0  Onset:2010-08-04, Days after vaccination: 0
Gender:Male  Submitted:2010-08-06, Days after onset: 2
Location:Georgia  Entered:2010-08-09, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3357BA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3035BA IMLA
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER0547Z SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Temperature, swollen upper left arm, hot to touch, sore. Shots received 8/4/10.

VAERS ID:394773 (history)  Vaccinated:2010-07-23
Age:11.0  Onset:2010-07-26, Days after vaccination: 3
Gender:Male  Submitted:2010-08-05, Days after onset: 10
Location:Kentucky  Entered:2010-08-10, 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: Healthy
Preexisting Conditions: None; Healthy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3357BA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3051CA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0339Z1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left deltoid at injection site redness and warm to the touch.

VAERS ID:394851 (history)  Vaccinated:2008-08-07
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2010-08-06
Location:New York  Entered:2010-08-10, 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: PCR Pertussis swab
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2998BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Bordetella test positive, Pertussis
SMQs:
Write-up: (+) Pertussis 8/4/10.

VAERS ID:394853 (history)  Vaccinated:2010-08-05
Age:11.0  Onset:2010-08-06, Days after vaccination: 1
Gender:Male  Submitted:2010-08-10, Days after onset: 4
Location:Pennsylvania  Entered:2010-08-10
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: Hx of tetralogy of fallot
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD041324UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3078AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3158AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Given injection of MENACTRA on 8/5/10 started with erythema 20 hrs later peaked at 98 degrees with erythema, induration (12 X 17 cm) receded spontaneously.

VAERS ID:394883 (history)  Vaccinated:2010-08-04
Age:11.0  Onset:2010-08-05, Days after vaccination: 1
Gender:Male  Submitted:2010-08-06, Days after onset: 1
Location:Pennsylvania  Entered:2010-08-10, Days after submission: 4
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Received TDAP and MCV on 8/4/10 at 330PM started with swelling and hives 20 hrs later Rxn 17 x 12 cm urticarial erythem patch on (L) upper arm.

VAERS ID:394916 (history)  Vaccinated:2010-08-09
Age:11.0  Onset:2010-08-10, Days after vaccination: 1
Gender:Male  Submitted:2010-08-11, Days after onset: 1
Location:New York  Entered:2010-08-11
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, eggs, peanuts, gluten. Tourettes and Celiac
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3486AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Condition aggravated, Tourette's disorder
SMQs:, Congenital, familial and genetic disorders (narrow)
Write-up: Pt experienced full-blown Tourettes event which is continuing at the time of this report. he had not had a serious event since he had his DTaP booster in 3/03. in retrospect his mother reports that the very first event was following his 18mo booster.

VAERS ID:394956 (history)  Vaccinated:2010-08-04
Age:11.0  Onset:2010-08-11, Days after vaccination: 7
Gender:Male  Submitted:2010-08-12, Days after onset: 1
Location:Tennessee  Entered:2010-08-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Heart rate increased, Pyrexia, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow)
Write-up: Fever, fast heartbeat, red itchy bumps. Scheduled doctors appt. today.

VAERS ID:394973 (history)  Vaccinated:2010-07-22
Age:11.0  Onset:2010-07-25, Days after vaccination: 3
Gender:Male  Submitted:2010-08-05, Days after onset: 11
Location:Ohio  Entered:2010-08-12, 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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3465AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3476AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.022721SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Several days after VARIVAX vaccine developed moderate amount of redness and swelling - no one measured - ice and BENADRYL.

VAERS ID:395026 (history)  Vaccinated:2010-08-10
Age:11.0  Onset:2010-08-12, Days after vaccination: 2
Gender:Male  Submitted:2010-08-12, Days after onset: 0
Location:Utah  Entered:2010-08-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURC3476AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3362AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0160Z0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site reaction, Injection site warmth, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large swelling, redness, hot to the touch, induration - spreading from injection site to axilla, shoulder and elbow - approximately 15 cm in diameter. Seems to spread from site of TdaP.

VAERS ID:395051 (history)  Vaccinated:2010-08-12
Age:11.0  Onset:2010-08-12, Days after vaccination: 0
Gender:Female  Submitted:2010-08-12, Days after onset: 0
Location:Pennsylvania  Entered:2010-08-12
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: Functional murmur
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0565Z1UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3465AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3446AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving vaccines, pt with syncope-lying down on table, pale, out for approximately 20 sec feet were raised; HR=60; BP 98/62; PT given lollipop and soda to drink (Pt did not have anything to drink or eat prior to vaccine administration). Pt stayed in office for 20 min-HR=60 BP 102/70. Pt walked out of office accompanied by mother.

VAERS ID:395055 (history)  Vaccinated:2010-08-09
Age:11.0  Onset:2010-08-10, Days after vaccination: 1
Gender:Male  Submitted:2010-08-11, Days after onset: 1
Location:Georgia  Entered:2010-08-12, 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
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR 0UNLA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site pain, Injection site swelling, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Child had headache, neck pain (improved now 8/11/10). Injection site redness, pain, swelling which is improving also. Advised MOTRIN 300mg Q6, BENADRYL 25mg. F/u 1 month.

VAERS ID:395074 (history)  Vaccinated:2010-08-12
Age:11.0  Onset:2010-08-12, Days after vaccination: 0
Gender:Female  Submitted:2010-08-12, Days after onset: 0
Location:Illinois  Entered:2010-08-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0664Z0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3511AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0605Z1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Hypotonia, Malaise, Tonic clonic movements, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Approx 5 min after receiving vaccines c/o "I don''t feel well". Was sitting in chair - put head between knees - sat up and then went limp in dad''s arms who was standing at side of chair. Placed on exam table - was unresponsive for approx 2 1/2 - 3 minutes when placed on table remained unresponsive. Then started with clonic/tonic type movement to arms- were curled up besides body- no incontinence or rolling of eyes but appeared to be seizure. Apparent seizure lasted approx. 2 minutes 911 was called at onset of going limp- Dr called to examining room and witnessed seizure. Transported to Medical Center for evaluation per Fire Dept.

VAERS ID:395106 (history)  Vaccinated:2010-07-28
Age:11.0  Onset:2010-07-29, Days after vaccination: 1
Gender:Male  Submitted:2010-08-04, Days after onset: 6
Location:Rhode Island  Entered:2010-08-13, 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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B046AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1445Y1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site reaction, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Warm, swollen, cutaneous reaction at site of TDAP, no evidence of flucturance.

VAERS ID:395107 (history)  Vaccinated:2010-07-29
Age:11.0  Onset:2010-07-30, Days after vaccination: 1
Gender:Male  Submitted:2010-08-04, Days after onset: 5
Location:Rhode Island  Entered:2010-08-13, 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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3046AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B046A0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site inflammation, Injection site pain, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large local reaction, warm, (R) arm TDAP inflamed, tender to touch. No significant erythema, approx 12cm diameter. TX - BENADRYL, ice ADVIL, rest.

VAERS ID:395145 (history)  Vaccinated:2010-08-10
Age:11.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Unknown  Entered:2010-08-13
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3340AA UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Erythema 48hrs after immunization no induration; no other findings. Described as painful yesterday, itchy today.

VAERS ID:395152 (history)  Vaccinated:2010-08-11
Age:11.0  Onset:2010-08-12, Days after vaccination: 1
Gender:Male  Submitted:2010-08-13, Days after onset: 1
Location:Arizona  Entered:2010-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3075AA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B049BA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0609Z1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt. presented with (R) arm swollen, red & warm to touch around site of vaccine. Had shot day before presenting. Rest exam was normal. Pt. given cephalexin 250 mg. 1 tab. 3x daily. Pt to return if conditions worsen.

VAERS ID:395186 (history)  Vaccinated:2010-08-10
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-13
Location:Indiana  Entered:2010-08-13
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: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVB206CA1IMLA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU3045AA0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:
Write-up: Wrong vaccine give for patient''s age Dtap given should have been Tdap.

VAERS ID:395195 (history)  Vaccinated:2010-08-05
Age:11.0  Onset:2010-08-10, Days after vaccination: 5
Gender:Female  Submitted:2010-08-13, Days after onset: 3
Location:Minnesota  Entered:2010-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none. Patient in the clinic for a well child check up.
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURU3083CA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient complaints of a red, swollen and hard around injection site.

VAERS ID:395265 (history)  Vaccinated:2010-08-12
Age:11.0  Onset:2010-08-12, Days after vaccination: 0
Gender:Female  Submitted:2010-08-16, Days after onset: 4
Location:Ohio  Entered:2010-08-16
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: cultures
CDC Split Type: meningococcalvaccine
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3341AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Confusional state, Culture, Mobility decreased, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Confusion, fever, won''t wake up, no mobility in left side.

VAERS ID:395313 (history)  Vaccinated:2010-08-03
Age:11.0  Onset:2010-08-04, Days after vaccination: 1
Gender:Male  Submitted:2010-08-06, Days after onset: 2
Location:Texas  Entered:2010-08-16, Days after submission: 10
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3437AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3051AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Lymph node pain, Lymphadenopathy
SMQs:
Write-up: Developed tenderness and mild swelling left axillary lymph nodes 24 hours post TDAP left deltoid.

VAERS ID:395320 (history)  Vaccinated:2010-08-04
Age:11.0  Onset:2010-08-04, Days after vaccination: 0
Gender:Male  Submitted:2010-08-09, Days after onset: 5
Location:Wisconsin  Entered:2010-08-16, 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3336AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3051AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient presented to clinic on 8/6/10 for allergy injections. Patient noted swelling on left deltoid where he received an immunization on 8/4/10. Swelling was approximately 4" X 3", raised 1/2". Patient reported tenderness in the area. No redness or warmth noted.

VAERS ID:395337 (history)  Vaccinated:2010-08-06
Age:11.0  Onset:2010-08-06, Days after vaccination: 0
Gender:Female  Submitted:2010-08-10, Days after onset: 4
Location:Arizona  Entered:2010-08-16, 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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3362AA UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3446AA UNRA
Administered by: Public     Purchased by: Other
Symptoms: Balance disorder, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving immuniz., pt. was in the parking lot with mom chatting with an acquaintance. Pt felt dizzy/unsteady-fainted. Came to within a few seconds. EMS called & pt was assessed - Mom refused transport. Pt. stated no food/liquid intake for last 4 hrs. Water given-pt left with mom - ambulating without difficulty. Color natural no distress noted.

VAERS ID:395358 (history)  Vaccinated:2010-08-05
Age:11.0  Onset:2010-08-05, Days after vaccination: 0
Gender:Female  Submitted:2010-08-05, Days after onset: 0
Location:Kansas  Entered:2010-08-16, Days after submission: 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB431AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1354Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3362AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061CA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0338Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 10 minutes after shots given patient had dizziness, seizure, and fainting for approximately 1 minute. Patient recovered after ammonia inhalant given. No falling, no injury. Blood pressure 98/60, pulse = 58. 911 called and pt. taken to hospital.

VAERS ID:395362 (history)  Vaccinated:2010-08-11
Age:11.0  Onset:2010-08-12, Days after vaccination: 1
Gender:Male  Submitted:2010-08-16, Days after onset: 4
Location:North Carolina  Entered:2010-08-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501000P0IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3509AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site oedema, Injection site warmth, Joint range of motion decreased, Oedema peripheral
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), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 8/13/10 Left deltoid warm & edematous. Limited ROM. Given protocol for local vaccine reaction. 8/16/10 swelling gone still redness using arm. (per Mom).

VAERS ID:395924 (history)  Vaccinated:2009-10-14
Age:11.0  Onset:2009-10-17, Days after vaccination: 3
Gender:Female  Submitted:2009-10-17, Days after onset: 0
Location:Virginia  Entered:2010-08-16, Days after submission: 303
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: MEDI0009105
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Abdominal discomfort, Malaise, Nasal congestion, Respiratory tract congestion, Rhinorrhoea
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: A non-serious spontaneous report of not feeling well, stomach complaints, nasal and throat congestion, and a runny nose has been received from the patient''s parent concerning an 11-year-old female patient, subsequent to receiving FLUMIST. The patient''s medical history and concomitant medications were not reported. On 14-Oct-2009, patient received FLUMIST. On 17-Oct-2009, the patient experienced not feeling well and developed stomach complaints, nasal and throat congestion, and a runny nose. The outcomes for the reported adverse events were not reported.

VAERS ID:395984 (history)  Vaccinated:2009-10-07
Age:11.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Male  Submitted:2009-10-07, Days after onset: 0
Location:North Carolina  Entered:2010-08-16, Days after submission: 313
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: MEDI0009015
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500754P IN 
Administered by: Public     Purchased by: Other
Symptoms: Accidental exposure, No adverse event
SMQs:
Write-up: A non-serious spontaneous report of "child moved and we squirted some in his eyes" was received from a non-health care professional concerning an 11-year-old male subsequent to FLUMIST. The patient''s medical history and concomitant medications were not reported. On 07-Oct-2009, the patient received FLUMIST. During the FLUMIST administration, the patient moved, and some of the vaccine was squirted in his eye. The patient''s eye was rinsed out with water. The patient stated that he "never had any problems." There was no adverse event associated with this medication error; therefore, treatment and reported/sponsor causality assessment are not applicable, and the event is considered resolved.

VAERS ID:396025 (history)  Vaccinated:2009-09-01
Age:11.0  Onset:2009-09-01, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 72
Location:Rhode Island  Entered:2010-08-16, Days after submission: 276
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: MEDI0009544
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: A non-serious spontaneous report of Flu-like symptoms has been received from a consumer/mother concerning her 11-year-old daughter, subsequent to FLUMIST. The patient''s past medical history and concomitant medications were not reported. About two months ago in approximately September 2009, the patient received FLUMIST. The same night after the vaccine was administered, the patient experienced a fever and other mild flu-like symptoms. The event resolved within 24 hours of onset.

VAERS ID:396578 (history)  Vaccinated:2009-09-08
Age:11.0  Onset:2009-09-08, Days after vaccination: 0
Gender:Female  Submitted:2009-09-11, Days after onset: 3
Location:South Carolina  Entered:2010-08-16, Days after submission: 339
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: MEDI0008863
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500677P IN 
Administered by: Other     Purchased by: Other
Symptoms: Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: A spontaneous, non-serious report of fever, headache and tiredness has been received from a registered nurse concerning an 11-year-old female patient subsequent to FLUMIST use. Medical history and concomitant medications were not reported. On 08-Sep-2009, the patient received FLUMIST. After receiving FLUMIST on 08-Sep-2009, the patient developed a fever of 101 and complained of headaches and being tired. No further information was available. The outcome of the events, fever, headache and tiredness, was unknown.

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