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Found 500157 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:499774 (history)  Vaccinated:2013-08-15
Age:14.0  Onset:2013-08-15, Days after vaccination: 0
Gender:Male  Submitted:2013-08-15, Days after onset: 0
Location:Illinois  Entered:2013-08-16, 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: KEPPRA 500 mg P.O. BID
Current Illness: No
Preexisting Conditions: Seizure disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0216082UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Fall, Loss of consciousness, Tension
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: After receiving 3rd HPV vaccine, patient fell from examining table, lost consciousness, become tense for one minute, regained consciousness. Patient has known seizure disorder.

VAERS ID:499787 (history)  Vaccinated:2013-08-13
Age:14.0  Onset:2013-08-14, Days after vaccination: 1
Gender:Female  Submitted:2013-08-16, Days after onset: 2
Location:California  Entered:2013-08-16
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
HPV4: HPV (GARDASIL)MERCK & CO. INC.H017698 UNLA
Administered by: Private     Purchased by: Private
Symptoms: Local swelling, Pain
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 14 yr 10 mo old female w/ pain and swelling to (L).

VAERS ID:499884 (history)  Vaccinated:2007-03-12
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-08-20
Location:Unknown  Entered:2013-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPAMAX; REBIF; AZURETTE
Current Illness: Food allergy
Preexisting Conditions:
Diagnostic Lab Data: 07/25/2013, Smear cervix, Positive for Human Papillomavirus(HPV)
CDC Split Type: WAES1308USA007115
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0186U1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Human papilloma virus test positive, Multiple sclerosis, Nuclear magnetic resonance imaging, Optic neuritis, Smear cervix abnormal
SMQs:, Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (broad)
Write-up: This spontaneous report as received from a nurse practitioner refers to an approximately 16 year old female patient with drug reactions/allergies to raspberries. On 11-JAN-2007 the patient was vaccinated with her first dose of GARDASIL (lot # 655619/1427F, exp date as 28-JUN-2009, 0.5 ml, intramuscular). On 12-MAR-2007 the patient was vaccinated with her second dose of GARDASIL (lot # 655618/0186U, exp date as 27-JUN-2009, 0.5 ml, intramuscular). Concomitant therapies included TOPAMAX, REBIF, and AZURETTE. The patient was diagnosed with multiple sclerosis in 2008 after presenting with symptoms of left optic neuritis. Patient had sought medical attention via office visit. MRI(Magnetic resonance imaging) was performed in 2008 with no result was provided. Treatment of REBIF was given for the event. The outcome of multiple sclerosis was reported as not recovered/not resolved. The nurse practitioner also reported that the patient had a PAP screening(Papanicolaou test) on 25-JUL-2013 that was positive for Human Papillomavirus (HPV). Upon internal review, multiple sclerosis was considered as other medical significant event. Additional information has been requested.

VAERS ID:499905 (history)  Vaccinated:2013-03-20
Age:14.0  Onset:2013-07-19, Days after vaccination: 121
Gender:Male  Submitted:2013-08-14, Days after onset: 26
Location:California  Entered:2013-08-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0176982UNLA
Administered by: Private     Purchased by: Other
Symptoms: Guillain-Barre syndrome, Immunoglobulin therapy, Miller Fisher syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Ocular motility disorders (narrow)
Write-up: Guillain Barre - Miller Fisher variant. Hospitalized IVIG followed by oral prednisone.

VAERS ID:500052 (history)  Vaccinated:2013-08-13
Age:14.0  Onset:2013-08-13, Days after vaccination: 0
Gender:Male  Submitted:2013-08-21, Days after onset: 8
Location:Iowa  Entered:2013-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: It was unknown if the subject had any concomitant medications or relevant medical history. It was unknown if the subject had any adverse events following previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A1038099A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Seizure like phenomena
SMQs:, Convulsions (narrow)
Write-up: This case was reported by a healthcare professional, via a sales representative, and described the occurrence of seizure like activity in a 14-year-old male subject who was vaccinated with HAVRIX (GlaxoSmithKline). Concurrent vaccination included HPV vaccine (non-GSK); Merck; unknown; unknown given on 13 August 2013; meningococcal acwy vaccine (non-GSK); non-GSK manufacturer; unknown; unknown given on 13 August 2013. On 13 August 2013 the subject received unspecified dose of HAVRIX (.5 ml, unknown). On 13 August 2013, less than one day after vaccination with HAVRIX, the subject experienced seizure like activity. The healthcare professional reported the subject experienced seizure like activity (unknown symptoms) sometime after the injection in the office. The patient had "Mountain Dew and crackers, felt better, and the seizure activity resolved". This case was assessed as medically serious by GSK. On 13 August 2013, the event was resolved.

VAERS ID:500161 (history)  Vaccinated:2013-08-22
Age:14.0  Onset:2013-08-22, Days after vaccination: 0
Gender:Female  Submitted:2013-08-22, Days after onset: 0
Location:Virginia  Entered:2013-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.H0186913IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSE59570IMLA
Administered by: Public     Purchased by: Public
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: Client very nervous prior to receiving shots. After receiving the 2 vaccines, she was alert, talking, color slightly pale. Suddenly, about 2 minutes after vaccination, clients eyes. Fluttered, color pale and began to slump in chair - completely fainted. Revived with seconds with smelling salts. After resting and sipping H20 x 15 min, client left facility to sit in car before leaving $g 15 min later.

VAERS ID:500271 (history)  Vaccinated:2013-08-08
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2013-08-22
Location:California  Entered:2013-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfacetamide sodium; Clonidine; VENTOLIN HFA; RETIN-A MICRO GEL; Benzoyl peroxide (+) Clindamycin phosphate
Current Illness: Attention deficit/hyperactivity disorder; Acne
Preexisting Conditions: Insomnia
Diagnostic Lab Data:
CDC Split Type: WAES1308USA009356
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0026411IMUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Lymphadenopathy
SMQs:
Write-up: This spontaneous report as received from a licensed vocational nurse refers to a 14 year old male patient with acne and attention deficit/hyperactivity disorder (ADHD and a history of insomnia and no drug reactions or allergies who on 20-JUL-2011, was vaccinated intramuscularly with the first 0.5 ml dose of GARDASIL (lot number 669285/0691AA, Exp. Date: 17-AUG-2013) and on 08-AUG-2013, was vaccinated with the second dose of GARDASIL (lot number J002641, Exp. Date: 10-DEC-2015). Concomitant therapies included Sulfacetamide sodium, Clonidine, VENTOLIN HFA, RETIN-A MICRO GEL, and Benzoyl peroxide (+) Clindamycin phosphate. The nurse reported that on 15-AUG-2013, the patient''s father called to the office regarding a lump in his son throat. The patient was seen in the office on 16-AUG-2013 and the physician diagnosed the patient with lymph node enlargement. Antibiotics, warm compress and Ibuprofen were given as a treatment for the experience. At the time of the report, the patient had not recovered. The relatedness for lymph node enlargement and GARDASIL was unknown. Additional information has been requested.

VAERS ID:500275 (history)  Vaccinated:2013-07-29
Age:14.0  Onset:2013-07-29, Days after vaccination: 0
Gender:Male  Submitted:2013-08-22, Days after onset: 24
Location:North Carolina  Entered:2013-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1308USA009024
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J003727 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia oral, Immediate post-injection reaction, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: This spontaneous report was received from a physician refers to a 14 year old male patient. No medical history or drug allergies were reported. On 29-JUL-2013, the patient was vaccinated with a dose of GARDASIL (lot # J003727, expiry: 07-NOV-2015), 0.5 ml, intramuscular. No concomitant medications were reported. On 29-JUL-2013, the patient''s mother reported to the physician that the patient experienced numbness and tingling of his entire tongue immediately after receiving GARDASIL. The patient''s tongue was getting better. However, there was still numbness and tingling on the tip of the patient''s tongue. The outcome of numbness and tingling of his entire tongue was reported as recovering. Additional information has been requested.

VAERS ID:502460 (history)  Vaccinated:2013-02-22
Age:14.0  Onset:2013-02-22, Days after vaccination: 0
Gender:Male  Submitted:2013-08-22, Days after onset: 180
Location:Washington  Entered:2013-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1303USA011609
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12050010IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB536PA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0097460IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.H0156430SCLA
Administered by: Public     Purchased by: Public
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: This spontaneous report was received from a medical assistant refers to a 14 year old patient (gender unknown). No medical history was reported. On 22-FEB-2013, the 14 year old patient was vaccinated with a 0.5 ml dose of PROQUAD (lot#, expiry not reported) subcutaneously. No concomitant medications were reported. The child is not experiencing any adverse reactions. Follow-up information was received from the reporting medical assistant. On 22-FEB-2013 at 14:30 the male patient received the first dose of PROQUAD (Merck) vaccination in the left arm with valid lot # H015643. Additionally on the same date, he received the second dose of hepatitis A vaccination (other company) intramuscularly in the left arm, the first dose of GARDASIL intramuscularly in the left arm with lot # H009746 and the first dose of a flu vaccine (other company) intramuscularly in the right arm. Additional information is not expected.

VAERS ID:500301 (history)  Vaccinated:2013-08-12
Age:14.0  Onset:2013-08-13, Days after vaccination: 1
Gender:Male  Submitted:2013-08-23, Days after onset: 10
Location:Unknown  Entered:2013-08-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1308USA009217
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0209010IMUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Fall, Ligament sprain, Nausea, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: This spontaneous report was received from a nurse practitioner concerning an approximately 14 year old male patient. There were no drug reactions or allergies. On 12-AUG-2013, the patient was vaccinated with the first dose of 0.5 milliliter (ml) of GARDASIL (lot number and expiry date reported as H020901 and 05-JUL-2015 respectively), intramuscularly. There were no concomitant medications. On 13-AUG-2013, the patient developed blurry vision, nausea, vomiting and lightheadedness after receiving his first dose of GARDASIL. On 14-AUG-2013, the patient experienced sprained ankle due to falling in a hole. The patient sought medical attention. The patient was seen by an unspecified optometrist on 15-AUG-2013 (yesterday). The patient was prescribed on unspecified amount of Meclizine due to the lightheadedness. No lab tests were performed. The patient was not recovered from blurry vision, nausea, vomiting and lightheadedness. The outcome of sprained ankle due to falling in a hole was unknown. The relatedness for all the events was unknown for GARDASIL. Additional information has been requested.

VAERS ID:500748 (history)  Vaccinated:2013-08-27
Age:14.0  Onset:2013-08-27, Days after vaccination: 0
Gender:Female  Submitted:2013-08-27, Days after onset: 0
Location:Kentucky  Entered:2013-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications at time of vaccination
Current Illness: Irregular menses
Preexisting Conditions: NKDA; No known medical problem
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0037270SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient fainted 10 minutes after Gardasil vaccine was administered. After patient woke up, cold packs were applied. Vitals were stable. Patient observed until recovery.

VAERS ID:500869 (history)  Vaccinated:2013-08-27
Age:14.0  Onset:2013-08-27, Days after vaccination: 0
Gender:Female  Submitted:2013-08-29, Days after onset: 2
Location:Pennsylvania  Entered:2013-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: Migraine 09/2011; Near syncope 01/2013; No known drug allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2173 IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.J006236 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Musculoskeletal pain, Oedema peripheral, Pain in extremity, Paraesthesia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: After vaccine given and Pt sitting for 15 min c/o blurred vision and foot pain and tingling. Pt laying down, Vitals monitored. Pt given fruit snacks and water. Vision and tingling cleared after 35 min Foot pain continued. Pt was rechecked in office at 11:00 8/28/2013 for bilateral leg pain Pain worse in right leg. C/o pain in back, shoulders legs and feet. Right foot swelling in AM noted by pt/ mother. Treating with Advil or Aleve prn.

VAERS ID:500873 (history)  Vaccinated:2013-08-06
Age:14.0  Onset:2013-08-06, Days after vaccination: 0
Gender:Male  Submitted:2013-08-29, Days after onset: 23
Location:North Carolina  Entered:2013-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE NOTED
Current Illness: None noted
Preexisting Conditions: None noted
Diagnostic Lab Data: None noted
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB692CA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0209010IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM121270IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B097AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0097831SCRA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Erythema, Pain
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Reddened area on the posterior and side of right arm with a quarter size blister. Pt c/o soreness and pain.

VAERS ID:501203 (history)  Vaccinated:2007-11-23
Age:14.0  Onset:2011-05-06, Days after vaccination: 1260
Gender:Female  Submitted:2013-09-02, Days after onset: 850
Location:Unknown  Entered:2013-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medicatons
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1308USA013849
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Dizziness, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: This spontaneous report as received from a nurse refers to a 17 year old female patient. On 23-NOV-2007, the patient was vaccinated with the first dose of GARDASIL (lot number and expiration date were not provided), 0.5 ml, intramuscular. She was vaccinated the three dose series on an unspecified date. The nurse noted that the patient experienced an adverse experience after completing GARDASIL series on an unspecified date. The nurse reported that the patient began the GARDASIL series on 23-NOV-2007 and completed the three dose series on an unspecified date without any complications noted during the course of the vaccine series. The patient sought medical attention and came to the unspecified physician''s office on 06-MAY-2011 to have an evaluation of lightheadedness and numbness and tingling "which was located in the lower half of her body, specifically her knees and legs". The unspecified physician ordered unspecified blood tests on an unspecified date to evaluate the patient''s symptoms. The patient was not given treatment for events. The outcome of events was reported as recovered on 27-AUG-2013. Additional information has been requested.

VAERS ID:501209 (history)  Vaccinated:2013-08-31
Age:14.0  Onset:2013-09-01, Days after vaccination: 1
Gender:Male  Submitted:2013-09-02, Days after onset: 1
Location:Michigan  Entered:2013-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA110820IMLA
Administered by: Other     Purchased by: Private
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: Red, swollen, and hot area directly below injection site. (Approximately 4" x 3").

VAERS ID:501312 (history)  Vaccinated:2013-08-31
Age:14.0  Onset:2013-08-31, Days after vaccination: 0
Gender:Female  Submitted:2013-09-03, Days after onset: 3
Location:Maryland  Entered:2013-09-03
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
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDR519060UNRA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Vaccine received about 5 PM. Felt lightheaded that evening. Had fever 103 degrees in morning and flu-like sympt.

VAERS ID:501396 (history)  Vaccinated:2013-08-09
Age:14.0  Onset:2013-08-09, Days after vaccination: 0
Gender:Female  Submitted:2013-08-23, Days after onset: 14
Location:Oregon  Entered:2013-09-03, 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: None
Current Illness: None
Preexisting Conditions: Allergy to codeine
Diagnostic Lab Data: See attached notes
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH20295IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4611AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Weakness and tingling of legs (right greater than left).

VAERS ID:501416 (history)  Vaccinated:2013-08-26
Age:14.0  Onset:2013-08-27, Days after vaccination: 1
Gender:Female  Submitted:2013-09-04, Days after onset: 8
Location:California  Entered:2013-09-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: NO
Preexisting Conditions: Allergy to dust
Diagnostic Lab Data: None was told by PA to keep an eye on her
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.UNKNOWN0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Anger, Disorientation, Somnambulism
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow)
Write-up: Patient became very angry, then became disoriented for about an hour, with sleepwalking type symptoms during the day, probably complex partial seizure.

VAERS ID:501548 (history)  Vaccinated:2013-09-04
Age:14.0  Onset:2013-09-04, Days after vaccination: 0
Gender:Male  Submitted:2013-09-05, Days after onset: 1
Location:California  Entered:2013-09-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
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.J0068500UNUN
Administered by: Private     Purchased by: Private
Symptoms: Head injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt had routine blood drawn and was given GARDASIL vaccine. While waiting to give urine specimen (standing) he passed out - hitting head on floor.

VAERS ID:501590 (history)  Vaccinated:2013-09-03
Age:14.0  Onset:2013-09-03, Days after vaccination: 0
Gender:Female  Submitted:2013-09-03, Days after onset: 0
Location:North Carolina  Entered:2013-09-05, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0037270UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0001901UNLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Fall, Headache, Nausea, Screaming, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Vaccines listed below given at approx 3:15 pm, pt then walked to lab waiting area and sat down. At approx 3:20 mother of pt started screaming. Nurses found pt slumped over in chair, unresponsive. Pt carried to exam table/room by MD - pt unresponsive for less than 1 minute. BP''s stable. Pt recovered after 15 mins had some nausea, HA, dizziness. Pt reported she has passed out before with blood work, but never shots.

VAERS ID:501868 (history)  Vaccinated:2013-09-07
Age:14.0  Onset:2013-09-07, Days after vaccination: 0
Gender:Male  Submitted:2013-09-09, Days after onset: 2
Location:Washington  Entered:2013-09-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Ear canal abrasion
Preexisting Conditions: Mood disorder; Anxiety; Migraines
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.HO218610IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA121300IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, 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: Pain, swelling, erythema, itching and tenderness in a 12x18 cm area around the injection site (left upper arm) responding well to cephtriaxone IM.

VAERS ID:502151 (history)  Vaccinated:2013-06-20
Age:14.0  Onset:2013-06-20, Days after vaccination: 0
Gender:Male  Submitted:2013-09-11, Days after onset: 83
Location:Pennsylvania  Entered:2013-09-11
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: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0213460IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)
Write-up: Patient felt lightheaded after injection and was prompted to lay flat for a few minutes. No change in vital signs. Left facility with Mother. Per Mother after getting home still complained of leg weakness and lightheadedness.

VAERS ID:502451 (history)  Vaccinated:2013-09-03
Age:14.0  Onset:2013-09-04, Days after vaccination: 1
Gender:Female  Submitted:2013-09-13, Days after onset: 9
Location:Texas  Entered:2013-09-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bactrim DS
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: TX130029PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC188AA0 RA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB677BA0 RA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURH134011 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.J0025051SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4612AA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0037131SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site reaction, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Large, red whelp 5 cm long and 3 cm wide, warm to touch and itchy, on the back side of right upper arm SQ.

VAERS ID:502677 (history)  Vaccinated:2013-09-12
Age:14.0  Onset:2013-09-12, Days after vaccination: 0
Gender:Male  Submitted:2013-09-13, Days after onset: 1
Location:New Jersey  Entered:2013-09-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J007354 IMUN
Administered by: Private     Purchased by: Private
Symptoms: Dyskinesia, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient became pale was standing sat in chair - 3-4 jerks of arms lasted < 15 seconds. Patient able to lay on table. Felt improved within 5 minutes. Patient had not eaten all day.

VAERS ID:502726 (history)  Vaccinated:2012-12-05
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2013-09-16
Location:Florida  Entered:2013-09-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Asthma
Diagnostic Lab Data: Blood/Urine
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1SYRRA
Administered by: Unknown     Purchased by: Other
Symptoms: Amnesia, Asthenia, Blood test, Blood urine present, Decreased appetite, Disturbance in attention, Dizziness, Lethargy, Syncope, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Weakness, lethargy, loss of appetite, inability to concentrate, some memory loss, dizziness, blood in urine, fainting spells and lightheaded symptoms.

VAERS ID:502823 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Unknown  Submitted:2013-09-17
Location:Unknown  Entered:2013-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1308USA013655
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: This spontaneous report as received from a Certified Medical Assistant (CMA) refers to a 14 year old patient of unknown gender. On an unknown date the pediatric patient was inadvertently administered an adult dosage of VAQTA. No adverse effects were reported. Additional information has been requested.

VAERS ID:502879 (history)  Vaccinated:2013-09-16
Age:14.0  Onset:2013-09-16, Days after vaccination: 0
Gender:Female  Submitted:2013-09-17, Days after onset: 1
Location:New Mexico  Entered:2013-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nortriptyline (PAMELOR) 10 mg capsule; diazepam (VALIUM) 2 mg tablet
Current Illness: None reported
Preexisting Conditions: Foot pain; Syncope; Chronic pain syndrome; Diaphragmatic disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSU4446AC2IMLA
Administered by: Private     Purchased by: Other
Symptoms: Lip swelling, Pharyngeal oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Hives, Swelling of lips, Urticaria, Swelling of throat.

VAERS ID:502962 (history)  Vaccinated:2013-09-05
Age:14.0  Onset:2013-09-06, Days after vaccination: 1
Gender:Female  Submitted:2013-09-18, Days after onset: 12
Location:Illinois  Entered:2013-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0129732IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Crying, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad)
Write-up: Mom states child came to her at 1:00 Am with fever and body aches. She was given Tylenol and continued to have fever and increased body/joint aches and was crying with pain. Complained that the tops of her feet hurt. She was taken to ER by 4:30 AM. She was monitored there for approximately 3.5 hrs and discharged home. She continued to have fever for the next 48 hrs.

VAERS ID:503276 (history)  Vaccinated:2013-09-18
Age:14.0  Onset:2013-09-18, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:New Jersey  Entered:2013-09-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADD; ADHD; Allergic Rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073540IMLA
Administered by: Private     Purchased by: Private
Symptoms: Mental status changes, Presyncope
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving HPV vaccine patient had a near syncopal episode with altered mental status lasting almost 45 minutes. After 45 minutes pt had returned to pre-vaccine status and was observed in office.

VAERS ID:503474 (history)  Vaccinated:2013-09-20
Age:14.0  Onset:2013-09-20, Days after vaccination: 0
Gender:Male  Submitted:2013-09-20, Days after onset: 0
Location:New Jersey  Entered:2013-09-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of syncope (vasovagal)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4766AA3IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073540IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Headache, Hypotonia, Pallor
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Received flu and GARDASIL vaccine, 1-2 min after said "I have a headache", then reported being dizzy. 1 minute later, turned pale and limp (was sitting). Returned to supine position, check HR (HRR) and came to after 1-2 minutes. Laid down for 15-15 minutes, was able to tolerate and return to baseline.

VAERS ID:503543 (history)  Vaccinated:2012-10-24
Age:14.0  Onset:2013-01-03, Days after vaccination: 71
Gender:Male  Submitted:2013-01-09, Days after onset: 6
Location:Ohio  Entered:2013-09-20, Days after submission: 253
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Influenza B virus test, 01/03/13, Positive
CDC Split Type: 2013SE01965
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH2109 IN 
Administered by: Other     Purchased by: Other
Symptoms: Influenza B virus test positive
SMQs:
Write-up: A report has been received from a health professional concerning a 14 year old, male patient. No medical history, concurrent disease or concomitant medication was provided. On 24-Oct-2012, the patient receiving nasal FLUMIST. The patient had positive test for influenza B on 03-Jan-2013. At the time of reporting, the outcome of the event of positive test for influenza B was unknown. The report was considered to be non-serious by the reporter.

VAERS ID:503546 (history)  Vaccinated:2012-10-16
Age:14.0  Onset:2013-01-06, Days after vaccination: 82
Gender:Female  Submitted:2013-01-08, Days after onset: 2
Location:Maryland  Entered:2013-09-20, Days after submission: 254
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE01943
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Influenza
SMQs:
Write-up: A report has been received from consumer, concerning a 15 year old, female patient (one of two sisters). The patient''s medical history and concomitant medications were not reported. On 16-Oct-2012, the patient received FLUMIST. On 06-Jan-2013, the patient and her sister, were both diagnosed with Influenza B. On 10-Jan-2013, the patient returned to school and was recovered. The report was considered to be non-serious by reporter. Summary of follow-up information received by AstraZeneca/MedImmune from consumer on 07-Mar-2013: event stop date entered, outcome changed from unknown to recovered. Corrected report 18-Mar-2013: third reporter, type other, entered.

VAERS ID:503638 (history)  Vaccinated:2012-11-01
Age:14.0  Onset:2013-02-01, Days after vaccination: 92
Gender:Male  Submitted:2013-03-25, Days after onset: 51
Location:Unknown  Entered:2013-09-20, Days after submission: 179
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness: Diabetic
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE20192
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody increased, Autoimmune disorder, Iritis, Uveitis
SMQs:, Systemic lupus erythematosus (narrow), Ocular infections (broad)
Write-up: A consumer report has been received. The report concerns a 14 year old male patient. The patient was diabetic. The patient started to receive Nasal FLUMIST during Nov-2012. The patient started to experience autoimmune issues including iritis, uveitis and ANA $g 600 since 01-Feb-2013. At the time of reporting, the event of autoimmune issues was ongoing and the outcome of the event of iritis, uveitis and ANA $g 600 was unknown. The report was considered to be non-serious by a company physician.

VAERS ID:503871 (history)  Vaccinated:2008-04-10
Age:14.0  Onset:2013-09-07, Days after vaccination: 1976
Gender:Female  Submitted:2013-09-24, Days after onset: 17
Location:Pennsylvania  Entered:2013-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: VZV DFA positive source: lesion accession #:310585203 collection date: 9/10/2013
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2616AA UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1975U1UNUN
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Herpes zoster, Rash, Varicella virus test positive
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Herpes zoster in a two dose varicella vaccine recipient who is immunocompromised (lupus, juvenile RA, Sjogren''s Syndrome). Location of rash was on right side of face. Also developed cellulitis. Lasted <4 weeks. IV acyclovir given in hospital and continued valacyclovir at home. She reported no history of varicella disease.

VAERS ID:503878 (history)  Vaccinated:2013-09-23
Age:14.0  Onset:2013-09-23, Days after vaccination: 0
Gender:Female  Submitted:2013-09-24, Days after onset: 1
Location:North Carolina  Entered:2013-09-24
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: Familial Hypercholesterolemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 0SYRLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Gaze palsy, Skin discolouration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Was fine at time of shot. A few seconds after shot was administered eyes rolled back in head and fell back on table (fainted) then began to convulse for maybe 10 seconds...nurse put her legs up in the air and I held fan in her face while beating on the wall for help. She then began to open her eyes and then close them again like she could not stay awake. After a few minutes color back and awake. Other nurse brought fluids and crakers for her to eat. Patient had had a big lunch around 1:30 and plenty of juice to drink before going to Health Dept.

VAERS ID:503992 (history)  Vaccinated:2011-06-30
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-09-24
Location:Georgia  Entered:2013-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1107USA00476
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0766Z1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a licensed practical nurse and the patient''s mother for GARDASIL, a Pregnancy Registry product, concerning a 14 year old female patient with no pertinent medical history or drug reactions/allergies who at the "sometime in the beginning of the year" was vaccinated with the first dose of GARDASIL. On 30-JUN-2011, the patient was vaccinated IM with the second 0.5 ml dose of GARDASIL (Lot # 666596/0766Z) into her left arm. There were no concomitant medications. Subsequently, on 06-JUL-2011, the patient found out that she was "almost 8 weeks pregnant". No adverse effect was reported. Follow-up information of prospective pregnancy report was received from licensed practical nurse. The patient''s history of previous pregnancies and live births is not known. No other co-suspects were reported. No concomitant medications were reported. It was reported that the patient''s estimated delivery date (EDD) was on 20-FEB-12 and based on that the last menstrual period (LMP) was calculated as of 16-MAY-2011. The patient was exposed to GARDASIL during the first and second and third trimester. It was reported that on 06-FEB-12, the patient delivered a male infant via vaginal delivery without complications. The infant''s APGAR scores are not available. Upon delivery, the infant was noted to be a normal, healthy newborn. The infant weight 7lbs and 8 oz, length 20 inches. No congenital anomalies reported. Additional information is not expected.

VAERS ID:504108 (history)  Vaccinated:2003-09-04
Age:14.0  Onset:2013-09-04, Days after vaccination: 3653
Gender:Female  Submitted:2013-09-25, Days after onset: 21
Location:Tennessee  Entered:2013-09-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH906AB IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad)
Write-up: Patient initially reported her left hand going numb while in class and being unable to effectively complete tasks requiring dexterity in the fingers. She said that this went on for a few days, but not only gets tingling in her fingers in the left hand when she crosses her arms or puts any kind of pressure on the nerves in her arm. The injection that we administered was in the left arm.

VAERS ID:504259 (history)  Vaccinated:2013-09-25
Age:14.0  Onset:2013-09-26, Days after vaccination: 1
Gender:Female  Submitted:2013-09-26, Days after onset: 0
Location:North Carolina  Entered:2013-09-26
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 vaccine.
Preexisting Conditions: None
Diagnostic Lab Data: VS 102/64 P 72 sat 97%
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS2   
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0200020IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Fall, Head injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: After HPV injection pt amb with mother out of exam room and was at check out desk and pt started to feel "whoosie" and fell to the floor and hit back of head on wall on way to floor. Passed out for 1-2 minutes, aroused and vs taken feet elevated until conscious and assisted to w/c and given juice and wheeled back to exam room for monitoring.

VAERS ID:504282 (history)  Vaccinated:2013-08-14
Age:14.0  Onset:2013-08-14, Days after vaccination: 0
Gender:Female  Submitted:2013-09-26, Days after onset: 43
Location:Texas  Entered:2013-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURJ12813SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.H0174332SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4612AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0001931SCLA
Administered by: Unknown     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving 4 immunizations the child fainted in the lobby, while waiting 15 minutes before leaving office.

VAERS ID:504541 (history)  Vaccinated:2013-08-12
Age:14.0  Onset:2013-08-13, Days after vaccination: 1
Gender:Male  Submitted:2013-09-28, Days after onset: 46
Location:Florida  Entered:2013-09-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None. They gave him Gardasil. He never had any reaction before to any other vaccination. They refused to put this severe adverse reaction on his chart because the vaccine with given without parental consent.
Current Illness: No
Preexisting Conditions: He has hereditary spherocytosis and asthma.
Diagnostic Lab Data: They did nothing but tell me to give the kid Pedialyte. The adverse reaction was completely misdiagnosed because I was unaware that this vaccine was given. They did it without any parental consent.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Dizziness, Nausea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: He was feeling very dizzy and sick to his stomach. He broke out in a rash all over his back. He threw up and had diarrhea every day for 5 days.

VAERS ID:504737 (history)  Vaccinated:2013-09-29
Age:14.0  Onset:2013-09-29, Days after vaccination: 0
Gender:Male  Submitted:2013-09-29, Days after onset: 0
Location:Illinois  Entered:2013-09-30, 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:
Diagnostic Lab Data: Pulse=EU; BP low
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS13086010UNLA
Administered by: Other     Purchased by: Private
Symptoms: Blindness, Dysarthria, Feeling cold, Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was administered Fluvirin. Sat down in waiting room. After approximately 5 min, was pale, loss of vision, sweating, cold, slurred speech, low blood pressure. Called 911 and evaluated by paramedics. Came to but went to hospital for further evaluation as advised by paramedics.

VAERS ID:504761 (history)  Vaccinated:2013-09-05
Age:14.0  Onset:2013-09-05, Days after vaccination: 0
Gender:Female  Submitted:2013-09-05, Days after onset: 0
Location:California  Entered:2013-09-30, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS355590IMLA
Administered by: Other     Purchased by: Private
Symptoms: Convulsion, Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt passed out and had seizure while resting on the chair 9/6 Pt. has vaso reaction per mom - doing ok today.

VAERS ID:504983 (history)  Vaccinated:2013-09-30
Age:14.0  Onset:2013-09-30, Days after vaccination: 0
Gender:Female  Submitted:2013-10-01, Days after onset: 1
Location:California  Entered:2013-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No, well at visit was here for regular check up.
Preexisting Conditions:
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0057130IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073540IMLA
Administered by: Private     Purchased by: Private
Symptoms: Haemoglobin, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted. Lasted only seconds, was sitting at the time. Had also had finger poke for hemoglobin. No injury occurred.

VAERS ID:505085 (history)  Vaccinated:2013-05-03
Age:14.0  Onset:2013-05-05, Days after vaccination: 2
Gender:Female  Submitted:2013-10-01, Days after onset: 149
Location:Michigan  Entered:2013-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/a
Preexisting Conditions: Asthma
Diagnostic Lab Data: Heart monitor for 30 days
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1SYRLA
Administered by: Unknown     Purchased by: Other
Symptoms: Abdominal pain, Back pain, Cardiac monitoring, Chest pain, Feeling hot, Headache, Palpitations, Toothache
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Racing heart beat, chest pain, back pain, tooth pain, abdomen pain, head ache, vision problems, face turn real hot.

VAERS ID:506094 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Unknown  Submitted:2013-10-07
Location:Unknown  Entered:2013-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1309USA014058
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster
SMQs:
Write-up: This spontaneous report as received from a physician refers to a 14 year old patient. On unknown dates the patient was vaccinated with two doses of VARIVAX (Merck) (lot#, expiration and dose unspecified). On an unknown date the patient experienced shingles. The patient sought medical attention via saw the physician. Antiviral medication was given for treatment. The event outcome was unknown. Additional information has been requested.

VAERS ID:506366 (history)  Vaccinated:2013-07-11
Age:14.0  Onset:2013-07-14, Days after vaccination: 3
Gender:Female  Submitted:2013-10-08, Days after onset: 86
Location:Massachusetts  Entered:2013-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Amylase and lipase initially normal - climbed to a peak of 287 and 437 respectively, they have trended down and are normal. Abdominal CT was normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0218612IMUN
Administered by: Unknown     Purchased by: Private
Symptoms: Abdominal pain, Amylase increased, Computerised tomogram abdomen normal, Lipase increased, Pancreatitis, Vomiting
SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Abdominal pain and vomiting - admitted to hospital, diagnosed with pancreatitis, was discharged on 07/22/14 improved - has recovered completely.

VAERS ID:506481 (history)  Vaccinated:2013-06-28
Age:14.0  Onset:2013-07-15, Days after vaccination: 17
Gender:Female  Submitted:2013-10-08, Days after onset: 85
Location:Utah  Entered:2013-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: She had another vaccination on 8/30/13
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H021861 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Menstruation irregular, Migraine
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Fertility disorders (broad)
Write-up: Patient has never had missed menses but reports that she has had irregular menses since this shot. She also has had dizziness and new onset migraines.

VAERS ID:506598 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-10-09
Location:Unknown  Entered:2013-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: MRI of brain and cervical spine were unremarkable. Laboratory testing showed positive antinuclear antibodies (ANA) with titers 1:160 with speckled pattern. Rheumatological evaluation was unrevealing raising a possibility of fibromyalgia. A tilt table test demonstrated a supine heart rate of 72 bpm which increased to a maximum of 124 bpm within 10 min of tilt without evidence of orthostatic hypotension. The results of the autonomic testing indicated POTS and positive small fiber neuropathy.
CDC Split Type: WAES1310USA003819
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody positive, Diarrhoea, Fatigue, Headache, Hypoaesthesia, Laboratory test abnormal, Nausea, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging spinal normal, Paraesthesia, Postural orthostatic tachycardia syndrome, Rheumatoid factor negative, Syncope, Tachycardia, Tilt table test positive, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)
Write-up: Information has been received from the authors in a published literature article, concerning a healthy 14-year-old female who five days after receiving the first injection of GARDASIL vaccine, experienced numbness and tingling in the toes. Over the following 2 weeks, the numbness and tingling increased to involve the lower extremities and pelvis. Other symptoms, such as fatigue, headache, nausea, diarrhea, weight loss and tachycardia ensued. Nuclear magnetic resonance imaging (MRI) of the brain and cervical spine were unremarkable, and laboratory testing showed positive antinuclear antibodies (ANA) with titers I: 160 with speckled pattern. Rheumatological evaluation was unrevealing raising a possibility of fibromyalgia. A tilt table test demon striated a supine heart rate of 72 bpm which increased to a maximum of 123 bpm within 10 min of tilt without evidence of orthostatic hypotension. Heart rate responses to the Valsalva maneuver and deep breathing test were unremarkable, and sweat output in the leg with the quantitative sudomotor test was borderline reduced. The results of the autonomic testing indicated Postural orthostatic tachycardia (POTS) and possible small fiber neuropathy, and the patient was started on metoprolol tartrate to control the tachycardia. Over the following 2 years, her symptoms had improved with the use of metoprolol tartrate for Postural orthostatic tachycardia syndrome (POTS) and amitriptyline. The reporter stated that neurocardiogenic syncope (NCS) was diagnosed during the tilt table test. The reporter stated nevertheless, none of the patients experienced complete resolution of symptoms, and all patients continued to experience some residual symptoms. Possible pathogenesis of the new onset POTS after vaccination may include the mechanism of molecular mimicry, whereas HPV vaccine epitopes may induce formation of cross-reacting antibodies against potential tarts of the autonomic ganglia, neurons, cardiac proteins or 231/2-adrenergic and M2/3 muscarinic receptors. Additionally, induction of bystander lymphocyte lymphocyte activation and a broad spectrum of cytokine responses elicited by the HPV vaccine may also be involved. The reporter stated that the temporal association between vaccination with GARDASIL and the onset of symptoms of POTS in healthy young women is significant and deserves further investigation for assessment of a possible casual relationship. Additional information has been requested.

VAERS ID:507231 (history)  Vaccinated:2013-10-10
Age:14.0  Onset:2013-10-10, Days after vaccination: 0
Gender:Male  Submitted:2013-10-10, Days after onset: 0
Location:California  Entered:2013-10-10
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H021705 SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Urticaria over entire body. Tx - BENADRYL liquid.

VAERS ID:506996 (history)  Vaccinated:2013-09-09
Age:14.0  Onset:2013-09-10, Days after vaccination: 1
Gender:Female  Submitted:2013-10-11, Days after onset: 31
Location:Connecticut  Entered:2013-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Private     Purchased by: Unknown
Symptoms: Balance disorder, Chest pain, Headache, Influenza like illness, Palpitations, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 9/11: rash x 2 days, flu like symptoms x 1 week. 9/19: chest pain, palpitations. Improving. 9/22: headache, dysequilibrium. Persistent. No prior similar symptoms.

VAERS ID:507099 (history)  Vaccinated:2013-10-11
Age:14.0  Onset:2013-10-11, Days after vaccination: 0
Gender:Female  Submitted:2013-10-12, Days after onset: 1
Location:California  Entered:2013-10-12
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
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.  IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain upper, Dizziness, Headache, Myalgia, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted as the vaccine went into her body. Headache, dizziness, nausea, muscle pain, stomach ache 12 hours later still.

VAERS ID:507309 (history)  Vaccinated:2013-10-15
Age:14.0  Onset:2013-10-15, Days after vaccination: 0
Gender:Male  Submitted:2013-10-15, Days after onset: 0
Location:Texas  Entered:2013-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: No
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT)SANOFI PASTEURUH925AA1IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSPT5331IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073340IMLA
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt. completed lab draw and 3 vaccinations. As pt. and family were walking out of the clinic, pt. became dizzy and fainted at the front entrance. Pt.''s father caught pt. so that he did not hit the floor. RN''s responded to CODE YELLOW call. Pt. was gently laid on the floor, RN checked HR=48, pt. diaphoretic, pale in color, eyes closed, normal respiratory breathing. RN elevated pt.''s feet. Pt. responded appropriately to all questions. Dr. spoke with pt. and parents. BP= 118/68. Pt. assisted to sitting position, then to standing position. Denied any dizziness. Pt. assisted to chair, given cup of water and frozen ice pop. After sitting in chair for a few minutes, pt. ambulated around the clinical area with RN without any sxs. Parents instructed to get a snack for pt. to help increase blood sugar. Parents verbalized understanding.

VAERS ID:507397 (history)  Vaccinated:2013-10-15
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2013-10-16
Location:Georgia  Entered:2013-10-16
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS    
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Nausea, Retching
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: About 10 seconds after receiving the shot he felt dizzy, nauseous, had to sit down. Had dry heaves.

VAERS ID:507521 (history)  Vaccinated:2013-10-10
Age:14.0  Onset:2013-10-10, Days after vaccination: 0
Gender:Female  Submitted:2013-10-17, Days after onset: 7
Location:Kentucky  Entered:2013-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC; FLONASE; SINGULAIR
Current Illness: None
Preexisting Conditions: Seasonal Allergic Rhinitis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH21738IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073540IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Diarrhoea, Feeling abnormal, Malaise, Nasal congestion, Nausea, Oropharyngeal pain, Palpitations, Respiratory tract congestion, Viral infection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: Overall not feeling well or like herself. Heart racing, cough and congestion, nausea, sore throat, diarrhea - was seen in the office on 10/16/13 and dx with viral illness.

VAERS ID:508699 (history)  Vaccinated:2013-07-24
Age:14.0  Onset:2013-09-22, Days after vaccination: 60
Gender:Female  Submitted:2013-10-21, Days after onset: 29
Location:Texas  Entered:2013-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase Nasal Spray 50 mcg; Zyrtec oral tablet 10 mg
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRI of Brain 10/03/2013; MRI of Orbits, Cervical Spine, Thoracic Spine 10/16/2013; Spinal Tap 10/17/2013
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0218610IMLA
Administered by: Private     Purchased by: Private
Symptoms: Anosmia, Colour blindness acquired, Colour vision tests abnormal, Lumbar puncture, Nuclear magnetic resonance imaging, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging spinal, Vision blurred
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (narrow), Retinal disorders (narrow)
Write-up: Quick onset of blurred vision in both eyes. Identification of color noted to be incorrect 4 days later. Loss of color perception a week later. Loss of the ability to smell.

VAERS ID:508966 (history)  Vaccinated:2007-06-14
Age:14.0  Onset:2007-06-14, Days after vaccination: 0
Gender:Female  Submitted:2013-10-22, Days after onset: 2322
Location:North Carolina  Entered:2013-10-22
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Right upper and lower extremity paralysis~Meningococcal Conjugate (Menactra)~1~14.67~Patient|Speech impairment~Meningococcal Con
Other Medications: Tb booster
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0018U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2277AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B005CA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Cognitive disorder, Guillain-Barre syndrome, Headache, Pain, Photosensitivity reaction, Sensory loss, Speech disorder
SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Hypersensitivity (broad)
Write-up: Mild Guillain Barre Syndrome: Right extremities had loss of sensation and no control. Speech impairment, not able to speak clearly or fluently. Unable to understand what was being said by others. Mild headache in someone who does not usually get headaches. Photo-sensitivity to bright light. First signs of symptoms occurred when standing and talking. Meningococcal Conjugate Vaccine was administered earlier in the day at a routine visit to the doctor''s office for Tb booster and TDaP, which were both administered at the same time. After two hours of symptoms, I slept it off for 4-6 hours. When I woke up everything was back to normal with slight soreness that went away after a few hours. I was informed that my parents had called the hospital as my doctor was not available. Hospital informed them that if the symptoms got worse that I was to come to the ER. Symptoms did not progress from onset, but did stay the same as mentioned above for the entire two hours.

VAERS ID:509150 (history)  Vaccinated:2013-09-17
Age:14.0  Onset:2013-09-17, Days after vaccination: 0
Gender:Female  Submitted:2013-09-17, Days after onset: 0
Location:Connecticut  Entered:2013-10-23, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE70330
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2027 IN 
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: A report has been received from a Health Professional concerning a 14 year old, female subject, who had been receiving FLUMIST (Intranasal). FLUMIST started on 17-Sep-2013. The patient experienced FLUMIST which started on 17-Sep-2013. FLUMIST was discontinued on 17-Sep-2013. The outcome of the event of FLUMIST is unknown. The report was considered to be non-serious.

VAERS ID:509359 (history)  Vaccinated:2013-10-18
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2013-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol prn
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH899AD0IN 
Administered by: Other     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: No adverse effects. A flu clinic was held at school. Mom indicated that she preferred patient be given "Live intranasal vaccine only." Mom also indicated patient has asthma on the top of form.

VAERS ID:509584 (history)  Vaccinated:2013-10-17
Age:14.0  Onset:2013-10-17, Days after vaccination: 0
Gender:Female  Submitted:2013-10-18, Days after onset: 1
Location:North Carolina  Entered:2013-10-25, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLOVENT; PROVENTIL
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH892AA SYRRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0097880SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Nausea, Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Rash at injection site (LA), wheezing, nausea, throat tightening.

VAERS ID:509777 (history)  Vaccinated:2013-10-26
Age:14.0  Onset:2013-10-26, Days after vaccination: 0
Gender:Male  Submitted:2013-10-26, Days after onset: 0
Location:California  Entered:2013-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS13442P IMLA
Administered by: Other     Purchased by: Private
Symptoms: Convulsion, Feeling hot, Gaze palsy, Musculoskeletal stiffness
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad)
Write-up: Eyes rolled back, convulsions, stiff, stated he felt hot, over 1 minute duration then pt snapped out of it. No treatment. Rested for 20 minutes and had water. Father took pt to MD to get evaluated.

VAERS ID:509895 (history)  Vaccinated:2013-09-23
Age:14.0  Onset:2013-09-25, Days after vaccination: 2
Gender:Female  Submitted:2013-10-24, Days after onset: 29
Location:Puerto Rico  Entered:2013-10-28, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDR53207 IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4428AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS7799K IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J004154 SCLA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Injection site rash, Nasal congestion, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: On 9/25/2013 the mother specifies that patient had rash in the neck, arms, face and chest. She was vaccinated on 9/23/2013. Patient arrives to us with these symptoms, headache, body aches, fever, and nasal congestion 10/24/2013.

VAERS ID:510102 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-10-29
Location:Unknown  Entered:2013-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA012345
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: This spontaneous report as received from a consumer, as part of a marketing research program, refers to a 14 year old female patient. In 2011, the patient was vaccinated with a dose of GARDASIL. (dose and lot# not reported). In 2011, the patient experienced "distorted skin" reaction at injection sites. The outcome of the event was reported as probably resolved before the third shot. The reporter considered the event to be related to GARDASIL. This is one of several reports received from the same source. Additional information is not expected.

VAERS ID:510130 (history)  Vaccinated:2013-08-19
Age:14.0  Onset:2013-08-20, Days after vaccination: 1
Gender:Male  Submitted:2013-10-26, Days after onset: 67
Location:California  Entered:2013-10-29, Days after submission: 3
Life Threatening? No
Died? Yes
   Date died: 2013-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Autopsy.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0200621IMLA
Administered by: Private     Purchased by: Private
Symptoms: Autopsy, Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.

VAERS ID:510399 (history)  Vaccinated:2013-10-15
Age:14.0  Onset:2013-10-15, Days after vaccination: 0
Gender:Female  Submitted:2013-10-30, Days after onset: 15
Location:Arkansas  Entered:2013-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: AR1316
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4698CB3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Head injury, Immediate post-injection reaction, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: On completion of flu injection she passed out and rolled out of chair hitting head on concrete. She quickly regained consciousness. She had not eaten and was given crackers and sprite. No injuries noted.

VAERS ID:510534 (history)  Vaccinated:2013-10-22
Age:14.0  Onset:0000-00-00
Gender:Unknown  Submitted:2013-10-30
Location:Virgin Islands  Entered:2013-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA014405
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.H012250 UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to a 14 year old patient of unknown gender. Medical history and drug allergies were not reported. On 22-OCT-2013, the patient was vaccinated with RECOMBIVAX HB lot # H012250, expiration date 06-FEB-2015 (concentration, dose and indication were not reported) that was exposed to three low temperature excursions of 28F for 24 hours, 31F for 24 hours and 30F for 96 hours. No adverse effect has been observed or reported. This is one of several reports from the same source. Additional information is not expected.

VAERS ID:510750 (history)  Vaccinated:2013-10-21
Age:14.0  Onset:2013-10-23, Days after vaccination: 2
Gender:Female  Submitted:2013-10-31, Days after onset: 8
Location:Tennessee  Entered:2013-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient had dysuria
Preexisting Conditions:
Diagnostic Lab Data: MRI brain, cervical, thoracic and lumbar spine -$g normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4772AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Decreased appetite, Dizziness, Hypoaesthesia, Nausea, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Numbness of left arm and leg. Flu shot given on Oct. 21, 2013. On Oct 22, 2013, she felt weak, nauseous and dizzy with anorexia. On Oct 23, 2013 -$g developed numbness on left arm and leg. No focal weakness.

VAERS ID:510853 (history)  Vaccinated:2013-10-28
Age:14.0  Onset:2013-10-31, Days after vaccination: 3
Gender:Male  Submitted:2013-11-01, Days after onset: 1
Location:Illinois  Entered:2013-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None. Mother reports father develops light rash in response to febrile illness, but patient''s temperature was not taken following the immunization.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSYJ4750IMRA
Administered by: Public     Purchased by: Private
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Developed a light red rash; not raised, no itching.

VAERS ID:510868 (history)  Vaccinated:2013-10-30
Age:14.0  Onset:2013-10-31, Days after vaccination: 1
Gender:Male  Submitted:2013-10-31, Days after onset: 0
Location:Oregon  Entered:2013-11-01, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FIBERCON
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: OR201326
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.H0126421IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0216080IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4414AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Discomfort, Erythema, Local reaction, Local swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right deltoid - local reaction, swelling approx 2" diameter warm to touch, erythema tx with ice and ibuprofen for discomfort.

VAERS ID:510992 (history)  Vaccinated:2013-08-12
Age:14.0  Onset:2013-08-12, Days after vaccination: 0
Gender:Female  Submitted:2013-11-03, Days after onset: 83
Location:Massachusetts  Entered:2013-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Private
Symptoms: Dysphagia, Ear disorder, Fatigue, Histamine intolerance, Migraine, Mobility decreased, Musculoskeletal stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Arthritis (broad)
Write-up: Migraine, extreme histamine reaction in head producing ear symptoms and stiff neck, swallowing difficulties, fever, extreme fatigue...unable to get out of bed...24 hrs.

VAERS ID:511354 (history)  Vaccinated:2012-11-19
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-05
Location:Florida  Entered:2013-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: 11/19/2012; Pregnancy test urine Positive
CDC Split Type: WAES1211USA010309
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, Pregnancy test urine positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning a 14 year old female patient with no pertinent medical history, drug reactions or allergies. The patient was vaccinated intramuscularly with a first 0.5 ml dose of GARDASIL (lot # not reported) on 19-NOV-2012. No other co-suspects were reported. There were not concomitant medications. The physician reported that on 19-NOV-2012 the patient was administered her first dose of GARDASIL and a subsequent urine pregnancy test was positive on that date. The patients LMP (approximately in 2012) and EDD were unknown. Initial exposure to GARDASIL was at an unknown gestational period. The patient sought medical attention at the office3. No treatment was given and the patient was referred to an obstetrician for follow up care. Complete blood count and metabolic panel were also ordered on 19-NOV-2013 (results not provided). Follow up information was received which stated that EDD was approximately July 2013. Additional information has been requested.

VAERS ID:511464 (history)  Vaccinated:2013-10-29
Age:14.0  Onset:2013-10-29, Days after vaccination: 0
Gender:Female  Submitted:2013-10-31, Days after onset: 2
Location:New York  Entered:2013-11-05, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BJ20140IN 
Administered by: Private     Purchased by: Public
Symptoms: Chills, Headache, Insomnia, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Received Quadrivalent FLUMIST vaccine on 10/29/13. About 3-4 hours after she started with HA - on sides, not frontal - persisted HA despite of ibuprofen 400 mg given at time of initial symptom - woke up with the headache and had it through the night (brief sleep). Associated nausea, no vomiting. Had chills but no fever, no rash. HA resolved over night on 10/30/13.

VAERS ID:511495 (history)  Vaccinated:2010-11-05
Age:14.0  Onset:2010-11-05, Days after vaccination: 0
Gender:Female  Submitted:2013-11-05, Days after onset: 1096
Location:Arizona  Entered:2013-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Arm hurt right away severely. About thirty minutes later blacked out at store. About two hours later severe migraine, stomach started hurting.
Preexisting Conditions: None
Diagnostic Lab Data: Cysts on the ovaries, IBS, Gastritis, Ulcers, Fibromyalgia
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Public
Symptoms: Abdominal pain upper, Fibromyalgia, Gastritis, Immediate post-injection reaction, Injection site pain, Irritable bowel syndrome, Loss of consciousness, Migraine, Ovarian cyst, Pain in extremity, Ulcer
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), Gastrointestinal ulceration (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (broad)
Write-up: Pain at injection site, black out, severe migraine, stomach hurting.

VAERS ID:511687 (history)  Vaccinated:2013-10-21
Age:14.0  Onset:2013-10-24, Days after vaccination: 3
Gender:Female  Submitted:2013-11-04, Days after onset: 11
Location:Connecticut  Entered:2013-11-06, Days after submission: 2
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: Seasonal allergies; Myopia
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT)SANOFI PASTEURU4769AB0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073540IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dermal cyst, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 3 days after vaccines given in (L) deltoid, pt dev a small "lump". Noted to have small dermal cyst to (L) axilla at time of visit today.

VAERS ID:512067 (history)  Vaccinated:2013-11-07
Age:14.0  Onset:2013-11-07, Days after vaccination: 0
Gender:Female  Submitted:2013-11-08, Days after onset: 1
Location:Massachusetts  Entered:2013-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Flovent and her albuterol inhaler!!! FYI I do not know which manf made the vaccines!
Current Illness: No
Preexisting Conditions: Asthma and many antibiotic allergies and outdoor allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Abnormal behaviour, Aggression, Anger
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow)
Write-up: SHE WAS IRATE! MY DAUGHTER IS VERY SHY, RESERVED, QUIET! SHE IS AN HONOR STUDENT! NOT IN HER CHARACTER AT ALL!!!! SHE WAS NOT HERSELF!! SHE WAS PHYSICAL LAST NIGHT W ME AND MY BF! SHE WOULD NEVER EVER LIFT A FINGER TO ANYONE!!!!! SHE WAS JUST SO IRATE AND FROM WHAT I COULD SEE SHE WAS NOT HERSELF SHE HAD A LOOK IN HER EYE I HAVE NEVER SEEN!! I DO NOT BELIEVE SHE KNEW WHAT SHE WAS DOING!! I PERSONALLY THINK IT WAS TO MANY SHOTS FOR SOMEONE WITH HER HISTORY OF ASTHMA AND ALLERGIES!!! SHE WAS NOT HERSELF!!!!!!!!! IT WAS MORE THAN A MILD IRRITABILITY LIKE THE SIDE EFFECTS SAY!!!!!

VAERS ID:512119 (history)  Vaccinated:2013-09-18
Age:14.0  Onset:2013-09-19, Days after vaccination: 1
Gender:Female  Submitted:2013-11-08, Days after onset: 50
Location:Connecticut  Entered:2013-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft and Loestrin 24 FE
Current Illness: None.
Preexisting Conditions: Allergy to eggs and sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Disturbance in attention, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)
Write-up: Severe headache and dizziness that has not cleared and has impacted ability to focus on reading, tasks, etc. without extreme headache. Being treated for headache with rest and today starting a short course of steroids. Also, nightmares and insomnia continuing since vaccine administration.

VAERS ID:512182 (history)  Vaccinated:2013-11-11
Age:14.0  Onset:2013-11-11, Days after vaccination: 0
Gender:Female  Submitted:2013-11-11, Days after onset: 0
Location:New York  Entered:2013-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH894AA IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J006236 IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After getting down from exam table, fainted and hit head on floor.

VAERS ID:512265 (history)  Vaccinated:2013-10-29
Age:14.0  Onset:2013-10-29, Days after vaccination: 0
Gender:Female  Submitted:2013-11-11, Days after onset: 13
Location:Maryland  Entered:2013-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine; VENTOLIN
Current Illness:
Preexisting Conditions: Asthma; TMJ; Obesity; Flat feet
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH900AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Injection site pain, Neck pain, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Fever started 4 hrs after vaccine administration and pain followed 30 min. later at 7pm. Mother took pt to ER at 8:30pm with arm and neck pain. Back pain started while in ER. ER gave Ibuprofen. Left ER with only mild arm pain at injection site. Next morning only mild arm pain persisted.

VAERS ID:512406 (history)  Vaccinated:2013-10-11
Age:14.0  Onset:2013-11-03, Days after vaccination: 23
Gender:Male  Submitted:2013-11-07, Days after onset: 4
Location:Illinois  Entered:2013-11-12, 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: Seen by Dr. 11/7/13 - Dx as fungal rash - cream given
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS7GH570IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0056881SCRA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Fungal skin infection, Rash erythematous
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: T/C with mother - states rash (red, blisters) noted 11/3 to trunk, groin area, increase in rash noted over 3 days - contacted health Dept 11/6 - no fever, itching noted.

VAERS ID:512555 (history)  Vaccinated:2013-11-08
Age:14.0  Onset:2013-11-08, Days after vaccination: 0
Gender:Female  Submitted:2013-11-12, Days after onset: 4
Location:Mississippi  Entered:2013-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None Reported
Diagnostic Lab Data: None
CDC Split Type: MS13012
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4655AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Pyrexia, Vomiting
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: Grandmother called @ 3:00 p.m and that states patient having "low grade fever" with slight swelling and redness at injection site and vomiting. Vaccine given @ 9:15 AM 11/8/13. Adverse event began @ 1:30 PM 11/08/13.

VAERS ID:512623 (history)  Vaccinated:2013-10-28
Age:14.0  Onset:2013-11-01, Days after vaccination: 4
Gender:Female  Submitted:2013-11-01, Days after onset: 0
Location:Mississippi  Entered:2013-11-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions: Convulsion
Diagnostic Lab Data: Body temperature, 103 F
CDC Split Type: 2013SE80956
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK2022 IN 
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Fatigue, Headache, Influenza B virus test positive, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: A report has been received from a Health Professional concerning a 14 year old female patient with a history of seizure disorder controlled on medications. On 28-Oct-2013 the patient received nasal FLUMIST Quadrivalent (intranasal). On 01-Nov-2013 the patient had a positive test for influenza b. The reporter also stated that the patient had symptoms of fever (103f), headache, and fatigue and had seizure. The outcome of the seizure, positive test for influenza b, fever (103f), headache, and fatigue were unknown. According to the reporter the seizure was serious as an important medical event. All other events were considered to be non-serious.

VAERS ID:512953 (history)  Vaccinated:2013-10-25
Age:14.0  Onset:2013-10-25, Days after vaccination: 0
Gender:Female  Submitted:2013-11-13, Days after onset: 19
Location:Illinois  Entered:2013-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA012646
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to a 14 year old female patient. On 10-AUG-2013, the patient was vaccinated with the first dose of GARDASIL injection, 0.5 ml, intramuscular. The second dose of GARDASIL on 20-OCT-2011 and the third dose of GARDASIL on 25-OCT-2013. No adverse effect reported. Additional information has been requested.

VAERS ID:512955 (history)  Vaccinated:2013-11-08
Age:14.0  Onset:2013-11-08, Days after vaccination: 0
Gender:Female  Submitted:2013-11-13, Days after onset: 5
Location:Unknown  Entered:2013-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311USA004448
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from a certified medical assistant refers to a 14 year old female patient. In 2011, the patient was vaccinated with the first 0.5 ml dose of GARDASIL (Lot # not reported) intramuscularly and on 08-NOV-2013, the patient received the second 0.5 ml dose of GARDASIL (Lot # not reported) intramuscularly. No adverse effects were reported. Additional information is not expected.

VAERS ID:513109 (history)  Vaccinated:2007-03-17
Age:14.0  Onset:2007-11-05, Days after vaccination: 233
Gender:Female  Submitted:2013-11-14, Days after onset: 2201
Location:North Carolina  Entered:2013-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho Tri Cyclen Birth control
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRI done several times and was diagnosed with Hypothyroidism in 2008 but levels returned to normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Arthralgia, Dyspnoea, Fatigue, Headache, Hypothyroidism, Nuclear magnetic resonance imaging, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypothyroidism (narrow), Arthritis (broad)
Write-up: Pain in legs and joints, severe fatigue, short breath and Chronic Headaches, still experiencing all symptoms.

VAERS ID:513279 (history)  Vaccinated:2013-10-17
Age:14.0  Onset:2013-10-17, Days after vaccination: 0
Gender:Female  Submitted:2013-11-15, Days after onset: 29
Location:Arkansas  Entered:2013-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: AR1327
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4698CB4IMRA
Administered by: Public     Purchased by: Private
Symptoms: Lip swelling, Swelling face, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Approx. 8 hours after receiving influenza injection at school clinic developed hives from head to toes and swelling of face, lips and tongue per mother''s report. Was given 2 Benadryl (not sure of dosage), slept all night and was completely recovered 24 hours after the shot.

VAERS ID:513464 (history)  Vaccinated:2012-08-01
Age:14.0  Onset:2012-08-01, Days after vaccination: 0
Gender:Male  Submitted:2013-11-16, Days after onset: 472
Location:Unknown  Entered:2013-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CONCERTA
Current Illness: Attention deficit/hyperactivity disorder
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311USA001785
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  SYRUN
Administered by: Other     Purchased by: Other
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: This spontaneous report was received from a consumer''s mother refers to a 14 year old male patient with ADD (Attention deficit/hyperactivity disorder). No medical history was reported. On an unknown date in August 2012, the patient was vaccinated with a dose of GARDASIL. Concomitant therapies included CONCERTA for ADD (Attention deficit/hyperactivity disorder). On an unknown date in August 2012, the patient experienced red at injection site, swelling plus pain. The outcome of red at injection site, swelling plus pain was reported as recovered/resolved with sequelae on an unknown date in August 2012, 4 days post injection. No lab tests were performed. Action taken with GARDASIL was reported as continued. The adverse event diminished after stopping the therapy. The events did not re-appear after restarting therapy. The reporter considered red at injection site, swelling plus pain to be related to GARDASIL. Additional information has been requested.

VAERS ID:513554 (history)  Vaccinated:2012-08-31
Age:14.0  Onset:2012-12-20, Days after vaccination: 111
Gender:Female  Submitted:2013-11-15, Days after onset: 330
Location:Minnesota  Entered:2013-11-18, Days after submission: 3
Life Threatening? Yes
Died? Yes
   Date died: 2013-01-08
   Days after onset: 19
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Diagnostic Lab Data: UNK
CDC Split Type: 2013SA114788
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ20244IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0106491IMLA
Administered by: Other     Purchased by: Other
Symptoms: Cardiopulmonary bypass, Death, Dyspnoea, Influenza, Oropharyngeal pain, Pulmonary oedema, Pyrexia, Transfusion, Wheezing
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.

VAERS ID:513736 (history)  Vaccinated:2013-08-26
Age:14.0  Onset:2013-09-12, Days after vaccination: 17
Gender:Female  Submitted:2013-11-19, Days after onset: 68
Location:Idaho  Entered:2013-11-19
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CBC = normal; Glucose levels = normal; EKG = normal; Chest X-ray = normal; B.P. = normal to low; No fever; U/A = normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0176980IMLA
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Blood glucose normal, Chest X-ray normal, Dizziness, Dyspnoea, Electrocardiogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: 2 weeks after immunization blacked out during volleyball game and went to ER. Ongoing symptoms of dizziness, passing out, trouble breathing, nausea and headaches. Missing school and working with doctors to relieve symptoms. After 90 days, still having reactions.

VAERS ID:513750 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-19
Location:Unknown  Entered:2013-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA013437
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This spontaneous report as received from a consumer, as part of a marketing research program refers to a 14 year old female daughter''s friend. In 2011, the patient was vaccinated with the second dose of GARDASIL (dose, route and lot number were not reported). No concomitant medications were reported. In 2011, the patient experienced "distorted skin" reaction at injection site and stated puffy for a couple months after 2nd shot of GARDASIL. The outcome of the events was reported as recovered (probably resolved before 3rd shot). It was noted that the reporter was unsure if the adverse event re-appear after restarting GARDASIL. MRK 30809-V503 HCC Qualitative Research. Additional information has been requested.

VAERS ID:513787 (history)  Vaccinated:2013-11-14
Age:14.0  Onset:2013-11-14, Days after vaccination: 0
Gender:Male  Submitted:2013-11-14, Days after onset: 0
Location:Maine  Entered:2013-11-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hives at age 10 NKA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BJ2109 IN 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: Headache, sl. vertigo, nausea rested and improved. Went to class but nausea worsened so he was sent home.

VAERS ID:513855 (history)  Vaccinated:2013-11-19
Age:14.0  Onset:2013-11-19, Days after vaccination: 0
Gender:Male  Submitted:2013-11-19, Days after onset: 0
Location:Arizona  Entered:2013-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BJ2013 IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.J008423 IM 
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Pallor, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Times approximate. Patient given Gardasil vaccine for HPV. Within a minute or so, was pale and dizzy and felt near-syncopal. He did not faint. Placed supine with feet elevated and recovered in 5-7 minutes without residual symptoms. Observed about one hour.

VAERS ID:513958 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-20
Location:Unknown  Entered:2013-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting; Headache; Dysarthria; Complex regional pain syndrome
Preexisting Conditions:
Diagnostic Lab Data: 10/11/2013, Computerised tomogram, No irregularities
CDC Split Type: WAES1311USA004028
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Computerised tomogram normal, Condition aggravated, Dysarthria, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: This spontaneous report as received from a physician refers to a 14 year old female patient. The patient concurrent condition included headache, reflux sympathetic dystrophy (RSD), slurred speech and vomiting. On 10-OCT-2013 the patient was vaccinated with GARDASIL (dose unknown). No concomitant medications were reported. Approximately on 11-OCT-2013, the day after vaccination, the patient experienced worsening of slurred speech, vomiting and headache. The outcome of the events was reported not recovered/not resolved. The patient sought medical attention and was taken to an emergency department in which CAT scan was conducted. CAT scan showed no irregularities and the patient was discharged. The event was ongoing. The patient had follow up scheduled with an unspecified neurologist on an unknown date. Additional information has been requested.

VAERS ID:513999 (history)  Vaccinated:2013-11-13
Age:14.0  Onset:2013-11-15, Days after vaccination: 2
Gender:Female  Submitted:2013-11-19, Days after onset: 4
Location:Georgia  Entered:2013-11-20, 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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALSB3223 IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0062361IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site anaesthesia, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain and numbness of extremity (left arm - site of GARDASIL).

VAERS ID:514245 (history)  Vaccinated:2013-05-13
Age:14.0  Onset:2013-06-14, Days after vaccination: 32
Gender:Female  Submitted:2013-11-21, Days after onset: 160
Location:Michigan  Entered:2013-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: No
Preexisting Conditions: Anxiety
Diagnostic Lab Data: Ultrasound and CT scan of abdomen and pelvis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0200021IMRA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Computerised tomogram abdomen, Oophorectomy, Ovarian cyst, Ultrasound abdomen, Ultrasound pelvis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ovarian tumours of unspecified malignancy (broad)
Write-up: Patient experienced severe abdominal pain and ended up in the ER on 6/14/13 where she had testing that showed she had a large ovarian cyst on her right ovary. She ended up having surgery on 8/22/2013 where they had to remove her ovary.

VAERS ID:514420 (history)  Vaccinated:2013-10-24
Age:14.0  Onset:2013-10-25, Days after vaccination: 1
Gender:Female  Submitted:2013-11-22, Days after onset: 28
Location:Indiana  Entered:2013-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK20221IN 
Administered by: Public     Purchased by: Public
Symptoms: Cough, Headache, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Patient vaccinated 10/24/13, on 10/25/13 in AM patient started with cough. Sunday 10/27 patient started with body aches, fever; headache. Fever up to 102 degrees F. Out of school Monday 10/28, Tues 10/29 1/2 day, Thurs 10/31 all day. Denies wheezing, vomiting, diarrhea. OTC medications taken: Ibuprofen 400mg. MUCINEX DM.

VAERS ID:514460 (history)  Vaccinated:2013-10-11
Age:14.0  Onset:2013-11-06, Days after vaccination: 26
Gender:Male  Submitted:2013-11-24, Days after onset: 18
Location:New Jersey  Entered:2013-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0 LA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain upper, Back pain, Decreased appetite, Headache, Nausea, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient had upset stomach and nausea. Patient vomited. Patient''s appetite decreased. Patient has had upset stomach and shaking of hand every since symptoms started. Two weeks after initial symptoms started, patient vomited again because of nausea and stomach pains. Patient complained of lower backache and headache.

VAERS ID:514772 (history)  Vaccinated:2013-11-11
Age:14.0  Onset:2013-11-12, Days after vaccination: 1
Gender:Male  Submitted:2013-11-25, Days after onset: 13
Location:Pennsylvania  Entered:2013-11-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: None
Diagnostic Lab Data: Lab tests unknown
CDC Split Type: 2013SA119318
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH906AE IMLA
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Pain
SMQs:
Write-up: Initial report was received from a healthcare professional on 15 November 2013. A 14-year-old male patient had received an intramuscular injection in the left deltoid of FLUZONE, lot number UH906AE, on 11 November 2013 and 24 hours later complained of body aches and developed shingles. The patient had no illness at the time of vaccination and no past medical history. Outcome was not recovered. Documents held by sender: None.

VAERS ID:514970 (history)  Vaccinated:2013-11-06
Age:14.0  Onset:2013-11-08, Days after vaccination: 2
Gender:Female  Submitted:2013-11-27, Days after onset: 19
Location:Maryland  Entered:2013-11-27
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: Eczema, hay fever
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH713AA1IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0062362IMLA
Administered by: Military     Purchased by: Unknown
Symptoms: Injection site pain, Injection site pruritus, Injection site rash, Injection site reaction, Injection site swelling, Rash generalised, Rash pruritic, Skin lesion
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 14 year old female received the GARDASIL/FLUMIST vaccine on 6 Nov 13. She states that 48 hours later she developed a ring lesion over her left arm surrounding the vaccine. She states her arm was swollen and sore feeling initially. The rash was very itchy at the site only. She went to her PCM and they gave her a steroid cream. It did not help much. She then developed a generalized rash that started on 25 Nov 13. The rash began on her chest and spread to her arms/legs. The rash is described as little itchy bumps everywhere. She denies any other systemic symptoms. She is being followed by dermatology for this condition as well.

VAERS ID:515203 (history)  Vaccinated:2013-11-24
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-24
Location:Washington  Entered:2013-11-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data: B/P took.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK2022 IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.J003727 SYRRA
Administered by: Private     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was very nervous/anxious. Fainted after HPV shot. Checks by Dr./Nurse. Recovered within 10 minutes. Told patient to stay in the room until feel better to leave.

VAERS ID:515271 (history)  Vaccinated:2013-11-19
Age:14.0  Onset:2013-11-20, Days after vaccination: 1
Gender:Male  Submitted:2013-11-26, Days after onset: 6
Location:Iowa  Entered:2013-12-02, 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: None
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0062361IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSP57ZX0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0202541SCLA
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Disturbance in attention, Injection site swelling, Malaise, Nausea, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: Got adol vaccines, Tdap, HPV #2, Ckpox #2 - c/o just not feeling well day later, nausea, slight diarrhea; swelling at site of injection, itching all over - c/o just not being able to concentrate. Got ibuprofen et BENADRYL started taking Wed - Th saw dr Th 11/21/13 - Dr feels rx to HPV. Informed to me receive 3rd dose.

VAERS ID:515486 (history)  Vaccinated:2013-11-27
Age:14.0  Onset:2013-11-27, Days after vaccination: 0
Gender:Female  Submitted:2013-12-03, Days after onset: 6
Location:Washington  Entered:2013-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None Known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSDF3KK IMAR
Administered by: Other     Purchased by: Private
Symptoms: Chest discomfort, Dizziness, Dry mouth, Dry throat, Headache
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)
Write-up: Within one minute of vaccine administration, patient complained of faintness/lightheadedness, tightness in chest and dry mouth/throat. 911 was called and patient was released after 10-15 min. as ok. Patient reported several days later that she still had a headache/lightheadedness.

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