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Case Details (Sorted by Age)

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VAERS ID:359392 (history)  Vaccinated:2009-09-11
Age:14.0  Onset:2009-09-12, Days after vaccination: 1
Gender:Male  Submitted:2009-09-15, Days after onset: 3
Location:Louisiana  Entered:2009-10-05, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Cerebral Palsy.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3011AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF486AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0857Y1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Herpes zoster, Rash vesicular
SMQs:, Retroperitoneal fibrosis (broad), Hypersensitivity (narrow)
Write-up: Pt presented with c/o right sided back pain & vesicular rash to right buttock & right leg. Referred to FNP. Dx: Herpes ZOSTER. Rx: VALTREX 500 mg TID X 7 days. ZOVIRAX cream to affected area QID X 5 days TYLENOL #3 PRN - pain.

VAERS ID:359398 (history)  Vaccinated:2009-08-18
Age:14.0  Onset:2009-08-20, Days after vaccination: 2
Gender:Female  Submitted:2009-09-08, Days after onset: 19
Location:New Jersey  Entered:2009-10-05, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0087Y0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Received GARDASIL shot on 8/18/09. Developed hives on 08/20/09 w/c lasted 2 days and an ED visit on 8/21/09.

VAERS ID:359552 (history)  Vaccinated:2009-10-05
Age:14.0  Onset:2009-10-05, Days after vaccination: 0
Gender:Female  Submitted:2009-10-05, Days after onset: 0
Location:Michigan  Entered:2009-10-06, 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: SPRINTEC 0.25/0.035mg; DDAVP 0.2mg
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3209AA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Deafness, Dizziness, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: Patient was in for a nurse visit, patient''s mom was given form to fill out. After patient received vaccine patient felt lightheaded, hot and could not hear. Patient was brought back into exam room and R.N. looked over patient. Patient''s mom stated she didn''t read form before vaccine given. Spoke with Dr. and he examined patient, gave orange juice and patient released by Dr.

VAERS ID:359597 (history)  Vaccinated:2009-09-30
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2009-09-30
Location:Pennsylvania  Entered:2009-10-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0035Y1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3068AA1IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3355AA1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Incorrect dose administered
SMQs:
Write-up: No adverse effect thus far. Patient inadvertently received extra ADACEL (prior dose on 4/10/08) and extra MENACTRA prior dose 01-26-09. MD

VAERS ID:359620 (history)  Vaccinated:2006-09-01
Age:14.0  Onset:2009-09-01, Days after vaccination: 1096
Gender:Female  Submitted:2009-10-05, Days after onset: 34
Location:Michigan  Entered:2009-10-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0909USA04206
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Blindness transient, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 14 year old female patient with no drug reactions/allergies who was vaccinated IM with the first 0.5 ml dose of GARDASIL "approximately three years ago" in approximately September 2006. Concomitant therapies included MENACTRA and another vaccine (manufacturer unknown). Right after getting the vaccine the patient experienced anxiety and temporary loss of vision. The patient was at the office when it happened. There were no lab diagnostic studies performed. The physician told the patient to remain seated for 10 to 15 minutes and the patient recovered. Upon internal review, temporary loss of vision was determined to be an other important medical event. All telephone attempts to obtain follow-up information have been unsuccessful. No further information is available.

VAERS ID:359621 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-05
Location:Unknown  Entered:2009-10-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0909USA04238
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Loss of consciousness, Memory impairment, Urinary incontinence
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), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a nurse concerning a 14 year old female patient who was vaccinated IM with the first 0.5 ml dose of GARDASIL. There were no concomitant therapies. Subsequently the patient passed out and started seizing, the patient experienced a full blown seizure, blacked out, could not hold her bladder and then came to and could not remember anything that had happened. The patient was in office while it happened. At the time of report the patient''s status was recovered. Upon internal review, seizure was determined to be an other important medical event. No further information is available.

VAERS ID:359698 (history)  Vaccinated:2009-09-26
Age:14.0  Onset:2009-09-27, Days after vaccination: 1
Gender:Female  Submitted:2009-09-27, Days after onset: 0
Location:Iowa  Entered:2009-10-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97846P1 UNLA
Administered by: Other     Purchased by: Other
Symptoms: Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Pt''s mother called next morning and stated pt had stiff neck and difficulty turning head. Mother observing and treating with NSAID and TYLENOL. At 14:30 spoke with pt, feeling much better with little stiffness. At 16:00 only minor stiffness, mostly recovered. Told to contact MD if not getting better or getting worse, faxed MD.

VAERS ID:359747 (history)  Vaccinated:2009-10-02
Age:14.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 5
Location:Indiana  Entered:2009-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspar
Current Illness: Feel has a Ball in throat. History hair loss but regrowing hair.
Preexisting Conditions: General anxiety disorder 10/2/09 MH: Anxiety disorder
Diagnostic Lab Data: Saw her therapist and talked with her psychiatrist. 10/2/09 Labs: TSH WNL, CBC WNL. 10/8/09 Labs: Influenza A(-) B(-).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0672Y1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acne, Blood test normal, Blood thyroid stimulating hormone, Dizziness, Dyskinesia, Full blood count, Heart rate increased, Hypoaesthesia, Influenza serology negative, Mood swings, Paraesthesia, Reflux oesophagitis, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific dysfunction (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)
Write-up: Patient complained of fast heart rate, dizziness, numbness and tingling in hands and feet. 10/12/09 Medical records received from dates of service 10/2/09 to 10/8/09 10/2/09 OV for c/o ball in throat feeling, acne, hair loss and to begin gardasil vaccination series. DX: questionable reflux, acne, hair loss. 10/8/09 OV c/o HA, dizziness, moody, heart racing, jerking arms, tingle in fingers occurring after getting gardasil vaccination. DX: HA, dizziness, tachycardia.

VAERS ID:359990 (history)  Vaccinated:2009-10-05
Age:14.0  Onset:2009-10-06, Days after vaccination: 1
Gender:Female  Submitted:2009-10-07, Days after onset: 1
Location:Ohio  Entered:2009-10-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3207AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Axillary pain, Lymphadenopathy, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Complained of swollen lymph nodes on R side of neck, stiff neck and soreness under R armpit.

VAERS ID:360063 (history)  Vaccinated:2009-09-24
Age:14.0  Onset:2009-09-24, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 13
Location:Pennsylvania  Entered:2009-10-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: none Allergies: NKDA
Diagnostic Lab Data: diagnostic laboratory, 09?/??/09, Basal metabolic normal; complete blood cell, 09?/??/09, normal Labs: CBC, BMP, UA, urine pregnancy test all normal/neg
CDC Split Type: WAES0909USA04823
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB291AA UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1486U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2663AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0737X UNRA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Crying, Dizziness, Dyspnoea, Dysstasia, Fatigue, Feeling abnormal, Full blood count normal, Headache, Hypoaesthesia, Hypokinesia, Injected limb mobility decreased, Injection site pain, Metabolic function test normal, Musculoskeletal pain, Myalgia, Nausea, Pain, Pregnancy test negative, Tenderness, Urine analysis normal, Vaccine positive rechallenge, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Information has been received from a physician and a licensed practical nurse concerning a 13 year old female with no pertinent medical history or no known drug allergies, who on 24-SEP-2009 was vaccinated with 0.5 ml of the first dose of GARDASIL (Lot number 659655/1486U) intramuscularly on the right arm. On the same day the patient received a dose of hepatitis A vaccine (inactive) (AVENTIS) (Lot number: AHAVB291AA) on the right arm, a dose of VARIVAX (Lot number: 661334/0737X) on the right arm, MENACTRA (Lot number U2663AA) left arm. The patient became lightheaded, had pain at the injection site, was dizzy and experienced numbness on the right leg while still in the office after vaccination. the patient was told if the symptoms got worse, to call the office or go to the emergency room (ER). The patient continued to feel bad, vomited and felt weak so the patient went to the ER. The patient was hydrated and got better. The physician reported that the patient recovered maybe on 01-OCT-2008, reported as "1 week after the first dose of GARDASIL". On 25-SEP-2009, the patient was in the office for a well visit and received the second dose of GARDASIL (Lot number 662404/0312Y) on the left arm, a dose of influenza virus vaccine (unspecified) (Lot number: U3177AA) and a dose of hepatitis A virus vaccine inactivated (Lot number 663913/0206Y) on the right arm. The patient then experienced severe pain at the injection site on the left arm. The nurse put ice on the injection site because the pain was so extreme the patient was crying. The patient was told to call the office if the symptoms got worse. The patient went to the ER. The patient had no fever. The ER notes from 27-SEP-2009, at 17:30 stated that the patient started to feel, on 25-SEP-2009, lightheaded and complained of pain all over-severe myalgia. The patient had difficulty moving her left arm and left leg. The patient got better 26-SEP-2009, but symptoms got worse 27-SEP-2009 night. The patient had nausea, dizziness sometimes, tired, aches and pains all over the body, and difficulty standing for more than 30 minutes (uses a cane and is slow to walk ). On 29-SEP-2009, the patient was in the office, and she was still with aches and pains, especially the shoulder and joints that were not swollen but tender. The patient complained "it hurts" and she could hardly move. The patient took an ALEVE on 28-SEP-2009. On 27-SEP-2009 or 28-SEP-2009 night, the patient had shortness of breath. The patient was instructed by the mother who is a nurse) to breath in a paper bag and the patient felt better. There were no respiratory problems at the office visit on 29-SEP-2009. The patient had severe myalgia and the patient was not recovered. A complete blood cell count and basal metabolic were normal. The patient was referred to see a neurologist (no other details available). It was unknown if events were life threatening (no mention in chart). Lightheaded and dizzy, pain at the injection site, numbness on the right leg, feel bad, vomited, felt weak, severe pain at the injection site, crying, lightheaded and dizziness, tired, tired, tired, tired, pain all over, severe myalgia, difficulty standing for more than 30 minutes, nausea, shoulder and joints are tender, shortness of breath and can''t hardly move were considered to be disabling by the physician. Additional information has been requested. 11/17/2009 PCP and ED record for 9/24 and 9/25/2009. Dx acute medication reaction Patient with c/o''s generalized weakness, Headache, fatigue and myalgias. neuro exam WNL, Tx IVF.

VAERS ID:360080 (history)  Vaccinated:2009-10-02
Age:14.0  Onset:2009-10-04, Days after vaccination: 2
Gender:Female  Submitted:2009-10-08, Days after onset: 4
Location:Minnesota  Entered:2009-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3201AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0469Y0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discolouration, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, puffy, purple around injection site. abx given.

VAERS ID:360095 (history)  Vaccinated:2009-10-06
Age:14.0  Onset:2009-10-07, Days after vaccination: 1
Gender:Male  Submitted:2009-10-08, Days after onset: 1
Location:Utah  Entered:2009-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 20 lesions all over body~Varicella (Varivax)~1~1.00~Patient|swollen, red at site~DTP (no brand name)~3~5.00~Sibling|rash on neck
Other Medications:
Current Illness: NO
Preexisting Conditions: Asthma, ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3047AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site pruritus, Injection site swelling, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red swelling at site, 3" in diameter, itchy, severe headache, nausea, bodyaches. following day redness and swelling increased to 4" in diameter

VAERS ID:360196 (history)  Vaccinated:2009-05-29
Age:14.0  Onset:2009-07-10, Days after vaccination: 42
Gender:Female  Submitted:2009-10-09, Days after onset: 91
Location:New York  Entered:2009-10-09
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 56 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: anxiety disorder 01/11/2010 PMH: Anxiety disorder
Diagnostic Lab Data: MRI spine/brain normal, all viral labs including hepatitis, herpes, HIV all negative 01/11/2010 LABS and DIAGNOSTICS: MRI of spine-lesion at T11-T12, UA cult-positive (E.coli), CSF-neg, Mycoplasma-positive, Viral studies-neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1584X1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2867AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abasia, Asthenia, Back pain, Blood test normal, CSF test normal, Constipation, Culture urine positive, Diplegia, Erythema multiforme, HIV test negative, Hepatitis viral test, Herpes simplex serology negative, Hypotonia, Incontinence, Laboratory test normal, Lumbar puncture normal, Muscular weakness, Mycoplasma infection, Mycoplasma serology positive, Myelitis transverse, Neurogenic bladder, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Paraesthesia, Ulcer, Urinary tract infection, Urine analysis normal, Viral test negative, Walking disability
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal ulceration (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Felt tingling of legs that slowly progressed to weakening of her legs. By later that day patient was unable to walk. Brought to hospital and admitted with workup diagnosed as Transverse Myelitis

VAERS ID:360200 (history)  Vaccinated:2009-10-06
Age:14.0  Onset:2009-10-07, Days after vaccination: 1
Gender:Male  Submitted:2009-10-09, Days after onset: 2
Location:Massachusetts  Entered:2009-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no. 10/14/09 Received medical records. Date of Service 10/6/09. PMH: None.
Diagnostic Lab Data: 10/14/09 Received medical records. Date of Service 10/6/09. Labs and Diagnostics: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500675P4IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2917AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460CA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Fall, Head injury, Hypotension, Loss of consciousness, Pallor, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Syncopal episode in bathroom when trying to get into shower. Felt dizzy,fell,hit top of head on sink, LOC for approx 45 seconds. Arrived at office dizzy and hypotensive. Drank 2 Liters of gatorade, observed for 1 hour, felt better and BP increased to 102/65. Discharged home. F/U later in evening doing well, no temp or dizzyness. 10/14/09 Received medical records. Date of Service 10/6/09. Dx: Severe Vaccine Reaction. Presenting sx: Pt. woke up and experienced dizzyness in the bathroom. He had an episode of syncope and hit his head on the sink. He presented with a headache, paleness, fever, and unstable hypotension. He drank 2 Liters of Gatorade and was walking and feeling good at time of discharge from physicians office an hour and 20 minutes later.

VAERS ID:360238 (history)  Vaccinated:2009-10-08
Age:14.0  Onset:2009-10-08, Days after vaccination: 0
Gender:Female  Submitted:2009-10-09, Days after onset: 1
Location:Texas  Entered:2009-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not available
Current Illness: None
Preexisting Conditions: Not Available
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960305P0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Per parent and EMS, patient had a fainting episode. Blood pressure was checked but everything was fine. Verified with father 10:00am 10/09/2009.

VAERS ID:360331 (history)  Vaccinated:2009-10-09
Age:14.0  Onset:2009-10-10, Days after vaccination: 1
Gender:Female  Submitted:2009-10-11, Days after onset: 1
Location:Idaho  Entered:2009-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Swine flu test negative was perfromed at the physician office.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Antibody test negative, Cough, Headache, Heart rate increased, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Eosinophilic pneumonia (broad)
Write-up: High Fever 102-103F, headaches, body and muscle aches, high heart rate, cough. Went to physician. Bed rest and ibuprofen.

VAERS ID:360494 (history)  Vaccinated:2009-10-10
Age:14.0  Onset:2009-10-10, Days after vaccination: 0
Gender:Male  Submitted:2009-10-12, Days after onset: 2
Location:Arizona  Entered:2009-10-12
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS9721501 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Headache, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever, chills, headache, runny nose.Treating with Motrin,fluids, and rest.

VAERS ID:360659 (history)  Vaccinated:2009-10-12
Age:14.0  Onset:2009-10-12, Days after vaccination: 0
Gender:Female  Submitted:2009-10-13, Days after onset: 1
Location:California  Entered:2009-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: 10/16/09 Medical records received for dates 10/12/09 to 10/15/09 PMH: Abdominal pain at 3 y/o. Endoscopy at 5 y/o.(-).
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU3198AA IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.131642IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Diarrhoea, Dizziness, Headache, Nausea, Syncope, Vaccination complication, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)
Write-up: dizziness, severe headache, nausea, vomiting 10/16/09 Medical records received for dates 10/12/09 to 10/15/09. Symptoms: Pt received vaccine 10/12/09 parent called MD office to state approx. « hour after vaccine pt. c/o dizziness, diarrhea, HA, vomiting 2-3x, syncope. F/u appt. 10/15/09 c/o stomach issues, HA, nausea. Decreased appetite continued. Assessment: Mild TTP LLQ, referred to GI specialist. Pt has HA if overeacts then vomits, stress worsens problem. DX: Possible reaction to vaccine. Chronic abdominal pain, chronic HA.

VAERS ID:360711 (history)  Vaccinated:2009-10-07
Age:14.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Female  Submitted:2009-10-08, Days after onset: 1
Location:Montana  Entered:2009-10-13, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED02149211A0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB360BA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0570X1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0850Y1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Ear pain, Eye movement disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Upon injection pt momentarily fainted: Eyes closed, body slumped. Eye lids fluttered open & pt began to cry saying her "ears hurt". Laid pt. down - applied cool paper towels to forehead. Pt rested & felt better after Approx 15 min.

VAERS ID:360753 (history)  Vaccinated:2008-11-01
Age:14.0  Onset:2008-12-01, Days after vaccination: 30
Gender:Female  Submitted:2009-10-06, Days after onset: 308
Location:Iowa  Entered:2009-10-14, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: none Allergies: NKDA
Diagnostic Lab Data: Cortrosyn stim was flat Labs: CBC, CRP, ANA, VIT D, Rennin, Blood Mercury normal, BMP : Na low, ACTH, Varicella AB test neg, Lyme test neg Dx studies: MRI Brain wnl
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.05700IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Addison's disease, Antinuclear antibody negative, Arthralgia, Blood cortisol decreased, Blood sodium decreased, Borrelia burgdorferi serology negative, C-reactive protein normal, Fatigue, Full blood count, Laboratory test, Myalgia, Nuclear magnetic resonance imaging brain normal, Vitamin D, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad)
Write-up: 2 wks post vaccine -$g myalgia/fatigue. Wt loss. Ultimate diagnosis Addison''s Disease 8/09. 10/26/2009 PCP and Endocrinologist records, initial visit 8/13/2009. Patient with c/o''s fatigue, arthralgias, myalgias and an 18 lb unexplained wt loss. Baseline cortisol levels were <1, patient dx''d with Addison''s disease. Tx: started on hydrocortisone bid.

VAERS ID:360860 (history)  Vaccinated:2009-09-23
Age:14.0  Onset:2009-10-05, Days after vaccination: 12
Gender:Female  Submitted:2009-10-12, Days after onset: 7
Location:Georgia  Entered:2009-10-14, 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: None
Preexisting Conditions: Drug allergy to PCN and Sulfa.
Diagnostic Lab Data: Referred to dermatologist.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB343BA1IMUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.U522U1IMUN
Administered by: Private     Purchased by: Public
Symptoms: Rash generalised, Skin papilloma
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash with wart like lesions on entire body.

VAERS ID:360945 (history)  Vaccinated:2009-10-08
Age:14.0  Onset:2009-10-08, Days after vaccination: 0
Gender:Female  Submitted:2009-10-14, Days after onset: 6
Location:Alabama  Entered:2009-10-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: electrocardiogram, 10/08/09, Normal; chest X-ray, 10/08/09, Normal; head computed axial, 10/08/09, Normal; diagnostic laboratory, 10/08/09, Blood work: Normal
CDC Split Type: WAES0910USA00980
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500711P IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0216Y1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test normal, Chest X-ray normal, Computerised tomogram head, Computerised tomogram normal, Convulsion, Electrocardiogram normal, Head injury, Loss of consciousness, Musculoskeletal stiffness
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), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad)
Write-up: Information has been received from a registered nurse concerning a 14 year old female who on 08-OCT-2009 was vaccinated with her second 0.5mL dose of GARDASIL (route and lot number not reported). Concomitant therapy included FLUMIST. IT was reported that half an hour later, on 08-OCT-2009, the patient experienced passed out, hit her head and had a seizure. The patient was taken to the emergency room and was released. The physician felt it was important to note that the patient had not eaten prior to vaccination. The patient recovered from hit her head, passed out and seizure on the same day. Follow up information was received from a registered nurse concerning the 14 year old female patient with no pertinent medical history reported and no known drug allergies who on 08-OCT-2009 was vaccinated with her second dose of GARDASIL (lot number 663451/0216Y) and concomitantly with a dose of FLUMIST (lot number 500711P). The registered nurse reported that the patient left the office and was in a restaurant when she "passed out and stiffened" on 08-OCT-2009. The patient was taken to the ER where a CT of the head, EKG, chest X-ray and blood work were performed (all normal). No treatment was needed. It was noted that the patient received the first dose of GARDASIL (route not reported, lot number 664780/0904Y, valid for ROTATEQ) on 16-JUL-2009. Upon internal review, seizure was determined to be an other important medical event. Additional information has been requested.

VAERS ID:361111 (history)  Vaccinated:2009-08-28
Age:14.0  Onset:2009-09-22, Days after vaccination: 25
Gender:Female  Submitted:2009-10-15, Days after onset: 23
Location:California  Entered:2009-10-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Mental disorder
Preexisting Conditions: PMH: Obesity. DM (well controlled on PO meds). Family h/o asthma , DM and hypertension. ALlergies: NKDA
Diagnostic Lab Data: diagnostic laboratory, negative for GUILLAIN-BARRE Syndrome LABS & DIAGS: Glucose 114, CRP 2.6 (H), acetylcholine binding neg. CSF cx w/gram stain no growth. ABD U/S liver diffuse fatty infiltration mild hydronephrosis R side. EGD- mild gastritis. CT brainb neg. CT spine cervical lordosis. CXR neg. XT lumbar spin- constipation
CDC Split Type: WAES0910USA01162
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0312Y2IMLA
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Abdominal pain, Abdominal pain upper, Asthenia, Back pain, Blood glucose increased, CSF cell count normal, Computerised tomogram, Constipation, Conversion disorder, Diabetes mellitus, Familial risk factor, Gastritis, Gram stain negative, Headache, Hepatic steatosis, Hiatus hernia, Hydronephrosis, Laboratory test normal, Migraine, Musculoskeletal pain, Obesity, Paraesthesia, Reflex test normal, Rehabilitation therapy, Ultrasound scan abnormal, Walking aid user, Walking disability
SMQs:, Rhabdomyolysis/myopathy (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Initial and follow-up information has been received from a physician concerning a 14 year old female with unspecified mental health issues who on 28-AUG-2009 was vaccinated with a dose of GARDASIL (dose, route and LOT# not reported). On 22-SEP-2009 the patient started complaining of abdominal pain and weakness. The patient was admitted to hospital and felt fine when she discharged on 25-SEP-2009. On 27-SEP-2009 the patient went to emergency room and was admitted again for headache, weakness and being unable to walk. The labs CT of head and CT of spine were performed and no outcome provided, the GUILLAIN-BARRE Syndrome test was negative. The patient had been discharged on an unspecified date but she was still unable to walk and had weakness. No further information was available at this time of the report. The patient was hospitalized. The reporter considered the abdominal pain, weakness, headache and being unable to walk to be an incapacity or significant disability. Additional information has been requested. 11/9/09 medical records and discharge summary received for DOS 9/22-9/25 and subsequent admission 9/27/09-10/02/09. Final DX: 9/22 admission- Hiatal hernia. FInak DX 9/27 admission -Migraine Headaches, Somataform Disorder, Diabetes, Obesity Patient initially admitted for stabbing epigastric/abd pain and pain in shuoulders and back, tingling in back. CT abd and pelvis neg. diagnosed w/small hiatal hernia by endoscopy. D/C to home. Returned to ED with c/o LE weakness and back pain. Also c/o severe HA. Unable to bear weight and walks with walker. DTRs 1/4. Normal sensation. Strength 5/5. All diags neg. Somataform disorder. Refer to psych and possible rehab/PT. Homehealth. D/C using walker. HA resolving.

VAERS ID:361343 (history)  Vaccinated:2009-10-13
Age:14.0  Onset:2009-10-15, Days after vaccination: 2
Gender:Female  Submitted:2009-10-18, Days after onset: 3
Location:Florida  Entered:2009-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Focalin XR 10 MG Capsules once daily
Current Illness: no
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500754P0IN 
Administered by: Unknown     Purchased by: Private
Symptoms: Pruritus, Rash erythematous, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Symptoms started Thursday night 10/15 with itchy legs, feet and hands during the night, no rash identified. After the second night(Friday 10/16), small faint red bumps appeared on lower legs. Sunday morning 10/18 woke to severly itchy rash/hives all over legs, feet, arms, hands and belly. Gave dose of benadryl @ 12:10 pm. At this point, almost 3 hours later (2:40 pm) rash and hives are gone. Do not know if they will return after Benadryl wears off.

VAERS ID:361592 (history)  Vaccinated:2009-10-15
Age:14.0  Onset:2009-10-18, Days after vaccination: 3
Gender:Male  Submitted:2009-10-19, Days after onset: 1
Location:North Carolina  Entered:2009-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Eye swelling, Hypersensitivity, Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: My son woke up Sunday morning after having the swine flu shot on thursday with the left side of his face red and a little swollen. By 5 o/clock sunday night it had got progressively worse now it was the whole side of his face his eye was swollen shut the redness, bumps and swelling had went all the way down his face to his neck, up in his hair line and back to his ear. I took him to the hospital I explained to them that he was not allergic to anything and that since when he woke up that morning it was like that so I didn''t think it was anything he was exposed to. I told them that the only thing that was different was that he had the swine flu shot. They did not seem to think that was the problem, they said it was a definite allergic reaction but to what they didnt know, so they told me to give him Benadryl and sent him home. Well by this morning 10/19/2009 at 7:00 AM it had got alot worse. I took him to the doctors again because it did not seem to me that the Benadryl was enough. I took him to our local doctor; told him the same thing I had told the hospital the night before, he examined him and said yes knowing what I had told him and my sons history that it was a allergic reaction to the swine flu vaccination that he has got on Thursday. Dr. put him on prednisone and told me to keep giving him Benadryl every four hours. Some of the swelling has went done but his eye is still almost shut from the swelling and his face is still red. I would like to know if anyone can tell me how long is this reaction gonna last. I am really concerned since it was a vaccine.

VAERS ID:361718 (history)  Vaccinated:2009-09-22
Age:14.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-08, Days after onset: 16
Location:Illinois  Entered:2009-10-20, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt had similar response to first dose, mom released after 1st shot given (per mom, given at another clinic)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0969Y1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Aphthous stomatitis, Dermatitis, Hypersensitivity, Lip swelling, Oral pain, Rash generalised, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Pt experienced lip swelling, total body rash and aphthous ulcers and tooth and mouth pain.

VAERS ID:361828 (history)  Vaccinated:2009-10-14
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-14
Location:Wisconsin  Entered:2009-10-20, Days after submission: 6
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: Pregnancy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1005Y1UNUN
Administered by: Public     Purchased by: Other
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Client pregnant - PHN missed reading yes to pregnant on screening questionnaire and she received VARICELLA vaccine.

VAERS ID:361918 (history)  Vaccinated:2009-08-12
Age:14.0  Onset:2009-08-12, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 64
Location:Oregon  Entered:2009-10-20, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0206Y1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0702X0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2919AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0805Y1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncope, (awoke on own within 30 sec).

VAERS ID:361945 (history)  Vaccinated:2009-10-19
Age:14.0  Onset:2009-10-20, Days after vaccination: 1
Gender:Female  Submitted:2009-10-21, Days after onset: 1
Location:Texas  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0604Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3015AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0994Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Headache, Neck pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Headache all day, neck hurts, and stomach ache. Tylenol around 10:00 AM, and Motrin in the afternoon did not releave headache.

VAERS ID:361995 (history)  Vaccinated:2009-05-08
Age:14.0  Onset:2009-05-13, Days after vaccination: 5
Gender:Male  Submitted:2009-10-21, Days after onset: 161
Location:Texas  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE 12/30/09 PMH: Allergic to penicillin
Diagnostic Lab Data: CBC, STREP SCREEN, RAPID FLU TEST 12/30/09 Labs/ Diagnostics: Glucose 135 (H); Sodium 4.9 (H). CSF WBC: 207 (H); CSF Protein: 81.9 (H); CT brain: unremarkable; bacterial antigen CSF: negative; CXR: normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2877AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood glucose increased, Blood sodium increased, CSF culture, CSF protein increased, CSF test abnormal, CSF white blood cell count increased, Chest X-ray normal, Dehydration, Full blood count, Headache, Influenza serology, Laboratory test normal, Meningitis viral, Nausea, Photophobia, Pyrexia, Scan brain, Streptococcus identification test, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: DEVELOPED FEVER, HEADACHE, NAUSEA, VOMITING 5/13/2009 AT NIGHT. LAB TESTS NEGATIVE-REFERRED TO HOSPITAL 12/30/09 DC Summary, ED and Hospital records received for DOS 05/14/09-05/16/09 Pt. presented with one-day history of headache, fever,vomiting, photophobia. Pt. admitted for rehydration, antibiotics. Discharged stable. DC DX: viral meningitis; headache, resolved; dehydration, resolved

VAERS ID:362125 (history)  Vaccinated:2009-10-20
Age:14.0  Onset:2009-10-20, Days after vaccination: 0
Gender:Male  Submitted:2009-10-21, Days after onset: 1
Location:Nebraska  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None listed on flu questionnaire
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3214AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 10-20-09 After lunch - school called to report redness at injection site, slight warmth and itchy. Denies fever or chills. Instructed mom to apply ice to area and may take BENADRYL for age and to contact MD or go to ER and that Dr. available for MD visit if needed.

VAERS ID:362181 (history)  Vaccinated:2008-10-08
Age:14.0  Onset:2009-02-02, Days after vaccination: 117
Gender:Female  Submitted:2009-10-21, Days after onset: 260
Location:Pennsylvania  Entered:2009-10-22, 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:
Preexisting Conditions: PMH: seizures; Allergies: NKDA.
Diagnostic Lab Data: head computed axial, 02/02/09, negative; electroencephalograpy, 09/29/09, an abnormal EEG due to the presence of three electrographic seizures; blood glucose, 02/02/09, 97, normal DX studies: ECG: asymptomatic; GCS: 14; Head CT: normal.
CDC Split Type: WAES0910USA02024
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAOB747AA1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1978U2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0995X1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Blood glucose normal, Computerised tomogram head, Computerised tomogram normal, Convulsion, Electric shock, Electrocardiogram normal, Electroencephalogram abnormal, Fall, Glasgow coma scale, Head injury, Scan brain, Screaming, 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), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a medical assistant and medical record concerning a 14 year old former healthy female with no known allergies who on 08-OCT-2008 was vaccinated intramuscularly with a third dose of GARDASIL (lot number 659964/1978U) in the left deltoid, a second dose of VARIVAX (Merck) (lot number 661661/0995X) subcutaneously in the right arm and a second dose of HAVRIX (lot number AHA0B747AA) intramuscularly in the right deltoid. On 02-FEB-2009 at 07:47 in the morning the patient experienced syncope and was transferred to the hospital emergency room. The head CT was negative and blood sugar was 97 which was normal. The patient was diagnosed with possible electrical shock. It was reported that the patient stated that she was shocked via hair straightener. The patient saw the physician on the same day and was diagnosed with possible seizure post electrical shock. On 10-APR-2009 the patient experienced seizure for 2 minutes, fell and hit her head on the floor and was sent to ER. The patient was started with TEGRETOL 200 mg twice a day. On 25-MAY-2009 dose of TEGRETOL was increased to 400 mg twice a day then 500 mg twice a day. The patient was also treated with folic acid 5 mg daily. On 04-MAY-2009 the patient experienced seizure for the third time. On 25-MAY-2009 therapy with TEGRETOL was discontinued and changed to KEPPRA. It was reported that the patient recovered on medications on 23-SEP-2009. On 29-SEP-2009 electroencephalograpy (EEG) showed abnormal for 3 electrographic seizures. Seizures were considered to be an other important medical event by the reporter. Additional information is not expected. All available medical records will be provided upon request. 01/05/10 MR received for DOS 09/17/09. DX: Grand mal seizures. Pt presented with grand mal sz lasting 5 mins and loud screem. Pt A, Ox3, comfortable; neuro exam: normal. Pt discharged home in stable condition.

VAERS ID:362272 (history)  Vaccinated:2009-10-21
Age:14.0  Onset:2009-10-21, Days after vaccination: 0
Gender:Female  Submitted:2009-10-22, Days after onset: 1
Location:Massachusetts  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: cold
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Malaise, Nausea, Pallor, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Turned pale. Nausea, near fainting. Weak and sick.

VAERS ID:362354 (history)  Vaccinated:2009-10-07
Age:14.0  Onset:2009-10-12, Days after vaccination: 5
Gender:Female  Submitted:2009-10-22, Days after onset: 10
Location:California  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR43212AA1IMUN
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500759F0IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Cough, Immunisation reaction, Nasopharyngitis, Upper respiratory tract infection, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives on face.

VAERS ID:362350 (history)  Vaccinated:2009-10-22
Age:14.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 1
Location:Nevada  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none PMH: None Allergies: NKDA
Diagnostic Lab Data: Labs: CBC, CMP, UA normal Dx studies: Xrays of nasal bones neg for fx
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU3201AA0IJLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0313Y0IJRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Fall, Full blood count normal, Joint swelling, Metabolic function test normal, Nervousness, Skin laceration, Swelling face, Syncope, Tremor, Urine analysis normal, X-ray normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: MY DAUGHTER FAINTED WITHIN 30 SECONDS AND FELL FLAT ON HER FACE FROM THE DOCTORS TABLE. STAFF BEGAN VITALS, OXYGEN, I.V... X-RAYS OF HER FACE WERE TAKEN, NOTHING BROKE BUT HER FACE AND NOSE IS SWELLED AND GASHED. HER RIGHT KNEE IS SWOLLEN AND IS CAUSES HER PAIN AS WELL. SHE IS SHAKEY. SHE WAS RELEASED AFTER A FEW HOURS OF EVALUATION AT URGENT CARE. WE WERE TOLD IT WAS BECAUSE SHE WAS ON HER PERIODAT THE TIME OF VACCINATING WITH GARDASIL. NO MEDS PERSCRIBED. WE WERE TOLD TO COME BACK IN 2 MONTHS. THIS HAPPENED TODAY. MY FATHER CONSENTED TO THIS VACCINATION BECAUSE HE IS LEGAL GUARDIAN. HE WAS TOLD SHE SHOULD GET THIS BECAUASE SHE IS SEXUALY ACTIVE. AND IT WAS SAFE.. I HAVE BEEN EDUCATING MYSELF WITH THIS GARDASIL AND I AM VERY FEARFULL THERE IS IRREVERSABLE DAMAGE DONE.... 11/16/2009, PCP/Urgent Care records from 10/22/2009,Dx syncopal episode post vaccine, patient with a syncopal episode that resulted in a fall, patient striking her nose. xrays neg for fx. tx: ice pack and Motrin,

VAERS ID:362513 (history)  Vaccinated:2007-03-15
Age:14.0  Onset:2009-10-06, Days after vaccination: 936
Gender:Female  Submitted:2009-10-19, Days after onset: 13
Location:Tennessee  Entered:2009-10-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: High-risk HPV on pap smear
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0637F IMUN
Administered by: Private     Purchased by: Private
Symptoms: Human papilloma virus test positive, Papilloma viral infection, Smear cervix abnormal
SMQs:
Write-up: Discovered high-risk HPV on pap.

VAERS ID:362562 (history)  Vaccinated:2009-10-20
Age:14.0  Onset:2009-10-21, Days after vaccination: 1
Gender:Female  Submitted:2009-10-23, Days after onset: 2
Location:Texas  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillan Naproxen Cyclobenzaprine
Current Illness: Sinus infection and sore ribs
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0605Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3016AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3249AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pruritus, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: client complains of hives, itching, swelling in cheeks, headache

VAERS ID:362680 (history)  Vaccinated:2009-10-08
Age:14.0  Onset:2009-10-09, Days after vaccination: 1
Gender:Female  Submitted:2009-10-25, Days after onset: 16
Location:Massachusetts  Entered:2009-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no illness at that time
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Private     Purchased by: Unknown
Symptoms: Contusion, Lethargy, Muscular weakness, Nausea, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Hypersensitivity (narrow)
Write-up: after the shot my daughter had begun to have extremely high fevers on and off up to 103 and on Oct 23rd her whole body became cover in hives and her skin appeared to be bruising. We went to her primary care and she refused to listen that it could be from the shot. Every morning she is lathargic, nauseous, and her muscles have become weak. It is now Oct 25th and for the past 3 days she has had hives at the same time of day {the same time the shot was given}.

VAERS ID:362764 (history)  Vaccinated:2009-02-11
Age:14.0  Onset:2009-02-11, Days after vaccination: 0
Gender:Male  Submitted:2009-10-26, Days after onset: 256
Location:Texas  Entered:2009-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CITALOPRAM 10/MG-D
Current Illness: DEPRESSION, HISTORY OF DRUG ABUSE-MARIJUANA
Preexisting Conditions: NONSE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2822AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1391X1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Feeling cold, Headache, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 2:20PM 5-7 MINUTES AFTER VACCINE ADMINISTRATION, PATIENT PALE, COOL AND C/D. FEELING DIZZY. PLACED ON EXAM TABLE B/P 100/60; P 72. R 16; ANSWERED APPROPRIATELY; VITALS 108/60. 2l45 SAT UP. C/O HEADACHE AND FEELING COLD. EMS ACTIVATED 3 PM EMS EVALUATED. NO NEED TO TRANSPORT. PT STATES HE FEELS OK.

VAERS ID:362776 (history)  Vaccinated:2009-10-15
Age:14.0  Onset:2009-10-18, Days after vaccination: 3
Gender:Female  Submitted:2009-10-26, Days after onset: 8
Location:Michigan  Entered:2009-10-26
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0604Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3022AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3246BA7IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1000Y0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Varicella post vaccine
SMQs:
Write-up: Immunized 10-15-09 with Tdap. Hep A, Varicella #1 MENACTRA. To 10-19-09 with varicella rash outbreak to torso, began appearing 10-18-09.

VAERS ID:362835 (history)  Vaccinated:2009-10-16
Age:14.0  Onset:2009-10-16, Days after vaccination: 0
Gender:Female  Submitted:2009-10-16, Days after onset: 0
Location:Louisiana  Entered:2009-10-26, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500707P1IN 
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Headache
SMQs:, Guillain-Barre syndrome (broad)
Write-up: At 0840 am FLUMIST given. At 0850 student c/o headache to front part of head and around eye area stated history of sinus and allergy problem. BP taken 110/80 HR 85 Rep 20 - 0910 student report headache worse. Student given BENADRYL 10 ml PO strong orders. No other S/S, stated just felt weak. No problem breathing, no erythema, no urticaria, no wheezing, no angioedema. 1110 states feeling better - mom to pick up after test.

VAERS ID:362895 (history)  Vaccinated:2009-10-21
Age:14.0  Onset:2009-10-22, Days after vaccination: 1
Gender:Male  Submitted:2009-10-26, Days after onset: 4
Location:California  Entered:2009-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3212AA0UNLA
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500760P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Mother of pt. That pt on 10/22/09-son states he had two random occasions at school that he found it harder to breathe, causing him to pause and put effort into ea breath. States instances were brief and not to extent that he was alarmed enough to seek medical care-no other episodes to date.

VAERS ID:363042 (history)  Vaccinated:2009-01-28
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-27
Location:Texas  Entered:2009-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX090003PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2017AB4IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Expired drug administered
SMQs:
Write-up: NO SIGNS OR SYMPTOMS. PATINET WAS GIVEN TD ON 1/28/09 THAT HAD EXPIRED ON 1/19/09. INSTRUCTED TO REPORT TO VAERS.

VAERS ID:363207 (history)  Vaccinated:2009-10-22
Age:14.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Male  Submitted:2009-10-22, Days after onset: 0
Location:Arizona  Entered:2009-10-27, 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:
Current Illness: None known reported
Preexisting Conditions: cardiac defects; hyperactivity; behavior issues; allergic to any meds containing ETOH
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP008AA0UNRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Body temperature increased, Chills, Cough, Decreased appetite, Hypersomnia, Malaise, Pyrexia, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)
Write-up: Temp 101 - 102 after vaccine, chills, usually hyperactive, but sleepy exhibiting malaise. Father administered 200 mg liquid gel MOTRIN. Hx of increased fever prior to vaccines listed below. Stayed home for one week during last week of September. Second call from father reporting child continuation with fever often as high as 103. Does come down with MOTRIN gel - not eating, congestion extreme coughing- sore stomach due to coughing.

VAERS ID:363530 (history)  Vaccinated:2009-10-27
Age:14.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-10-28, Days after onset: 1
Location:Nebraska  Entered:2009-10-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500756P0IN 
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Red raised rash both arms from elbows to hands 3 hours after H1N1 nasal mist. Resolved by morning. Advised mom if rash returns-give BENADRYL and contact our office.

VAERS ID:363546 (history)  Vaccinated:2009-08-18
Age:14.0  Onset:2009-08-19, Days after vaccination: 1
Gender:Female  Submitted:2009-10-28, Days after onset: 70
Location:California  Entered:2009-10-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0909USA00379
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Disturbance in attention, Dizziness, Fatigue, Headache, Vaccination complication
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)
Write-up: Information has been received from a physician concerning a female patient who on approximately 12-AUG-2009, "three weeks ago", was vaccinated intramuscularly into the deltoid with a dose of GARDASIL. The next morning after vaccination, on approximately 13-AUG-2009, the patient had experienced headaches and dizziness every day for the last three weeks. The patient also had not been able to concentrate in school. The patient sought medical attention by an office visit. The patient recovered from all symptoms on 02-SEP-2009. Follow up information was received from the physician who reported that the 14 year old patient on 18-AUG-2009 was vaccinated with her first dose of GARDASIL (Lot No. 663452/0671Y). On 19-AUG-2009, the patient experienced severe headache and dizziness. The patient was prescribed ANTIVERT for the treatment of dizziness. Although the patient was going to school, she was very tired and had difficulty concentrating. The patient sought unspecified medical attention. At the time of the report, the patient had recovered from all symptoms. The patient''s headache, dizziness, disturbance in attention, and fatigue were considered to be other important medical events by the reporter. No further information is available. 11/2/09 Medical records received for date 9/2/09. DX: Adverse rx to vaccine. Presenting SX: c/o severe HA, dizziness x3wks. Pt states began after first vax of gardasil.

VAERS ID:363718 (history)  Vaccinated:2009-05-28
Age:14.0  Onset:2009-05-29, Days after vaccination: 1
Gender:Male  Submitted:2009-10-29, Days after onset: 153
Location:Texas  Entered:2009-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX090021PR
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2873AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Eye pain, Headache, Muscular weakness, Musculoskeletal discomfort, Oropharyngeal pain, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Arthritis (broad)
Write-up: 5/29/09 COMPLAINED OF HEADACHE, LEG WEAKNESS, HIP JOINT PAIN, EYE PAIN UNTIL 5/31/09. SORE THROAT AND CONGESTION 5/30/09-5/31/09. IBUPROFEN ONLY.

VAERS ID:364029 (history)  Vaccinated:2009-10-20
Age:14.0  Onset:2009-10-21, Days after vaccination: 1
Gender:Male  Submitted:2009-10-30, Days after onset: 9
Location:Unknown  Entered:2009-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: Asthma 11/6/09 Medical records received for date 10/22/09 PMH: ADHD, asthma
Diagnostic Lab Data: None 11/6/09 Medical records received for date 10/22/09Labs: allery test (-)eggs.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP005AA0IJUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Allergy test negative, Hypersensitivity, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Child woke up at 2330 with hives and itching. Hives mostly on arms and sides. Benadryl was given. Taken to the ED and given Decadron and Benadryl. Improvement noted on 10/23/2009. 11/6/09 Medical records received for date 10/22/09. DX: Allergic reaction acute. Chief c/o generalized uticaria with itching. Received H1N1 vax 1 day previous. Assessment: hives on legs, arms, chest. Rash generalized. Pt. dc home rash resolved after tx.

VAERS ID:364064 (history)  Vaccinated:2009-09-17
Age:14.0  Onset:2009-09-19, Days after vaccination: 2
Gender:Female  Submitted:2009-10-30, Days after onset: 41
Location:Texas  Entered:2009-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ASTHMA
Diagnostic Lab Data: DID NOT SEE A DOCTOR
CDC Split Type: TX090032PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2925AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3029AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0741Y1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: RIGHT ARM RED AND SWOLLEN AND HIVES PRESENT. MOM APPLIED BENADRYL CREAM AND GAVE HER ZYRTEC.

VAERS ID:364266 (history)  Vaccinated:2008-11-19
Age:14.0  Onset:2008-11-19, Days after vaccination: 0
Gender:Male  Submitted:2009-11-02, Days after onset: 348
Location:Texas  Entered:2009-11-02
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: PENICILLIN ALLERGY, SULFA, EES
Diagnostic Lab Data: NONE
CDC Split Type: TX090033PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB247AA IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2730AA IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2768BA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Musculoskeletal pain, Musculoskeletal stiffness
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: PATIENT COMPLAINED STIFF NECK, PAIN IN LEFT SHOULDER BLADE, LEFT SIDE OF BACK

VAERS ID:364268 (history)  Vaccinated:2009-10-30
Age:14.0  Onset:2009-11-01, Days after vaccination: 2
Gender:Female  Submitted:2009-11-02, Days after onset: 1
Location:California  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1353Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3053AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Erythema, Pruritus, Tenderness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (broad)
Write-up: BURNING AND ITCHY SENSATION, 3X3 INCH DIAMETER REDNESSSLIGHTLY TENDER TX-APPLY COLD COMPRESS

VAERS ID:364332 (history)  Vaccinated:2009-10-15
Age:14.0  Onset:2009-10-17, Days after vaccination: 2
Gender:Female  Submitted:2009-10-26, Days after onset: 9
Location:Arizona  Entered:2009-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500760P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Cough, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Slightly elevated temperature from Oct 17th-Oct 19th accompanied by headache. Then developed cough. Still has slight cough.

VAERS ID:364591 (history)  Vaccinated:2009-10-15
Age:14.0  Onset:2009-10-19, Days after vaccination: 4
Gender:Female  Submitted:2009-11-03, Days after onset: 15
Location:Illinois  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergy to apples
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest X-ray, Cough, Headache, Influenza like illness, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: FLu like sysmptoms, fever, aches, cough, headache. Treatment was OTC fever reducers, did have chest x-ray. Doctor suspected H1N1 - did not test. But suspected flu mist was cause.

VAERS ID:364622 (history)  Vaccinated:2009-08-22
Age:14.0  Onset:2009-08-22, Days after vaccination: 0
Gender:Female  Submitted:2009-11-03, Days after onset: 73
Location:Texas  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX090050PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB235BA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2662AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3027AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.D271X0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: WITHIN 5 MINUTES AFTER RECEIVING SHOTS, RASH AND ITCHING BEGAN ON HANDS, WRISTS, AND ARMS (SMALL, RED, RAISED BUMPS) 25 MG BENADRYL PO VITAL SIGNS P68, RR14, BP 110/70. OBSERVATIONS FOR 1 HOUR POST VACCINATION WITH NO WHEEZING OR DISTRESS NOTED. SYMPTOMS SUBSIDED WITH BENADRYL.

VAERS ID:364785 (history)  Vaccinated:2009-10-24
Age:14.0  Onset:2009-10-24, Days after vaccination: 0
Gender:Male  Submitted:2009-11-03, Days after onset: 10
Location:Pennsylvania  Entered:2009-11-03
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: Family physician ordered blood work and x-ray-prescribed cephalexin 500 mg BID
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP002AA0IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3188AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Blood test, Lymphadenopathy, Pain, X-ray
SMQs:
Write-up: Student states started having pain at R "armpit" 45 minutes after receiving the H1N1 vaccine in R deltoid. Came to school nurse office on 10/27/09 to report it. Had not seen Dr prior to visit to my office. Called mother and referred family physician. Axilla area had an enlarged lymph node.

VAERS ID:364913 (history)  Vaccinated:2009-10-27
Age:14.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-10-29, Days after onset: 2
Location:Indiana  Entered:2009-11-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-Provera last dose 8-27-09
Current Illness: None
Preexisting Conditions: Lortabs-per patient
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Eye swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: GARDASIL given on 10-27-09. Mother calls 10-29-09 and states patient had puffy face and eyes the afternoon of 10-27-09. States c/o chest tightness either late PM 10-27 or 10-28 and continues today. BENADRYL 25 mg TID and go to ER for increased sx.

VAERS ID:364977 (history)  Vaccinated:2008-11-14
Age:14.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-11-04, Days after onset: 355
Location:Texas  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX090069
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2790BA UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2561AA UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abasia, Asthenia, Chest pain, Condition aggravated, Crying, Dyskinesia, Dyspnoea, Emotional distress, Hypoaesthesia, Paraesthesia, Pleurisy, Rash
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: APPROXIMATELY 20 MINUTES AFTER RECEIVING VACCINE PATIENT COMPLAINING OF CHEST PAIN WITH DIFFICULTY BREATHING V/S 148-96 R20 P82 CLEAR BREATH SOUNDS ON AUSCULTATION ANTERIOR AND POSTERIOR AND RASH COMPLAINED OF TINGLING TO BOTH HANDS. HAD PATIENT BREATHE IN PAPER BAG WITHOUT RELIEF. CLIENT STATES CP TOO BAD TO AMBULATE. EMS CALLED AND PATIENT TRANSFERRED TO LOCAL HOSPITAL. PATIENT RELEASED SAME DAY FROM ER DX: PLEURISY. 11/4/08 PUBLIC HEALTH OFFICE HAD FLU CLINIC ON THIS DATE. INFLUENZA AND MCV4 WAS PROVIDED. PATIENT 14/8 RECEIVED INFLUENZA INJECTION TO L DELTOID AND MCV4 TO R DELTOID. HE THEN WENT BACK TO HIS CLASSROOM. APPROX. 20-30 MIN LATER HE CAME BACK TO C/O BURNING SUBSTERNAL CHEST PAIN AND DIFFICULTY BREATHING. VS: 148-96 P82 R20, CLEAR BREATH SOUNDS ANTERIORLY/POSTERIORLY NO RALES, WHEEZING, RHONCHI, NO RASH. DURING ASSESSMENT CLIENT BEGAN COMPLAINING OF NUMBNESS/TINGLING TO BOTH HAND AND FINGER. TRIED TO GET CLIENT TO BREATHE IN BROWN PAPER BAG. HE BEGAN TO CRY SAYING CP WAS INCREASING. A MALE EMPLOYEE AND I TRIED TO HELP HIM TO A VEHICLE TO BE TRANSPORTED FOR EXAM BUT CLIENT STATED HE WAS TOO WEAK TO WALK SO EMS WAS NOTIFIED. WHILE WAITING FOR EMS ARRIVAL, V/S RETAKEN BP 152/92 P90 R20 BREATHING SOUNDS REMAINED CLEAR, NO RASH NOTED TO INCREASE ABD/BACK, NOTED R HAND BEGAN TO CONTRACT AND CLIENT CONTINED TO CRY. STAFF UNABLE TO COMFORT CLIENT. EMS ARRIVED AT SCENE, CLIENT WAS TRANSPORTED TO ER FOR ASSESSMENT. RECEIVED REPORT AT APPROXIMATELY 4 PM THAT CLIENT WAS RELEASED WITH WITHOUT MEDS AND DX: PLEURISY.

VAERS ID:365065 (history)  Vaccinated:2009-10-12
Age:14.0  Onset:2009-10-12, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 9
Location:California  Entered:2009-11-04, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Ankle injury
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3198AA0IMUN
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500760P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Flu and H1N1 nasal given 10/12/09 and later that day few (hours later) got rash, itchy on legs only. Using BENADRYL helps but rash recurs. No other symptoms.

VAERS ID:365069 (history)  Vaccinated:2009-10-20
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2009-10-29
Location:Alabama  Entered:2009-11-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA UNUN
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:365230 (history)  Vaccinated:2009-10-29
Age:14.0  Onset:2009-10-30, Days after vaccination: 1
Gender:Female  Submitted:2009-11-04, Days after onset: 5
Location:Arkansas  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Had a seizure 3yr ago and is on Kepra.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3260DA1IMRL
Administered by: Military     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Patient had seizure at 6:30 am the next morning after having the flu shot. Went to ER. Precautionary.

VAERS ID:365324 (history)  Vaccinated:2009-10-28
Age:14.0  Onset:2009-10-31, Days after vaccination: 3
Gender:Male  Submitted:2009-11-05, Days after onset: 5
Location:Alabama  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Was diagnosed with H1N1 flu 11/03/09- Treated with Tamiflu, Advair, allbuterol, Tylenol, Mucinex. Positive Type A, Culture sent.
CDC Split Type: AL0926
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP003AA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature increased, Cough, Dysphonia, Influenza serology positive, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad)
Write-up: C/O cough, congestion in chest hoarseness. Onset 10/31/09 T-100, taking Tylenol and Mucinex for cough, will call MD and might see MD for visit.

VAERS ID:365329 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-05, Days after onset: 1
Location:Georgia  Entered:2009-11-05
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Hypoplastic left heart syndrome, status post complete repair (7/16/1997).PMH: hypertrophic cardiomyopathy, open heart sx x3, multiple med, food and environ allergies Allergies: Multiple.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP018AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cheilitis, Erythema, Hypersensitivity, Lip swelling, Multiple allergies, Paraesthesia, Pruritus, Swelling face, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: hives covering entire body, starting at neck and back; swelling and redness in face and lips; itching; throat tingling. 11/06/09 and 11/09/09 Medical records received for DOS 11/04/09. Final DX: Acute allergic reaction. Hives and swollen lip approx 1hr s/p H1N1 vaccine. H/O multiple allergies and hypertrophic cardiomyopathy. O2 sat 98%. Resolved with antihistamine and steroid tx. D/C to home. 11/9/09: ED Records received for date of service 11/4/09. Dx: Acute allergic reaction. No new information.

VAERS ID:365497 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-05, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0702X1UNLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Mother stated that 10 minutes after the patient received the GARDASIL vaccine, the patient reported to have a tight feeling in her throat and the patient started to feel hot. Patient was told by doctor to wait 10 minutes and symptoms should go away.

VAERS ID:365503 (history)  Vaccinated:2009-11-05
Age:14.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Male  Submitted:2009-11-06, Days after onset: 1
Location:Iowa  Entered:2009-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe stomach pain and vomiting beginning approximately 4 hours after receiving flumist

VAERS ID:365832 (history)  Vaccinated:2009-10-27
Age:14.0  Onset:2009-10-28, Days after vaccination: 1
Gender:Male  Submitted:2009-11-07, Days after onset: 10
Location:Tennessee  Entered:2009-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ok
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: flu tests, cvc blood test
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood test, Cough, Headache, Influenza serology, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever 101-102, headache, bad cough, with congestion.

VAERS ID:365833 (history)  Vaccinated:2009-10-27
Age:14.0  Onset:2009-10-30, Days after vaccination: 3
Gender:Female  Submitted:2009-11-07, Days after onset: 8
Location:Tennessee  Entered:2009-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ok
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500767P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bronchitis, Chest discomfort, Cough, Headache, Oropharyngeal pain, Pneumonia, Pulmonary congestion, Pyrexia, Red cell distribution width increased, Rhinorrhoea
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad)
Write-up: Bad cough, congestion, fever, went to bronchitis-pneumonia.

VAERS ID:366160 (history)  Vaccinated:2009-11-02
Age:14.0  Onset:2009-11-03, Days after vaccination: 1
Gender:Male  Submitted:2009-11-09, Days after onset: 6
Location:Connecticut  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient had been seen by PMD sinusitis. On day 11 of 15 of amoxicillin on the date he received vaccination
Preexisting Conditions: Intermittent asthma and seasonal allergies. 11/20/09 Hospital records received service dates 11/7/09 to 11/11/09. Asthma. Seasonal allergies. Allergy - Nickel containing compounds.
Diagnostic Lab Data: 11/20/09 Hospital records received service dates 11/7/09 to 11/11/09. LABS and DIAGNOSTICS: NCS/EMG - Normal. MRI Cervical Spine - Tiny C7-T1 disc protrusion, otherwise WNL. Serum IgA 420 mg/dL (H). CHEM - Glucose 160 mg/dL (H) Phosphorus 5.2 mg/dL (H) ALT 14 U/L (L) Alk Phos 157 U/L (H)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase decreased, Areflexia, Blood alkaline phosphatase increased, Blood glucose increased, Blood immunoglobulin A increased, Blood phosphorus, Blood product transfusion, Electromyogram normal, Guillain-Barre syndrome, Headache, Immunoglobulin therapy, Intensive care, Intervertebral disc protrusion, Lethargy, Lymphocyte percentage increased, Muscular weakness, Nerve conduction studies normal, Nuclear magnetic resonance imaging abnormal, Oropharyngeal pain, Pain, Red blood cells CSF positive
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad)
Write-up: Patient began to experience weakness and lower extremities and hands one day after receiving H1N1 vaccination. Is now admitted to our PICU for presumed Guillain-Barre. 11/10/09 Medical records received for date 11/2/09 to 11/9/09. DX: Pt. admitted to hosp. for mild GBS secondary to H1N1 vax. Pt was seen on 11/2/09 with c/o pain on left side. Pt. received H1N1 vax in left arm. 11/4/09 pt c/o sore throat, HA, lethargic after taking abx for sinus inf. Later returned to office with worsening of sx. Assessment: parent feels pt is experiencing GBS. (+) rectal abscess. Pt. referred to ID. 11/9/09 After consult pt. admitted to hospital. 11/20/09 Hospital records received service dates 11/7/09 to 11/11/09. Assessment: Presumed GBS. Transferred from another facility. Progressive lower extremity weakness and loss of lower extremity reflexes. IVIG. Head ache. Prior to discharge patellar reflexes +2 ankle jerk reflexes +1.

VAERS ID:366231 (history)  Vaccinated:2009-11-07
Age:14.0  Onset:2009-11-09, Days after vaccination: 2
Gender:Female  Submitted:2009-11-09, Days after onset: 0
Location:Washington  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt awoke with rash on entire body (concentrated on trunk and arms). About 36 hrs post vaccination.

VAERS ID:366347 (history)  Vaccinated:2009-11-03
Age:14.0  Onset:2009-11-06, Days after vaccination: 3
Gender:Female  Submitted:2009-11-10, Days after onset: 4
Location:Georgia  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu like illness~Influenza (Seasonal) (no brand name)~1~12.00~Patient
Other Medications: She takes Strattera
Current Illness: No
Preexisting Conditions: ADD, Factor 5
Diagnostic Lab Data: I''m sure she will recover.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.UNKNOWN0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Cough, Eye pain, Fatigue, Influenza, Myalgia, Nasal congestion, Pyrexia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Eosinophilic pneumonia (broad)
Write-up: Stuffy nose, cough congestion. Fever the next day of 103. Extreme fatigue, muscle aches, eye pain. Runny nose. Fever is on its 4th day. Missed school 2 days posibly more. It appears she has gotten the flu from the vaccine.

VAERS ID:366668 (history)  Vaccinated:2009-08-06
Age:14.0  Onset:2009-08-07, Days after vaccination: 1
Gender:Male  Submitted:2009-11-11, Days after onset: 96
Location:New Mexico  Entered:2009-11-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Otitis media resolved
Preexisting Conditions: Bipolar; PTSD; AOHD; OCD 12/17/09 PMH: Reactive attachment disorder, behavioral problems with out-patient psychotherapy, nosebleeds, Fx. wrists, recent earache.
Diagnostic Lab Data: EEG; BMP; CBC; ECG; Hep panel; See copy of discharge summary 12/17/09 LABS and DIAGNOSTICS: Electroencephalogram-unremarkable for epileptiform activity, Low voltage fast activity consistent with sedative hypnotic use was seen throughout, Head Ct-no intracranial abnormality.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURV2992AA0SCLA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURERAC52B030AR5IMLA
Administered by: Private     Purchased by: Public
Symptoms: Aggression, Agitation, Computerised tomogram normal, Crying, Disorientation, Electrocardiogram, Electroencephalogram, Electroencephalogram normal, Epistaxis, Grand mal convulsion, Headache, Hepatitis viral test, Hypotension, Malaise, Metabolic function test, Screaming, Tachycardia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: New onset of seizures. Seen and treated in the emergency room and pediatric intensive care. 12/17/09 (01/04/2010-Dup. rec received) hospital records received for DOS 08/07/09-08/09/09 Dx: New onset seizures Patient presented in ER, screaming, combative, disorientated, tachycardic, hypotensive and bleeding from the nose. Patient received vaccination yesterday. Mother reported that patient called her today and complained of severe headache, not feeling well and was crying. Mother returned home and witnessed generalized tonic-clonic seizure. In ambulance, patient received valium for combativeness alternating with seizures. Admitted- one episode of sudden agitation during hospitalization. Patient treated with Torazepam, Haldol, saline bolus (3 liters). Discharged home.

VAERS ID:366627 (history)  Vaccinated:2009-11-05
Age:14.0  Onset:2009-11-06, Days after vaccination: 1
Gender:Male  Submitted:2009-11-11, Days after onset: 5
Location:Virginia  Entered:2009-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Claritin 10mg daily
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRI: negative for transverse myelitis; LP: negative for infection; EMG: positive for slowing 11/12/09 LABS and DIAGNOSTICS: Head CT Neg, MRI of thoracic, lumbar and cervical spine were normal with no evidence of transverse mylitis or other cord lesion, Blood culture: No growth, CSF cultures: No WBCs or organisms seen, CK-MB 4.7, 3.6, CK 209, TP 8.1, ALB 5.4, AP 158, AST 35 and ALT 27.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP010AA0IMLA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3207AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abasia, Alanine aminotransferase normal, Antinuclear antibody positive, Areflexia, Arthralgia, Aspartate aminotransferase normal, Asthenia, Ataxia, Back pain, Bacterial test, Blood albumin increased, Blood alkaline phosphatase increased, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood culture negative, Blood immunoglobulin G normal, Borrelia test negative, CSF culture negative, CSF test normal, Cellulitis, Computerised tomogram normal, Culture urine negative, Electromyogram abnormal, Fatigue, Gait disturbance, Guillain-Barre syndrome, Headache, Hypokinesia, Immunoglobulin therapy, Lumbar puncture normal, Muscle spasms, Muscular weakness, Myalgia, Nasopharyngitis, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging normal, Protein total normal, Sensory loss, Staphylococcus test positive, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Began with muscle spasms and back pain. One hour later had headache and inability to walk. Presented to the ED and was found to be areflexic. Admitted to hospital. Diagnosed with GBS and treated with IvIg. Responded and was discharged 4 days later. 11/12/09 Hospital records received DOS 11/06/09-10/10/09 Diagnosis: Lower extremity weakness Patient presented to emergency room with headache, unsteady gait and lower extremity weakness. On the prior day, the patient had received H1N1 and seasonal flu vaccine and subsequently felt cold, had back spasms and muscle pain. One hour later, the patient had inability to walk. Patient had recently returned from a trip. Patient reported two month history of headaches behind eyes, numbness with sharp shooting pains in legs, numbness in arms and pain in shoulder. Physical examination noted ataxia, decrease in sensation and motor strength in lower extremities and no reflexes in lower extremities. Arms had decrease of strength and motor activity. Physical therapy (PT) consultation assessment noted peripheral polyneuropathy thought likely secondary to Guillain-Barre Syndrome according to “neuro” following H1N1 vaccination. The PT consult noted patient had shuffling gait with walker. The Patient was discharged home with PT/OT follow-up.

VAERS ID:366756 (history)  Vaccinated:2009-11-07
Age:14.0  Onset:2009-11-08, Days after vaccination: 1
Gender:Female  Submitted:2009-11-12, Days after onset: 4
Location:Colorado  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: no
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Headache, Pain, Rhinalgia, Sinus congestion
SMQs:, Dementia (broad)
Write-up: Severe headache, body aches and sinus congestion with nasal pain. Took three days to recover with school time lost. Very severe headache for 29 hours.

VAERS ID:366820 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Male  Submitted:2009-11-12, Days after onset: 8
Location:Pennsylvania  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1007390IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Erythema, Injection site erythema, Injection site pruritus, Injection site rash, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Approx 40 minutes after given injection, developed rash on same arm and hand that had the H1N1 injection. BENADRYL given. Red and itchy.

VAERS ID:366928 (history)  Vaccinated:2009-01-27
Age:14.0  Onset:2009-01-27, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 289
Location:Texas  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: h/o beast pain, redenss, swelling.
Diagnostic Lab Data: Multiple blood tests, cardiac stress tests, EEG, MRIs, & general physical exams.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y2IJAR
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Asthenia, Blood test, Breast swelling, Cardiac stress test, Chest pain, Dizziness, Electroencephalogram, Erythema, Fall, Fatigue, Feeling hot, Gait disturbance, Hypoaesthesia, Loss of consciousness, Nuclear magnetic resonance imaging, Pain, Paraesthesia, Syncope, Tenderness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad)
Write-up: Initially after the vaccination Jasmyne felt hot and passed out. She was woozy and we waited until she was more stable so we could take her home. Within a week roughly she started to have random fainting spells which she had never experienced before. Additionally, she has numbness/tingling in arms and legs and intermittent chest pains. She is constantly fatigued and because we never know when she will have a fainting episode she is homeschooled. She tends to be very weak and dizzy after she faints and it can take a hour or so for her to regain any strength. Many times her legs give out when she is walking and she falls down. She has seen multiple doctors and specialists. We just monitor her condition and make sure stay hydrated and we also increased her sodium to try and combat the fainting which has been slightly effective. The biggest issue now is the constant fatigue and pain she experiences regularly. 11/16/09 Medical records received fro DOS 1/27/09. PCP notes documents vaccine dates and h/o beast pain, redness, swelling. ABx therapy.

VAERS ID:366948 (history)  Vaccinated:2009-11-10
Age:14.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 2
Location:Florida  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy "shot" two weeks before H1N1 vaccine given. Has been on this medications for the last 4 years.
Current Illness: None
Preexisting Conditions: Asthma, and allergies to shell fish, grass and mold.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP018AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Body temperature increased, Influenza like illness
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad)
Write-up: Back ache. Next day ILI with temp of 103.

VAERS ID:366969 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 8
Location:Florida  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B041BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0808Y0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Child received TDAP, VZV. Walked out of clinic in good spirits, alert, coherent, color good. Ten minutes later mom came back to clinic to report client had passed out for few seconds in car. Child alert when nurse arrived. Still dizzy, pale. BP 90/60, P 60, cold comp applied. Juice and H2O given. After few minutes child alert. BP 100/60, P 60.

VAERS ID:367044 (history)  Vaccinated:2007-11-09
Age:14.0  Onset:2007-11-16, Days after vaccination: 7
Gender:Female  Submitted:2009-10-01, Days after onset: 684
Location:California  Entered:2009-11-12, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Vaccines was painful at time
Preexisting Conditions: 12/04/09 PMH: ADHD; NKDA; scoliosis; anxiety attack
Diagnostic Lab Data: Blood Labs CT Scan; ECG test; EMG test; Pelvic test. Eye test; head; neck; back MRI. Done twice. 3 Neurologist MD (seen) meds. 12/04/09 Labs/Diagnostics:CT brain scan : no evidence of acute intracranial pathology; AST 10 (L); ALT 28 (L);
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.001261UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2351AA1UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC2609AA1UNUN
Administered by: Public     Purchased by: Public
Symptoms: Abasia, Alanine aminotransferase decreased, Aspartate aminotransferase decreased, Asthenia, Ataxia, Blood alkaline phosphatase decreased, Blood test, Chest X-ray normal, Dyspnoea, Dysuria, Electrocardiogram, Electrocardiogram normal, Electromyogram, Fatigue, Gynaecological examination, Headache, Hot flush, Malaise, Nuclear magnetic resonance imaging, Ophthalmological examination, Scan brain, Scoliosis, Syncope, Urine analysis normal, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: 11/16/2007 approx. 1:30 p.m. Fri at school admin principal called. Pt was feeling very ill. Could not walk and feeling body weak. Unable to express herself went to ER. Blood work, CT scan EGD test. On 11/18/2007 went back to ER Hosp. Referred to Neurologist w/meds. 12/04/09 ED records received for DOS 11/16/09. Pt. brought to ED after fainting at school, feeling very tired; c/o shortness of breath, painful urination. Discharged home. DX: ataxia vs. pseudoataxia 12/04/09 ED records received for DOS 11/18/09. Pt presents with vertigo, headache, hot flashes, "legs not cooperating". Discharged home.

VAERS ID:367045 (history)  Vaccinated:2009-11-09
Age:14.0  Onset:2009-11-10, Days after vaccination: 1
Gender:Female  Submitted:2009-11-12, Days after onset: 2
Location:Kansas  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU29373BA UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mild redness upper arm.

VAERS ID:367078 (history)  Vaccinated:2009-11-11
Age:14.0  Onset:2009-11-11, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data: CBC-WNL; PT/PTT-WNL; Electrolytes-WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Activated partial thromboplastin time normal, Blood electrolytes normal, Contusion, Erythema, Full blood count normal, Prothrombin time normal, Pruritus, Tenderness
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (broad)
Write-up: Received swine FLUMIST, 1 hr later developed redness, itching and bruising to bilateral lower extremities. Redness and itching resolved in 1 hr, bruising persisted x 24 h, lower extremities also tender to palpation.

VAERS ID:367090 (history)  Vaccinated:2009-11-02
Age:14.0  Onset:2009-11-02, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Maryland  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2773AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1076Y SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling size of golf ball reported at site of Tdap

VAERS ID:367116 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Male  Submitted:2009-11-04, Days after onset: 0
Location:Mississippi  Entered:2009-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101276060UNUN
Administered by: Other     Purchased by: Public
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: BP 120/70, HR 76, general rash-BENADRYL given at 12:00pm. Mom came to school to pick up. Received H1N1 this am at school. Approx 1200pm c/o rash to school nurse.

VAERS ID:367123 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:Mississippi  Entered:2009-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 0.3 mg epi sq; 50 BENADRYL IV; 116 HR tachy; O2; NS IV
Current Illness: sore throat, swollen, dizzy, SOB, BP 150/90, rash L arm, blotchy
Preexisting Conditions: none/ had gallbladder surgery
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101276060UNLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Received H1N1 vaccine at school. BP 150/90, dizzy, SOB. To hospital ER. Treated and released home with parents. D/c to home.

VAERS ID:367220 (history)  Vaccinated:2009-11-06
Age:14.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 6
Location:New Jersey  Entered:2009-11-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: BP 106/56 HR 73
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500737P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving seasonal Flumist @ about 4:50pm patient walked from exam room to waiting room, felt dizzy and fainted. Hitting her chin and back of her head when she fell.

VAERS ID:367251 (history)  Vaccinated:2009-11-13
Age:14.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 0
Location:Indiana  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: none noted
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102041P10IJLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Erythema, Injection site erythema, Injection site oedema, Injection site pruritus, Injection site warmth
SMQs:, Anaphylactic reaction (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: C/o Lt upper arm itching. Area red, warm to touch. No signs of respiratory distress. Ice pack to reduce edema, Benadryl 50 mg po. Client returned to School nurse office 10 minutes after receiving Benadryl with c/o of neck and chest redness with chest tightness. After 15 minutes, client states no further discomfort.

VAERS ID:367319 (history)  Vaccinated:2009-11-09
Age:14.0  Onset:2009-11-10, Days after vaccination: 1
Gender:Male  Submitted:2009-11-13, Days after onset: 3
Location:California  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED 0 RA
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS 0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling cold, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: LEFT AND RIGHT ARMS WERE NUMB AS IF THEY WERE ASLEEP. NO FEELING IN EITHER ARM. ARMS WERE ALSO COLD WITH TINGLING SENSATION.

VAERS ID:367382 (history)  Vaccinated:2009-11-14
Age:14.0  Onset:2009-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-11-14, Days after onset: 0
Location:Colorado  Entered:2009-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies, Allergy Induced Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Nausea directly after receiving vaccine and continuing for approximately an hour.

VAERS ID:367595 (history)  Vaccinated:2009-11-05
Age:14.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 11
Location:Florida  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: none that I''m aware of, but patient and mother stated she reacts "to a lot of things".
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500758P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature normal, Flushing, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Student/Patient stated her cheeks became flushed. She returned to the clinic where she was evaluated by a nurse. She denied any other symptoms at that time. Her cheeks were visibly flushed. Temperature was normal. About 30 minutes later she stated she thought her throat felt a little tight. She was given 25 mg of Benadry po. Parent was contacted. She was observed for another 30 minutes - 45 minutes. Her cheeks returned to a normal color, she stated her throat was no longer tight. Denied any further symptoms. Upon follow-up with student a few days later, she stated she had no further complications.

VAERS ID:367604 (history)  Vaccinated:2008-06-18
Age:14.0  Onset:2009-02-20, Days after vaccination: 247
Gender:Female  Submitted:2009-11-16, Days after onset: 269
Location:California  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: felt weak,nausea,dizzy,passing out
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0070X3IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal discomfort, Acne, Arthropod bite, Asthenia, Convulsion, Dizziness, Headache, Hyperhidrosis, Hypersomnia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: seizure, headache,dizziness, weakness, stomach discomfort 12/17/09 clinic records received for DOS 07/31/07and 6/18/08 and vaccination list record received for DOS 12/09/1993 thr 06/18/2008. DX: Well Adolescent Care, Acne 07/31/07 office note docu. sports physical with unlimited participation. 06/18/08 office note notes c/o not sleeping well and insect bite X 1wk. Parent concerned about excessive sleep and sweats alot. Acne on face and upper back. Prescriptions given:clindamycin phosphate 1% TOP, benzoyl peroxide 6% TOP and differin 0.1% TOP. Vaccination rec reflect patient received HPV on 07/31/07, 10/09/07 and 06/18/08.

VAERS ID:367651 (history)  Vaccinated:2009-10-15
Age:14.0  Onset:2009-10-18, Days after vaccination: 3
Gender:Male  Submitted:2009-11-09, Days after onset: 22
Location:Iowa  Entered:2009-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol as needed for asthma.
Current Illness: None
Preexisting Conditions: Asthmatic
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500759P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Pain, Pyrexia, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever, aches, fatigue for approx 30 hrs.-treated with sleep, fluid, and ibuprofen. Fever was low grade 99.5-100 degrees. This child has rarely had fevers. He''s usually <98.6 degrees. I''m fairly confident he had a mild reaction to the vaccination.

VAERS ID:367705 (history)  Vaccinated:2009-11-07
Age:14.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Female  Submitted:2009-11-07, Days after onset: 0
Location:Virginia  Entered:2009-11-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: BP 106/60 HRR
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500780P0IN 
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: After receiving nasal H1N1 FLUMIST pt c/o headache, dizziness and tingling head. S/S began 5-10 min post-vaccination and resolved 5-10 min after onset.

VAERS ID:367710 (history)  Vaccinated:2009-11-06
Age:14.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-06, Days after onset: 0
Location:Texas  Entered:2009-11-16, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0702X2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Injection site erythema, Injection site pain, Injection site swelling, Local reaction, Musculoskeletal pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 24 hours after receiving the injection the patient complained of numbness in her left arm - the pain radiated to shoulder-the area did ha a local reaction area was red and swollen. She also complained of numbness and tingling in her fingertips.

VAERS ID:367892 (history)  Vaccinated:2009-11-06
Age:14.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-06, Days after onset: 0
Location:Kentucky  Entered:2009-11-16, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1038Y1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Rash papular
SMQs:
Write-up: Erythematous papules over arms, legs, and upper chest. Some areas of urticaria over elbows. Gave BENADRYL 12.5 mg BID and ranitidine 150mg bid.

VAERS ID:367982 (history)  Vaccinated:2009-11-14
Age:14.0  Onset:2009-11-14, Days after vaccination: 0
Gender:Female  Submitted:2009-11-17, Days after onset: 3
Location:Colorado  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE Identified
Preexisting Conditions: NONE Identified
Diagnostic Lab Data: Pt''s blood pressure was low when assessed after reaction, and patient never gained full color after syncope.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyskinesia, Fall, Head injury, Hypotension, Loss of consciousness, Muscle rigidity, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient jerked backwards, went rigid and fell straight back on her head on a concrete carpeted floor. Patient lost conciousness for a few seconds, and regained orientation thereafter. She was given orange juice, and laid on her back. Paramedics were present and assessed her head injury and transported the patient to the nearby Hospital.

VAERS ID:368015 (history)  Vaccinated:2009-11-05
Age:14.0  Onset:2009-11-11, Days after vaccination: 6
Gender:Female  Submitted:2009-11-13, Days after onset: 2
Location:New York  Entered:2009-11-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: No; Differin topical started that day
Current Illness: No; sister had flu 11/5/09
Preexisting Conditions: No
Diagnostic Lab Data: In ER: normal BMP; CBC; HCG; Mono spot; drug screen.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.90249Y0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood glucose normal, Blood human chorionic gonadotropin, Drug screen negative, Fatigue, Full blood count normal, Hypersomnia, Influenza, Menarche, Metabolic function test normal, Mononucleosis heterophile test negative, Nervous system disorder, Speech disorder, Staring
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad)
Write-up: Started flu sx evening 11/6 (presumed H1N1). Took Ibuprofen only. On 11/11 had staring spell, became nonverbal. Ambulance got normal glucose. Slowly improved over 2 hr in ER. Diagnosed "fatigue, 1st menses" I think this was a CNS symptom of influenza. Seen in office 11/12 normal neurological exam. Phone next day still sleeping a lot. Improving at date of report. Update: Pt hospitalized 11/15 - 17/09 for altered mental status. Extensive work up [EEG, LP, MRI, CT, Viral titers and PCR''s] failed to identify a cause. As of today she is definitely improved.

VAERS ID:368045 (history)  Vaccinated:2009-10-23
Age:14.0  Onset:2009-10-26, Days after vaccination: 3
Gender:Male  Submitted:2009-10-30, Days after onset: 4
Location:North Carolina  Entered:2009-11-17, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3211AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3248AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, warm, swelling and then just pain. Went to ER-given BENADRYL-resolved.

VAERS ID:368268 (history)  Vaccinated:2009-11-15
Age:14.0  Onset:2009-11-17, Days after vaccination: 2
Gender:Male  Submitted:2009-11-17, Days after onset: 0
Location:California  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500780P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: I have swollen pinky left handside.

VAERS ID:368341 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2009-11-18
Location:New York  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None reported

VAERS ID:368356 (history)  Vaccinated:2009-10-05
Age:14.0  Onset:2009-11-15, Days after vaccination: 41
Gender:Female  Submitted:2009-11-18, Days after onset: 3
Location:New Jersey  Entered:2009-11-18
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. specifically made appt. just for the vaccine.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Private     Purchased by: Unknown
Symptoms: Fatigue, Menstrual disorder, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: I''m not even sure if it related to the vaccine. I''m trying to figure this out. Large red welts buttocks and back torso area. extremely tired. lasted approx. 1hr. noted same on feet. few on legs. gave benadryl, but seemed to be fading prior to dose. next day in school noticed red raised "welts" on fingers. also went away. not sure if this is something to be concerned about, esp. since vaccine was the only most recent change. menses was 21days not 28.

VAERS ID:368458 (history)  Vaccinated:2009-11-17
Age:14.0  Onset:2009-11-17, Days after vaccination: 0
Gender:Male  Submitted:2009-11-18, Days after onset: 1
Location:Mississippi  Entered:2009-11-18
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: Haven''t taken to doctor yet. Waiting to see if vomiting continues.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: It started with headache, then started vomiting about 1 1/2 hour later. Vomited 2 more times and continued to have a headache. Currently at 12:30 PM on 11/18 only slight headache, and keeping soup down so far.

VAERS ID:368551 (history)  Vaccinated:2009-11-17
Age:14.0  Onset:2009-11-18, Days after vaccination: 1
Gender:Female  Submitted:2009-11-18, Days after onset: 0
Location:New York  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient received seasonal flu vaccine approximately 3 - 4 week ago without any noted side effects. Provider would need to provide specific information r/t manufacturer and lot number for vaccine. Patient has not recovered at this time. S
Current Illness: None
Preexisting Conditions: NKDA, NK food allergies Afebrile and in usual state of health
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Crying, Feeling abnormal, Irritability, Myalgia, Oropharyngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad)
Write-up: Fever $g 101, irritability, generalized muscle soreness, crying, stating "I feel so bad", sore throat.

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