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Case Details (Sorted by Age)

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VAERS ID: 389425 (history)  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:2010-05-24
Onset:2010-05-26
   Days after vaccination:2
Submitted: 2010-05-26
   Days after onset:0
Entered: 2010-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0620Y / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1328Y / 0 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Left arm swollen, hot, red, painful. Recommended Benadryl & ice packs.


VAERS ID: 389430 (history)  
Age: 5.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2010-02-19
Onset:2010-02-19
   Days after vaccination:0
Submitted: 2010-05-26
   Days after onset:95
Entered: 2010-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UT034AA / 0 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Decreased appetite, Pain in extremity, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Per phone call with child''s mother; mom states since vaccine was given, child had fever, vomiting, rash on his back and on his eye lids; that night she took child to ER. Was told to give Benadryl by mouth; child saw PCP on Monday 02/22/10 at clinic; mom states child had decrease appetite and feet hurt was told by PCP possible reaction to H1N1 the child had received at school on Friday.


VAERS ID: 389435 (history)  
Age: 5.0  
Gender: Male  
Location: Arkansas  
Vaccinated:2010-04-29
Onset:2010-05-12
   Days after vaccination:13
Submitted: 2010-05-26
   Days after onset:14
Entered: 2010-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1272Y / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0886Y / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Blood culture negative, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: Blood Culture negative.
CDC Split Type:

Write-up: Fever and rash.


VAERS ID: 389452 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2010-05-19
Onset:2010-05-21
   Days after vaccination:2
Submitted: 2010-05-26
   Days after onset:5
Entered: 2010-05-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0141Z / 1 LA / SC

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

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

Write-up: Left arm red and itchy use ice pack and Ibuprofen prn, can use Benadryl cream, for itch.


VAERS ID: 389495 (history)  
Age: 5.0  
Gender: Female  
Location: Iowa  
Vaccinated:2010-05-25
Onset:2010-05-26
   Days after vaccination:1
Submitted: 2010-05-27
   Days after onset:1
Entered: 2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B106CA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1118Y / 1 LL / SC

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

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

Write-up: Red, itchy at injection site, afebrile x 2d. Use Ice et Hydrocortisone Cr. 1% prn.


VAERS ID: 389512 (history)  
Age: 5.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2010-05-20
Onset:2010-05-21
   Days after vaccination:1
Submitted: 2010-05-27
   Days after onset:6
Entered: 2010-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0464Y / 0 RL / IM

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

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

Write-up: Redness, swelling and pain at injection site. Headache, malaise and fever of 102F.


VAERS ID: 389594 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2010-05-25
Onset:2010-05-27
   Days after vaccination:2
Submitted: 2010-05-28
   Days after onset:1
Entered: 2010-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS C3192BA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D06747 / 3 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 01842 / 1 RA / SC

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

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

Write-up: Woke up swelling and redness to left arm. Used cold compress. No fever. Redness and swelling increasing in size. Area measures 5 x 8 cm.


VAERS ID: 389621 (history)  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:2010-05-27
Onset:2010-05-28
   Days after vaccination:1
Submitted: 2010-05-28
   Days after onset:0
Entered: 2010-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1603Y / 1 RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site induration, Injection site rash, Injection site swelling, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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: Has asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered 5-27-10. Pt woke up next morning with swollen arm at site. Dr assessed 1 1/2" indurated urticarial on right triceps non-tender - rash secondary to VARIVAX.


VAERS ID: 389630 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-05-25
Onset:2010-05-26
   Days after vaccination:1
Submitted: 2010-05-28
   Days after onset:2
Entered: 2010-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B114CB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB408AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0709Y / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1436Y / 1 RA / SC

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

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:
CDC Split Type:

Write-up: Bilateral swelling on upper arms, with redness and pain with touch. Resolved by 5-28-10.


VAERS ID: 389643 (history)  
Age: 5.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2010-05-26
Onset:2010-05-26
   Days after vaccination:0
Submitted: 2010-05-29
   Days after onset:3
Entered: 2010-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER DON''T KNOW / 4 LA / -

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: egg allergy, intolerant to gluten and caesin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the DTap shot, patient developed a red patch about the size of a softball on his arm in a ring around the injection site. It was red and warm to the touch. No fever or itching or significant pain was reported by 5yr old. Still red but seems to be fading as of 5/29/10, 3 days after shot. Seen by Dr. on 5/28/10 who said it was a "localized reaction" and not to worry unless it got worse.


VAERS ID: 389696 (history)  
Age: 5.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2010-05-25
Onset:2010-05-26
   Days after vaccination:1
Submitted: 2010-05-27
   Days after onset:1
Entered: 2010-06-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 4 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site cellulitis
SMQs:

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

Write-up: L arm cellulitis.


VAERS ID: 389742 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-05-21
Onset:2010-05-22
   Days after vaccination:1
Submitted: 2010-05-24
   Days after onset:2
Entered: 2010-06-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1660Y / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1557Y / 1 RL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 3.26-06 failure to thrive.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red indurated area around shot area. 5.5X3.5 cm. No drainage. Not painful.


VAERS ID: 389759 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2010-05-18
Onset:2010-05-19
   Days after vaccination:1
Submitted: 2010-06-01
   Days after onset:13
Entered: 2010-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Crying, Nightmare, Screaming, Sleep terror
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

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

Write-up: Daughter began to experience night terrors. She sits up in bed screaming and crying and can not be awakened. She also has been experiencing severe nightmares. This went from occurring every few months to occurring nightly since the night after her 5 year old vaccinations.


VAERS ID: 389773 (history)  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2010-05-27
Onset:2010-05-27
   Days after vaccination:0
Submitted: 2010-06-01
   Days after onset:5
Entered: 2010-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3322AA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0123 / 3 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Gait disturbance, Injection site swelling, Oedema peripheral, Pain, Skin lesion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: S: Pt''s mom states he woke up this AM with swelling of L thigh and he was unable to walk on it. During the day pain improved, but the swelling has worsened. O: L thigh erythematous lesion L mid thigh edema of upper thigh extending toward knee ROM and patella reflex intact. No warmth noted at thigh.


VAERS ID: 389791 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2010-05-21
Onset:2010-05-28
   Days after vaccination:7
Submitted: 2010-06-01
   Days after onset:4
Entered: 2010-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B137AA / - LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB349BA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0141Z / 1 RL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CT of head nl, nl glucose done, no electrolytes ordered.
CDC Split Type:

Write-up: Felt ill for 7 days, large local reaction where KINRIX given. KINIRIX and Hep A given in left thigh. PROQUAD in right thigh. Felt ill then sz on day #8. Seems better after seizure. No meds given at hosp.


VAERS ID: 389817 (history)  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2010-05-24
Onset:2010-05-25
   Days after vaccination:1
Submitted: 2010-05-26
   Days after onset:1
Entered: 2010-06-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3040AA / 4 RA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1670Y / 1 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1148Y / 1 UN / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Blister, Oedema peripheral
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

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

Write-up: Pt was seen on 5/24/10 for physical given DTaP and HEP A in R arm. Started with a swelling yesterday and looks blistery in R arm today.


VAERS ID: 389828 (history)  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:2010-05-25
Onset:0000-00-00
Submitted: 2010-05-26
Entered: 2010-06-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3475AA / 0 RL / IM

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

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

Write-up: Provider (NP) ordered a DTaP and a Tdap was given. The pt is not having any adverse reactions. No adverse event.


VAERS ID: 389829 (history)  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:2010-05-20
Onset:2010-05-20
   Days after vaccination:0
Submitted: 2010-05-21
   Days after onset:1
Entered: 2010-06-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B080AA / 3 RA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA. Febrile seizures age 2 and 3 yrs. Not vaccine- related.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received 1 vaccine, DTAP. R arm. Mom reports he complained about pain that evening but she did not observe the arm. Next day school nurse called clinic stating redness, swelling and heat from elbow to top of shoulder. Temp 100.4. Mom brought patient to clinic. R arm had redness, heat and swelling elbow to shoulder size of baseball at top on thin arms. Applied ice packs, advised intermittent timing, TYLENOL or MOTRIN. If difficulty breathing or worse, take to ER.


VAERS ID: 389836 (history)  
Age: 5.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2010-05-24
Onset:2010-05-24
   Days after vaccination:0
Submitted: 2010-05-26
   Days after onset:2
Entered: 2010-06-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45350 / 4 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARITIN; FLONASE; PATANOL
Current Illness: Cough and congestion
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left upper arm red, swollen, painful, itches. Started the evening of receiving the shot and was still red and swollen when patient came into office on 5-26-10.


VAERS ID: 389872 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-05-27
Onset:2010-05-29
   Days after vaccination:2
Submitted: 2010-06-02
   Days after onset:4
Entered: 2010-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3191AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0871Y / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1165Y / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Rash erythematous, Rash macular, Skin tightness, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Redness and swelling near injection site. Right arm 14 x 14 cm erythematous patch, warm, blanching and mildly tight.


VAERS ID: 389886 (history)  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:2010-05-29
Onset:2010-05-29
   Days after vaccination:0
Submitted: 2010-06-02
   Days after onset:4
Entered: 2010-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / -

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

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

Write-up: Rash and swelling at injection site thru June 1.


VAERS ID: 389918 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-05-14
Onset:2010-05-15
   Days after vaccination:1
Submitted: 2010-05-18
   Days after onset:3
Entered: 2010-06-03
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362BA / 0 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1561Y / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Diarrhoea, Injection site erythema, Injection site swelling, Injection site warmth, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Vomiting/diarrhea. Red, swelling to injection site. Felt hot to injection site. Treatment for cellulitis was given.


VAERS ID: 389920 (history)  
Age: 5.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2010-05-25
Onset:2010-05-27
   Days after vaccination:2
Submitted: 2010-05-28
   Days after onset:1
Entered: 2010-06-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1290Y / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1446Y / 1 RA / SC

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

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

Write-up: Sx forearm swollen/red, local reaction. BENADRYL / heat PRN.


VAERS ID: 389926 (history)  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2010-04-13
Onset:2010-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2010-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B103AC / 0 LA / IM
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP109AA / 0 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362AA / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Crying, Enuresis, Gait disturbance, Injection site erythema, Injection site swelling, Local reaction
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Left arm local reaction -$g swollen and red - woke up in night and had wet the bed - mother described muscles as solid and he was walking funny and crying the night after vaccinations - mother reported this child "had a seizure after a shot when really little" - mother and sister have seizure diagnosis.


VAERS ID: 389927 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-05-18
Onset:2010-05-18
   Days after vaccination:0
Submitted: 2010-05-20
   Days after onset:2
Entered: 2010-06-03
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B102B / 5 LA / UN

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

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

Write-up: Local redness heat, swelling with central blistering at site of vaccine.


VAERS ID: 390056 (history)  
Age: 5.0  
Gender: Male  
Location: D.C.  
Vaccinated:2010-06-03
Onset:2010-06-06
   Days after vaccination:3
Submitted: 2010-06-06
   Days after onset:0
Entered: 2010-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Unknown       Purchased by: Other
Symptoms: Decreased appetite, Fatigue, Pyrexia, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: He has been running a fever of 101-102, tired, loss of appetite, thirsty. Called nurse line traced back to shot.


VAERS ID: 390094 (history)  
Age: 5.0  
Gender: Male  
Location: Iowa  
Vaccinated:2010-06-01
Onset:2010-06-02
   Days after vaccination:1
Submitted: 2010-06-03
   Days after onset:1
Entered: 2010-06-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B154AA / - LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362AA / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1269Y / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1743Y / 1 RL / UN

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

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

Write-up: Swelling L thigh 7cm x 7 1/2cm, which is indurated, redness also on overlying. No fever.


VAERS ID: 390129 (history)  
Age: 5.0  
Gender: Male  
Location: Georgia  
Vaccinated:2010-06-02
Onset:2010-06-04
   Days after vaccination:2
Submitted: 2010-06-04
   Days after onset:0
Entered: 2010-06-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009AA / 4 RA / IM

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

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

Write-up: Rt. deltoid swollen, redness, warm to touch. Itching, some pain - state patient. Tx. KEFLEX 250MG/5mL 1 tsp po every 6 x 10 days. ATARAX 10/5mL.


VAERS ID: 390152 (history)  
Age: 5.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2010-06-03
Onset:0000-00-00
Submitted: 2010-06-05
Entered: 2010-06-07
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 4 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1336Y / 1 LA / SC

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

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

Write-up: (L) arm red, swollen, hot to touch 2 days s/p vaccine admin, antibiotics Rxed.


VAERS ID: 390176 (history)  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:2010-05-24
Onset:2010-05-30
   Days after vaccination:6
Submitted: 2010-06-04
   Days after onset:5
Entered: 2010-06-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740Y / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Decreased activity, Decreased appetite, Joint swelling, Oedema peripheral, Pain, Pruritus, Skin warm, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started with hives yest. Better with BENADRYL; today worsening despite BENADRYL, not very itchy; today felt warm as well; today noted fingers swollen Rt hand and Rt $g Lt knees swollen. C/o pain; no St/URI SXS/HA; DECR activity, DECR appetite but drinking well with good UOP; no new exposures; had MMR vaccine 5/24.


VAERS ID: 390219 (history)  
Age: 5.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2010-06-07
Onset:2010-06-07
   Days after vaccination:0
Submitted: 2010-06-07
   Days after onset:0
Entered: 2010-06-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1290Y / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0025Z / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient vomited 2 minutes after vaccine administration. No other signs or symptoms of severe reaction or illness. No significant crying -$g just vomit spontaneously.


VAERS ID: 390313 (history)  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2010-06-02
Onset:2010-06-07
   Days after vaccination:5
Submitted: 2010-06-08
   Days after onset:1
Entered: 2010-06-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1538Y / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1269Y / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1202Y / 1 RA / SC

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

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

Write-up: On 6/7/10 patient broke out in hives all over both of his thighs. The hives were red half circles/odd shapes according to his mother. She took him to ER on 6/7/10. On 6/8/10 mother reports that patient hives are bigger and puffier and are now on his lower legs and ankles too. No fever.


VAERS ID: 390320 (history)  
Age: 5.0  
Gender: Male  
Location: Oregon  
Vaccinated:2010-06-04
Onset:2010-06-08
   Days after vaccination:4
Submitted: 2010-06-09
   Days after onset:1
Entered: 2010-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3322BA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0037 / 3 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site rash, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Localized urticarial rash (4 x 4 cm) on (L) bicep w/ site of IPV injection approximately 3-4 days after vaccine. No other vaccines given (L) bicep (DTap given (R) bicep). No tx necessary.


VAERS ID: 390378 (history)  
Age: 5.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2010-06-01
Onset:2010-06-02
   Days after vaccination:1
Submitted: 2010-06-04
   Days after onset:2
Entered: 2010-06-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1564Y / 1 LA / SC
VARCEL: VARICELLA (VARILRIX) / GLAXOSMITHKLINE BIOLOGICALS 1702Y / 1 RA / SC

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

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

Write-up: ? Reaction to Dtap to RA - after injection swollen, red and warm to touch - mom said 1/2 of arm - (8cm x 10cm).


VAERS ID: 390379 (history)  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2010-06-08
Onset:2010-06-09
   Days after vaccination:1
Submitted: 2010-06-10
   Days after onset:1
Entered: 2010-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B141BA / - RA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0185Z / - LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Severe headache followed by syncope ~ 20 hours after vaccination. Normal exam afterwards.


VAERS ID: 390451 (history)  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2010-05-17
Onset:2010-05-18
   Days after vaccination:1
Submitted: 2010-06-02
   Days after onset:15
Entered: 2010-06-11
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 3 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04801 / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1565Y / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1602Y / 0 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site warmth, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: L arm - able to raise arm normally. No weakness. Greatest area of erythema is around site of DTaP. Varicella site below & behind main area of redness. Eryth from top of shoulder to elbow. Feels sl. warm not indurated. Does c/o pain on palpitation.


VAERS ID: 390462 (history)  
Age: 5.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2010-06-02
Onset:2010-06-03
   Days after vaccination:1
Submitted: 2010-06-04
   Days after onset:1
Entered: 2010-06-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B103CA / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1270Y / - RL / SC
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1559Y / - LL / SC

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

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

Write-up: Redness & swelling at vaccine administration sites (L) SQ 4cm swelling - thigh, (R) SQ 5cm swelling - thigh.


VAERS ID: 390463 (history)  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2010-05-24
Onset:2010-05-25
   Days after vaccination:1
Submitted: 2010-06-02
   Days after onset:8
Entered: 2010-06-11
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04801 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1565Y / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1602Y / 1 RA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: 999.S
CDC Split Type:

Write-up: Had DTAP in right arm on 5/24/10, 3 days ago. Noted some eryth & swelling 2nd day, getting more over last 24 hrs. No fevers, does c/o some pn, but able to use arm normally. No prior vaccine RXNS.


VAERS ID: 390483 (history)  
Age: 5.0  
Gender: Male  
Location: Arizona  
Vaccinated:2010-06-09
Onset:2010-06-10
   Days after vaccination:1
Submitted: 2010-06-10
   Days after onset:0
Entered: 2010-06-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1657Y / 1 UN / SC

Administered by: Public       Purchased by: Private
Symptoms: Gaze palsy, Hypotonia, Influenza like illness, Irritability, Loss of consciousness, Nausea, Pallor, Pyrexia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 1am pt went to moms room and vomited and lost color in face and was feverish. Mom gave ibuprofen fever went down, then at 6am pt was fussy and his face was really pale and he told mom that he had to vomit and when she was about to take him to the bathroom he passed out for 10sec. His eyes rolled back and then he came out of it. Mom said he got shots and this may be a reaction to the DTaP.


VAERS ID: 390529 (history)  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:2010-06-08
Onset:2010-06-09
   Days after vaccination:1
Submitted: 2010-06-11
   Days after onset:2
Entered: 2010-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Dime size red welp on left upper thigh on injection site. Warm to the touch, painful and itchy to patient. Following morning, 06/10/2010, injection site had grown significantly was very warm to the touch, painful and itchy. Returned to the clinic vaccine was received. Was told to take Benadryl every 6 hrs. and prescription medication Cephalexin. Told to give Dr. a call in the a.m. to let her know how the whelp was looking. The following day, 6/11/2010 whelp had grown overnight. Called Dr. at her clinic. She had the patient come in and get a steroid shot in the arm and start on prescription steroids the following day along with current prescription of Cephalexin.


VAERS ID: 390564 (history)  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:2010-06-08
Onset:2010-06-10
   Days after vaccination:2
Submitted: 2010-06-14
   Days after onset:4
Entered: 2010-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B154AA / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0185Z / - LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Rash erythematous, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 3 cm erythema area (L) upper arm 20-25 red spots over trunk with a few vesicular.


VAERS ID: 390629 (history)  
Age: 5.0  
Gender: Female  
Location: Illinois  
Vaccinated:2010-06-10
Onset:2010-06-11
   Days after vaccination:1
Submitted: 2010-06-12
   Days after onset:1
Entered: 2010-06-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3558AA / 4 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D6548 / 3 LL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Joint swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: R leg red, swollen medial to injections tp, injection site, superiorly and inferiorly at time if exam on 6-12-10, (R) leg is 2cm wider than (L) leg, knee swollen to occlude "dimples" except for inferomedial. 16 cm x14cm is at site of affected area at longest and widest points. No induration at injection site. Sx peaked 7pm 6-11-10.


VAERS ID: 390657 (history)  
Age: 5.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-08-01
Onset:2010-05-31
   Days after vaccination:1034
Submitted: 2010-06-08
   Days after onset:8
Entered: 2010-06-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Varicella post vaccine
SMQs:

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: Her only medical condition is ADHD and she takes CONCERTA 36 mg daily.
Diagnostic Lab Data: Photos of her face and body can be sent
CDC Split Type:

Write-up: Patient received the Chicken Pox vaccine at 5 years of age and broke out with the chicken pox anyways on 5/31/2010. If this vaccine does not work it should not be a requirement when children enter kindergarten.


VAERS ID: 390671 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-06-07
Onset:2010-06-09
   Days after vaccination:2
Submitted: 2010-06-09
   Days after onset:0
Entered: 2010-06-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3191AA / - LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0304 / - LA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E46122 / - RA / UN

Administered by: Public       Purchased by: Other
Symptoms: Induration, Pain, Pruritus, Rash erythematous, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Location on (R) posterior area of arm. Rash is pink, warm (Hot)/ and induration. Pt complains of pruritis and pain to touch. Tx: pt seen by Dr. pt prescribed antibiotic. Pt has f/up appt on 6/11/2010 to check on skin condition.


VAERS ID: 390682 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2010-06-09
Onset:0000-00-00
Submitted: 2010-06-10
Entered: 2010-06-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B086AB / 5 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D06741 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0871Y / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1204Y / 1 RA / SC

Administered by: Other       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

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

Write-up: Child vaccinated at school clinic. Mother gave vaccinating nurse child''s shot record. Child vaccinated according to shot record and requirements for entering kindergarten. School nurse called later in day to notify PH that she had a more up to date shot record on child than what mother had and that child only really needed to have 2nd varicella vaccine. No adverse events noted.


VAERS ID: 390716 (history)  
Age: 5.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2010-05-14
Onset:2010-05-14
   Days after vaccination:0
Submitted: 2010-06-15
   Days after onset:32
Entered: 2010-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1337Y / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Flushing, Swelling face, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Folic Acid 1 mg po daily Singulair 4mg po q am prn Zyrtec 5mg po q am prn Penicillin 250 mg po bid
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Referral made to allergist .
CDC Split Type:

Write-up: Facial swelling and flushing, mild wheezing, hives.


VAERS ID: 390717 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2010-06-11
Onset:2010-06-11
   Days after vaccination:0
Submitted: 2010-06-15
   Days after onset:4
Entered: 2010-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B116BA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0175Z / 0 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: BLOODY NOSE OFF AND ON ALL DAY, NEVER HAD A BLOODY NOSE PREVIOUSLY.


VAERS ID: 390837 (history)  
Age: 5.0  
Gender: Male  
Location: Arizona  
Vaccinated:2010-06-02
Onset:2010-06-09
   Days after vaccination:7
Submitted: 2010-06-16
   Days after onset:7
Entered: 2010-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 9104510 / - UN / SC

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

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

Write-up: Pea-sized mobile induration right arm.


VAERS ID: 390852 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2010-06-08
Onset:2010-06-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2010-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B091AA / - GM / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR B1090 / - LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1777Y / - RA / SC

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

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

Write-up: Erythema, edema, itching at injection site BENADRYL prn.


VAERS ID: 390863 (history)  
Age: 5.0  
Gender: Female  
Location: Iowa  
Vaccinated:2010-06-10
Onset:2010-06-11
   Days after vaccination:1
Submitted: 2010-06-12
   Days after onset:1
Entered: 2010-06-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B137AA / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0106Z / 0 RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site discomfort, Injection site erythema, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mother reported redness and discomfort to right shoulder 1 day following PROQUAD. She marked limits of the wheal of redness. Overnight it has grown or expanded 1 cm further. Child complains of pain however has no constitutional symptoms.


VAERS ID: 390896 (history)  
Age: 5.0  
Gender: Male  
Location: Washington  
Vaccinated:2010-06-14
Onset:2010-06-16
   Days after vaccination:2
Submitted: 2010-06-17
   Days after onset:1
Entered: 2010-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3322AA / 4 LA / IM

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

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

Write-up: (L) shoulder with 9 cm area of erythema below injection site flat without induration no sig tenderness local reaction to DTaP.


VAERS ID: 390915 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-06-15
Onset:2010-06-16
   Days after vaccination:1
Submitted: 2010-06-17
   Days after onset:1
Entered: 2010-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 4 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0106Z / 1 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49135 / 4 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: neck pain~Influenza (Seasonal) (FluMist)~UN~3.42~Patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Noon next day had fever 101 and headache, given Tylenol and pain/fever gone. Took bath at 5pm, broke out in hives. Benadryl given and hives went away and didn''t come back.


VAERS ID: 390980 (history)  
Age: 5.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2010-06-09
Onset:2010-06-11
   Days after vaccination:2
Submitted: 2010-06-18
   Days after onset:7
Entered: 2010-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1290Y / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1606Y / 1 RL / SC

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

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

Write-up: RL - Bright red area 2x2cm. warm to touch, firm and tender. LL - Pale pink area 6x8cm not warm not tender.


VAERS ID: 390997 (history)  
Age: 5.0  
Gender: Male  
Location: Idaho  
Vaccinated:2010-06-14
Onset:2010-06-14
   Days after vaccination:0
Submitted: 2010-06-18
   Days after onset:4
Entered: 2010-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B248BA / 3 LL / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357Y / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1743Y / 1 LL / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Contusion, Erythema, Injection site oedema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Mild reactive airway disease that has outgrown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: He had significant pain with fever the afternoon and evening after the vaccine with warmth and tenderness of the thigh. He awoke several times that evening with a low grade fever. 24 hours after the vaccine, his entire left thigh swelled with edema from thigh to the knee (see photo). The fever resolved with less pain 24-48 hours after the vaccine, but then he has complained of mild itching at the vaccine site. 3-4 days later the swelling has improved slightly, with less pain but mild bruising of the thigh tissue where the erythema was previously.


VAERS ID: 391020 (history)  
Age: 5.0  
Gender: Female  
Location: Alabama  
Vaccinated:2010-06-17
Onset:2010-06-18
   Days after vaccination:1
Submitted: 2010-06-18
   Days after onset:0
Entered: 2010-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 4 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0261Z / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0548 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1060Y / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0067Z / 1 RL / SC

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

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

Write-up: Erythema noticed by parent this AM 6/18/10. Per doctor pt to start BACTRIM 400/5 2 tsp BID x 10 days, BACTROBAN ointment to inj site QID; and maternal anxiety; pt going out of town with grandparent.


VAERS ID: 391009 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2010-06-18
Onset:2010-06-18
   Days after vaccination:0
Submitted: 2010-06-20
   Days after onset:2
Entered: 2010-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain upper, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: First symptoms were stomach pain at 9:00pm on June 18th, then on the morning of June 19th 4:00am he presented with more stomach pain and a fever of 102 degrees. Advil was given at that time. At 12:00pm that same day fever developed again and Advil was given again at that time. June 20th, fever is gone, but now a 2.5 inch red swollen area has developed on his right leg where the shot was given.


VAERS ID: 391065 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2010-06-09
Onset:2010-06-10
   Days after vaccination:1
Submitted: 2010-06-10
   Days after onset:0
Entered: 2010-06-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 02327 / 0 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Gait disturbance, Injection site erythema, Injection site swelling
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

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

Write-up: Left thigh (injection site) with redness and swelling from thigh to knee. No warmth non tender to touch. Walks with mild limp. Motrin for pain.


VAERS ID: 391099 (history)  
Age: 5.0  
Gender: Female  
Location: Kansas  
Vaccinated:2010-06-08
Onset:2010-06-17
   Days after vaccination:9
Submitted: 2010-06-21
   Days after onset:4
Entered: 2010-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / 0 RL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0185Z / 1 RL / UN

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

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

Write-up: Developed moderate to large (half dollar sized) red, fluid-filled lesions in (Rt) axillary area and down (Rt) side of anterior chest. Has 20-50 lesions. Child seen by Dr. MD on 6/21/10. Dr. believed these lesions to be VARICELLA & prescribed BACITRACIN ointment to lesions.


VAERS ID: 391114 (history)  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2010-06-11
Onset:2010-06-11
   Days after vaccination:0
Submitted: 2010-06-21
   Days after onset:10
Entered: 2010-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0174Z / 0 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Child developed small welt on arm that Proquad was given.


VAERS ID: 391117 (history)  
Age: 5.0  
Gender: Male  
Location: Arizona  
Vaccinated:2010-06-16
Onset:2010-06-17
   Days after vaccination:1
Submitted: 2010-06-21
   Days after onset:4
Entered: 2010-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B116BA / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0106Z / - LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE.
Preexisting Conditions: NONE.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Parent reports redness and swelling of arm day after immunizations. Child admitted to hospital on 06/17/2010 with redness and swelling of arm and shoulder. Diagnosed with cellulitis. Treated with IV antibiotics and MIVF. Patient discharged from hospital to home on 06/19/2010 with oral Clindamycin, oral Diphenhydramine, and oral acetaminophen. Seen by PCP 06/21/2010 - Improving, Swelling resolved, minimal erythema.


VAERS ID: 391130 (history)  
Age: 5.0  
Gender: Male  
Location: Idaho  
Vaccinated:2010-06-15
Onset:2010-06-15
   Days after vaccination:0
Submitted: 2010-06-21
   Days after onset:6
Entered: 2010-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B091AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1149Y / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Mass, Palpitations, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Occurring for 2 days. Red area on anterior thigh 10 x 13 cm and going into the left groin. Has a hard movable mass in the left groin. Has increased warmth and tenderness with palpitation. Amoxicillin - Pot clavulanate 600 - 42 9mg/5ml. 7.5ml BID - 10 days.


VAERS ID: 391131 (history)  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:2010-05-27
Onset:2010-05-28
   Days after vaccination:1
Submitted: 2010-06-11
   Days after onset:14
Entered: 2010-06-22
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0871Y / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1329Y / 1 RA / SC

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

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

Write-up: 3 cm red wheal to (R) upper arm. 1 cm red nodule to (L) thigh.


VAERS ID: 391176 (history)  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2009-12-11
Onset:2010-06-15
   Days after vaccination:186
Submitted: 2010-06-15
   Days after onset:0
Entered: 2010-06-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3322BA / 4 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0480 / 3 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1060Y / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0971Y / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin for strep pharyngitis
Current Illness: Strep day 9 of treatment
Preexisting Conditions: Strep as noted
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Has vesicular lesions scattered over trunk, neck and groin.


VAERS ID: 391184 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-06-03
Onset:2010-06-05
   Days after vaccination:2
Submitted: 2010-06-14
   Days after onset:9
Entered: 2010-06-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B154AA / 3 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB417BA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1114Y / 1 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 4 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865Y / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Culture throat, Injection site erythema, Injection site rash, Oral pustule, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Pharyngitis (primary diagnosis)
Preexisting Conditions: None
Diagnostic Lab Data: Throat culture sent on 6/5/2010
CDC Split Type:

Write-up: Clinic/MD visit on 6/5/2010. Fever and rash on left arm after receiving vaccines on 6/3/2010. MD findings on 6/5/2010 Visit: Pustule on right tonsil. Left shoulder slight redness, no induration.


VAERS ID: 391189 (history)  
Age: 5.0  
Gender: Male  
Location: Unknown  
Vaccinated:2010-06-08
Onset:2010-06-08
   Days after vaccination:0
Submitted: 2010-06-09
   Days after onset:1
Entered: 2010-06-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (DECAVAC) / SANOFI PASTEUR U2630AA / - LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0304 / - RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Chest X-ray, Cough, Dyspnoea, Full blood count, Lethargy, Pyrexia, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Developmental delay
Diagnostic Lab Data: CBC; WBC, 15.8; CXR
CDC Split Type:

Write-up: Received vaccine 6-8-10. Came to ER 6-9-10 at 1930 c/o resp. difficulty, fever, lethargy 6-8-10 PM coughing. BP 121/88, T 99.1, HR 160, R 40 lateral.


VAERS ID: 391199 (history)  
Age: 5.0  
Gender: Female  
Location: Illinois  
Vaccinated:2010-06-22
Onset:2010-06-22
   Days after vaccination:0
Submitted: 2010-06-22
   Days after onset:0
Entered: 2010-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - AR / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 AR / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 AR / UN

Administered by: Unknown       Purchased by: Other
Symptoms: Fall, Gaze palsy, Pallor, Posture abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Daughter was standing next to me and made some strange noises. I looked and her head was cocked to the side, her eyes were rolling into the back of her head and she was shaking. Within seconds, she hit the floor. Doctor and nurse turned her to her side and applied a cold compress to her forehead. She came to and was gray in color. She stayed on the floor for a few minutes and then we went into a room to sit. She had a popsicle and her blood pressure was taken again and we walked a bit prior to finally leaving the office.


VAERS ID: 391233 (history)  
Age: 5.0  
Gender: Female  
Location: Vermont  
Vaccinated:2010-06-16
Onset:2010-06-17
   Days after vaccination:1
Submitted: 2010-06-18
   Days after onset:1
Entered: 2010-06-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B091AA / 4 LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0532 / 3 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1289Y / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0026Z / 1 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Keloid scar, Pain in extremity, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 9.5 cm x 7.5 cm flare warm to the touch. Painful and itchy. This happened the next day after. Also a 1 cm keloid looking mark (left deltoid area).


VAERS ID: 391291 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-06-07
Onset:2010-06-08
   Days after vaccination:1
Submitted: 2010-06-23
   Days after onset:15
Entered: 2010-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 5 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0176Z / 2 RA / SC

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

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

Write-up: Warm red slightly patch to Kinrix site per provider.


VAERS ID: 391431 (history)  
Age: 5.0  
Gender: Female  
Location: Missouri  
Vaccinated:2010-06-21
Onset:2010-06-22
   Days after vaccination:1
Submitted: 2010-06-25
   Days after onset:3
Entered: 2010-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LA / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RA / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site rash, Lethargy, Rash erythematous, Rash macular, Skin warm
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: She developed a rash starting at the injection sites and spreading down her arms, to her face, to her legs, and eventually to her back over the course of 3 days. The rash was hot to the touch and blotchy red. While it didn''t cause a fever, we did notice some lethargy.


VAERS ID: 391432 (history)  
Age: 5.0  
Gender: Male  
Location: New York  
Vaccinated:2010-06-15
Onset:2010-06-16
   Days after vaccination:1
Submitted: 2010-06-24
   Days after onset:8
Entered: 2010-06-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

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

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

Write-up: Scratching on his (R) arm swollen from elbow to shoulder (huge), in pain, very hot. CORTISONE cream was put on the arm a few times. Put cold ice compress on the arm.


VAERS ID: 391453 (history)  
Age: 5.0  
Gender: Female  
Location: Colorado  
Vaccinated:2010-06-04
Onset:2010-06-07
   Days after vaccination:3
Submitted: 2010-06-07
   Days after onset:0
Entered: 2010-06-25
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139A / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1355Y / 1 LL / SC

Administered by: Private       Purchased by: Other
Symptoms: Local reaction, Myosclerosis, Pain in extremity, Pyrexia, Rash macular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: MMR/KINRIX 4 days ago in quad then c/o leg pain & sl fever & red blotchy rash. Redness some over 2 days. Alert, happy. (L) quad with red blotchy spots, some muscle induration in area. A) local rxn to DTaP. P) Sx relief. CB if worsens.


VAERS ID: 391466 (history)  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2010-06-24
Onset:2010-06-24
   Days after vaccination:0
Submitted: 2010-06-25
   Days after onset:1
Entered: 2010-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1565Y / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: MMR was given in RT lower. After shot was given a dime size wheal appeared to the patient''s left of where the shot was given.


VAERS ID: 391469 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-06-16
Onset:2010-06-16
   Days after vaccination:0
Submitted: 2010-06-18
   Days after onset:2
Entered: 2010-06-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B115AA / - LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1147Y / 1 RA / UN

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

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

Write-up: First noticed redness and swelling after receiving shot on 6/16/10 progresses redness, swelling, itchy L upper arm on 6/18 approximately 12.5 x 9 cm area of erythema.


VAERS ID: 391481 (history)  
Age: 5.0  
Gender: Female  
Location: Iowa  
Vaccinated:2010-06-22
Onset:2010-06-24
   Days after vaccination:2
Submitted: 2010-06-25
   Days after onset:1
Entered: 2010-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B106CA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1118Y / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1429Y / 1 LL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt did have several insect bites on body
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, warm, hard, afebrile, ice applied. Ibuprofen given, child doesn''t act any different.


VAERS ID: 391486 (history)  
Age: 5.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2010-06-02
Onset:2010-06-21
   Days after vaccination:19
Submitted: 2010-06-25
   Days after onset:4
Entered: 2010-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358BA / 4 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0362Z / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0052 / 3 LL / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0175Z / 0 RL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Blood amylase increased, Full blood count, Lymphocyte percentage, Parotitis, Red blood cell count increased, Streptococcus test negative, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Short stature; No allergies
Diagnostic Lab Data: Strep, negative; Amylase, 219; CBC WBC, 11.9, poly 75%, lymph 21%
CDC Split Type:

Write-up: Parotitis developing approximately 18 days post PROQUAD, started (Lt), then (Rt) side within 2 days, no treat.


VAERS ID: 391504 (history)  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:2006-04-12
Onset:2010-06-18
   Days after vaccination:1528
Submitted: 2010-06-27
   Days after onset:9
Entered: 2010-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1387CA / 4 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pertussis, Polymerase chain reaction
SMQs:

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

Write-up: Child was tested for Pertussis on 6/23/2010 and was PCR Positive. Culture results pending.


VAERS ID: 391545 (history)  
Age: 5.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2010-06-15
Onset:2010-06-16
   Days after vaccination:1
Submitted: 2010-06-21
   Days after onset:5
Entered: 2010-06-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357Y / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1659Y / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Induration, Injection site pain, Injection site pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No meds now or at time of shots-had Prednisone for asthma a month or so after shots
Current Illness: None
Preexisting Conditions: Asthmatic hx
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom reported that on Wedns. 6/16 approx. 24 hrs after receiving shots she noticed redness and hard, hot swelling (about size of half dollar) and welts around shot site (left thigh) after complaints from child of itching and pain at site (per dad on f/u case). No respiratory symptoms or anything indicative of systemic involvement. Dad reports they gave BENADRYL per PCP x1 and child has been fine since (call dated 6-21-10 for f/u).


VAERS ID: 391549 (history)  
Age: 5.0  
Gender: Male  
Location: Arizona  
Vaccinated:2010-06-07
Onset:2010-06-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2010-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E46122 / 0 UN / IM

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

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

Write-up: Redness. BENADRYL, Keflex.


VAERS ID: 391588 (history)  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2010-06-28
Onset:2010-06-28
   Days after vaccination:0
Submitted: 2010-06-28
   Days after onset:0
Entered: 2010-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 6017Z / 0 UN / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 913955 / 0 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Lip swelling, Oxygen saturation normal, Pruritus, Respiratory distress, Swelling face, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None; BENADRYL; ORAPRED; epinephrine-given for allg rxn.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Oxygen saturation-normal
CDC Split Type:

Write-up: Vomiting, resp distress, hives, swollen face, lips swollen, itchy. Oxygen saturation 98%, given BENADRYL, ORAPRED and epinephrine. 911 called, pt took ambulance to ER.


VAERS ID: 391600 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-06-24
Onset:2010-06-25
   Days after vaccination:1
Submitted: 2010-06-28
   Days after onset:3
Entered: 2010-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / - LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0175Z / - RL / SC

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

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

Write-up: Mother reports hot, swollen, red, circle (approx 3 inch diameter) to left leg following vaccine administration. Called hospital Friday, 6/25/10, they told her these symptoms were not uncommon and to place cold compress on site and take Ibuprofen. Took to medical care on Sunday, 6/27/2010. Started on antibiotics for possible bacterial infection. No temperature at time of visit.


VAERS ID: 391665 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2009-11-12
Onset:2009-11-12
   Days after vaccination:0
Submitted: 2010-06-29
   Days after onset:228
Entered: 2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)) / MEDIMMUNE VACCINES, INC. 500796 / - - / IN

Administered by: Public       Purchased by: Private
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Half of vaccine dosage was administered.


VAERS ID: 391740 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-06-16
Onset:2010-06-17
   Days after vaccination:1
Submitted: 2010-06-29
   Days after onset:12
Entered: 2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 4 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0480 / 3 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1355Y / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 17464 / 1 UN / SC

Administered by: Other       Purchased by: Public
Symptoms: Injection site erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Onset redness of (L) arm at vac. site 1 day later. On set hives 1 1/2 week after vaccines.


VAERS ID: 391758 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-06-28
Onset:2010-06-29
   Days after vaccination:1
Submitted: 2010-06-29
   Days after onset:0
Entered: 2010-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 0 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1657Y / 1 LA / SC

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

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:

Write-up: Swollen, redness to injection site, pain soreness.


VAERS ID: 391820 (history)  
Age: 5.0  
Gender: Female  
Location: Washington  
Vaccinated:2010-06-28
Onset:2010-06-30
   Days after vaccination:2
Submitted: 2010-06-30
   Days after onset:0
Entered: 2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365AA / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0413 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1709Y / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1228Y / 1 RL / SC

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

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

Write-up: Pt left anterior thigh was very red and swollen at the DTAP injection site.


VAERS ID: 391830 (history)  
Age: 5.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2010-06-28
Onset:2010-06-28
   Days after vaccination:0
Submitted: 2010-06-30
   Days after onset:2
Entered: 2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC0B116BA / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABVB408AA / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1147Y / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1401Y / 1 LA / SC

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

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

Write-up: Fever at 101 evening after shots given which continued to 6-30-10 at noon and was treated successfully with ADVIL. Redness to (L) arm from above elbow to shoulder with some warmth but no pain. Some swelling to (L) arm.


VAERS ID: 391878 (history)  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2010-06-28
Onset:2010-06-28
   Days after vaccination:0
Submitted: 2010-06-28
   Days after onset:0
Entered: 2010-07-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1660Y / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1596Y / 1 RA / SC

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

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

Write-up: Vaccines given about 9 am. Father called at 10:24 and stated pt eyes were swollen (L) about 3/4 way and R about 1/2 way. RTC Asap Tx with BENADRYL.


VAERS ID: 391922 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-06-28
Onset:2010-06-29
   Days after vaccination:1
Submitted: 2010-06-30
   Days after onset:1
Entered: 2010-07-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3381AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0480 / 3 LL / IM

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

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

Write-up: Swelling of left leg where immunizations were given. Pt''s mom instructed to give ibuprofen & ice the site of swelling.


VAERS ID: 391945 (history)  
Age: 5.0  
Gender: Female  
Location: Indiana  
Vaccinated:2010-06-30
Onset:2010-07-01
   Days after vaccination:1
Submitted: 2010-07-02
   Days after onset:1
Entered: 2010-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / 1 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0186Z / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Body temperature increased, Injection site erythema, Injection site pain
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: T100, 3 inch diameter red raised area with lighter central portion noted on Rt upper arm where she received SQ injection. Mother states tenderness to touch but moves extremity without difficulty. Parent has been using cool compresses to site. Recommended warm compresses and to continue using Ibuprofen. Mother to call physician if no improvement by 7/3/10.


VAERS ID: 391958 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-06-23
Onset:2010-06-24
   Days after vaccination:1
Submitted: 2010-06-25
   Days after onset:1
Entered: 2010-07-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. D1743Y / 1 LA / SC

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

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

Write-up: Swelling and redness on injection site left deltoid.


VAERS ID: 392003 (history)  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-06-30
Onset:2010-07-01
   Days after vaccination:1
Submitted: 2010-07-02
   Days after onset:1
Entered: 2010-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1269Y / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0025Y / 1 LL / SC

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

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

Write-up: Redness, warm to touch, slightly raised LT from Vaccine. KINRIX. Tx: Was seen By Dr today (02 JUL 2010 @ 1315) and advised to apply cold compress. Childrens MOTRIN TID PRN for swelling and pain. Monitor for increase swelling, redness, warm, Pain, and itchiness and immobility and to go to ER if other symptoms persist.


VAERS ID: 392006 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-06-29
Onset:2010-06-30
   Days after vaccination:1
Submitted: 2010-07-02
   Days after onset:2
Entered: 2010-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0106Z / 1 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Full blood count normal, Oedema peripheral, Pain in extremity, Pyrexia, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Deltoid swelling and pain. Fever.


VAERS ID: 392007 (history)  
Age: 5.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2010-07-02
Onset:2010-07-02
   Days after vaccination:0
Submitted: 2010-07-02
   Days after onset:0
Entered: 2010-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0480 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0336Z / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0068Z / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cough, Injection site erythema, Injection site swelling, Rash, Sneezing, Somnolence, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergies to milk, beef, pork, egg. autistic spectrum disorder. asthma
Diagnostic Lab Data: none
CDC Split Type:

Write-up: He developed a rash with coughing, sneezing, drowsiness and vomiting shortly after vaccines given today with left arm swelling and redness noted first.


VAERS ID: 392019 (history)  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-07-01
Onset:2010-07-02
   Days after vaccination:1
Submitted: 2010-07-03
   Days after onset:1
Entered: 2010-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 RA / IJ

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

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

Write-up: Large hard, hot, red lump just below the injection site.


VAERS ID: 392034 (history)  
Age: 5.0  
Gender: Male  
Location: Alabama  
Vaccinated:2010-06-18
Onset:2010-06-29
   Days after vaccination:11
Submitted: 2010-07-05
   Days after onset:6
Entered: 2010-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0413 / 3 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12894 / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. P5914 / 1 RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient developed asymptomatic rash consistent with erythema multiforme. Completely resolved by 7/4 without interventions.


VAERS ID: 392045 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-02-02
Onset:2010-07-04
   Days after vaccination:1248
Submitted: 2010-07-05
   Days after onset:1
Entered: 2010-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1985CA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10682 / 3 RL / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1530F / 1 LL / SC

Administered by: Private       Purchased by: Other
Symptoms: Rash papular, Varicella
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 30 + red papules sparsely dispersed with concentration in groin, neck, axilla and trunk; dx with varicella. Received varicella vaccines on 07/29/03 & 02/02/2007.


VAERS ID: 392046 (history)  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-01-22
Onset:2010-07-04
   Days after vaccination:163
Submitted: 2010-07-05
   Days after onset:1
Entered: 2010-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 02472CA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D00372 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0563Y / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1167Y / 1 RL / SC

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

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

Write-up: Red papules sparsely dispersed with concentration in groin, neck, and axilla. Received varicella vaccines on 07/24/2006 and 01/22/2010.


VAERS ID: 392048 (history)  
Age: 5.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2010-06-29
Onset:2010-06-29
   Days after vaccination:0
Submitted: 2010-07-01
   Days after onset:2
Entered: 2010-07-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / - LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0185Z / - RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: arm warm, red, inflamed arm twice size of other arm to elbow~Influenza (Seasonal) (Fluzone)~3~3.00~Patient
Other Medications: Had taken Amox for strept throat 6-6-10
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None stated.


VAERS ID: 392102 (history)  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2010-06-28
Onset:2010-06-28
   Days after vaccination:0
Submitted: 2010-07-06
   Days after onset:8
Entered: 2010-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362AA / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR UF393AC / 0 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR E06531 / 0 RA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UF716AA / 0 RA / SC

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

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

Write-up: Vaccine administered @ 11AM. Approximately 8 - 10 hrs later, patient had fever 102 degree. Parents administered Motrin. Within 24 hrs of administration patient afebrile no other signs and symptoms of side effects.


VAERS ID: 392146 (history)  
Age: 5.0  
Gender: Female  
Location: Alabama  
Vaccinated:2010-06-29
Onset:2010-07-04
   Days after vaccination:5
Submitted: 2010-07-06
   Days after onset:2
Entered: 2010-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164AB / 0 LG / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1567Y / 1 LG / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1445Y / 1 LG / SC

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

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

Write-up: Raised rash on legs, arms, stomach, and cheeks. No fever, no itching, no pain. Vaccines given on 6/29/10. Rash started on 7/4/10.


VAERS ID: 392253 (history)  
Age: 5.0  
Gender: Female  
Location: Indiana  
Vaccinated:2010-05-06
Onset:0000-00-00
Submitted: 2010-06-29
Entered: 2010-07-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / - RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1223Y / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1428Y / 1 RA / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Chest X-ray, Haematology test, Pyrexia, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Allergic; PCN
Diagnostic Lab Data: Hematology; Urinalysis; Chest X-ray
CDC Split Type:

Write-up: Fever 100 degrees F - 104 degrees.


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