MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 544402 cases in entire database

Case Details (Sorted by Age)

This is page 2684 out of 5445

Result pages: prev   2585 2586 2587 2588 2589 2590 2591 2592 2593 2594 2595 2596 2597 2598 2599 2600 2601 2602 2603 2604 2605 2606 2607 2608 2609 2610 2611 2612 2613 2614 2615 2616 2617 2618 2619 2620 2621 2622 2623 2624 2625 2626 2627 2628 2629 2630 2631 2632 2633 2634 2635 2636 2637 2638 2639 2640 2641 2642 2643 2644 2645 2646 2647 2648 2649 2650 2651 2652 2653 2654 2655 2656 2657 2658 2659 2660 2661 2662 2663 2664 2665 2666 2667 2668 2669 2670 2671 2672 2673 2674 2675 2676 2677 2678 2679 2680 2681 2682 2683 2684 2685 2686 2687 2688 2689 2690 2691 2692 2693 2694 2695 2696 2697 2698 2699 2700 2701 2702 2703 2704 2705 2706 2707 2708 2709 2710 2711 2712 2713 2714 2715 2716 2717 2718 2719 2720 2721 2722 2723 2724 2725 2726 2727 2728 2729 2730 2731 2732 2733 2734 2735 2736 2737 2738 2739 2740 2741 2742 2743 2744 2745 2746 2747 2748 2749 2750 2751 2752 2753 2754 2755 2756 2757 2758 2759 2760 2761 2762 2763 2764 2765 2766 2767 2768 2769 2770 2771 2772 2773 2774 2775 2776 2777 2778 2779 2780 2781 2782 2783   next


VAERS ID:471691 (history)  Vaccinated:2012-10-19
Age:11.0  Onset:2012-10-19, Days after vaccination: 0
Gender:Male  Submitted:2012-10-26, Days after onset: 7
Location:California  Entered:2012-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA697AA IMLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC109BB IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB646BA IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0110436 IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4287AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H011963 SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Patient was getting shorts of breath. Heartrate got elevated. Office had to call paramedics. While getting benadryl paramedics were on the way to the clinic.

VAERS ID:471890 (history)  Vaccinated:2012-10-22
Age:11.0  Onset:2012-10-22, Days after vaccination: 0
Gender:Female  Submitted:2012-10-22, Days after onset: 0
Location:Georgia  Entered:2012-10-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainting~Vaccine not specified (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness: Body pain; Hx of fever
Preexisting Conditions: Acute pharyngitis; Allergic conjunctivitis; Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH715AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt complained to mom "not feeling good", walked to lobby area and fainted.

VAERS ID:471935 (history)  Vaccinated:2012-10-29
Age:11.0  Onset:2012-10-29, Days after vaccination: 0
Gender:Male  Submitted:2012-10-29, Days after onset: 0
Location:Texas  Entered:2012-10-29
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: dr visit
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12045210IMRA
Administered by: Other     Purchased by: Private
Symptoms: Concussion, Fall, Head injury, Headache, Swelling face, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Patient received flu vaccine (he was standing by mom while seeing his younger sibling receive the flu shot) and shortly fell to floor resulting with a bump on side of forehead. He was conscious the entire time answering all questions being asked of him and placed ice pack on bump immediately. (Swelling went down before he was pushed in motor chair to car). He also had some water. He said his head hurt and parents took him to visit dr right away. We offered to call ambulance, however they said it was not necessary. I followed up with mom at 11:30 and then 12:30. They had just left dr office and dr said he had a concussion to only give Tylenol and refrain from sports this week, but that he would be ok. Dr. said he had fainting episode due to possibly watching brother get vaccine administered. Mom said he would be fine and I told her I would continue following up with her throughout the week.

VAERS ID:471968 (history)  Vaccinated:2012-10-26
Age:11.0  Onset:2012-10-26, Days after vaccination: 0
Gender:Male  Submitted:2012-10-29, Days after onset: 3
Location:Michigan  Entered:2012-10-29
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4283AA IM 
TDAP: TDAP (ADACEL)SANOFI PASTEURC3898BA IM 
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Heart rate irregular, Hypotension, Mydriasis, Pallor, Somnolence, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Paleness, dizziness, blurring of vision, sleepiness, weakness & loss of strength in extremities, dilated pupils, low BP, & irregular heart rate & rhythm. Laid pt down, used ammonia salts as inhalant, gave juice and bite of cheese, cold cloth (pt not diaphoretic) & continued to take VS. Third party called 911 to get EMTs here. Worked with pt for approximately 40 min before EMTs arrived. EMTs called because of pt continued to have loss of strength in extremities and sleepiness.

VAERS ID:472144 (history)  Vaccinated:2012-10-27
Age:11.0  Onset:2012-10-27, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Michigan  Entered:2012-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB667BB UNLL
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA10126 UNRL
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B085AA UNLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0096351UNRL
Administered by: Private     Purchased by: Public
Symptoms: Fall, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: He fainted fell out of chair was pale, lasted for maybe a minute. Woke up when on floor. We elevated legs put coat under his head. He kept saying "how did I end up on the floor". I got Dr. and he checked his breathing and heart asked how he felt.

VAERS ID:472160 (history)  Vaccinated:2012-10-26
Age:11.0  Onset:2012-10-26, Days after vaccination: 0
Gender:Male  Submitted:2012-10-29, Days after onset: 3
Location:Arkansas  Entered:2012-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Atopic dermatitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB591BA IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4285AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B094AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Lt arm swollen, red. c/o itching; started the evening of shots 10/26/12. BENADRYL tid for 5 days.

VAERS ID:472171 (history)  Vaccinated:2012-10-24
Age:11.0  Onset:2012-10-24, Days after vaccination: 0
Gender:Female  Submitted:2012-10-30, Days after onset: 6
Location:Utah  Entered:2012-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH733AA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swollen to approximately the size of golf ball with pain at injection site that radiated into shoulder and back.

VAERS ID:472258 (history)  Vaccinated:2012-10-20
Age:11.0  Onset:2012-10-20, Days after vaccination: 0
Gender:Male  Submitted:2012-10-23, Days after onset: 3
Location:Pennsylvania  Entered:2012-10-30, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Allergy testing
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH734AB0SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Allergy test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt. got hive from shoulder to elbow after flu shot. No previous reactions to other imms.

VAERS ID:472354 (history)  Vaccinated:2012-10-22
Age:11.0  Onset:2012-10-22, Days after vaccination: 0
Gender:Male  Submitted:2012-10-22, Days after onset: 0
Location:Hawaii  Entered:2012-10-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinusitis diagnosed in ER
Preexisting Conditions:
Diagnostic Lab Data: X-ray; no labs
CDC Split Type: HI1204
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 UNLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Fatigue, Headache, Sinusitis, X-ray
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: 0911 Received TIV 0925 c/o dizziness & headache. No resp diff. T 98.3 BP 100/72 AP-96. 0936 ate 1/2 cracker & sip water 0950 c/o (L) leg pain. 1100 to ER c/o (L) arm & (L) leg pain. MD was told (L) jaw was drooping but not seen by MD. Very fatigued. BENADRYL (po) given & started talking more. Given oral Penicillin for sinusitis. Discharged home.

VAERS ID:472546 (history)  Vaccinated:2012-10-17
Age:11.0  Onset:2012-10-18, Days after vaccination: 1
Gender:Male  Submitted:2012-10-30, Days after onset: 12
Location:Utah  Entered:2012-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH730AA3IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4341AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4393BA0IMLA
Administered by: Private     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)
Write-up: Large, swollen redness around injection site 1 day after admin. Pt. given 3 vaccines, all in the same arm per his & parents request. Parents say he had had previous imm. reactions. But they are unsure as to when.

VAERS ID:472578 (history)  Vaccinated:2012-10-23
Age:11.0  Onset:2012-10-23, Days after vaccination: 0
Gender:Male  Submitted:2012-10-25, Days after onset: 2
Location:Louisiana  Entered:2012-10-30, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen elixir
Current Illness: Well child
Preexisting Conditions: NKA; No birth defects noted; Childhood asthma and exercise induced bronchospasm
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4412BA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4395AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Head injury, Induration, Laceration, Skin warm, Suture insertion, Swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt. received ADACEL and MENACTRA to LD, syncoped and hit head on window sill in room. Received staples for laceration to head in ER. Returned on 10/25 for possible concussion and vaccine reaction to LD. Raised induration 11 cm x 11 cm and warm.

VAERS ID:472293 (history)  Vaccinated:2011-08-24
Age:11.0  Onset:2012-09-01, Days after vaccination: 374
Gender:Male  Submitted:2012-10-26, Days after onset: 55
Location:Connecticut  Entered:2012-10-31, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: 201209900
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Bordetella test positive, Cough, Culture throat positive, Fatigue, Laboratory test
SMQs:, Anaphylactic reaction (broad)
Write-up: Initial case received from a consumer on 18 October 2012. A 12 year old male patient was administered an intramuscular injection of ADACEL on 24 August 2011, lot number not reported. The patient''s medical history and concomitant medications were not reported. Several months later on an unspecified date in September 2012, the patient began having an excessive cough. The patient was assessed by a physician on an unknown date and a throat culture was performed. The culture results were positive for pertussis. Laboratory tests performed and the tests results were not specified. The patient was prescribed antibiotics on an unknown date. Details of treatment were not reported. The patient outcome is not yet recovered at the time of the report and the patient is reported as still coughing and is often tired. No further details were available at the time of this report. Documents held by sender: None.

VAERS ID:472317 (history)  Vaccinated:2012-10-30
Age:11.0  Onset:2012-10-30, Days after vaccination: 0
Gender:Female  Submitted:2012-10-31, Days after onset: 1
Location:Florida  Entered:2012-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA702AA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0420AE0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4274AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Face oedema, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Rash on face the evening of 10/30/12. Benadryl was administered orally. 10/31/12 c/o headache and facial edema.

VAERS ID:472750 (history)  Vaccinated:2012-10-23
Age:11.0  Onset:2012-10-24, Days after vaccination: 1
Gender:Female  Submitted:2012-10-25, Days after onset: 1
Location:California  Entered:2012-10-31, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Strep (-)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4527EA6IMLA
Administered by: Private     Purchased by: Private
Symptoms: Oropharyngeal pain, Pyrexia, Rhinorrhoea, Streptococcus test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Within 12 hours of flu shot patient had 4 episodes of vomiting, fever to 103 for 24 hours and sore throat and runny nose.

VAERS ID:472925 (history)  Vaccinated:2012-10-20
Age:11.0  Onset:2012-10-22, Days after vaccination: 2
Gender:Female  Submitted:2012-10-22, Days after onset: 0
Location:Puerto Rico  Entered:2012-10-31, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL 25 mg IM; SOLUMEDROL 80 mg IM
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data: Allergic reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4242AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B093BA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H013642 SCLA
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Rash generalised
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Patient got vaccinated on 10-20-2012. Tdap, MCV & Varicella. Presented with rash all over body on 10-22-2012.

VAERS ID:472991 (history)  Vaccinated:2012-10-30
Age:11.0  Onset:2012-10-30, Days after vaccination: 0
Gender:Female  Submitted:2012-10-30, Days after onset: 0
Location:Massachusetts  Entered:2012-11-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4273AA UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4181AA UNRA
Administered by: Private     Purchased by: Public
Symptoms: Fall, Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt rec tdap & MENACTRA in (rt) arm at 3:15 pm, walked out of rm immed. after, was standing at counter, stated she didn''t feel good, and then fainted fell backwards about 3 mins after vaccines. Woke within 30 seconds & discharged to home.

VAERS ID:473176 (history)  Vaccinated:2012-10-12
Age:11.0  Onset:2012-10-12, Days after vaccination: 0
Gender:Male  Submitted:2012-11-01, Days after onset: 20
Location:Georgia  Entered:2012-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to albuterol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0420AE1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mild redness & swelling at site of injection - pain with movement no treatment (just rest).

VAERS ID:472678 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-31
Location:Louisiana  Entered:2012-11-02, Days after submission: 2
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: Not reported
Diagnostic Lab Data: Culture of the bumps but has not received the results yet.
CDC Split Type: 201209991
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4267AB SYRUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Culture, Injection site erythema, Injection site pustule, Injection site rash, Injection site swelling, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Initial report was received from a health care professional on 23 October 2012. An 11-year-old female patient had received an injection of MENACTRA, lot number U4267AB (route, site and date of administration not reported) and an unspecified amount of time later experienced a rash at the site of injection that formed a blister and small bumps with pus in them. The physician did a culture of the bumps but has not received results yet. The injection site was also swollen and red. No further information was provided. The patient''s outcome was not reported. Documents held by sender: None.

VAERS ID:473217 (history)  Vaccinated:2011-10-24
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-24
Location:Louisiana  Entered:2012-11-02, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CMP; CRP; Creatinine Kinase; Sed rate; ASO titer; ANA; Rheumatoid Factor; Epstein-Barr Virus; CBC; UA; X-rays of hips & femur
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501113P3IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0476AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM100570IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3874BA5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Antinuclear antibody, Blood creatine phosphokinase, C-reactive protein, Epstein-Barr virus test, Full blood count, Metabolic function test, Myalgia, Pain in extremity, Red blood cell sedimentation rate, Rheumatoid factor, Streptococcus test, Urine analysis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt took (HPV #1) 1 year ago 10-24-11. On 11-4-12 she went to her pediatrician with c/o severe leg pain & muscle aches.

VAERS ID:472834 (history)  Vaccinated:2012-09-12
Age:11.0  Onset:2012-09-20, Days after vaccination: 8
Gender:Female  Submitted:2012-11-04, Days after onset: 45
Location:Illinois  Entered:2012-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRLA
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0SYRLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRRA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe stomach pain.

VAERS ID:472936 (history)  Vaccinated:2012-10-25
Age:11.0  Onset:2012-10-25, Days after vaccination: 0
Gender:Male  Submitted:2012-11-05, Days after onset: 11
Location:Michigan  Entered:2012-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB646AA IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0636AE IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4283AA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt had redness and swelling at injection site on right arm at time of onsite. Mom took pt to ED on 10/26/12 at 1920 area of redness was 2"x4" at time of visit. He was treated for cellutits by taking Keflex 200mg PO BID for 7 days, and to take OTC Motrin and Claritin. Pt f/u with PCP on Monday/Tuesday and improvement noted.

VAERS ID:473453 (history)  Vaccinated:2012-10-18
Age:11.0  Onset:2012-10-18, Days after vaccination: 0
Gender:Female  Submitted:2012-11-05, Days after onset: 18
Location:New York  Entered:2012-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB515BA1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4290AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4421AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient experienced a syncopal episode 20 minutes post immunization.

VAERS ID:473302 (history)  Vaccinated:2012-11-06
Age:11.0  Onset:2012-11-06, Days after vaccination: 0
Gender:Male  Submitted:2012-11-06, Days after onset: 0
Location:Nevada  Entered:2012-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Received vaccine, was well, stood up and stepped off exam table and was syncopal. Woke within a few minutes, aao x 4, c/o dizziness. Has him recline, slowly raised head and gave food. Neuros intact, no dizziness when dc''d.

VAERS ID:473762 (history)  Vaccinated:2012-10-22
Age:11.0  Onset:2012-10-22, Days after vaccination: 0
Gender:Female  Submitted:2012-11-05, Days after onset: 14
Location:Washington  Entered:2012-11-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Vital signs check, check normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21060IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0097460UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4261AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3974AA0UNRA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Presyncopal (Dizzy only).

VAERS ID:474013 (history)  Vaccinated:2012-10-25
Age:11.0  Onset:2012-10-26, Days after vaccination: 1
Gender:Male  Submitted:2012-11-06, Days after onset: 11
Location:New Jersey  Entered:2012-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH734AB6UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4414AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4395AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis allergic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Developed hives/allergic rash day after received vaccine.

VAERS ID:473680 (history)  Vaccinated:2012-11-07
Age:11.0  Onset:2012-11-08, Days after vaccination: 1
Gender:Male  Submitted:2012-11-08, Days after onset: 0
Location:Kentucky  Entered:2012-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH21080IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0142310IMGM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4375AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4328AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0064631IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site pain, Injection site swelling, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Injection site redness/swelling/pain along with systemic fever, headache, neck pain.

VAERS ID:476354 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-30
Location:Michigan  Entered:2012-11-08, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4240AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B080DA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient had syncopal episode after receiving MENACTRA & Tdap (BOOSTRIX) vaccines.

VAERS ID:476363 (history)  Vaccinated:2012-11-05
Age:11.0  Onset:2012-11-06, Days after vaccination: 1
Gender:Female  Submitted:2012-11-07, Days after onset: 1
Location:Georgia  Entered:2012-11-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0101AE0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEUR4383AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0073281SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt. received VZV shot in La on 11-5-12. Came back to clinic on 11-7-12 c/o swelling & redness. She was seen by RN and encouraged to put cool compress several x daily and explained this is one of the side effects, and encouraged to see an M.D. if worsening occurs. 11-8-12 at 2:45PM mom states "It was still red this AM but not any worse".

VAERS ID:476364 (history)  Vaccinated:2012-11-05
Age:11.0  Onset:2012-11-07, Days after vaccination: 2
Gender:Male  Submitted:2012-11-08, Days after onset: 1
Location:Pennsylvania  Entered:2012-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No active problems; No known allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4019AA0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURU4325AB0IMUN
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Swollen arm, red and painful.

VAERS ID:476365 (history)  Vaccinated:2012-11-06
Age:11.0  Onset:2012-11-06, Days after vaccination: 0
Gender:Female  Submitted:2012-11-08, Days after onset: 2
Location:New Mexico  Entered:2012-11-08
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURG15420IMUN
Administered by: Private     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt. vomited at 6 pm on the day of vaccination.

VAERS ID:476366 (history)  Vaccinated:2012-11-05
Age:11.0  Onset:2012-11-06, Days after vaccination: 1
Gender:Female  Submitted:2012-11-08, Days after onset: 2
Location:Colorado  Entered:2012-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4247AA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B081BA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Headache, Lethargy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Received TDAP and MCV4 11/5/2012. Fever of 101.9 F, headache, back ache, sore arm 11/6/2012. 11/7/2012 Lethargy, mild temp. 11/8/2012 Back to school.

VAERS ID:473796 (history)  Vaccinated:2012-11-09
Age:11.0  Onset:2012-11-09, Days after vaccination: 0
Gender:Female  Submitted:2012-11-09, Days after onset: 0
Location:California  Entered:2012-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies
Preexisting Conditions: Denies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0629AE0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0411AE1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4260AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B081BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0110871SCLA
Administered by: Public     Purchased by: Public
Symptoms: Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Nausea, vomited X1, pale.

VAERS ID:473802 (history)  Vaccinated:2012-11-06
Age:11.0  Onset:2012-11-06, Days after vaccination: 0
Gender:Male  Submitted:2012-11-09, Days after onset: 3
Location:Massachusetts  Entered:2012-11-09
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: ADHD
Diagnostic Lab Data: Vaccine site was cultured for C&S and patient was prescribed antibiotic for cellulitis and Benadryl for local reaction.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4034AA1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Cellulitis, Culture, Injection site discharge, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, erythema, pain and itching around vaccine injection site. Small amt yellowish d/c at the injection site on day 3.

VAERS ID:475796 (history)  Vaccinated:2011-10-24
Age:11.0  Onset:2011-10-27, Days after vaccination: 3
Gender:Female  Submitted:2012-02-06, Days after onset: 102
Location:New Jersey  Entered:2012-11-09, Days after submission: 277
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Illness at the time of vaccination was well.
Diagnostic Lab Data: Not reported
CDC Split Type: 201110475
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURU4178AA IDLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4241AA IDRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial report was received from a health care professional on 28 October 2011. An 11-year-old female patient had received a FLUZONE Intradermal in left deltoid, lot number U4178AA and MENACTRA in right deltoid, lot number U4241AA on 24 October 2011. On 27 October 2011, 3 days after vaccination the patient was seen in the doctor office for swelling at the right deltoid in which radiates down to the mid arm. The patient also complained of pain. No further informational was available at the time of the report. The patient outcome was unknown. Follow-up information was received from a healthcare professional on 20 January 2012. The patient outcome was reported as recovered/resolved. Documents held by sender: none.

VAERS ID:473854 (history)  Vaccinated:2012-11-08
Age:11.0  Onset:2012-11-09, Days after vaccination: 1
Gender:Male  Submitted:2012-11-12, Days after onset: 3
Location:Tennessee  Entered:2012-11-12
Life Threatening? Yes
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: Required Dr visit on 11/09/2012 with Steroid shot and ER visit on 11/10/2012 with steroid shot.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B094AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.G0074611SCRA
Administered by: Unknown     Purchased by: Private
Symptoms: Chest pain, Dyspnoea, Eye swelling, Heart rate increased, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: R arm edema 5inch X 7 inch, eyes swollen shortness of breath, rapid pulse and chest pain.

VAERS ID:473903 (history)  Vaccinated:2012-10-25
Age:11.0  Onset:2012-10-31, Days after vaccination: 6
Gender:Male  Submitted:2012-11-13, Days after onset: 13
Location:Maine  Entered:2012-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: T 98.2 well
Preexisting Conditions: None known
Diagnostic Lab Data: LP & MRI & labs done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ20252IN 
Administered by: Other     Purchased by: Public
Symptoms: Activities of daily living impaired, Central nervous system lesion, Dizziness, Fatigue, Hypoaesthesia, Laboratory test, Lumbar puncture, Nausea, Nuclear magnetic resonance imaging brain abnormal, VIIth nerve paralysis, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: 6 days after rec FLUMIST, student c/o nausea and later on developed vomiting - dizziness as reported by his mother. Dx - Bell''s palsy & now being worked up by neurology - (+) MRI for brain lesions again as reported to me by his mother. She said the doctor is r/o ADEM or MS. Has numbness Rt hand residual & still out of school to date, fatigue, & light-headed. Hospitalized - IV steroids per mother. Has been out of school since Nov 1 2012.

VAERS ID:474080 (history)  Vaccinated:2012-11-09
Age:11.0  Onset:2012-11-09, Days after vaccination: 0
Gender:Male  Submitted:2012-11-14, Days after onset: 5
Location:New Jersey  Entered:2012-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA005339
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED 2UNLA
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Cold sweat, Diarrhoea, Dizziness, Fall, Headache, Nausea, Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)
Write-up: This spontaneous report as received from a physician refers to a 11 years old male patient with no pertinent medical history, drug reactions or allergies. The patient was vaccinated with dose 1 of GARDASIL (lot #, dose and route not reported) on 09-NOV-2012. Other suspect therapies included a dose of AFLURIA (lot #, dose and route not reported) on 09-NOV-2012. Concomitant medications included: Tdap (manufacturer unspecified). The physician reported that the patient also had blood drawn for unspecified blood work (results not provided) on 09-NOV-2012. After receiving the GARDASIL, the patient felt dizzy and nauseated, and had an episode of "explosive diarrhea" and fainted on toilet. No injuries incurred. Physician reported at that time, patient had no wheezing, no injuries and no hypotension but patient was "clammy and pale". After leaving the office, he had another syncopal episode and diarrhea in the parking lot. No injuries reported from fall. The mother of the patient called the physician the weekend to report that the patient continued to have vomiting, diarrhea and severe headache and that she was taking him to the emergency room. The physician stated the mother would call to follow up on his status. No treatment information was reported. The outcome of syncopal episode and fall was unknown. The relatedness for the reported events was not provided for GARDASIL and AFLURIA. Additional information has been requested.

VAERS ID:474146 (history)  Vaccinated:2012-11-14
Age:11.0  Onset:2012-11-14, Days after vaccination: 0
Gender:Female  Submitted:2012-11-14, Days after onset: 0
Location:Oklahoma  Entered:2012-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: HS Purpura
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0629AE0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4275AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3976AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: PATIENT RECEIVED TDAP, MCV4 AND HPV VACCINE TODAY. AFTER GIVING THE LAST VACCINE WHICH WAS HPV AT 11:16 AM PATIENT PASSED OUT. SHE WAS STILL SEATED IN CHAIR AT TIME. I CAUGHT PATIENT WHEN SHE WAS STARTING TO LEAN OVER AND LAID HER BACK ON MY LAP. WE APPLIED COOL DAMP CLOTHES TO HER FACE AND NECK. SHE CAME BACK AROUND WITHIN THE NEX MINUTE. WE SAT HER BACK UP IN CHAIR AND SHE WENT OUT AGAIN. WE THEN MOVED HER ONTO THE EXAM TABLE TO LIE DOWN. AFTER SHE CAME BACK AROUND WITHIN THE NEXT MINUTE SHE DENIED ANY NAUSEA. SHE SAID HER HEAD HURT A LITTLE BIT. O2 SAT WAS 99% HER BP WAS 119/57 AND PULSE WAS 88. BP REPEATED AND WAS 110/59. STATED SHE WANTED TO TRY AND SIT UP. AT 11:33 WE SAT HER UP AND SHE DRANK SOME WATER. AT 11:34 HER BP WAS 108/67 AND PULSE 93. AT 11:39 HER BP WAS 101/53 AND PULSE 82. SHE SAID SHE WANTED TO LAY BACK AGAIN. I RECHECKED HER BP AT 1145 AND IT WAS 102/56 AND PULSE 82. AT 1154 SHE SAT UP ON EDGE OF EXAM TABLE AND SAID "SHE FEELS BETTER" COLOR WAS GOOD AT THIS TIME ALSO. AT THIS TIME WE HAD HER TO STAND UP AND SHE SAID SHE FELT FINE. HAD HER TAKE A FEW STEPS AND SHE SAID SHE WAS FINE. HER GAIT WAS GOOD. AT 11:58 SHE SAID SHE "FEELS BETTER" AND WALKED OUT OF CLINIC WITH HER MOTHER.

VAERS ID:478085 (history)  Vaccinated:2012-08-16
Age:11.0  Onset:2012-11-06, Days after vaccination: 82
Gender:Female  Submitted:2012-11-14, Days after onset: 8
Location:Illinois  Entered:2012-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA003278
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0566AE SCAR
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to an 11 years old patient. The patient was vaccinated SC, with a dose of 0.65 ml ZOSTAVAX instead of VARIVAX(Merck) on 06-NOV-2012. No other co-suspects were reported. No concomitant medications were reported. No adverse effects reported. The patient''s mom had called physician''s office. At the time of the report, the patient''s outcome was unknown. Additional information has been requested.

VAERS ID:474298 (history)  Vaccinated:2012-11-14
Age:11.0  Onset:2012-11-14, Days after vaccination: 0
Gender:Female  Submitted:2012-11-15, Days after onset: 1
Location:California  Entered:2012-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Right sided abdominal pain
Preexisting Conditions: Austism Spectrum Disorder, Migraines (takes Tylenol), nocturnal enuresis on Desmopressin
Diagnostic Lab Data: Referred to neurology.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA695BA2IMLL
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0129680IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4285AA0IMRA
Administered by: Unknown     Purchased by: Other
Symptoms: Loss of consciousness, Neurological examination, Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Received MCV4, HPV4, then FLUARIX, mom noticed was shaking whole body, then fainted (loc for about 2 mintues), went to car, was shaking/pale, then 7:30pm started shaking again; shaking throughout day and night. Went to MD office on 11/15/12, was seen to have intermittent episodes of brief (few seconds) fine tremors in various locations not all at once (head, shoulders, left foot, arms). Normal neuro exam otherwise.

VAERS ID:474302 (history)  Vaccinated:2012-11-14
Age:11.0  Onset:2012-11-14, Days after vaccination: 0
Gender:Female  Submitted:2012-11-15, Days after onset: 1
Location:California  Entered:2012-11-15
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 SENT TO EMERGENCY ROOM
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0022AE0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4074BA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B085BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: PATIENT GIVEN HPV, MCV AND TDAP VACCINES. AFTER THE TDAP VACCINE SHE FAINTED, PROVIDER NOTIFIED. PT RESPONDED WITH AMNONIA INHALANT, 911 AND AMBULANCE CALLED. TAKEN TO ER VIA AMBULANCE.

VAERS ID:474595 (history)  Vaccinated:2012-11-12
Age:11.0  Onset:2012-11-13, Days after vaccination: 1
Gender:Male  Submitted:2012-11-15, Days after onset: 2
Location:Pennsylvania  Entered:2012-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH717AC UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSAX01460UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B093DA5UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: (R) arm red, swollen, hot to touch.

VAERS ID:474827 (history)  Vaccinated:2012-10-09
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2012-11-14
Location:Massachusetts  Entered:2012-11-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: H/O wheeze
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH721AC3IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4099AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3819AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt received meningococcal and Tdap in right arm 10/9/12 - sometime before Halloween pt noticed she was breaking out in welts at night in that area. Itchy but self resolve - only happening at night.

VAERS ID:477023 (history)  Vaccinated:2012-11-07
Age:11.0  Onset:2012-11-07, Days after vaccination: 0
Gender:Female  Submitted:2012-11-16, Days after onset: 9
Location:Connecticut  Entered:2012-11-16
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4283AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B088AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Hypoaesthesia, Immediate post-injection reaction, Injection site reaction, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Received Tdap (R) deltoid right after shot felt tingling down area. 1-2 hrs later started to c/o pain (R) palm & numbness let forearm & 5th finger. Ultimately had some weakness. Improving when examined on 11/12/12.

VAERS ID:474642 (history)  Vaccinated:2012-11-15
Age:11.0  Onset:2012-11-16, Days after vaccination: 1
Gender:Female  Submitted:2012-11-17, Days after onset: 1
Location:Connecticut  Entered:2012-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, swollen, hot to the touch area around injection site. Large part of upper arm affected. Sore and tender.

VAERS ID:476962 (history)  Vaccinated:2012-08-22
Age:11.0  Onset:2012-08-22, Days after vaccination: 0
Gender:Male  Submitted:2012-11-19, Days after onset: 89
Location:Unknown  Entered:2012-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA004113
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0097460UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Fatigue, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: This spontaneous report as received from a physician refers to an 11 years old male patient. The patient was vaccinated with first dose of GARDASIL (lot number reported as H009746, expired date unknown) on 22-AUG-2012. The patient also received a dose of MENACTRA on the same date. No other co-suspects were reported. The patient experienced malaise, general muscle pain and fatigue after administration of first dose of GARDASIL on 22-AUG-2012. The muscle pain was generalized but especially involved both legs. The symptoms resolved after 2 days without requiring treatment. The patient''s parents declined to continue to GARDASIL series. It was unknown if the patient had sought medical attention. Additional information is not expected. This is one of several reports received from the same source.

VAERS ID:474963 (history)  Vaccinated:2012-10-29
Age:11.0  Onset:2012-10-29, Days after vaccination: 0
Gender:Female  Submitted:2012-11-20, Days after onset: 22
Location:Maine  Entered:2012-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: she is currently recovering
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH733AC5IM 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4260AA0IM 
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B081BA0IM 
Administered by: Private     Purchased by: Public
Symptoms: Herpes simplex, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever up to 105.7 for 5 days (starting 6-7 hours after injections), ended up diagnosed with primary HSV outbreak. Recieved influenza, menactra and Tdap that day

VAERS ID:475056 (history)  Vaccinated:2012-11-07
Age:11.0  Onset:2012-11-08, Days after vaccination: 1
Gender:Female  Submitted:2012-11-09, Days after onset: 1
Location:Massachusetts  Entered:2012-11-20, Days after submission: 11
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: Anxiety; GERD
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ2143 IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4268AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4137AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness and swelling, cellulitis, measurements of areas (R) 14 x 16 cm and (L) 11 x 8 1/2 cm. Symptoms started 24 hours post injections.

VAERS ID:477336 (history)  Vaccinated:2012-10-23
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-24
Location:Michigan  Entered:2012-11-20, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSX110421IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSU4383AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: Patient received initial MENVEO 8/21/12 and another on 10/23/12. No adverse event (s) were reported. Parents notified verbally stated no adverse effect noticed.

VAERS ID:477412 (history)  Vaccinated:2012-11-16
Age:11.0  Onset:2012-11-16, Days after vaccination: 0
Gender:Female  Submitted:2012-11-19, Days after onset: 3
Location:California  Entered:2012-11-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B094DA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The injection site was swollen, hot, red, painful and itchy. Went to doctor, who prescribed cephalexin.

VAERS ID:477415 (history)  Vaccinated:2012-11-12
Age:11.0  Onset:2012-11-13, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2012-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB646BA UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H010649 UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM11047 UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073CA UNLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling, redness, tenderness on both arms, more significant on right arm.

VAERS ID:477438 (history)  Vaccinated:2012-11-13
Age:11.0  Onset:2012-11-13, Days after vaccination: 0
Gender:Male  Submitted:2012-11-15, Days after onset: 2
Location:Arizona  Entered:2012-11-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Asthma exacerbation
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4372AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4152AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness, Musculoskeletal stiffness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad)
Write-up: Nurse witnessed patient pass out & arms become stiff.

VAERS ID:477463 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2012-11-20
Location:Louisiana  Entered:2012-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No ADHD
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0636AE0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM120810IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B094EA4IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling & redness & warm to both injection sites. Mild tenderness to touch. (L) arm 8 cm area erythematous (R) arm 17 cm.

VAERS ID:477359 (history)  Vaccinated:2012-11-12
Age:11.0  Onset:2012-11-12, Days after vaccination: 0
Gender:Male  Submitted:2012-11-20, Days after onset: 8
Location:New York  Entered:2012-11-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH745AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4428AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4247AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Altered state of consciousness, Clonus, Dizziness, Fall, Immediate post-injection reaction, Tremor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: The child received #1 Tdap, #2 Influenza vacc in (L) arm, #3 MENACTRA on (L) arm. As 3rd needle was being removed, he fell forward across his knees, had moderate clonic movements, brief loss of awareness x < 30 sec with mild shaking of upper ext. - then came to with slight dizziness.

VAERS ID:477362 (history)  Vaccinated:2012-11-19
Age:11.0  Onset:2012-11-19, Days after vaccination: 0
Gender:Male  Submitted:2012-11-21, Days after onset: 2
Location:North Carolina  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110330IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Arm sore, slightly red on 11/19/12 pm. After lunch on 11/20/12 redness increased & area increased swelling.

VAERS ID:477363 (history)  Vaccinated:2012-11-20
Age:11.0  Onset:2012-11-20, Days after vaccination: 0
Gender:Female  Submitted:2012-11-21, Days after onset: 1
Location:Texas  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1397AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4412AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4384AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0160561SCLA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted after receiving vaccinations. Rested and drank water. Patient left with mother at approximately 11:10.

VAERS ID:475121 (history)  Vaccinated:2012-11-08
Age:11.0  Onset:2012-11-09, Days after vaccination: 1
Gender:Male  Submitted:2012-11-23, Days after onset: 14
Location:Kansas  Entered:2012-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None
Diagnostic Lab Data: None needed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH734AD IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4375AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B093AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Significant local reaction of approximately 3 inches diameter of redness and induration at injection site.

VAERS ID:475122 (history)  Vaccinated:2012-11-21
Age:11.0  Onset:2012-11-22, Days after vaccination: 1
Gender:Female  Submitted:2012-11-23, Days after onset: 1
Location:Minnesota  Entered:2012-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU43997AC IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4335AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0131821SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, warmth around the injection site. Baseball size. These symptoms progressively worsened in intensity over the next 24 hours. Ice the area frequently today, and continue to take Ibuprofen as needed for pain control. If the redness worsens, and spreads past the demarcated area, or patient develops fevers, or systemic signs of illness, recommend starting antibiotic-cephalexin, course provided to patient per MD.

VAERS ID:477508 (history)  Vaccinated:2011-10-25
Age:11.0  Onset:2011-10-25, Days after vaccination: 0
Gender:Male  Submitted:2012-11-05, Days after onset: 377
Location:Pennsylvania  Entered:2012-11-25, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Fever, pneumonia, vomiting then x 3~Vaccine not specified (no brand name)~UN~0.15~Patient|Post vaccination of earliest schedule
Other Medications:
Current Illness: Sinusitis/cold
Preexisting Conditions: Eczema; Allergies; Seborrheic Dermatitis; Weaken Immune; Encephalopathy (10/8/2008)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0515AA1UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM10123 UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0786AA1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain upper, Appetite disorder, Asthenia, Condition aggravated, Constipation, Eczema, Emotional disorder, Fatigue, Headache, Hypersensitivity, Immediate post-injection reaction, Insomnia, Nausea, Skin lesion
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Headache, stomach ache, nausea, immediately & continues regularly as well as day 1 & 2 fatigue & weakness. Continued with return of eczema & skin lesions that all above are reoccurring. Allergies began soon after year round sinusitis without relief. Constipation. Difficulty with emotional control & sleep. Appetite fluctuations.

VAERS ID:475271 (history)  Vaccinated:2012-11-21
Age:11.0  Onset:2012-11-25, Days after vaccination: 4
Gender:Female  Submitted:2012-11-26, Days after onset: 1
Location:Wisconsin  Entered:2012-11-26
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: CBC, CMP, Lyme titer, CT of head
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Borrelia test, Computerised tomogram head, Dysgeusia, Eyelid function disorder, Full blood count, Metabolic function test, VIIth nerve paralysis
SMQs:, Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)
Write-up: Pt complained of not being able to shut her eye completely, stated that when she was eating that everything tasted funny, and then when she smiled, one half of her face didn''t move. On 11/25/12, my daughter was taken to the Emergency Room to find out what happened, lab work drawn, and CT of the head was performed as well. After 3 hours in the ER, diagnosed with Bells palsy, and then followed up with her doctor on 11/26/2012, which also confirmed Bells Palsy.

VAERS ID:477520 (history)  Vaccinated:2012-09-04
Age:11.0  Onset:2012-09-04, Days after vaccination: 0
Gender:Male  Submitted:2012-11-06, Days after onset: 63
Location:Illinois  Entered:2012-11-26, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0555AE UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0603AE SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Cold sweat, Feeling abnormal, Immediate post-injection reaction
SMQs:, Dementia (broad), Hypersensitivity (narrow)
Write-up: Immediately after receiving HPV vaccine pt stated tongue felt funny & got clammy. He was always able to talk & drink water pulse 62 BP 110/70 again P - 64 BP 110/80. Patient observed for 15 minutes, symptoms subsided & pt left clinic.

VAERS ID:477535 (history)  Vaccinated:2012-11-21
Age:11.0  Onset:2012-11-23, Days after vaccination: 2
Gender:Female  Submitted:2012-11-26, Days after onset: 3
Location:Texas  Entered:2012-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4260AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4383AA0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site cellulitis
SMQs:
Write-up: ADACEL & MENACTRA administered right arm 11/21/12. Patient returned on 11/23/12 with dx. cellulitis right upper arm.

VAERS ID:475320 (history)  Vaccinated:2012-11-09
Age:11.0  Onset:2012-11-09, Days after vaccination: 0
Gender:Male  Submitted:2012-11-26, Days after onset: 17
Location:Unknown  Entered:2012-11-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Risk factor(s): Blood drawn for unspecified blood work
Diagnostic Lab Data:
CDC Split Type: 2012033962
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRUN
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED  SYRUN
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0SYRUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cold sweat, Diarrhoea, Dizziness, Fall, Headache, Nausea, Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)
Write-up: This medically confirmed spontaneous report (initial receipt: 12-Nov-2012) concerns an 11-year-old male patient, who had no pertinent medical history or drug allergies. He was not taking any concomitant medication at the time of the event. On 09-Nov-2012 the patient received AFLURIA (batch number was not provided). On the same day he also received Tdp vaccine and his first dose of GARDASIL injection. The patient also had blood drawn for unspecified blood work when vaccines were administered. On 09-Nov-2012, after receiving vaccination, the patient felt dizzy and nauseated. He had an episode of ''explosive diarrhoea'' and fainted on toilet. No injuries incurred. At that time, the patient had no wheezing, no injuries and no hypotension, but the patient was ''clammy and pale''. After leaving the office, the patient had another syncopal episode and diarrhoea in the parking lot. No injuries reported from the fall. The mother called the physician this weekend to report that the patient continued to have vomiting, diarrhoea and severe headache and that she was taking him to the ER (Emergency Room).

VAERS ID:477493 (history)  Vaccinated:2010-07-19
Age:11.0  Onset:2012-11-25, Days after vaccination: 860
Gender:Female  Submitted:2012-11-27, Days after onset: 2
Location:Massachusetts  Entered:2012-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to Azithromycin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B648CA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0221Z1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Rash, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Scattered vesicular lesions 30-40 over face and trunk.

VAERS ID:477500 (history)  Vaccinated:2012-11-26
Age:11.0  Onset:2012-11-26, Days after vaccination: 0
Gender:Female  Submitted:2012-11-27, Days after onset: 1
Location:Oregon  Entered:2012-11-27
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: Facial x-rays
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0109152IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Face and mouth X-ray, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)
Write-up: Pt got dizzy and fell to the floor.

VAERS ID:475470 (history)  Vaccinated:2012-10-23
Age:11.0  Onset:2012-10-24, Days after vaccination: 1
Gender:Male  Submitted:2012-11-20, Days after onset: 27
Location:California  Entered:2012-11-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: None
Preexisting Conditions: Gastroesophageal reflux; Hyperlipidemia
Diagnostic Lab Data: Neg CSF, Blood culture
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSX110520IMUN
Administered by: Private     Purchased by: Private
Symptoms: Blood culture negative, CSF culture negative, Immunoglobulin therapy, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: The child complained of bilateral leg weakness the day after vaccines and progressively worsen. He was admitted to hospital 11/10 - 11/15/12 and received 2 doses of IVIG. Symptoms improved.

VAERS ID:475512 (history)  Vaccinated:2012-11-28
Age:11.0  Onset:2012-11-28, Days after vaccination: 0
Gender:Female  Submitted:2012-11-28, Days after onset: 0
Location:Oklahoma  Entered:2012-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Currently had a cough
Preexisting Conditions: Nasal Allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA697AA IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0106490IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4275AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3976AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Patient felt dizzy and nauseated, felt like they might pass out. Cold rags applied to forehead and neck. Vital signs at 1104 BP=117/53 pulse=72 vital signs remained stable.

VAERS ID:475709 (history)  Vaccinated:2012-11-28
Age:11.0  Onset:2012-11-28, Days after vaccination: 0
Gender:Female  Submitted:2012-11-28, Days after onset: 0
Location:Mississippi  Entered:2012-11-28
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: No Known Allergies
Diagnostic Lab Data: Serum glucose from lab taken
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4545GA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0113500IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4290AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4383AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Blood glucose, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Sign & symptoms of syncope noted after 15 mins. shot check, occur at 5:05pm, then O2 stat check (98%) and pulse 86 also patient reevaluated per Dr.

VAERS ID:475712 (history)  Vaccinated:2012-11-20
Age:11.0  Onset:2012-11-20, Days after vaccination: 0
Gender:Female  Submitted:2012-11-29, Days after onset: 9
Location:New York  Entered:2012-11-29
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21430IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4081AA0IMUN
Administered by: Private     Purchased by: Public
Symptoms: Anaphylactic reaction, Dysphagia, Dyspnoea, Oropharyngeal pain, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Developed dyspnea, sore throat and hives all over with difficulty swallowing 2 hours after vaccines were given went to ER and treated for anaphylaxis.

VAERS ID:475728 (history)  Vaccinated:2012-11-28
Age:11.0  Onset:2012-11-29, Days after vaccination: 1
Gender:Female  Submitted:2012-11-29, Days after onset: 0
Location:Pennsylvania  Entered:2012-11-29
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: Frequent viral infections, low antibody titres to pneumococcus, low absolute lymphocyte count, borderline low IgG, allergic rhinitis, GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0109161IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site reaction, Local reaction, Myalgia, Pain, Skin lesion
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient now painful, erythematous local reaction with myalgias. At school on post-vaccine day 1 she developed two erythematous, slightly raised, sore lesions that felt like bruises" around the injection site. One was 2cm x 1cm and the other 1.2cm in diameter.

VAERS ID:475831 (history)  Vaccinated:2012-11-27
Age:11.0  Onset:2012-11-28, Days after vaccination: 1
Gender:Male  Submitted:2012-11-29, Days after onset: 1
Location:Florida  Entered:2012-11-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swelling/redness (years ago per mom)~Vaccine not specified (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS122474P0UNRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB549CA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURUA331AA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B081BA0UNLA
Administered by: Public     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)
Write-up: Patient had redness, swelling at injection site limited to the upper arm (left).

VAERS ID:475911 (history)  Vaccinated:2012-11-30
Age:11.0  Onset:2012-11-30, Days after vaccination: 0
Gender:Male  Submitted:2012-11-30, Days after onset: 0
Location:South Dakota  Entered:2012-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0IDLA
Administered by: Unknown     Purchased by: Private
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient got up immediately following the vaccination and then passed out in the hallway. He was easily revived and seemed okay.

VAERS ID:476519 (history)  Vaccinated:2012-10-08
Age:11.0  Onset:2012-10-10, Days after vaccination: 2
Gender:Male  Submitted:2012-10-15, Days after onset: 5
Location:Michigan  Entered:2012-11-30, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: No illness/sickness reported
Preexisting Conditions: Patient is allergic to PCN; No other conditions
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB646AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4289AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B085CA5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Burning sensation, Rash erythematous, Rash generalised, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow)
Write-up: Patient broke out with red bumps all over. They were itching and burning. They looked like hives. Patient''s symptoms lasted about a week and a half. Patient was treated with ATARAX 25mg, CLARITIN 10 mg and was sent home with Epi Pen Jr.

VAERS ID:476148 (history)  Vaccinated:2012-11-21
Age:11.0  Onset:2012-11-21, Days after vaccination: 0
Gender:Male  Submitted:2012-12-03, Days after onset: 12
Location:Indiana  Entered:2012-12-03
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: Pt was born premature. Pt has a strong family history of allergies and asthma.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H009840 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dysphonia, Erythema, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Pt started coughing, his voice got really high-pitched, and his face got red. Pt''s airway was evaluated by APRN and she could tell that it was physically closing. Treatment included: First Epipen was injected IM; Second 25mg Benadryl was given; Third 125mg SoluMedrol was given; Last pt received Albuterol Nebulizer Treatment in office.

VAERS ID:476167 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-06, Days after vaccination: 3
Gender:Male  Submitted:2012-12-04, Days after onset: 59
Location:California  Entered:2012-12-04
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: 48-72 hrs after the flu vaccination my son became sick. After about 1 week his right eye started watering. We went to the ophthalmologist a week later and they and she advised us that my son has optic neuritis. He lost partial vision in his right eye due to this and was admitted into hospital for 6 days.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 IMUN
Administered by: Other     Purchased by: Private
Symptoms: Blindness unilateral, Cough, Lacrimation increased, Loss of consciousness, Optic neuritis, Oropharyngeal pain, Rhinorrhoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (broad), Lacrimal disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Runny nose, sore throat, cough, watery eye with 10-15 minute blackouts numerous times a day.

VAERS ID:476169 (history)  Vaccinated:2012-11-27
Age:11.0  Onset:2012-12-03, Days after vaccination: 6
Gender:Male  Submitted:2012-12-04, Days after onset: 1
Location:Nevada  Entered:2012-12-04
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER   AR
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER   AR
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: SEVERE SWELLING REDNESS AND PAIN AT INJECTION SITE AND IRRITABILITY.

VAERS ID:476301 (history)  Vaccinated:2012-11-27
Age:11.0  Onset:2012-11-27, Days after vaccination: 0
Gender:Male  Submitted:2012-12-04, Days after onset: 7
Location:Arizona  Entered:2012-12-04
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: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0106491IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Patient stated he felt dizzy. Laid patient down on exam table. Patient stated felt better. BP 113/68. Patient sat up BP 100/67 and stated felt fine. Patient stood up BP 98/69 and patient stated felt fine. Walked patient to car and notified him to lay down if he feels dizzy again. Also if he does not feel better by laying down go to ER.

VAERS ID:476316 (history)  Vaccinated:2012-11-26
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2012-11-28
Location:Michigan  Entered:2012-12-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: BS at incident 130
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC. 0IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4397AA0IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B099BA0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1062AA1SCUN
Administered by: Private     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncopal episode 11/28/12, 2 days after immunizations - recovered & none since.

VAERS ID:476336 (history)  Vaccinated:2012-11-19
Age:11.0  Onset:2012-11-21, Days after vaccination: 2
Gender:Male  Submitted:2012-11-21, Days after onset: 0
Location:North Carolina  Entered:2012-12-04, Days after submission: 13
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ20251IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110510UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis, Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Cellulitis down left deltoid approx. 13cm width x 14cm length; red, warm to touch; tx: cold compress to site watch for spreading, BENADRYL as needed. Call office with concerns.

VAERS ID:476491 (history)  Vaccinated:2012-11-20
Age:11.0  Onset:2012-11-20, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Colorado  Entered:2012-12-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H013977 UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4313AA UNRA
Administered by: Private     Purchased by: Public
Symptoms: Vaccination site erythema, Vaccination site pain, Vaccination site swelling
SMQs:
Write-up: Red, swollen, tender at site of vaccination(s).

VAERS ID:476509 (history)  Vaccinated:2012-11-28
Age:11.0  Onset:2012-11-30, Days after vaccination: 2
Gender:Female  Submitted:2012-11-30, Days after onset: 0
Location:California  Entered:2012-12-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH721AA2IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0106492IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4261AA1IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B076BA1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0147282SCRA
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)
Write-up: Pt had VZV / Tdap on (R )-side on 11/28/12. On 11/29/12 pt started having TTP / redness / swelling on (R) upper arm. Tx - KEFLEX, BENADRYL & icing.

VAERS ID:476688 (history)  Vaccinated:2012-10-17
Age:11.0  Onset:2012-10-19, Days after vaccination: 2
Gender:Female  Submitted:2012-12-05, Days after onset: 47
Location:Colorado  Entered:2012-12-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH751AA1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4269AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B092DA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Oedema peripheral, Rash generalised
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Patient was given 3 immunization 10/17/2012 she had MCV4 and Tdap in left deltoid. She came in 10/19/2012 with arm swollen and rash all over her body. Patient was placed on Prednisone. Patient did recover.

VAERS ID:476683 (history)  Vaccinated:2012-11-10
Age:11.0  Onset:2012-11-10, Days after vaccination: 0
Gender:Female  Submitted:2012-12-06, Days after onset: 26
Location:Unknown  Entered:2012-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA011369
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.0629AE0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Crying, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: This spontaneous report as received from a physician assistant refers to a 11 years old female patient. The patient was vaccinated with the first dose of GARDASIL (lot # 673256/0629AE) 0.5 ml intramuscularly on 10-NOV-2012. Secondary suspect therapy included a dose of unspecified flu vaccine (manufacture unknown) given intramuscularly on 10-NOV-2012. Concomitant therapies included MENACTRA and TDaP given along with GARDASIL on 10-NOV-2012. Within a minute, the patient felt dizzy and had a feeling of impending doom. She appeared pale and was crying. She laid down and after a few minutes she started pacing. After about 30 minutes, the reporter was comfortable with her leaving because she seemed more calm. The reporter hadn''t heard back from the patient since the adverse event happened, so he was assuming that she had recovered, but could not verify this. No lab tests were performed. No treatment was given. The patient had sought unspecified medical attention. Additional information has been requested.

VAERS ID:476883 (history)  Vaccinated:2012-11-26
Age:11.0  Onset:2012-11-27, Days after vaccination: 1
Gender:Male  Submitted:2012-12-06, Days after onset: 9
Location:Virginia  Entered:2012-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Blood work and thigh and hip x-ray
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood test, Hypoaesthesia, Muscular weakness, Myalgia, Pain in extremity, X-ray of pelvis and hip
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain and weakness in right thigh. Area numb to being touched, but touch is painful in the muscle.

VAERS ID:476898 (history)  Vaccinated:2012-12-06
Age:11.0  Onset:2012-12-06, Days after vaccination: 0
Gender:Female  Submitted:2012-12-06, Days after onset: 0
Location:Michigan  Entered:2012-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4275AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4136BA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt felt nauseated, went extremely pale, got dizzy/lightheaded. Pt had not eaten anything the morning prior to her immunizations.

VAERS ID:477065 (history)  Vaccinated:2012-12-05
Age:11.0  Onset:2012-12-05, Days after vaccination: 0
Gender:Female  Submitted:2012-12-07, Days after onset: 2
Location:Colorado  Entered:2012-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0146451UNRA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Nausea, Petechiae, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Nausea began after HPV vaccine, vomiting started at 11 PM - emesis every hour x 5 hours. Petechial rash on face and neck started 12/6/12. Low grade temp of 100. Patient returned to clinic 12/6/12, examined by Dr. and treated with ZOFRAN, 4mg. Advised to RTC if fever persisted $g 3 days.

VAERS ID:477067 (history)  Vaccinated:2012-12-05
Age:11.0  Onset:2012-12-05, Days after vaccination: 0
Gender:Male  Submitted:2012-12-05, Days after onset: 0
Location:Illinois  Entered:2012-12-07, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0129731IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0152221SCRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Balance disorder, Dizziness, Dysarthria, Eye movement disorder, Fatigue, Feeling abnormal, Lethargy, Nausea, Skin warm, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)
Write-up: 2 vaccines administered. Client sat on exam table while VARIVAX given. Client laid down on (R) side while GARDASIL given. Face color pink, warm to touch. Eyes rolled back and when asked client stated he was dizzy. He remained responsive, answering questions. BP 124/85, steady pulse. When sat up was lethargic and weak, not sitting well without support. Had not eaten much. Gave apple juice. Remained weak, unsteady with VS normal. Dad helped to car 12:50 PM. Event reported to supervisor. Discussed ER, Urgent Care, call to family Dr. Mother said she would call Dr. for f/u. T.C. to Mom 2:15. Client ate lunch, feels nauseated, tired and is lying down. She called Dr. office and is waiting for return call. States client continues to be unsteady, weak. 12-6-12 T/C with Mother. R/T F/U care. Mother states con''t to act "spacey and stoned", sleepy, minimal eye contact, speech slur. Mother states Dr. office has not returned call for appt. Encouraged mother to contact PMD again or take to E.R. if symptoms do not improve.

VAERS ID:477141 (history)  Vaccinated:2012-11-14
Age:11.0  Onset:2012-11-14, Days after vaccination: 0
Gender:Male  Submitted:2012-12-07, Days after onset: 23
Location:Illinois  Entered:2012-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB605CA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110660IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B085AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0136401SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Arms were sore and swollen by the time he got home from vaccinations. Both arms were involved. Swelling continued and mom sought medical treatment on 11/16/2012 from primary doctor. Reports both arms were swollen and red from shoulder to elbows. Was given oral predisone and completely resolved.

VAERS ID:477840 (history)  Vaccinated:2012-12-01
Age:11.0  Onset:2012-12-01, Days after vaccination: 0
Gender:Female  Submitted:2012-12-07, Days after onset: 6
Location:Unknown  Entered:2012-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA001116
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0162380IMLA
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: This spontaneous report was received from a Nurse refers to an 11 years old female patient with vaccination. The patient was vaccinated with, .5 ml GARDASIL on 01-DEC-2012. No other co-suspects were reported. Concomitant medications included: BENADRYL. On 01-DEC-2012 the patient experienced urticaria, 1 day after onset of therapy. The patient was treated with BENADRYL was reported. The outcome of urticaria was reported as recovered/resolved. The relatedness for urticaria is unknown for GARDASIL. No further information is available.

VAERS ID:477172 (history)  Vaccinated:2012-12-06
Age:11.0  Onset:2012-12-06, Days after vaccination: 0
Gender:Female  Submitted:2012-12-08, Days after onset: 2
Location:Pennsylvania  Entered:2012-12-08
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: Anxiety. Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Erythema, Induration, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe arm pain. Severe swelling, redness, and hardness of shoulder to elbow.

VAERS ID:477330 (history)  Vaccinated:2012-09-10
Age:11.0  Onset:2012-12-04, Days after vaccination: 85
Gender:Male  Submitted:2012-12-05, Days after onset: 1
Location:Massachusetts  Entered:2012-12-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy symptoms few weeks prior
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH716AC UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3989AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H007527 UNLA
Administered by: Private     Purchased by: Public
Symptoms: Blister, Fatigue, Feeling abnormal, Macule, Papule, Rash, Rash pustular, Skin lesion
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Dementia (broad), Hypersensitivity (narrow)
Write-up: Rash noted in AM with few previous night, tired not self, no other symptoms. Macules, papules, vesicular/pustular lesions lower abdomen to pelvic area, few on back $g 30 lesions.

VAERS ID:477403 (history)  Vaccinated:2012-11-30
Age:11.0  Onset:2012-11-30, Days after vaccination: 0
Gender:Female  Submitted:2012-12-03, Days after onset: 3
Location:Tennessee  Entered:2012-12-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine oral solution
Current Illness: Well child checkup
Preexisting Conditions: ADHD; Anxiety disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0101230IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B102BA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Musculoskeletal stiffness, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Rec''d GARDASIL #1 on 11-30-12. Mother states c/o nausea Friday night. Child awakened Saturday am & went to shower. Mom heard her collapse, patient came out of shower, vomited, became dizzy again. C/o of feeling "stiff" symptoms lasted about 1 hr & then were gone. Mom states she doesn''t want her to have any more GARDASIL.

VAERS ID:477422 (history)  Vaccinated:2012-12-07
Age:11.0  Onset:2012-12-09, Days after vaccination: 2
Gender:Male  Submitted:2012-12-10, Days after onset: 1
Location:New Hampshire  Entered:2012-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of vaccination nor any symptoms of illness.
Preexisting Conditions: Nystatin, apples. Seasonal allergies to pollens. Asthma. No other health issues.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS 0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Gait disturbance, Headache, Immediate post-injection reaction, Increased upper airway secretion, Injection site pain, Nausea, Oropharyngeal pain, Pain, Pain in extremity, Poor quality sleep, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Vaccine injury report December 10, 2012. Patient received the TDap vaccine at 10am on Friday, December 7, 2012. He immediately felt pain (left arm) at the injection site like a "charley horse" and felt the vaccine run through his arm. He seemed to be ok the rest of the day with just soreness in his arm. The following day he felt tired, his throat was slightly sore. On Sunday, December 9, 2012 he reported symptoms of headache, chills, lack of energy, mucus in his throat. As of early evening he had a fever of 100F and the headache pain increased. Overnight he did not sleep well. He had chills and fever all night with nausea. At 6am Monday, December 10, 2012, he presented symptoms of 103F fever, nausea, headache, chills, body aches and total lack of energy, uncontrollable body shaking and dizzy enough that I had to walk him to the bathroom. As of 6:50pm this evening he still has the same symptoms.

VAERS ID:477484 (history)  Vaccinated:2012-12-10
Age:11.0  Onset:2012-12-10, Days after vaccination: 0
Gender:Female  Submitted:2012-12-10, Days after onset: 0
Location:California  Entered:2012-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0106491IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSU4237AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncopal episode after immunizations.

VAERS ID:477816 (history)  Vaccinated:2012-11-30
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2012-12-10
Location:Unknown  Entered:2012-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA003480
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0096Z1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: This spontaneous report as received from a other health professional. The primary reporter is a nurse who states the same expired GARDASIL lot # (666595/0096Z) expiration date 14Oct2012, was administered to 3 clients. This was the second dose in the GARDASIL series for all three clients, and they were vaccinated on 30Nov2012. Client one, vaccinated in right deltoid. No other co-suspects were reported. No treatment information was reported. All drop down boxes apply to all three clients. No concomitant medications were reported. No other information was provided.

VAERS ID:477617 (history)  Vaccinated:2012-11-30
Age:11.0  Onset:2012-12-01, Days after vaccination: 1
Gender:Male  Submitted:2012-12-03, Days after onset: 2
Location:Georgia  Entered:2012-12-11, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4289AA0SYRRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B093BA0SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling at site of injection 1 day after it was given - fever-felt tired.

VAERS ID:477649 (history)  Vaccinated:2011-09-01
Age:11.0  Onset:2012-09-01, Days after vaccination: 366
Gender:Male  Submitted:2012-12-11, Days after onset: 101
Location:Pennsylvania  Entered:2012-12-11
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Happened at home
Preexisting Conditions: Chromosome disorder in family, recessive H63D
Diagnostic Lab Data: Sees both rheumatologist and nuerologist at Medical Center. Has peripheral nerve damage to legs. Suffers from POTs syndrome.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4054BA1SYRUN
Administered by: Unknown     Purchased by: Private
Symptoms: Muscular weakness, Nerve injury, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow)
Write-up: Fever accompanied by leg and arm weakness.

VAERS ID:479065 (history)  Vaccinated:2012-12-05
Age:11.0  Onset:2012-12-06, Days after vaccination: 1
Gender:Male  Submitted:2012-12-10, Days after onset: 4
Location:California  Entered:2012-12-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B071BB0UNLA
Administered by: Other     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Father reported today (12-10-12) that his son had fever of 104 degrees on Thursday night (12-6-12). Fever resolved without treatment and temperature was normal on 12-8-12.

VAERS ID:477860 (history)  Vaccinated:2012-12-10
Age:11.0  Onset:2012-12-11, Days after vaccination: 1
Gender:Male  Submitted:2012-12-12, Days after onset: 1
Location:Virginia  Entered:2012-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4055BA0SCLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B0800A IMRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 8 x 9 cm raised red itchy wheal.

VAERS ID:478191 (history)  Vaccinated:2012-12-14
Age:11.0  Onset:2012-12-14, Days after vaccination: 0
Gender:Male  Submitted:2012-12-14, Days after onset: 0
Location:California  Entered:2012-12-14
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 STATED.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH721AC0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4330AB0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Incorrect dose administered, No adverse event
SMQs:
Write-up: NO ADVERSE EFFECT NOTED, OBSERVED, ASSESSED OR STATED. AFTER CHILD HAD RECEIVED HIS DOSE OF MCV4 AND FLU, WHICH WERE CONSENTED FOR, I WAS NOTIFIED BY A PARTNER NURSE THAT THIS SAME CHILD HAD RECEIVED A DOSE OF MCV4 ON 12/12/2012, WHICH HAD NOT BEEN CONSENTED FOR AND WAS NOT DOCUMENTED ON THE PREVIOUS CONSENT OR IN CAIR. CHILD SHOWED NO ADVERSE RESPONSE AND WAS CHECKED ON IN THE CLASSROOM AND WAS WITHOUT NEGATIVE SYMPTOM OR DISTRESS OF ANY KIND, AS WELL. MOTHER WAS IMMEDIATELY NOTIFIED AND SITUATION WAS EXPLAINED TO HER IN DETAIL AND STATED UNDERSTANDING. ADVISED HER TO FOLLOW UP WITH THE CHILD''S PMD FOR ANY CONCERNS. COMMUNICABLE DISEASE LEAD NURSE WAS ALSO NOTIFIED FOR FURTHER DIRECTION.

Result pages: prev   2585 2586 2587 2588 2589 2590 2591 2592 2593 2594 2595 2596 2597 2598 2599 2600 2601 2602 2603 2604 2605 2606 2607 2608 2609 2610 2611 2612 2613 2614 2615 2616 2617 2618 2619 2620 2621 2622 2623 2624 2625 2626 2627 2628 2629 2630 2631 2632 2633 2634 2635 2636 2637 2638 2639 2640 2641 2642 2643 2644 2645 2646 2647 2648 2649 2650 2651 2652 2653 2654 2655 2656 2657 2658 2659 2660 2661 2662 2663 2664 2665 2666 2667 2668 2669 2670 2671 2672 2673 2674 2675 2676 2677 2678 2679 2680 2681 2682 2683 2684 2685 2686 2687 2688 2689 2690 2691 2692 2693 2694 2695 2696 2697 2698 2699 2700 2701 2702 2703 2704 2705 2706 2707 2708 2709 2710 2711 2712 2713 2714 2715 2716 2717 2718 2719 2720 2721 2722 2723 2724 2725 2726 2727 2728 2729 2730 2731 2732 2733 2734 2735 2736 2737 2738 2739 2740 2741 2742 2743 2744 2745 2746 2747 2748 2749 2750 2751 2752 2753 2754 2755 2756 2757 2758 2759 2760 2761 2762 2763 2764 2765 2766 2767 2768 2769 2770 2771 2772 2773 2774 2775 2776 2777 2778 2779 2780 2781 2782 2783   next

New Search

Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=2684&PERPAGE=100&ESORT=AGE


Copyright © 2016 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166