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Case Details (Sorted by Age)

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VAERS ID: 126206 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:1999-07-07
Onset:1999-07-09
   Days after vaccination:2
Submitted: 1999-07-09
   Days after onset:0
Entered: 1999-07-20
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A903A2 / 5 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0123J / 2 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0799H6 / 4 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Myalgia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2days following vax pt exp redness, soreness under the inject site.


VAERS ID: 126322 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1999-06-28
Onset:1999-06-30
   Days after vaccination:2
Submitted: 1999-07-01
   Days after onset:1
Entered: 1999-07-26
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 5 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1973H / 2 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 461854 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NC99049

Write-up: 2day p/vax pt exp rash left thigh, urticaria, edema, itching


VAERS ID: 126352 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-06-21
Onset:1999-07-02
   Days after vaccination:11
Submitted: 1999-07-16
   Days after onset:14
Entered: 1999-07-26
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1656H / 1 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Dermatitis bullous, Injection site hypersensitivity, Injection site oedema, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: h/a - no fevor
Preexisting Conditions: allergy to pediazole
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC99051

Write-up: 11day p/vax pt devel 101.1f, has varicella over face, neck, back, chest, abd, buttocks, legs. site swelling w/papules


VAERS ID: 126361 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:1999-07-21
Onset:1999-07-22
   Days after vaccination:1
Submitted: 1999-07-22
   Days after onset:0
Entered: 1999-07-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 888A2 / 1 RA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2817A2 / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: day p/vax pt devel vomiting twice, temp 99.1f


VAERS ID: 126385 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Colorado  
Vaccinated:1999-07-15
Onset:1999-07-16
   Days after vaccination:1
Submitted: 1999-07-19
   Days after onset:3
Entered: 1999-07-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0348J / 2 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Oedema, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Claritin
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: progressively inc swelling & redness no fever, eating well/sleep well;using arm well c/o pain 24hr ago;


VAERS ID: 126471 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:1997-06-20
Onset:1999-07-07
   Days after vaccination:747
Submitted: 1999-07-21
   Days after onset:14
Entered: 1999-07-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0070E / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0542E / 1 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: nasal allergies, down syndrome, asthma
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: approx 2yr p/vax pt devel full case of chickenpox


VAERS ID: 126484 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:1999-05-04
Onset:1999-05-04
   Days after vaccination:0
Submitted: 1999-05-17
   Days after onset:13
Entered: 1999-07-29
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0060H / 1 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Pharyngitis, Vasodilatation
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt, fever w/all vax per mom~ ()~~~In patient
Other Medications: atemperaton susp.
Current Illness: none
Preexisting Conditions: convulsions & takes allergy inj.
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type: TX99134

Write-up: evening of vax pt devel redness @ inject site. 5/13 devel induration size of egg. seen @ clinic w/mild redness & warmth to touch. seen by regular MD, temp ranging from 99-100f was dx w/tonsillitis & given ceptin & cataflan


VAERS ID: 126489 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:1999-06-09
Onset:1999-06-10
   Days after vaccination:1
Submitted: 1999-06-14
   Days after onset:4
Entered: 1999-07-29
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455839 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1751H / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795H / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1661H / 2 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Dermatitis bullous, Pain, Pharyngitis, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma, not on daily steroid treatments
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TX99141

Write-up: day p/vax pt broke out w/6 pox then covered w/pox by 6/13. temp 101f. will not eat or drink due to pain in mouth & throat.


VAERS ID: 126499 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Delaware  
Vaccinated:1999-07-16
Onset:1999-07-18
   Days after vaccination:2
Submitted: 1999-07-19
   Days after onset:1
Entered: 1999-07-30
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462314 / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1982H / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 462367 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: claritin, syrup, ppd, conng, #249711
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: DE9904

Write-up: 2days p/vax pt exp redness at inject site w/swelling. rx zithromax therapy & benadryl


VAERS ID: 126793 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-07-21
Onset:1999-07-22
   Days after vaccination:1
Submitted: 1999-07-22
   Days after onset:0
Entered: 1999-08-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1973H / 3 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: observation/physical exam
CDC Split Type:

Write-up: day p/vax pt exp area of induration, erythema & warmth on lt arm area assoc w/pruritus


VAERS ID: 126798 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:1999-06-04
Onset:1999-06-04
   Days after vaccination:0
Submitted: 1999-06-07
   Days after onset:3
Entered: 1999-08-02
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 4 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1741H / 4 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0117J / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0800B6 / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0313J / 1 - / SC L

Administered by: Public       Purchased by: Unknown
Symptoms: Headache, Oedema peripheral, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA990073

Write-up: p/recv vax pt devel stomach ache, severe h/a, fever (104f), sent to ER, pt arm slightly swollen & red.


VAERS ID: 126805 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:1999-07-09
Onset:1999-07-11
   Days after vaccination:2
Submitted: 1999-07-23
   Days after onset:12
Entered: 1999-08-02
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0132J / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302A1 / 4 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Oedema peripheral, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2days p/vax pt devel ? fever, hot to touch, swollen arm x1week. tx: ice, tylenol, warm compress


VAERS ID: 126820 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:1998-11-09
Onset:1999-04-24
   Days after vaccination:166
Submitted: 1999-06-29
   Days after onset:66
Entered: 1999-08-02
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RA / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0895H / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1001H / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0786K / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1061H / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TX99144

Write-up: onset of rash 4/24/99 for about 3days; no fever; no meds; no complications


VAERS ID: 126828 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:1999-07-12
Onset:1999-07-12
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:0
Entered: 1999-08-02
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1844H / 1 LA / -

Administered by: Other       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX99154

Write-up: red itchy area @ inject site approx 10cm in size; no hives or rash; pt c/o itchy felling; ``can I scratch my arm''''


VAERS ID: 126831 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:1999-06-30
Onset:1999-07-01
   Days after vaccination:1
Submitted: 1999-07-30
   Days after onset:29
Entered: 1999-08-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 5 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0117J / 2 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 794A3 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ppd;
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/1/99 redness & swelling to right arm; small amt of swelling; APAP & ice


VAERS ID: 126866 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:1999-07-27
Onset:1999-07-29
   Days after vaccination:2
Submitted: 1999-07-29
   Days after onset:0
Entered: 1999-08-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1478H / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 596B9 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: pt als had infected mosquito bites on legs;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC 12.6/13/40/291;
CDC Split Type:

Write-up: swelling/hot/red/tender lt arm swollen @ axilla 22 3/4cm @ mid arm 20 1/2cm;sx occurred approx 40hr p/vax;no fever;WBC 12,600;


VAERS ID: 126892 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Utah  
Vaccinated:1999-06-24
Onset:1999-06-24
   Days after vaccination:0
Submitted: 1999-07-28
   Days after onset:34
Entered: 1999-08-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462312 / 5 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0128J / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 800L5 / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0304J / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, Dermatitis bullous, Injection site hypersensitivity, Injection site oedema, Oedema
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had seemed to limp p/dtap whn younger~ ()~~~In patient
Other Medications: augmentin started 6/27 for cellutitis
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/recv vax pt devel small spot/bump @ inject site; then over following day devel spreading erythematous, edematous area 16 x 11cm; other areas of itching/patchy erythema & edema; 6/27 appeared to cellulitis, treated w/augmentin


VAERS ID: 126966 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Alaska  
Vaccinated:1999-08-03
Onset:1999-08-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1999-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Tachycardia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: pt on 8/5/99 pt began tremors, inc heart rate; seen in clinic 1pm, inc heart rate gone


VAERS ID: 127524 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:1999-05-14
Onset:1999-05-16
   Days after vaccination:2
Submitted: 1999-05-17
   Days after onset:1
Entered: 1999-08-09
   Days after submission:84
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 450496 / UNK RL / -

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: vitamins
Current Illness: none
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 899139187A

Write-up: p/vax pt devel inj site react; redness & a bump the size of baseball; seen by MD


VAERS ID: 127117 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Utah  
Vaccinated:1999-07-26
Onset:1999-07-27
   Days after vaccination:1
Submitted: 1999-07-28
   Days after onset:1
Entered: 1999-08-10
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES C007 / 2 RA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0996880 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1544H / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 459097 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain, Back pain, Headache, Neck pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling devel large lump in legs @ 13 1/2mo w/DTP dose 3~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergies (cause unk) dx chronic urticaria per mD asthma s/soccasionally non for 4yr
Allergies:
Diagnostic Lab Data: NONe
CDC Split Type: UT992718

Write-up: 24hr p/vax c/o bad h/a;temp remained 102 given APAP or motrin q 4hr;c/o stomach pain, legs & back pain, neck pain;


VAERS ID: 127372 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Unknown  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1999-08-02
Entered: 1999-08-11
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 4087

Write-up: p/vax pt exp transient numbness from the rt shoulder down to the foot, & lasted ten minutes a/resolving;


VAERS ID: 127152 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:1999-07-30
Onset:1999-08-01
   Days after vaccination:2
Submitted: 1999-08-03
   Days after onset:2
Entered: 1999-08-12
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7387AA / 5 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1985H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 463511 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: vitamims nasal spray
Current Illness: allergic rhinitis
Preexisting Conditions: seasonal allergy/mild asthma
Allergies:
Diagnostic Lab Data: none; neurologic eval pending
CDC Split Type:

Write-up: day following vax pt devel motor tics approx 36 hr p/vax


VAERS ID: 127203 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-06-29
Onset:1999-07-01
   Days after vaccination:2
Submitted: 1999-08-09
   Days after onset:39
Entered: 1999-08-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0932710 / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0794K / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had a large red area that was warm to touch on lt thigh;advised to use ibuprofen every 6 hours & ice several times a day;


VAERS ID: 127234 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:1999-08-02
Onset:1999-08-05
   Days after vaccination:3
Submitted: 1999-08-10
   Days after onset:5
Entered: 1999-08-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1187H / 2 LA / -

Administered by: Public       Purchased by: Other
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/pt recv vax exp swelling of arm;


VAERS ID: 127247 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Mississippi  
Vaccinated:1999-08-10
Onset:1999-08-10
   Days after vaccination:0
Submitted: 1999-08-10
   Days after onset:0
Entered: 1999-08-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0196E / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Hypersensitivity
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none
Current Illness: mom said might have noticed red spot on eye before came into chair
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS99030

Write-up: p/pt vax exp swelling under rt eye; mom noticed about 15min p/vax;no resp distress-child smiling & in no distress;pt sent to ER for check; tx DPH; dx: allergic react localized under rt eye;disch in good condition;


VAERS ID: 127259 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Ohio  
Vaccinated:1999-07-27
Onset:1999-08-03
   Days after vaccination:7
Submitted: 1999-08-05
   Days after onset:2
Entered: 1999-08-16
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2841A2 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: OH99050

Write-up: p/recv vax pt exp severe rash w/ large welts; ears bright red, nape of neck; tx oral benadryl per mom;


VAERS ID: 127287 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-08-06
Onset:1999-08-08
   Days after vaccination:2
Submitted: 1999-08-09
   Days after onset:1
Entered: 1999-08-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0131T / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 802F4 / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Rash maculo-papular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: redness, swelling from shoulder to elbow of rt arm;edema, blotchy rash;


VAERS ID: 127318 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Maine  
Vaccinated:1999-08-03
Onset:1999-08-04
   Days after vaccination:1
Submitted: 1999-08-09
   Days after onset:5
Entered: 1999-08-18
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 6 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1177H / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0800 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/pt recv vax seen in MD office w/lt arm red & swollen size of nickle; no fever; no neurological sign rpt; parents says it grew to size of half dollar; subsiding now;


VAERS ID: 127323 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:1999-07-30
Onset:1999-07-31
   Days after vaccination:1
Submitted: 1999-08-12
   Days after onset:12
Entered: 1999-08-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1843H / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/pt recv vax pt had chickenpox like rash; fever +, itching blistering lesions face, arms, grouped on ant lt forearm trunk only few on legs; given Claritin Reditabs; aveeno products, & instructed to take cool showers;


VAERS ID: 127393 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-08-14
Onset:1999-08-14
   Days after vaccination:0
Submitted: 1999-08-16
   Days after onset:2
Entered: 1999-08-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: shortly p/vax started itching on legs;devel eloped whelps all over legs similar to mosquito bites;


VAERS ID: 127388 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-08-16
Onset:1999-08-17
   Days after vaccination:1
Submitted: 1999-08-17
   Days after onset:0
Entered: 1999-08-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO473 / 4 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous, Oedema, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 8/17/99 afternoon, swelling, redness & blister first noticed today 6/17/99 given motrin;


VAERS ID: 127465 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:1999-07-14
Onset:1999-07-15
   Days after vaccination:1
Submitted: 1999-07-16
   Days after onset:1
Entered: 1999-08-23
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 902A2 / 4 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 459933 / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0438J / 1 RA / SC

Administered by: Public       Purchased by: Other
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: n/a
Preexisting Conditions: n/a
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: p/vax pt devel blinking often


VAERS ID: 127472 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Ohio  
Vaccinated:1999-04-20
Onset:0000-00-00
Submitted: 1999-08-18
Entered: 1999-08-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1559E / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1681E / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Alopecia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none performed
CDC Split Type:

Write-up: p/2nd vax pt devel inc of hair loss & dx w/alopecia; remains w/some hair loss but growing back;


VAERS ID: 127495 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Arkansas  
Vaccinated:1999-08-19
Onset:1999-08-19
   Days after vaccination:0
Submitted: 1999-08-19
   Days after onset:0
Entered: 1999-08-23
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0699J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Dysphonia, Face oedema, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: nka
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt subjective breathing problems; eye swollen; hoarseness; epinephrine given


VAERS ID: 127575 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1999-07-29
Onset:1999-08-05
   Days after vaccination:7
Submitted: 1999-08-08
   Days after onset:3
Entered: 1999-08-24
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462356 / 5 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 05437 / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 796K6 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site mass
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt exp red circle surrounding dime size, hard nodule w/some bruising, zero induration


VAERS ID: 127579 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-08-14
Onset:1999-08-15
   Days after vaccination:1
Submitted: 1999-08-18
   Days after onset:3
Entered: 1999-08-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 739AA / 4 LA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 619AZ / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt exp sore lt arm; swelling w/redness & heat; swelling described as golf ball size; also fever; dx infection secondary to the vax; placed on antibiotics


VAERS ID: 127586 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:1999-08-12
Onset:1999-08-12
   Days after vaccination:0
Submitted: 1999-08-16
   Days after onset:4
Entered: 1999-08-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911D2 / 2 RA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1777H / 2 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1791H / 2 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt exp deltoid muscle pain; tx: motrin


VAERS ID: 127598 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Oregon  
Vaccinated:1999-08-04
Onset:1999-08-06
   Days after vaccination:2
Submitted: 1999-08-10
   Days after onset:4
Entered: 1999-08-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0434H / UNK - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax area of erythema & induration of lt upper arm where inj was given; started to itch; it was elected to cover for possible cellulitis w/po antibiotic; felt this was a tissue react


VAERS ID: 127604 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-08-18
Onset:1999-08-19
   Days after vaccination:1
Submitted: 1999-08-19
   Days after onset:0
Entered: 1999-08-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1551H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0802F / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0450J / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cough, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flue symptons, 2 mo old, first series~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax started coughing; awakened & vomited phlegm x2; T101; tx: tylenol & tepid bath, but inc when rx wears off; MD admits to flu like symptoms x1wk; recovery cont


VAERS ID: 127640 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-08-18
Onset:1999-08-18
   Days after vaccination:0
Submitted: 1999-08-18
   Days after onset:0
Entered: 1999-08-26
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457787 / 4 - / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1781H / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 2120192010 / 4 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Asthma, Cough, Rhinitis, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: approx 15min p/vax father reported coughing & runny nose;child was wheezing, tight cough, rhinorrhea, hives;


VAERS ID: 127691 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:1999-08-26
Onset:1999-08-26
   Days after vaccination:0
Submitted: 1999-08-26
   Days after onset:0
Entered: 1999-08-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 0942540 / UNK LA / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER N042512 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 0795H / UNK RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol syrup
Current Illness: NONE
Preexisting Conditions: Egg allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: urticaria hives on neck-resolved p/epi given;


VAERS ID: 127697 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Montana  
Vaccinated:1999-08-20
Onset:1999-08-20
   Days after vaccination:0
Submitted: 1999-08-23
   Days after onset:3
Entered: 1999-08-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0918090 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0547J / UNK RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn w/pertussis;~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pertussis rxn;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: post vax given-noticed it was expired;


VAERS ID: 127704 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Kentucky  
Vaccinated:1999-01-07
Onset:1999-01-07
   Days after vaccination:0
Submitted: 1999-08-19
   Days after onset:223
Entered: 1999-08-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0115H / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY990032

Write-up: p/sitting on GM lap fell to floor & appeared to lose consciousness;taken to exam room & lay down on table became alert & responsive accurately to questions;appeared to be unconscious about 1 1/2-2min;no injuries noted;


VAERS ID: 127705 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Kentucky  
Vaccinated:1999-07-27
Onset:1999-07-27
   Days after vaccination:0
Submitted: 1999-08-06
   Days after onset:10
Entered: 1999-08-27
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118J / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY990034

Write-up: local reaction sore, swollen, red lt arm started evening p/vax given;inc over 48hr;


VAERS ID: 127708 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1999-08-16
Onset:1999-08-16
   Days after vaccination:0
Submitted: 1999-08-16
   Days after onset:0
Entered: 1999-08-27
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / 5 LA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0753J / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1975H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 459932 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: redness 2-3cm above immunization site w/in 10" began fading w/in 5" more above MMR site;


VAERS ID: 127723 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1999-06-08
Onset:1999-06-08
   Days after vaccination:0
Submitted: 1999-08-24
   Days after onset:77
Entered: 1999-08-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462314 / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0352J / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0800H / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Asthma, Dyspnoea, Rhinitis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: zantac
Current Illness: NONE
Preexisting Conditions: allergic to peanuts & eggs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt exp sneezing; vomiting; wheezing; difficulty breathing; tx: benadryl, Epi Pen Jr, inhaler tx vent .5; Prelone; observed X4hrs in office; home on Pediapred


VAERS ID: 127765 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Hawaii  
Vaccinated:1999-08-17
Onset:1999-08-18
   Days after vaccination:1
Submitted: 1999-08-20
   Days after onset:2
Entered: 1999-08-30
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1352A / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7980A / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: p/vax pt devel redness, swelling, limping & tenderness over rt anterior thigh;8/19/99 swelling & redness extended from anterior thigh to knee+warmth;tx w/keflex-improved;resolved by 8/21/99;


VAERS ID: 127767 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1999-08-20
Onset:1999-08-21
   Days after vaccination:1
Submitted: 1999-08-24
   Days after onset:3
Entered: 1999-08-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0543J / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 801A2 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: lt upper arm swollen, 33 x 3; discolored, purpulish, red, tender;


VAERS ID: 127805 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-08-19
Onset:1999-08-21
   Days after vaccination:2
Submitted: 1999-08-24
   Days after onset:3
Entered: 1999-08-31
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462314 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0546J / 2 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 464252 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Injection site abscess, Injection site hypersensitivity, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: allergic to gantrisin
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt devel 8x8cm area of erythema w/superficial sore, seeping area; low grade fever & dec in activity


VAERS ID: 127814 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:1999-08-16
Onset:1999-08-21
   Days after vaccination:5
Submitted: 1999-08-24
   Days after onset:3
Entered: 1999-08-31
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / 1 GM / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0794H / 2 GM / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 458435 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: had puncture wound-8/16/99 of his foot; was put on antibiotics; wound uncpmplica
Preexisting Conditions: puncture wound, on antibiotics
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt devel T104.1, 3 days; given ibuprofen; observation; not other neuro symptoms


VAERS ID: 127829 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Nebraska  
Vaccinated:1999-07-26
Onset:1999-07-27
   Days after vaccination:1
Submitted: 1999-07-28
   Days after onset:1
Entered: 1999-08-31
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462355 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 05425 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0800H / 4 MO / PO

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

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

Write-up: p/vax pt rt arm at site of inj red, swollen, warm, tender, suspect allergic


VAERS ID: 127832 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-05-14
Onset:1999-05-19
   Days after vaccination:5
Submitted: 1999-08-26
   Days after onset:99
Entered: 1999-08-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1785H / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Dyspnoea, Lymphadenopathy, Pyrexia, Testicular disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Fertility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: rapid sttedp, neg
CDC Split Type:

Write-up: p/vax pt devel difficulty breathing; fever; and dec appetite; findings on exam include: pos posterior cervical adenopathy to corner of mandibular ramus; lt testes mildly tender to palpation; dx: probable mumps; pt given ibuprofen & APAP


VAERS ID: 127842 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:1999-06-30
Onset:1999-07-07
   Days after vaccination:7
Submitted: 1999-08-26
   Days after onset:50
Entered: 1999-09-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462314 / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0122J / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 461370 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Petechiae, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/7 plt- 9,000; 7/8 plt- 7,000;
CDC Split Type:

Write-up: pt devel petechial rash; Dx as ITP; tx w/IVIG;


VAERS ID: 127861 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Alabama  
Vaccinated:1999-08-13
Onset:1999-08-13
   Days after vaccination:0
Submitted: 1999-08-13
   Days after onset:0
Entered: 1999-09-02
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 865A2 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0126J / 2 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798A / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 04473 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Cough, Face oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9916

Write-up: p/vax mom returned back to clinic w/child crying eyes puffed lower eye lid;mom states child started to cough & stated couldn''t breathe good;mom sent to MD office given Decadron & DPH;


VAERS ID: 127870 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1999-08-26
Onset:1999-08-27
   Days after vaccination:1
Submitted: 1999-08-28
   Days after onset:1
Entered: 1999-09-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462355 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0919J / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0800K / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: peanut allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever & lt arm red & swollen @ inj site;


VAERS ID: 127873 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:1999-08-17
Onset:1999-08-19
   Days after vaccination:2
Submitted: 1999-08-24
   Days after onset:5
Entered: 1999-09-02
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1749N / 2 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: VA99038

Write-up: redness & swelling of rt arm;


VAERS ID: 127894 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Georgia  
Vaccinated:1999-08-16
Onset:1999-08-18
   Days after vaccination:2
Submitted: 1999-08-25
   Days after onset:7
Entered: 1999-09-03
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2937A2 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1970H / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Pelvic pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: p/vax pt T102-105;c/o pelvic/joint pain & sluggishness cont until 8/23/99;pt taken to MD for eval;grandma stated child better a/going to MD & MD could find nothing wrong w/child;family told to return to MD if any s/s returned;


VAERS ID: 127904 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Virginia  
Vaccinated:1999-08-24
Onset:1999-08-24
   Days after vaccination:0
Submitted: 1999-08-31
   Days after onset:7
Entered: 1999-09-03
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER N0596 / 4 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp inconsolable crying p/DTP vax;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: goose-egg red, warm, itchy area on rt upper arm began the same evening;gradual improvement p/3 days;


VAERS ID: 127909 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:1999-08-05
Onset:1999-08-06
   Days after vaccination:1
Submitted: 1999-08-19
   Days after onset:13
Entered: 1999-09-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1182H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 459933 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CA990086

Write-up: mom called hlth dept to report pt has swelling to fingers on both hands occurring 24hr p/vax;denies any other s/s;


VAERS ID: 127914 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Alabama  
Vaccinated:1999-08-24
Onset:1999-08-24
   Days after vaccination:0
Submitted: 1999-08-26
   Days after onset:2
Entered: 1999-09-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0994640 / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 2 - / SC A
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 463511 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt c/o fever ranging from 101-103 nausea & vomiting;tx APAP suppository;Tigan suppository;


VAERS ID: 128058 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:1999-08-26
Onset:1999-08-26
   Days after vaccination:0
Submitted: 1999-09-02
   Days after onset:7
Entered: 1999-09-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113J / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Rash, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: seizure at 15 months; mild varicella-2 lesions;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99082055

Write-up: p/vax pt exp seizures for one minute; also exp fine rash from head to toe & purple discoloration surrounding eyes; rash was tx w/diphenhydramine; no fever noted;sz considered an other medical event;


VAERS ID: 128086 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-08-23
Onset:1999-08-24
   Days after vaccination:1
Submitted: 1999-08-24
   Days after onset:0
Entered: 1999-09-07
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1186H / 2 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795M / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA991588

Write-up: p/vax pt exp swollen sore lt arm; advised comfort measures; cold compress; elevation when resting; tylenol; activity w/arm;


VAERS ID: 128090 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Mississippi  
Vaccinated:1999-08-04
Onset:1999-08-05
   Days after vaccination:1
Submitted: 1999-08-25
   Days after onset:20
Entered: 1999-09-07
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0802E / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0648H / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: na
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type: MS99037

Write-up: p/vax pt exp local reaction; health dept exam revealed swollen rt deltoid; warm to touch; slight redness; suggested tylenol; ice pack or cool h2o pack; also benadryl


VAERS ID: 128127 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:1999-08-10
Onset:1999-08-11
   Days after vaccination:1
Submitted: 1999-08-23
   Days after onset:12
Entered: 1999-09-08
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1781H / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0797A / 4 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Rash maculo-papular, Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax areas noted over entire body, including trunk, extremities, face;areas vary in size from 1cm to large blotches, some raised & red, some brown & not raised;red raised areas over entire body;probably DTAP rxn;


VAERS ID: 128131 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:1999-07-22
Onset:1999-07-24
   Days after vaccination:2
Submitted: 1999-07-24
   Days after onset:0
Entered: 1999-09-08
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 909A / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0348J / 2 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0801L / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0313J / 1 LA / -

Administered by: Other       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 4x6cm erythema, tenderness surrounding inj site lt deltoid;


VAERS ID: 128138 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-08-19
Onset:1999-08-19
   Days after vaccination:0
Submitted: 1999-09-02
   Days after onset:14
Entered: 1999-09-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / UNK LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2948A2 / UNK RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P02572 / UNK LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0124J / UNK RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Gaze palsy, Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AZ9923

Write-up: leaving room fell to floor apparently passed out; eyes rolled back, picked pt up & laid on table ammonia given; awoke but pale would not talk;20-30min a/color returned to face shaking of extremities x 2-4sec p/falling to floor;


VAERS ID: 128158 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-05-16
Onset:1999-05-16
   Days after vaccination:0
Submitted: 1999-08-18
   Days after onset:94
Entered: 1999-09-09
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 841A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2808H / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1331H / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 2794K / 5 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none; physcial exam by MD
CDC Split Type: MI99082

Write-up: p/vax T105.2; tx:tylenol; would go to 103 for short time then go back to 105.2; MD exam; no other symptoms; 5/17 fever went to 101 for 24hr; no swelling or marks at inj site;


VAERS ID: 128221 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-08-18
Onset:1999-08-20
   Days after vaccination:2
Submitted: 1999-08-31
   Days after onset:11
Entered: 1999-09-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 3 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2933A2 / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1787H / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0799D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Conjunctivitis, Cough, Pyrexia, Rash maculo-papular, Rhinitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: AZ9920

Write-up: p/vax pt devel fever, lasted 4 days; fever as high as 104; had cough; coryza & conjunctivitis along w/fever; devel raised red bumps on most of body; fever returned w/rash;8/31 pt feels fine


VAERS ID: 128225 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Virginia  
Vaccinated:1999-08-20
Onset:1999-08-20
   Days after vaccination:0
Submitted: 1999-08-20
   Days after onset:0
Entered: 1999-09-13
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388AA / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 2 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0802I / UNK MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Hypertonia, Hypotension, Hypotonia, Strabismus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA99045

Write-up: p/vax pt fell to the floor from a standing position; p/being pick up pt stiffened; eyes were rolled to the lt side of her head; EMS called; BP 70/pal 96.8ax


VAERS ID: 128241 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Colorado  
Vaccinated:1999-08-24
Onset:1999-08-26
   Days after vaccination:2
Submitted: 1999-08-27
   Days after onset:1
Entered: 1999-09-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1542H / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0799L / 4 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Injection site hypersensitivity, Injection site mass
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: none
CDC Split Type: CO99030

Write-up: p/vax pt exp raised, red at inj site; cranky & irritable for 3 days; tx: tylenol


VAERS ID: 128246 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:1999-08-10
Onset:1999-08-10
   Days after vaccination:0
Submitted: 1999-08-11
   Days after onset:1
Entered: 1999-09-14
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none noted
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA99087

Write-up: pt to ER & adm to hosp w/swelling to face & hands; no further problems stated;Annual follow-up received on 12/06/00 provided no additional data.


VAERS ID: 128261 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-08-24
Onset:1999-08-24
   Days after vaccination:0
Submitted: 1999-09-02
   Days after onset:9
Entered: 1999-09-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2808A2 / 3 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Asthenia, Somnolence, Vasodilatation
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: well child
Preexisting Conditions: echineasia; asthma not a problem last year & 1/2
Allergies:
Diagnostic Lab Data: na
CDC Split Type: WI99028

Write-up: p/vax pt c/o being tired; quiet & c/o stomach ache; very warm outside; flushed face; felt better starting 8/29/99; mom stated she believes this problem could also be related to starting kindergarten all day


VAERS ID: 128267 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:1999-08-12
Onset:1999-08-12
   Days after vaccination:0
Submitted: 1999-08-13
   Days after onset:1
Entered: 1999-09-14
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 910A2 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1970H / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0802C / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dermatitis bullous, Hypothermia, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Accidents and injuries (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: GA99090

Write-up: p/vax pt started breaking out on abd & back c/itching; rash has spread to all parts of body; rash has pus in the center; T95


VAERS ID: 128297 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:1999-08-06
Onset:1999-08-12
   Days after vaccination:6
Submitted: 1999-08-13
   Days after onset:1
Entered: 1999-09-15
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1753H / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0800B / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site pain, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX99167

Write-up: pt devel fever 8/13/99 during the noc t103;lt arm deltoid area red, hot & painful;area approx 3 inch in diameter;MD examined child ENT, chest, abd, clear;instructed to given APAP & apply heat to arm;


VAERS ID: 128351 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:1999-08-27
Onset:1999-08-27
   Days after vaccination:0
Submitted: 1999-09-01
   Days after onset:5
Entered: 1999-09-17
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0708J / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA990094

Write-up: p/vax pt returned to clinic c/lumps all over body; referred to ER & private provider;seen in ER & given benadryl


VAERS ID: 128359 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Colorado  
Vaccinated:1999-08-20
Onset:1999-08-20
   Days after vaccination:0
Submitted: 1999-08-30
   Days after onset:10
Entered: 1999-09-17
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 5 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 464253 / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 07095 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt exp swelling/4cmx4cm area of erythema rt arm;


VAERS ID: 128380 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Tennessee  
Vaccinated:1999-08-10
Onset:1999-08-10
   Days after vaccination:0
Submitted: 1999-08-11
   Days after onset:1
Entered: 1999-09-20
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172AB / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0122D / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0797M / 5 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Cough, Face oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: na
Current Illness:
Preexisting Conditions: allergic rxn (hives) approx 15 mos
Allergies:
Diagnostic Lab Data: took to private MD-giving benadryl
CDC Split Type: TN9932

Write-up: p/vax pt exp face swelling; some coughing; seen in ER; kept approx 3 hr p/epinephrine; benadryl; pediapred; breathing tx


VAERS ID: 128381 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Tennessee  
Vaccinated:1999-08-02
Onset:1999-08-12
   Days after vaccination:10
Submitted: 1999-08-24
   Days after onset:12
Entered: 1999-09-20
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 92A2 / 5 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798M / 5 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN99034

Write-up: p/vax pt began running fever 101-102 & broke out c/ red spots all over; mom took to ER pt had T100; 8/23 recovered


VAERS ID: 128394 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:1999-07-26
Onset:1999-07-28
   Days after vaccination:2
Submitted: 1999-09-17
   Days after onset:51
Entered: 1999-09-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1761H / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Muscle twitching, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99090226

Write-up: pt started blowing on fingers & shaking them vigorously;rpt shaking hands to prevent "fingers from catching fire" sensation spread to feet;arms;chin;pt ``afraid of catching fire'''' medical attention sought;f/u pt Dx c/tourette''s syndrome


VAERS ID: 128416 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Utah  
Vaccinated:1999-08-20
Onset:1999-08-20
   Days after vaccination:0
Submitted: 1999-09-14
   Days after onset:25
Entered: 1999-09-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6938AA / 4 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2941A2 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0957 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0538J / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Facial palsy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp fever as baby w/all vax;pt sibling also exp fever as baby w/1st vax;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: UT992524

Write-up: p/vax pt had n/v & fever;fever ran as high as 103 for 3 days;tx w/motrin, rest, etc;2 days later went to kindergarten could not smile;went to MD dx w/Bell''s rPalsey_;Acyclovir rx given;platelet rx given but still has facial paralysis;


VAERS ID: 128464 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Alabama  
Vaccinated:1999-06-30
Onset:0000-00-00
Submitted: 1999-08-14
Entered: 1999-09-27
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Autism, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: premature, 24-26 wks gestation
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt began to exhibit autistic behavior; lost the ability to speak or communicate; Annual FU: never recovered his ability to speak or comprehend.


VAERS ID: 128472 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Illinois  
Vaccinated:1999-08-12
Onset:1999-08-12
   Days after vaccination:0
Submitted: 1999-08-31
   Days after onset:19
Entered: 1999-09-27
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 7330AA / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1985H / 2 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 461371 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Arrhythmia, Convulsion, Cyanosis, Dyspepsia, Dyspnoea, Hypoventilation, Mydriasis, Pallor, Somnolence, Syncope, Tachycardia, Tongue disorder, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: negative
CDC Split Type:

Write-up: pt became unconscious;had dilated pupils;rapid tongue movement;circumoral cyanosis;no resp x 10 sec; BP 118/66; P 142 irregular;gasped for air, than shallow R 14;conscious but lethargic;N/V undigested food;pale;Dx poss sz;hosp


VAERS ID: 128477 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1998-10-28
Onset:1998-10-29
   Days after vaccination:1
Submitted: 1998-12-02
   Days after onset:34
Entered: 1999-09-27
   Days after submission:298
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 3 LA / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2617A2 / 3 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0900H / 2 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 453225 / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt devel T103.7 for 46hr; APAP would bring it down to 102 for couple hr; barely conscious most of the day


VAERS ID: 128518 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Connecticut  
Vaccinated:1999-08-20
Onset:1999-08-20
   Days after vaccination:0
Submitted: 1999-09-03
   Days after onset:14
Entered: 1999-09-27
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2948A2 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1983H / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: eczema
Preexisting Conditions: eczema but no allergy to eggs;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt given vax & devel urticarial rash on face;arms & itching all over & did not feel good;


VAERS ID: 128546 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1999-09-14
Onset:0000-00-00
Submitted: 1999-09-14
Entered: 1999-09-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462315 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0349J / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 463283 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Conjunctivitis, Face oedema, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: well child
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had rxn where eyes got swollen & red & also vomiting;pt given epi 11:37AM;


VAERS ID: 128571 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-08-31
Onset:1999-09-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1999-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462355 / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0919J / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0799A / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: large hive top of lt thigh-large red lump followed by small hives on both legs-circular rings, itchy;DPH given did not disappear until 5 days later;


VAERS ID: 128595 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: New York  
Vaccinated:1999-08-30
Onset:1999-09-13
   Days after vaccination:14
Submitted: 1999-09-16
   Days after onset:3
Entered: 1999-09-27
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0284J / 1 - / -

Administered by: Other       Purchased by: Public
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: amoxicillin
Current Illness: Om
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt devel trunk rash consistent w/chickenpox;symptomatic therapy


VAERS ID: 128611 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Colorado  
Vaccinated:1999-09-09
Onset:1999-09-10
   Days after vaccination:1
Submitted: 1999-09-14
   Days after onset:4
Entered: 1999-09-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464304 / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0931J / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 461368 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: mom reported site became red & swollen on Friday 9/10/99;By afternoon it was 2x the size-very hot w/large red bump in center;


VAERS ID: 128612 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:1999-05-11
Onset:1999-05-12
   Days after vaccination:1
Submitted: 1999-09-14
   Days after onset:125
Entered: 1999-09-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462312 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0127J / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 079314 / 5 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NA
Preexisting Conditions: allergic to lorabid-breaks out in a rash
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt rt hip was swollen, red & hot to touch;no lump or knot noted;


VAERS ID: 128636 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:1999-09-07
Onset:1999-09-07
   Days after vaccination:0
Submitted: 1999-09-07
   Days after onset:0
Entered: 1999-09-27
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 4 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Headache, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergy: motrin
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH99064

Write-up: p/vax pt c/o severe h/a; axillary T101.3; no non-aspirin product given; 9/9 spoke to mom pt ok; seen by MD; stated probably had a cold


VAERS ID: 128693 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Wyoming  
Vaccinated:1999-07-26
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1999-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462317 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1352 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 456272 / 4 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Infection, Lymphadenopathy, Nausea, Pharyngitis, Purpura, Pyrexia, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: WY998

Write-up: p/vax pt exp temp inc; nausea; rash on arms; pustules present; 2+ cervical adenopathy; strep pharyngitis;maculopapular rashes


VAERS ID: 128769 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:1999-08-31
Onset:1999-09-01
   Days after vaccination:1
Submitted: 1999-09-08
   Days after onset:7
Entered: 1999-09-30
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A911A2 / 5 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PRN proventil;Prelone
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH9919

Write-up: 1" hard area, pale center w/#" irregular red area, APAP PRN; used 1/2" needle;


VAERS ID: 128808 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-08-13
Onset:1999-08-14
   Days after vaccination:1
Submitted: 1999-08-17
   Days after onset:3
Entered: 1999-10-01
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 426150 / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1547H / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0802F / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WI99027

Write-up: p/vax pt devel generalized rash (hives) beginning 8/14 PM;parents noted swelling of hands AM of 8/15 accompanied by recurrence of hives;seen @ ER & DPH prescribed q 4-6hr;rash reoccurs/subsides p/DPH;


VAERS ID: 128813 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-05-17
Onset:0000-00-00
Submitted: 1999-05-20
Entered: 1999-10-01
   Days after submission:134
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 888A2 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1547H / 2 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 459098 / 4 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WI99016

Write-up: p/vax pt crabby all day;child is breaking out in a hive type rash all over body w/a raised welt type area on neck;c/o itchiness;dx as hives;


VAERS ID: 128877 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-09-15
Onset:1999-09-26
   Days after vaccination:11
Submitted: 1999-09-27
   Days after onset:1
Entered: 1999-10-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1344H / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp raised, reddened, swollen area on thigh @ age 4~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: raised, reddened, swollen area on thigh;


VAERS ID: 128948 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:1999-09-21
Onset:1999-09-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1999-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0008BA / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 1day p/vax pt devel large 3-4" red & indurated tender area around inj site;


VAERS ID: 128982 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1999-08-25
Onset:1999-08-29
   Days after vaccination:4
Submitted: 1999-09-02
   Days after onset:4
Entered: 1999-10-07
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 5 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1175 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 802K / 4 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 7125 / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Asthenia, Asthma, Chest pain, Cough, Dysphonia, Dyspnoea, Injection site hypersensitivity, Injection site oedema, Rhinitis, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI99089

Write-up: labored breathing, horse cough, tight chest;wheezing 9/2/99;runny nose 8/29/99;tired, crying;8/26/99 swollen, warm rt arm;


VAERS ID: 128985 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:1999-09-16
Onset:1999-09-16
   Days after vaccination:0
Submitted: 1999-10-01
   Days after onset:15
Entered: 1999-10-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0962260 / 3 - / IM A
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P1412 / 1 - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0375J / 3 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 3mo w/DTP dose 1;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: approx p/arm began to swell & get red & hot almost 6" days;the next am was swollen from top of shoulder to the elbow, redness & hot spot inc in size;swollen past the elbow 2";hard spot on arm;


VAERS ID: 128997 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1999-08-31
Onset:1999-09-06
   Days after vaccination:6
Submitted: 1999-09-10
   Days after onset:4
Entered: 1999-10-07
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 5 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N1061 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0117J / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA or medical conditions
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: MI99092

Write-up: p/vax pt got red rash on legs, upper inner aspect of arms, abd, c/o itchy;no other sx;mom called MD who said to observe & bring child to office if gets worse;


VAERS ID: 129145 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Mississippi  
Vaccinated:1999-08-03
Onset:1999-08-22
   Days after vaccination:19
Submitted: 1999-09-30
   Days after onset:39
Entered: 1999-10-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH - / 5 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0547J / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 462367 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Dermatitis bullous, Ecchymosis, Immune system disorder, Pruritus, Somnolence
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: hep b given 1994
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: complete blood workup & exam by MD
CDC Split Type: MS99040

Write-up: blister w/red ring began on ankle-redness & swelling inc;many more spots appeared;tx w/Zyrtec & claritin w/no help;spots itch & gets extremely tired & sleeps;volleyball size & appear as bruise;MD states something lit up immune system;


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