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Case Details (Sorted by Age)

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VAERS ID:193869 (history)  Vaccinated:1998-06-12
Age:11.0  Onset:2002-11-08, Days after vaccination: 1610
Gender:Male  Submitted:2002-11-22, Days after onset: 14
Location:Unknown  Entered:2002-11-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: ME02011
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.00284 EXP 12/9 SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.00604 EXP 07/ SCLL
Administered by: Private     Purchased by: Private
Symptoms: Blister, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itch on chest and back. Then developed rashes on chest and back and arms and legs. Total about $g 50 a few developed blisters. All over in 4 days.

VAERS ID:193889 (history)  Vaccinated:2002-11-13
Age:11.0  Onset:2002-11-14, Days after vaccination: 1
Gender:Female  Submitted:2002-11-21, Days after onset: 7
Location:New Jersey  Entered:2002-11-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol nebulizer, Advair, Zyrtec, Singulair
Current Illness: NONE
Preexisting Conditions: Asthma, seasonal allergies.
Diagnostic Lab Data: "Any diagnostic studies done at the hospital."
CDC Split Type: U200201023
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0969AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: It was reported that an 11 year old female received Fluzone SV ''2002-''2003 (lot number U0958AA), administered on 11/13/02. The next day on (11/14/02), the pt developed redness, swelling, and pain at the injection site. She presented to the ER on 11/15/02 and was admitted hospital. She was discharged from the hospital on 11/16/02 with the diagnosis of cellulitis. It was not reported whether the pt recovered from the event. Reported on 03/04/2003: "From follow-up #1 correspondence received at Aventis Pasteur Inc. On 02/24/2003, it was reported that the 10-year-old patient was hospitalized for one day. No other vaccines were given within 4 weeks. Patient has a history of asthma and seasonal allergies. Concomitant medications include albuterol nebulizer, advair, zyrtec and singulair. Patient had no illnesses at the time of vaccination. A 15-day follow up report received 12/16/2003 adds: On 12/08/2003, the hospital discharge summary and office notes were received. The lot # of the product was reported as U0969AA, not U0958AA, as initially reported. The discharge diagnosis was cellulitis vs. allergic reaction. She was prescribed Augmentin 5cc 3 times daily for 10 days and was advised to follow-up with her family physician. No other info was provided. No further info is anticipated, this case is considered closed.

VAERS ID:193982 (history)  Vaccinated:2002-09-03
Age:11.0  Onset:2002-09-03, Days after vaccination: 0
Gender:Male  Submitted:2002-09-05, Days after onset: 2
Location:Washington  Entered:2002-11-26, Days after submission: 82
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil MDI prn
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC Split Type: WA021865
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0153M0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0397M1SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0520AA IMRA
Administered by: Private     Purchased by: Public
Symptoms: Headache, Nausea, 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)
Write-up: Fever, headache, nausea, vomiting.

VAERS ID:194022 (history)  Vaccinated:2002-10-14
Age:11.0  Onset:2002-10-15, Days after vaccination: 1
Gender:Male  Submitted:2002-10-23, Days after onset: 8
Location:Michigan  Entered:2002-11-26, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MI2002086
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5353B20IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0527AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)
Write-up: Client reported to parents on 10/15/02 severe pain and swelling in right arm. Parents states child was crying and stayed home from school. Mother took child to ER at Huron Valley Hospital later taht afternoon. ER staff discharged client with antibiotics and Benadryl and instructed parents to apply a heating pad - per father. Client stayed home from school 10/16 and 10/17. Returned to school 10/18/02. Father state he is doing fine, no pain and no swelling at this time.

VAERS ID:194226 (history)  Vaccinated:1999-06-03
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2002-11-25
Location:New York  Entered:2002-12-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Lyme disease dx in 1995
Diagnostic Lab Data: Sept 1995-positive lyme elisa and positive 16m blott
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 2  
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt was diagnosed with lyme disease in 1995. In 1998 and 1999 was vaccinated with Lymerix at medical center in the lyme vaccine trial. Since that time has chronic and at times severe headaches-muscle and joint pain. Per follow up, box 8 on original VAES for should not have indicated prolongation of hospitalization. There was only IV therapy as outpatient. Also, this case is a clinical trial and is not worked up by VAERS.

VAERS ID:194248 (history)  Vaccinated:2002-11-08
Age:11.0  Onset:2002-11-28, Days after vaccination: 20
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2002-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dermatitis bullous, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Had chicken pox rash all over body on arm, chest, back, scalp, feet, legs. Really itchy. Lumps behind ear lobes.

VAERS ID:194467 (history)  Vaccinated:2002-11-02
Age:11.0  Onset:2002-11-22, Days after vaccination: 20
Gender:Male  Submitted:2002-11-22, Days after onset: 0
Location:Washington  Entered:2002-12-03, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0317M1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pallor, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Temperature 101.4, paleness, headache, sleepy. Had Tylenol and laid on couch and was ok after that. Once fever broke, child was fine; no further problems.

VAERS ID:194580 (history)  Vaccinated:2000-09-13
Age:11.0  Onset:2000-09-14, Days after vaccination: 1
Gender:Male  Submitted:2002-11-29, Days after onset: 806
Location:Maryland  Entered:2002-12-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0997K SCRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU0298AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Electroencephalogram abnormal, Injection site mass, Muscle atrophy, Skin ulcer, Strabismus
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child received dt in L arm 9/13/00 mother noted weakness and decreased mass there almost immediately. The muscle mass has continued to decrease especially over deltoids with weakness and decrease ROM. Referred to hospital medical center 11/29/02 for evaluation. Follow-up report on 3/3/03: Send to hospital for evaluation by physical medicine. EMG''s done were consistent with "a likely brachial plexopathy with significant axon loss lesion. The axon loss lesion involved C5, C6 & C7 lwds. This fits a so called neurologic amypopathy." He has been started on physical therapy. PT present no improvement. Neurology eval: bilateral esotropia, abnormal EEG. Annual follow up on 12/23/03: "Vaccine recipient did not recover from the adverse events that were reported for this vaccination. Pt still weak. Has received numerous pt sessions with marginal improvement."

VAERS ID:194670 (history)  Vaccinated:2002-11-29
Age:11.0  Onset:2002-11-30, Days after vaccination: 1
Gender:Unknown  Submitted:2002-12-02, Days after onset: 2
Location:Illinois  Entered:2002-12-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0308M0SC 
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child received varicella vaccine 11/29/02, per mom, fever 11/30/02 and 12/01/02 rash appeared 11/30/02 am, seen in office 12/2/02 with moderate varicella.

VAERS ID:195069 (history)  Vaccinated:2002-11-20
Age:11.0  Onset:2002-11-21, Days after vaccination: 1
Gender:Male  Submitted:2002-12-10, Days after onset: 19
Location:Missouri  Entered:2002-12-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ear & throat redness
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MO2002042
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5314A22 RA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR00100SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0385AA  LA
Administered by: Public     Purchased by: Public
Symptoms: Infection, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Td, IPV and Hep B given on 11-20-02. On 11-21-02 Ct awoke with rash t/o body. Ct went to ER on 11-21-02 pm. Ct tested for strep on 11-21-02. Ct also had fever 102-103. Mother notified on 11-22-02 Ct was (+) for strep. Mother states ER told her reaction was combination of having immunization and coming down with strep infection. Ct. was treated with Benadryl and Amoxicillin.

VAERS ID:195179 (history)  Vaccinated:2002-11-04
Age:11.0  Onset:2002-11-18, Days after vaccination: 14
Gender:Male  Submitted:2002-12-13, Days after onset: 25
Location:Ohio  Entered:2002-12-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Exercise induced asthma
Diagnostic Lab Data: Blood glucose 445; SGOT 210 u/l; SGPT 382 u/l; Alk phos 201; Bilirubin 117
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0348M1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal discomfort, Anorexia, Constipation, Diabetes mellitus, Diarrhoea, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Vomiting and diarrhea 11/13/02 to 11/18/02. Constipated and myalgia, anorexia 11/23/02 and vague abdominal discomfort. Diagnosed Diabetic mellitus juvenile on 11/23/02. Myositic and hepatitis 11/23/02.

VAERS ID:195343 (history)  Vaccinated:2002-10-14
Age:11.0  Onset:2002-10-14, Days after vaccination: 0
Gender:Female  Submitted:2002-12-05, Days after onset: 52
Location:North Carolina  Entered:2002-12-26, Days after submission: 21
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Chest x-ray one wk later-acute pneumonia.
CDC Split Type: NC02120
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5296C90IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Dizziness, Dysphonia, Dyspnoea, Feeling abnormal, Pain, Pallor, Pneumonia, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within 1st hour after shot pt symptoms were high fever 102 to 103, pale, lifeless, body hurt all over, dizzy, hoarse, cough, breathing difficulty, vomited.

VAERS ID:195421 (history)  Vaccinated:2002-10-24
Age:11.0  Onset:2002-10-24, Days after vaccination: 0
Gender:Female  Submitted:2002-10-25, Days after onset: 1
Location:Wisconsin  Entered:2002-12-26, Days after submission: 62
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Reaction to amoxicillin
Diagnostic Lab Data: NONE
CDC Split Type: WI0221
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5353B20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Headache, Pharyngolaryngeal pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 10/24/02 Evening throat sore, sleepy (9PM), temperature 99.2. 10/25/02 Up once at night; 6AM nauseated, temperature 99.9. No emesis, slight headache, slept most of day. 4PM warm, sleepy.

VAERS ID:195521 (history)  Vaccinated:2002-12-12
Age:11.0  Onset:2002-12-13, Days after vaccination: 1
Gender:Male  Submitted:2002-12-16, Days after onset: 3
Location:New Mexico  Entered:2002-12-26, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.03171  
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Broke out in hives; went to doctor and had to go to ER.

VAERS ID:195717 (history)  Vaccinated:2002-12-19
Age:11.0  Onset:2002-12-19, Days after vaccination: 0
Gender:Male  Submitted:2002-12-19, Days after onset: 0
Location:Georgia  Entered:2003-01-02, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: L ear defect
Diagnostic Lab Data: NONE
CDC Split Type: GA02134
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5355A20 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0629M1 RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0525AA  LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0481M0 LA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Feeling abnormal
SMQs:, Dementia (broad), Accidents and injuries (narrow)
Write-up: Fell out of chair-caught before hitting floor. Child stated, "I feel bad."

VAERS ID:195922 (history)  Vaccinated:2002-11-20
Age:11.0  Onset:2002-11-20, Days after vaccination: 0
Gender:Female  Submitted:2002-11-21, Days after onset: 1
Location:Michigan  Entered:2003-01-08, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Followed up with physician and was undergoing an MRI.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0527AA0IMRA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0704M2IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Abdominal pain upper, Crying, Dyskinesia, Eye movement disorder, Headache, Injection site pain, Loss of consciousness, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: After receiving TD and Hep B, complained of headache and began crying (within about 1-2 minutes). Mother standing next to her and held and braced her, preventing her from falling. She lost consciousness and had eye''s rolling back, flaccid jerking movements of extremities and incontinent of urine. Regained consciousness within 1 minute and complained of a headache, stomach ache and pain in left deltoid area.

VAERS ID:196251 (history)  Vaccinated:2002-12-12
Age:11.0  Onset:2002-12-30, Days after vaccination: 18
Gender:Female  Submitted:2002-12-31, Days after onset: 1
Location:New Mexico  Entered:2003-01-15, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM755A23 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0568M0 LA
Administered by: Private     Purchased by: Public
Symptoms: Dermatitis bullous, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varivax vaccine given on 12/12/02, mom came to clinic today with child starting with rash on 12/030/02; Approx 57 active chicken pox lesions on body.

VAERS ID:196349 (history)  Vaccinated:2002-02-13
Age:11.0  Onset:2002-02-15, Days after vaccination: 2
Gender:Female  Submitted:2003-01-09, Days after onset: 328
Location:North Carolina  Entered:2003-01-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: "High sensitivity to many medications, foods, multivitamins". She could not take penicillin, cephalosporins, multivitamins (caused a rash), or eat certain foods.
Diagnostic Lab Data: UNK
CDC Split Type: A0360249A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Rash papular
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 2/13/02, the vaccinee received her 1st injection of Engerix-B. On 2/15/02, she developed a red, papular rash on her left lateral flank. The rash resolved on 2/20/02. The reporter stated that the rash was possibly related to Engerix-B.

VAERS ID:196386 (history)  Vaccinated:2002-04-23
Age:11.0  Onset:2002-04-23, Days after vaccination: 0
Gender:Female  Submitted:2003-01-09, Days after onset: 261
Location:California  Entered:2003-01-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0366803A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 0IM 
Administered by: Private     Purchased by: Other
Symptoms: Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: On 4/23/02, the vaccinee received her 1st injection of Engerix-B. On 4/23/02, at an unspecified time post vax, the vaccinee experienced a vasovagal response; she fainted. The reporter stated that when the vaccinee fell, she hit her head. The mother "was hysterical" and insisted that the "rescue squad" be called. The physician provided unspecified treatment at the office. The reporter stated that the vasovagal reaction was probably related to Engerix-B. As of 4/23/02, the event had resolved.

VAERS ID:196467 (history)  Vaccinated:2002-10-09
Age:11.0  Onset:2002-10-10, Days after vaccination: 1
Gender:Male  Submitted:2003-01-09, Days after onset: 91
Location:Wisconsin  Entered:2003-01-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: There was no relevant medical history, concurrent conditions or concurrent medications.
Diagnostic Lab Data: UNK
CDC Split Type: A0383243A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5286A20 LA
Administered by: Public     Purchased by: Other
Symptoms: Blister, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A nurse reported the occurrence of Zoster type rash in an 11 y.o. male who was vaccinated with Hep B vaccine Recombinant (Engerix-B) for prophylaxis. The reporter submitted this report directly to VAERS. There were no relevant past medical history or concurrent medications. On 10/9/02, the subject received his first injection of Engerix-B (10 mcg) in the left deltoid (lot # ENG5286A). Approximately 24 hrs later on 10/10/02 the subject developed a rash on both arms along a dermatome, which was characterized by 9 or 10 eruptions varying from blisters to crusting. The child had no fever or rash on the chest or abdomen or any other part of the body. As of 10/11/02, the event persisted.

VAERS ID:196813 (history)  Vaccinated:2003-01-20
Age:11.0  Onset:2003-01-20, Days after vaccination: 0
Gender:Male  Submitted:2003-01-20, Days after onset: 0
Location:New York  Entered:2003-01-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: History of car sickness.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0819AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt fainted and recovered without sequelae or injury.

VAERS ID:196916 (history)  Vaccinated:2001-04-27
Age:11.0  Onset:2001-04-27, Days after vaccination: 0
Gender:Female  Submitted:2003-01-23, Days after onset: 636
Location:Texas  Entered:2003-01-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Type I diabetes 12/5/02 dxd
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3338A20  
Administered by: Private     Purchased by: Unknown
Symptoms: Diabetes mellitus, Fatigue, Feeling abnormal, Feeling cold, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Dementia (broad), Guillain-Barre syndrome (broad)
Write-up: After receiving her 1st in series Hepatitis B vaccine, patient sat down on the floor and stated that she felt weird. She stayed at the doctors office and ate crackers and water until she felt better. Fatigue, tingling of hands and feet, feeling cold.

VAERS ID:197089 (history)  Vaccinated:2002-08-19
Age:11.0  Onset:2002-08-19, Days after vaccination: 0
Gender:Male  Submitted:2003-01-10, Days after onset: 144
Location:Colorado  Entered:2003-02-03, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: C003002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS52860IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Headache, Hyperhidrosis, Pallor, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Immediately after, child stumbled and said he was dizzy. His color was pale, he was diaphoretic and "trying to go to sleep". He remained dizzy and complained of a headache. The next AM, went to school.

VAERS ID:197091 (history)  Vaccinated:2003-01-09
Age:11.0  Onset:2003-01-09, Days after vaccination: 0
Gender:Female  Submitted:2003-01-10, Days after onset: 1
Location:Texas  Entered:2003-02-03, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: TX03010
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5368A20IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A20IMRA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia, Hypokinesia, Injection site reaction, Pain, Skin striae
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Right arm had streaks, web-like, cold to touch, numb and painful knuckles, blue and unable to move arm (sometimes). Numbness comes and goes. (Due to no insurance, ER visit denied).

VAERS ID:197095 (history)  Vaccinated:2003-01-09
Age:11.0  Onset:2003-01-09, Days after vaccination: 0
Gender:Male  Submitted:2003-01-10, Days after onset: 1
Location:Texas  Entered:2003-02-03, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: TX03006
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0304M0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0789M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dyskinesia, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt briefly lost consciousness. Mother stated his body slightly jerked.

VAERS ID:197332 (history)  Vaccinated:2003-01-22
Age:11.0  Onset:2003-01-23, Days after vaccination: 1
Gender:Female  Submitted:2003-01-24, Days after onset: 1
Location:Nevada  Entered:2003-02-06, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NV0303
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5368A EXP 03/0 RA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM759A2 EXP 03/0 LA
Administered by: Public     Purchased by: Other
Symptoms: Cellulitis, Contusion, Injection site pain, Joint range of motion decreased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Right arm very tender to the touch from shoulder to finger tips. 01/24/2003 Pt has strai radial apparent and loss of ROM or strength. No redness or induration at injection site. Small 1cm bruise.

VAERS ID:197433 (history)  Vaccinated:2003-01-31
Age:11.0  Onset:2003-01-31, Days after vaccination: 0
Gender:Male  Submitted:2003-01-31, Days after onset: 0
Location:Tennessee  Entered:2003-02-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zithromax
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5355A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Approximately one hour after injection patient became dizzy, nauseated and pale. Symptoms lasted approximately one hour then resolved no specific treatment was required.

VAERS ID:197438 (history)  Vaccinated:2003-01-16
Age:11.0  Onset:2003-01-16, Days after vaccination: 0
Gender:Female  Submitted:2002-01-16, Days after onset: 365
Location:Arizona  Entered:2003-02-07, Days after submission: 387
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Told ambulance driver numbness in legs for two weeks (mother denies medical problems)
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood sugar taken by paramedics WNL (112)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0347M1SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0526AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Circulatory collapse, Hyperhidrosis, Hypoventilation, Pallor
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)
Write-up: Had Td and MMR. Experienced a vasomotor collapse with loss of consciousness. Diaphoresis-lips blue, resp shallow, weak pulse. Assisted onto the bed in nurses'' office. CH called. O2 started 10ml/mask, Epnephrine 0.3cc sub. Began responding within one minute. Remained pale-paramedics responded within 6 min. Within one hour walked to car with mother.

VAERS ID:197829 (history)  Vaccinated:2003-02-14
Age:11.0  Onset:2003-02-15, Days after vaccination: 1
Gender:Male  Submitted:2003-02-16, Days after onset: 1
Location:Missouri  Entered:2003-02-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypokinesia, Tenderness
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The TD vaccine was given to my son in his right upper arm. The next morning he complained of the left arm being very sore and sore to the touch. The next day Sunday he can bearly move the left arm. I have applied heat pad to the sore arm.

VAERS ID:198039 (history)  Vaccinated:2003-01-30
Age:11.0  Onset:2003-02-05, Days after vaccination: 6
Gender:Male  Submitted:2003-02-06, Days after onset: 1
Location:Alabama  Entered:2003-02-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: AL0306
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.5252A20IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0192M0IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0524AA IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURU10730IMLA
Administered by: Public     Purchased by: Private
Symptoms: Flushing, Pain, Skin reaction
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 02/5/03 - skin reaction like sunburn, stinging, rash on abdomen, chest and back. Mother called pediatrician and was told rash would last 5-7 days; given Benadryl. 2/6/03 Child returned to school, cheeks still red, but feels fine according to father. Mother states rash was on hands and legs today. Decided taking child to pediatrician.

VAERS ID:198102 (history)  Vaccinated:2003-01-29
Age:11.0  Onset:2003-01-31, Days after vaccination: 2
Gender:Female  Submitted:2003-02-05, Days after onset: 5
Location:Florida  Entered:2003-02-21, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to cats
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5366A22IMLL
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0821AA0IMRL
Administered by: Public     Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother reports child broke out in a red rash 1/31/03 at night all over her body; given Benadryl as directed by private physician. On 2/1/03 at night she broke out in hives; Benadryl give again. Seen by private MD 2/5/03, diagnosed with viral exanthem, not allergic reaction.

VAERS ID:198289 (history)  Vaccinated:2003-02-13
Age:11.3  Onset:2003-02-14, Days after vaccination: 1
Gender:Male  Submitted:2003-02-17, Days after onset: 3
Location:Texas  Entered:2003-02-25, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Adventis/C1257AA/LA/4 previous doses
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEUR40817AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed induration and erythema ( 3 X 3in ) at the site of injection accompanied by pain within 12 hrs of injection.

VAERS ID:198612 (history)  Vaccinated:2003-02-13
Age:11.0  Onset:2003-02-13, Days after vaccination: 0
Gender:Female  Submitted:2003-02-13, Days after onset: 0
Location:Georgia  Entered:2003-03-03, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA03010
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0817AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0481M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Father standing next to pt. Pt sitting in chair, and slid to floor with head laying in chair seat, pale skin. Laid her into floor flat and applied erol towels to face. Pt vomited rolled to R side. BP 90/50. Pulse 80. Responsive.

VAERS ID:199502 (history)  Vaccinated:2001-08-01
Age:11.0  Onset:2001-08-01, Days after vaccination: 0
Gender:Male  Submitted:2003-03-07, Days after onset: 583
Location:Unknown  Entered:2003-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Food allergies
Diagnostic Lab Data:
CDC Split Type: WAES0202USA01266
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Lymphadenopathy, Nasal congestion, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Info has been received from a pharmacist concerning an 11 year old male with many food allergies and a possible yeast allergy who in 8/01 was vaccinated with a 1st dose and in 2/02 was vaccinated with a 2nd dose of Hep-B. The pharmacist reported that approx. 1 to 2 days after each dose, the pt developed a non-specific rash, swollen glands, a low-grade fever and congestion. All symptoms seemed to resolve approx. 1 week after onset. Additional info has been requested.

VAERS ID:199564 (history)  Vaccinated:2002-08-20
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2003-03-07
Location:Michigan  Entered:2003-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0209USA02401
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Headache, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Info. has been received from a registered nurse concerning an approx 11 y.o. male w/no medical history and NKDA, who on 8/20/02 was vax''d w/a 1st dose of Hep B vax recombinant. There was no concomitant medication. Subsequently, the PT developed a severe headache for 3 days and a rash on his back, chest, and arms. Unspecified medical attention was sought. No further info. is available.

VAERS ID:199788 (history)  Vaccinated:2002-08-30
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2003-03-12
Location:Kentucky  Entered:2003-03-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Injection site erythema, Injection site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Lost appetite, vomiting X 3 days, left arm got red and swollen.

VAERS ID:200008 (history)  Vaccinated:2003-02-18
Age:11.0  Onset:2003-02-19, Days after vaccination: 1
Gender:Female  Submitted:2003-03-19, Days after onset: 28
Location:California  Entered:2003-03-21, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Bee-sting allergy per ER paperwork
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5367A21IMLA
Administered by: Other     Purchased by: Public
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Student seen at local hospital ER about 36 hours post vaccine for "maculopapular rash noted to the anterior/posterior trunk and all four extremities". Vital signs were: T-99.0, HR=80. Student was given Visteril 25 mg po PER and discharged with prescription for Atarax 25 mg PO TID for 3 days.

VAERS ID:200407 (history)  Vaccinated:2003-01-02
Age:11.0  Onset:2003-01-03, Days after vaccination: 1
Gender:Female  Submitted:2003-01-21, Days after onset: 18
Location:Pennsylvania  Entered:2003-03-28, Days after submission: 66
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Redness inject site, screaming;DTaP (unknown mfr);1;0;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: PA0310
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0197M0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hive like rash left arm with c/o itch noted 1/3/03 a.m. Rash also noted on neck and face 1/4/03 then cleared. Benadryl PO taken PRN for itchiness.

VAERS ID:200412 (history)  Vaccinated:2003-02-11
Age:11.0  Onset:2003-02-11, Days after vaccination: 0
Gender:Female  Submitted:2003-03-13, Days after onset: 30
Location:Texas  Entered:2003-03-28, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX03037
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0832M2IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0522AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site mass, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 02/13/2003 Red 2 1/2 inches x 2 1/2 inches. Fever, hard knot

VAERS ID:200415 (history)  Vaccinated:2003-02-07
Age:11.0  Onset:2003-02-27, Days after vaccination: 20
Gender:Male  Submitted:2003-03-20, Days after onset: 21
Location:Iowa  Entered:2003-03-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: slight cold
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: IA03005
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0568M0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed fever 02/27/2003 and broke out with chicken pox 02/28/2003. ( 20+ pox). Sister recevied varicella vaccine same day, no pox developed.

VAERS ID:200419 (history)  Vaccinated:1997-11-12
Age:11.0  Onset:2003-03-20, Days after vaccination: 1954
Gender:Female  Submitted:2003-03-21, Days after onset: 1
Location:Michigan  Entered:2003-03-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0695E0 LA
Administered by: Public     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Child has varicella which she contracted from her brother

VAERS ID:200560 (history)  Vaccinated:2003-03-19
Age:11.0  Onset:2003-03-19, Days after vaccination: 0
Gender:Male  Submitted:2003-03-31, Days after onset: 12
Location:North Carolina  Entered:2003-03-31
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CONCERTA 36MG/DAY
Current Illness: NONE
Preexisting Conditions: ADHD
Diagnostic Lab Data: CHEST X-RAY IN HOSPITAL, CAT SCAN IN HOSPITAL AFTER ASKING FOR SOME TYPE OF CHECK-UP ON HIS HEAD BECAUSE THEY WERE TRYING TO DISCHARGE HIM FROM THE HOSPITAL WITHOUT DOING ANYTHING ABOUT HIS HEAD THAT HE HAD FALLEN STRAIGHT BACK ON. THERE WAS NO CARPET ON THE FLOOR WHERE HE HIT EITHER. THEY DID AN EKG AT THE HOSPITAL, HE ALSO HAD AN MRI 3 DAYS LATER BECAUSE THE CT SCAN SHOWED DEAD BRAIN TISSUE IN THREE PLACES. HE HAS BEEN REFERRED TO A NEUROLOGIST WHO WILL DO A MRA TO LOOK AT ALL OF THE VESSELS IN THE BRAIN AND DETERMINE WHAT CAN BE DONE IF ANYTHING. THE MRI REVEALED THE SAME AS THE CT SCAN, THAT THERE WERE PLACES THAT HAD DIED FROM A LACK OF OXYGEN. THEY ARE CALL INFARCTS. HE DIDN''T RECEIVE ANY OXYGEN UNTIL THE RESCUE SQUAD GOT THERE 15-20
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0534M1IMRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU0528AA0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure decreased, Dizziness, Eye movement disorder, Hyperaesthesia, Injection site mass, Loss of consciousness, Oedema, Shock, Skin discolouration
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: 3-19-03 RECEIVED A SECOND DOSE OF HEPATITIS-B VACCINE (FIRST DOSE WAS IN 1997) AND ALSO A SHOT OF TETANUS/DIPTHERIA VACCINE. HE WATCHED THE NURSE GIVE HIM THE SHOTS AS HE ALWAYS HAS, EVEN FOR IV''S HE WATCHES, SO HE ISN''T SQUEEMISH BECAUSE OF THAT; HOWEVER, WHEN WE GOT TO THE CHECK-OUT WINDOW ABOUT 2 MINUTES AFTER THE SHOTS, HE SAID HE FELT DIZZY AND I TURNED AROUND TO TALK WITH HIM AND WHEN I TURNED AROUND HIS EYE WERE ROLLED BACK IN HIS HEAD AND HE WAS FALLING STRAIGHT BACK, THERE WAS NOTHING I COULD DO. HE FELL VERY HARD ON HIS SHOULDERS AND THE BACK OF HIS HEAD BECAUSE HE FELL STRAIGHT BACK. I WENT DOWN TO HIM IMMEDIATELY AND TRIED TO AROUSE HIM BUT HE WAS UNCONSCIOUS. I CALLED FOR HELP IMMEDIATELY AND YELLED THAT HE HAD PASSED OUT AND THEY CAME RUNNING. WHEN THE NURSE GOT TO HIM HE STARTED TO RE-GAIN CONSCIOUSNESS RIGHT AFTER THAT. HIS MOUTH DREW TO THE SIDE AND HIS EYES JUST ROLLED AROUND IN A STRANGE GAZE, AS A PERSON HAVING A SEIZURE, BUT I''M NOT SURE IF HE ACTUALLY HAD A LITTLE SEIZURE OR NOT. WHEN I MENTIONED IT TO THE NURSE, SHE DIDN''T SEEM CONCERNED. I HAVE HEARD THAT NOT ALL SEIZURES ARE VERY LONG AND EVENTFUL, ALL I KNOW IS THAT FOR HIS MOUTH TO DO WHAT IT DID WAS NOT NORMAL FOR HIM AND THAT IS WHY I MENTIONED IT TO THE NURSE THAT FIRST HELPED US. I DON''T KNOW IF ANYONE EVEN WROTE IT IN A REPORT. I DID MENTION IT AT THE HOSPITAL ALSO. THEY RE-EVALUATED HIM AND HIS BLOOD PRESSURE KEPT DROPPING AND HE STARTED INTO SHOCK. HE TURNED YELLOW AND SPLOTCHY AND SHOOK VERY HARD. HE WAS SOAKED ON HIS BACK WHEN WE PICKED HIM UP OFF OF THE FLOOR. HE HAD A VERY LARGE BUMP ON THE BACK OF HIS HEAD BUT NO BREAK IN THE SKIN, ONLY SURFACE BLOOD BRUISES. THEY CALLED THE RESCUE SQUAD BECAUSE HIS PRESSURE WAS GETTING WORSE AND WHEN THEY GOT THERE THEY GAVE HIM OXYGEN AND PUT A COLLAR ON HIM AND STRAPPED HIM TO A BOARD AND TOOK HIM TO THE HOSPITAL EMERGENCY ROOM. WHEN HE GOT THERE THEY DID BLOOD WORK AND A CHEST X-RAY AND TRIED TO MAKE ME BELIEVE THAT HE HAD PASSED OUT FROM SEEING THE NEEDLE. THEY DIDN''T EVEN OFFER ANYTHING FOR PAIN UNTIL I ASKED, AND THEY CAME TO ME WITH DISCHARGE PAPERS FOR ME TO SIGN AND I ASKED THEM WHY THEY DIDN''T DO SOMETHING LIKE A CT SCAN ON HIS HEAD BECAUSE MOST OF HIS FALL WAS FELT BY HIS HEAD? THEY SAID THAT THEY DIDN''T SEE THE NEED TO BECAUSE HE HAD NOT LOST CONSCIOUSNESS. THEY WERE WRONG. AT ANY CHANCE FOR EITHER HIM OR MYSELF TO TELL THE STORY THERE WAS THE TRUE STORY, WHICH DEFINITELY INCLUDED THE LOSS OF CONSCIOUSNESS. THEY GAVE HIM A CT SCAN AND PUT IN THE HOSPITAL FILE THAT IT WAS AT THE MOTHERS REQUEST. (VERY STRANGE) OF COURSE I WANTED IT DONE TO RULE OUT ANY HEAD INJURY BUT THEY WOULDN''T HAVE EVEN DONE ANYTHING ABOUT HIS HEAD IF I HADN''T SAID ANYTHING. WELL, IT GETS WORSE! THE CT SCAN REVEALED WHITE MATTER INFARCTS THAT SHOULDN''T BE IN A YOUNG PERSONS BRAIN AND ADVISED THAT HE GET AN MRI. HE RETURNED FOR THE MRI BECAUSE IT WAS A MOBILE UNIT, THE HOSPITAL DOESN''T HAVE THEIR OWN MACHINE. THE MRI WAS DONE 3 DAYS LATER AND CONFIRMED THAT HE DID IN FACT HAVE THREE SEPERATE INFARCTS IN DIFFERENT PLACES AND A POSSIBLE OTHER PROBLEM WITH AN ARTERY THAT THEY THEN RECOMMENDED BE FOLLOWED BY A NEUROLOGIST. THEY REFERRED US TO A DOCTOR AND ARRANGED THE APPOINTMENT FOR US. WE HAVE NOT BEEN THERE YET AS OF THIS FILING, BUT I SUSPECT HE WILL DO AN MRA AND POSSIBLE OTHER BRAIN TESTS. THE HEALTH DEPARTMENT SAID THAT THEY WERE DOING AN INCIDENT REPORT ON THIS AND I HAVE REQUESTED A COPY OF IT FOR MY RECORDS. I ASKED TO SEE THE BOTTLES OF VACCINE THAT THEY USED IMMEDIATELY FOLLOWING THE EPISODE AND THE NURSE TOOK ME TO THE REFRIGERATOR AND SHOWED THEM TO ME . THEY WERE NOT EXPIRED AT THAT TIME, HOWEVER I DIDN''T THINK TO COPY THE LOT NUMBER, ETC AT THAT TIME BUT I AM SURE THAT THEY WOULD HAVE HAD TO DO THIS ON HIS RECORD. I ASKED THEM TO REPORT THE VACCINE AND TOLD THEM THAT I THOUGHT THAT THEY SHOULDN''T GIVE IT TO ANY OTHER PEOPLE. I ASKED THEM LATER ON A FOLLOW UP VISIT, AND THEY SAID THAT THEY GAVE MANY

VAERS ID:200588 (history)  Vaccinated:2002-08-28
Age:11.0  Onset:2002-08-29, Days after vaccination: 1
Gender:Male  Submitted:2003-01-22, Days after onset: 146
Location:Washington  Entered:2003-04-01, Days after submission: 69
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WA031916
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0411L IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1325L SC 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0134M IM 
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0463AA IM 
Administered by: Private     Purchased by: Public
Symptoms: Headache, Neck pain, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child c/o fever, headache, light sensitivity, and neck pain x 2 days mother reported. Called back and said pt symptoms went away and would not be seen.

VAERS ID:200986 (history)  Vaccinated:2003-02-04
Age:11.0  Onset:2003-02-04, Days after vaccination: 0
Gender:Male  Submitted:2003-03-27, Days after onset: 51
Location:California  Entered:2003-04-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM763A21IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Dysgeusia, Dyspnoea, Hyperventilation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed hives, hyperventilation, SOB, funny taste in mouth, cough approx. 1 1/2 hours after vaccine admin.

VAERS ID:200993 (history)  Vaccinated:1996-08-16
Age:11.0  Onset:2003-03-29, Days after vaccination: 2416
Gender:Male  Submitted:2003-03-31, Days after onset: 2
Location:Georgia  Entered:2003-04-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clarinex, Nasonex, Optivor-placed on Bioxin
Current Illness:
Preexisting Conditions: Allergic rhino conj, allergies and asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Public     Purchased by: Unknown
Symptoms: Parotitis
SMQs:, Oropharyngeal infections (narrow)
Write-up: 11 y with two doses of MMR 1/8/93 and 8/16/96. Seen in office on 3/31/03 with parotitis. Possible vaccine failure suspected, probable mumps suspected. F/U in three days.

VAERS ID:200999 (history)  Vaccinated:2003-03-18
Age:11.0  Onset:2003-03-19, Days after vaccination: 1
Gender:Male  Submitted:2003-03-19, Days after onset: 0
Location:Montana  Entered:2003-04-07, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspar
Current Illness: NONE
Preexisting Conditions: Agoraphobia and Seborrneic dermatitis
Diagnostic Lab Data:
CDC Split Type: MT0303
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM755A21IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Diarrhoea, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Per mom, client work up at 4AM on 3/19 with stomach cramps, nausea/vomiting, diarrhea and fever of 102.1 F. Client also developed a flat red spot on left temple. Site of injection looks fine, no redness, pain or swelling. Mom to treat with fever reducer, increased fluids and monitor symptoms. If no improvement will seek medical attention.

VAERS ID:201085 (history)  Vaccinated:2003-04-02
Age:11.0  Onset:2003-04-02, Days after vaccination: 0
Gender:Female  Submitted:2003-04-02, Days after onset: 0
Location:Georgia  Entered:2003-04-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0464M2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt received hep B vaccine. Left and went to lobby with mother and passed out. She hit her head on the floor when she fell. 137/81 P 71 3:40pm, 127/84 P 93 3:50pm, 119/79 P 99 4:05. Went to private MD to check knot on her head.

VAERS ID:201174 (history)  Vaccinated:2003-04-03
Age:11.0  Onset:2003-04-03, Days after vaccination: 0
Gender:Male  Submitted:2003-04-08, Days after onset: 4
Location:Arizona  Entered:2003-04-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic, rhinitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0534M IMRA
Administered by: Private     Purchased by: Unknown
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)
Write-up: Fever to 105. Vomiting

VAERS ID:201193 (history)  Vaccinated:2003-03-31
Age:11.0  Onset:2003-04-01, Days after vaccination: 1
Gender:Female  Submitted:2003-04-02, Days after onset: 1
Location:Minnesota  Entered:2003-04-09, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0818AA5 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Joint range of motion decreased, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm swelling near shoulder. Seen in clinic about 48 hours after Td immunization. Very slightly red, tender, arm sore and unable to elevate well. Temp 101, achy. Placed on Keflex 500mg BID for 10 days. Leaving to go out of town today. Parents to call with update.

VAERS ID:201200 (history)  Vaccinated:2003-03-31
Age:11.0  Onset:2003-04-01, Days after vaccination: 1
Gender:Male  Submitted:2003-04-02, Days after onset: 1
Location:Massachusetts  Entered:2003-04-09, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURERTA850IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site induration, Injection site pain, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Tenderness erythema (15cm x 15cm), induration (10cm x 10cm) on L arm. Treated as cellulitis with Cephalixin 25mg, 10 days.

VAERS ID:201733 (history)  Vaccinated:2003-04-14
Age:11.0  Onset:2003-04-15, Days after vaccination: 1
Gender:Female  Submitted:2003-04-16, Days after onset: 1
Location:Maryland  Entered:2003-04-18, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5374821 LA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0829AA0 RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received Hep B #2 and Td on 4/14/03. L arm started swelling pm on 4/15/03 swelling and erythema (+) pruritis (+) warmth 3.5in x 2in-Benadryl and hydrocortisone treated.

VAERS ID:201735 (history)  Vaccinated:2003-04-01
Age:11.0  Onset:2003-04-01, Days after vaccination: 0
Gender:Female  Submitted:2003-04-01, Days after onset: 0
Location:California  Entered:2003-04-18, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5372A20 LA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM763A20 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1000M1 RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEUR40827AA  LA
Administered by: Other     Purchased by: Other
Symptoms: Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt fainted after shots. Pt became pale with loc for1-2 sec. Pt awoke with ammonia inhalant, vs taken, given Pedialyte, and assited to exam table. Pt left after 15 min with no problem.

VAERS ID:201979 (history)  Vaccinated:2002-09-16
Age:11.0  Onset:2002-09-16, Days after vaccination: 0
Gender:Female  Submitted:2003-03-03, Days after onset: 168
Location:Michigan  Entered:2003-04-22, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: MI2003019
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0355M1 LA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Chest pains 4hours with shot. No other symptoms. Taken to ER- chest pain lasted 10 min. in ER and was discharged. No EKG or medication taken. OK symptoms to receive dose of vaccine and to wait 48 hours after vaccine before to ER again.

VAERS ID:202078 (history)  Vaccinated:2003-04-14
Age:11.0  Onset:2003-04-15, Days after vaccination: 1
Gender:Male  Submitted:2003-04-16, Days after onset: 1
Location:California  Entered:2003-04-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM537A0 RA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM759A0 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0858M1 LA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABLACTD815 LA
Administered by: Other     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Child received Td and MMR in same left arm. Next day noted to have redness and swelling. came to clinic for PPD reading and seen by nurse on 04/16/2003. Had 4 x 6 cm red, warm, swollen area left deltoid.

VAERS ID:202120 (history)  Vaccinated:1995-05-30
Age:11.0  Onset:2003-04-16, Days after vaccination: 2878
Gender:Male  Submitted:2003-04-17, Days after onset: 1
Location:South Dakota  Entered:2003-04-24, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0404B0SC 
Administered by: Private     Purchased by: Public
Symptoms: Infection
SMQs:
Write-up: Has chicken pox illness. More than 100 pox.

VAERS ID:202135 (history)  Vaccinated:1995-09-26
Age:11.0  Onset:2003-01-11, Days after vaccination: 2664
Gender:Female  Submitted:2003-04-23, Days after onset: 101
Location:Maine  Entered:2003-04-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: No
CDC Split Type: ME03014
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0398B   
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Stomach pretty covered. Low grade fever. Some on arms. Few on legs, quite pronounced. 5 or 6 days total.

VAERS ID:202429 (history)  Vaccinated:2003-02-24
Age:11.0  Onset:2003-03-21, Days after vaccination: 25
Gender:Female  Submitted:2003-03-27, Days after onset: 6
Location:Texas  Entered:2003-05-01, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: None known
Diagnostic Lab Data: Unknown
CDC Split Type: TX03043
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1029M2 RA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Seizures occurred while patient was in school; went to emergency room.

VAERS ID:202712 (history)  Vaccinated:2003-04-30
Age:11.0  Onset:2003-04-30, Days after vaccination: 0
Gender:Male  Submitted:2003-05-01, Days after onset: 1
Location:Louisiana  Entered:2003-05-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
Symptoms: Dyspnoea, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Came into Peds ER with complaints of can''t breathe and itching. Placed in Crisis Room. Epi 1:1000 given Benadryl and Solumediol. Pt discharged to home after 3 hour observation.

VAERS ID:202739 (history)  Vaccinated:2003-04-30
Age:11.0  Onset:2003-04-30, Days after vaccination: 0
Gender:Female  Submitted:2003-04-30, Days after onset: 0
Location:California  Entered:2003-05-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;;Hep A (Havrix);1;9;In Sibling;Syncope;Hep B (Engerix-B);3;7;In Patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM763A21IM 
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0827AA IM 
Administered by: Private     Purchased by: Private
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: 2-3 minutes after the vaccination had syncopy, fell the the ground, woke up in 5-10 seconds.

VAERS ID:202769 (history)  Vaccinated:2003-04-01
Age:11.0  Onset:2003-04-20, Days after vaccination: 19
Gender:Female  Submitted:2003-04-22, Days after onset: 2
Location:California  Entered:2003-05-08, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Allergy to Pollen-Hayfever
Diagnostic Lab Data: UNK
CDC Split Type: CA030028
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5314A22 LA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM727A20 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0487M0 LA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Per telephone call, uncle reports that on Sun. 04/20/2003-child complained of pimple itching. On 04/22/2003 when uncle called states that "pimple-like lesions erupted mainly on torso." States < 10 lesions on body. Denies evaluated temp or malaise.

VAERS ID:202891 (history)  Vaccinated:2003-04-29
Age:11.9  Onset:2003-04-29, Days after vaccination: 0
Gender:Female  Submitted:2003-05-05, Days after onset: 6
Location:Colorado  Entered:2003-05-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Seasonal allergy to pollen, Allergic cefzil.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1029M2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Eyelid oedema, Nausea, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 1 1/2 post #3HB, client complained of nausea. Hives began on chest, then neck and face. Eyes swelled shut. Eventually total body hives. To family MD, given Zyrtec and Benadryl PO.

VAERS ID:203720 (history)  Vaccinated:2003-05-06
Age:11.0  Onset:2003-05-06, Days after vaccination: 0
Gender:Male  Submitted:2003-05-13, Days after onset: 7
Location:California  Entered:2003-05-28, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE-seen for physical
Preexisting Conditions: Allergic rhinitis, history of chronic headaches.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0009N0 RA
Administered by: Private     Purchased by: Other
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: Patient received vaccine Hep A on 05/06/2003 in late morning. Patient went to school and in afternoon developed right side facial pain and weakness. Diagnosis as Ball''s Palsy. (Patient had similar symptoms twice and recovered, not associated with vaccines). In past 5 days much better.

VAERS ID:203896 (history)  Vaccinated:2003-05-21
Age:11.0  Onset:2003-05-22, Days after vaccination: 1
Gender:Male  Submitted:2003-05-23, Days after onset: 1
Location:Kentucky  Entered:2003-05-28, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type: KY2003069
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0833AA4IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Dad notified swelling redness Lt arm on 5/22/03 pm, Seen in the office 5/23/03 10am, area of redness no swelling at injection site 4"x2". No other reaction.

VAERS ID:203911 (history)  Vaccinated:2003-05-06
Age:11.0  Onset:2003-05-12, Days after vaccination: 6
Gender:Female  Submitted:2003-05-27, Days after onset: 15
Location:Indiana  Entered:2003-05-29, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Had been on meds for bronchitis/sinusitis on 4/28/03.
Preexisting Conditions: NKA
Diagnostic Lab Data: Tests and cultures negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1038M1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Joint range of motion decreased, Myelitis transverse, Neuropathy, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 5/12/03 temp 99.3, unable to move limbs or stand; alert and talking. Admitted by doctor to medical center; testing treatment. Diagnosed Transverse Myelitis. Some improvement daily; transferred to hospital rehab 5/21/03 for further therapy. 5/14/03 School nurse called health department saying student in hospital. The 60 day follow up received on 8/6/03 states per family doctor''s office nurse, will continue to take therapy for "fine motor skills" next few months. The medical record states per review of initial hospital record, diagnosis at that time was cervical radiculapathy.

VAERS ID:204028 (history)  Vaccinated:2003-05-21
Age:11.0  Onset:2003-05-23, Days after vaccination: 2
Gender:Male  Submitted:2003-05-23, Days after onset: 0
Location:Virginia  Entered:2003-06-02, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1140M2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling left arm 13 cm length. Left arm 21.5 cm circumference, right arm 20 cm circumference.

VAERS ID:204080 (history)  Vaccinated:2003-05-13
Age:11.0  Onset:2003-05-13, Days after vaccination: 0
Gender:Female  Submitted:2003-05-14, Days after onset: 1
Location:Texas  Entered:2003-06-03, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;Hep B (Engerix-B);3;11;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX03056
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5378A22IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash upper body, front and back, also face. Itching - bad.

VAERS ID:204238 (history)  Vaccinated:2001-01-22
Age:11.0  Onset:2001-04-20, Days after vaccination: 88
Gender:Female  Submitted:2003-05-29, Days after onset: 769
Location:North Carolina  Entered:2003-06-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Comvalescantor, ANA (+) 1:80, EBV Titers c/w. Old infection
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1474K1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Asthma, Fibromyalgia, Laboratory test abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Developed fibromyalgia 04/20/2001. Diagnosed with asthma 04/30/2003.

VAERS ID:204245 (history)  Vaccinated:2003-05-23
Age:11.0  Onset:2003-05-23, Days after vaccination: 0
Gender:Male  Submitted:2003-05-29, Days after onset: 6
Location:Colorado  Entered:2003-06-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1230M1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.08181M0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Injection site rash, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: Pt right away after getting MMR #2 and Varivax got a rash around both injection sites 5x5cm. Pt was given 37.5mg of Benadryl. Pt waited 20 min. Then had a hard time breathing. He was also given 0.3ml of epinephrine 1:10000 subq in L arm. Pt started feeling better also given Orapred 15mg 15cc 40 min later at 11:40am. Pt feeling better but sleepy. Released home with Rx Prednisone 20mg tabs bid x 3-5 days.

VAERS ID:204305 (history)  Vaccinated:1995-03-01
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2003-05-30
Location:Unknown  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Antibody titer for mumps was negative
CDC Split Type: WAES0206USA01857
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a registered nurse concerning a female with no allergies, who on 2/13/89 and 3/1/95 was vaccinated with a first and second dose of MMR II. Concomitant therapy included Synthroid. The pt''s antibody titer was negative for mumps. The pt sought unspecified medical attention. Additional info has been requested.

VAERS ID:204378 (history)  Vaccinated:2002-09-09
Age:11.0  Onset:2002-09-09, Days after vaccination: 0
Gender:Male  Submitted:2003-05-30, Days after onset: 263
Location:Indiana  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma NOS, Egg allergy
Diagnostic Lab Data: NONE
CDC Split Type: 0209USA01354
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1498L IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0234M IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a licensed practical nurse concerning an 11 year old male patient with an allergy to egg whites, no known drug allergies and history of asthma who on 09/09/2002 at 10:00 was vaccinated in the right hip with an intramuscular injection of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(642439/0234M), which had been reconstituted with a dose of diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (Infanrix)(Lot # provided: U0306). Subsequently the patient developed redness and slight swelling at the injection site. Follow-up information received from a health care provider indicated that on 09/09/2002 at 10:00, the patient also received a dose of hepatitis B virus vaccine rHBsAg (yeast)(Lot # 641450/1498L) given intramuscular in the left arm. In the follow-up information received it is unknown whether the patient has had adverse experiences with prior vaccination. It was noted that no laboratory tests were performed. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:204379 (history)  Vaccinated:2002-09-09
Age:11.0  Onset:2002-09-09, Days after vaccination: 0
Gender:Female  Submitted:2003-05-30, Days after onset: 263
Location:Illinois  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: 0209USA01356
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0234M IM 
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a registered nurse concerning an 11 year old white female student with no known drug allergies, who on 09/09/2002 at 15:00 was vaccinated intramuscularly in the left hip with a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(Lot # 642439/0234M) that had been "reconstituted" with diphtheria toxoid/pertussis vaccine/teta (Lot # V0306AC). There was no illness at the time of vaccination. At 15:00 on 09/09/2002, the patient developed redness and slight swelling at the injection site. The patient sought unspecified medical attention. Subsequently, the patient recovered. Additional information is not expected.

VAERS ID:204423 (history)  Vaccinated:2002-11-20
Age:11.0  Onset:2002-11-20, Days after vaccination: 0
Gender:Female  Submitted:2003-05-30, Days after onset: 190
Location:Michigan  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0211USA02020
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEUR 5IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0153M2IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0635M2SC 
Administered by: Other     Purchased by: Private
Symptoms: Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a registered nurse concerning an 11 year old female with no known allergies and no past medical history who in the AM of 11/20/02 was vaccinated SQ with the third dose of MMR II (639692/0635M). Concomitant vaccinations that day in the AM included a third dose of hep B vaccine recombinant (642741/0153M) given IM and sixth dose of Td (V0527AA) given IM. Concomitant medications on 9/3/02 included a first dose of MMR II. Concomitant medications on 11/19/02 included a second dose of MMR II (639692/0635M) given SQ and a second dose of hep B vaccine (642741/0153M) given IM. There was no illness at the time of vaccination. Subsequently, on 11/20/02 at 11AM the pt experienced a headache and arm soreness. Unspecified medical attention was sought. The reporter indicated that the pt recovered on 11/20/02. No diagnostic tests or lab data was reported. No further info is expected.

VAERS ID:204475 (history)  Vaccinated:2003-02-17
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2003-05-30
Location:Unknown  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0302USA02324
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Information has been received from a consumer concerning an 11 year old male who on 02/17/2003 was vaccinated with a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot # not reported). Subsequently the pt experienced pain and swelling in the injected arm. The school nurse examined the boy and saw no signs of swelling, however the pt was complaining of pain. Unspecified medical attention was sought. Additional info has been requested.

VAERS ID:204486 (history)  Vaccinated:2003-03-07
Age:11.0  Onset:2003-03-07, Days after vaccination: 0
Gender:Female  Submitted:2003-05-30, Days after onset: 83
Location:Unknown  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0303USA01362
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Headache
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning an 11 year old child who on 03/07/2003 was vaccinated with a second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot # not reported). Additional suspect therapy was vaccination on the same day with a second dose of hepatitis B vaccine recombitant (yeast) (MSD) (lot # not reported). Concomitant therapy included vaccination on the same day with a first dose of tetanus toxoid (manufacturer unknown) (lot # not reported). Follow up info received from the nurse stated that the pt had a fever on the evening of the vaccines and for the next 2 days. It was initially reported that on 03/10/2003 the mother reported that the pt had developed a fever and a rash. On follow up it was reported that the mother had called the physician''s practice to state that the child had developed a rash and a headache. When the child was seen at the physician''s practice on 03/10/2003 there was no rash. Additional follow up info received from the nurse indicated that there was evidence of a local reaction and what had been reported as a rash was only red cheeks with dry skin. Additional info has been requested.

VAERS ID:204587 (history)  Vaccinated:2003-06-03
Age:11.0  Onset:2003-06-03, Days after vaccination: 0
Gender:Female  Submitted:2003-06-04, Days after onset: 1
Location:California  Entered:2003-06-06, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Headache, but ears were closed
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5372A22IMRA
Administered by: Other     Purchased by: Public
Symptoms: Headache, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Headache, fever. On 06/05/2003: Reported to have hives, but feeling better.

VAERS ID:204589 (history)  Vaccinated:2003-06-03
Age:11.0  Onset:2003-06-04, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Georgia  Entered:2003-06-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Inhaler
Current Illness: Mosquito bites
Preexisting Conditions: Asthma
Diagnostic Lab Data: Titers to be drawn in 6 wks
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0831AA0 RA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Received adult TD in right deltoid

VAERS ID:204674 (history)  Vaccinated:2003-05-07
Age:11.0  Onset:2003-05-08, Days after vaccination: 1
Gender:Male  Submitted:2003-05-08, Days after onset: 0
Location:Georgia  Entered:2003-06-10, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UA - WNL
CDC Split Type: GA03051
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5358AA0IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0817AA5IMLA
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)
Write-up: Started itching and urticaria first in RV arm - then all over the body. No resp problem.

VAERS ID:204822 (history)  Vaccinated:2003-05-24
Age:11.0  Onset:2003-05-24, Days after vaccination: 0
Gender:Male  Submitted:2003-06-06, Days after onset: 13
Location:New York  Entered:2003-06-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: History of prenatal pleural effusion requiring ? drainage.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1196M0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Malaise, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccinated 8am 5/24 with pneumovax. 1 hour later, had quarter sized redness. 5 hours later, systemic symptoms (achiness, malaise), 3 inch redness by that night. Fever next day 104.2 despite Motrin. 48 hours later, WBC count 27K. Subsequently admitted due to progressive site of lesion; raised margins and systemic symptoms. Admitted for 4 days for parenternal antibiotics.

VAERS ID:204837 (history)  Vaccinated:2003-06-05
Age:11.0  Onset:2003-06-06, Days after vaccination: 1
Gender:Male  Submitted:2003-06-11, Days after onset: 5
Location:Connecticut  Entered:2003-06-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5178A21IMLA
Administered by: Private     Purchased by: Other
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash-fine, lacy, itchy - diffuse developed within 24 hours after Hep B #2.

VAERS ID:205010 (history)  Vaccinated:2003-06-04
Age:11.0  Onset:2003-06-04, Days after vaccination: 0
Gender:Male  Submitted:2003-06-09, Days after onset: 5
Location:California  Entered:2003-06-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0127M1 LA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Hypotonia, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Approximately 3 minutes after MMR injection, pt went limp and back in the chair and his body was shaking for about 5 seconds. After sitting him up, he was alert and oriented complaining of headache and nausea. He only had coffee for breakfast. We gave him cookies and water. About 5 minutes later, pt had no complaints. Vital signs were stable. Pt was then seen by MD.

VAERS ID:205448 (history)  Vaccinated:2003-06-11
Age:11.0  Onset:2003-06-14, Days after vaccination: 3
Gender:Male  Submitted:2003-06-17, Days after onset: 3
Location:Kentucky  Entered:2003-06-25, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0141N2IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0836AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0074N0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Three days post vaccine pt developed varicella rash which progressed to number of lesions, $g 300. Had fever 102 x 2 days.

VAERS ID:205528 (history)  Vaccinated:2003-06-11
Age:11.0  Onset:2003-06-11, Days after vaccination: 0
Gender:Male  Submitted:2003-06-16, Days after onset: 5
Location:Kansas  Entered:2003-06-27, Days after submission: 11
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hyperactivity, developmental concerns
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5292A22  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0177N1  
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Eye oedema, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10 minutes after receiving Hep B #3/Varivax #1, left eye swollen and pt began wheezing, right eye red. Treatment included Epi SQ .3 cc (1:1000), Benadryl 25mg IM and Albuterol breathing tx (2.5mg). Ox never dropped below 96%. Prednisone po 60mg.

VAERS ID:205647 (history)  Vaccinated:2003-05-14
Age:11.0  Onset:2003-05-25, Days after vaccination: 11
Gender:Female  Submitted:2003-05-27, Days after onset: 2
Location:Georgia  Entered:2003-07-01, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: GA03062
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0821AA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0550M0 LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling around needle site.

VAERS ID:205648 (history)  Vaccinated:2003-05-14
Age:11.0  Onset:2003-05-25, Days after vaccination: 11
Gender:Female  Submitted:2003-05-27, Days after onset: 2
Location:Georgia  Entered:2003-07-01, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: GA03063
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU0821AA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0550M0 LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling and blister around needle site.

VAERS ID:205652 (history)  Vaccinated:2003-05-19
Age:11.1  Onset:2003-05-19, Days after vaccination: 0
Gender:Female  Submitted:2003-05-20, Days after onset: 1
Location:Georgia  Entered:2003-07-01, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA03068
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0821AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, pain to left deltoid area. 05/23/2003: Called mom, child much better, swelling down.

VAERS ID:205690 (history)  Vaccinated:2003-05-20
Age:11.0  Onset:2003-05-20, Days after vaccination: 0
Gender:Male  Submitted:2003-06-12, Days after onset: 23
Location:Indiana  Entered:2003-07-01, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: local swelling;DTaP (unknown mfr);3;1;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Eggs, peanuts, amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0943M0 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1038M1 LA
Administered by: Public     Purchased by: Public
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed highly pruritic rash which progressed from neck to entire body. MD prescribed Prednisone and Benadryl too. Rash lasted 4 days.

VAERS ID:205901 (history)  Vaccinated:2003-06-27
Age:11.0  Onset:2003-06-28, Days after vaccination: 1
Gender:Male  Submitted:2003-06-30, Days after onset: 2
Location:Massachusetts  Entered:2003-07-08, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD95 IM 
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site mass, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Within 8 hours he had a hard lump about 1/4" away from site of injection which was tender and red. Also some swelling under his arm by mother''s account. Lump was the size of a puppy''s ball - that resolved but redness persists 3 days after immunization.

VAERS ID:205964 (history)  Vaccinated:2003-06-24
Age:11.0  Onset:2003-06-24, Days after vaccination: 0
Gender:Male  Submitted:2003-06-27, Days after onset: 3
Location:Minnesota  Entered:2003-07-09, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0746AC IMLA
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Gave pediatric dose instead of adult dose.

VAERS ID:206220 (history)  Vaccinated:2003-07-02
Age:11.0  Onset:2003-07-04, Days after vaccination: 2
Gender:Male  Submitted:2003-07-08, Days after onset: 4
Location:Michigan  Entered:2003-07-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0527AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1158M0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash macular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed fever - 100.2F - 2 days following vaccine. Seemed to recover. 6 days following vaccine, developed maculo-papular rash over arms, sides and inside of his legs. No itching or fever with rash. Patient is recovering.

VAERS ID:206366 (history)  Vaccinated:2002-08-30
Age:11.0  Onset:2002-08-30, Days after vaccination: 0
Gender:Female  Submitted:2002-09-04, Days after onset: 5
Location:Washington  Entered:2003-07-18, Days after submission: 317
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WA031938
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1379K1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Five to ten minutes after receiving vaccine, she fainted in lobby, hit back of head on tile floor. I ran out to lobby to see her on floor. She appeared to have a small reflexive arching of her body for 5-10 seconds. No history of seizures. She regained consciousness and responded to questions. We called the medics, came within 5 minutes, transported to ER. She had no breakfast.

VAERS ID:206383 (history)  Vaccinated:2003-07-08
Age:11.0  Onset:2003-07-09, Days after vaccination: 1
Gender:Female  Submitted:2003-07-11, Days after onset: 2
Location:North Carolina  Entered:2003-07-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0528AA  RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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)
Write-up: Fever to 102 degrees F within 24 hours. Red spots around injection site on skin and swelling. Rash gone 07/11/2003. Some swelling continues.

VAERS ID:206552 (history)  Vaccinated:2003-07-16
Age:11.0  Onset:2003-07-16, Days after vaccination: 0
Gender:Male  Submitted:2003-07-16, Days after onset: 0
Location:Massachusetts  Entered:2003-07-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD93 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Localized reaction in deltoid area with swelling and redness. Onset-immediately.

VAERS ID:206564 (history)  Vaccinated:2003-07-08
Age:11.0  Onset:2003-07-09, Days after vaccination: 1
Gender:Female  Submitted:2003-07-09, Days after onset: 0
Location:California  Entered:2003-07-23, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS6535A21 LA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0324N1 LA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0829AA0 RA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed rash.

VAERS ID:206770 (history)  Vaccinated:2003-07-22
Age:11.0  Onset:2003-07-22, Days after vaccination: 0
Gender:Male  Submitted:2003-07-24, Days after onset: 2
Location:Virginia  Entered:2003-07-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx: Mother states child had febrile seizures as toddler related to vaccine administration.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0946M0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Loss of consciousness, Muscle twitching, Skin discolouration
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt briefly lost consciousness approximately 1 minute after vaccine administered. He began to slowly slide out of chair, eyes were open, limbs began twitching. Revived when arms was grabbed, name shouted. Remained slightly green for approximately 5 minutes. Lay down vitals monitored. HR 92 initially after 1 minute BP 104/64 P 71. Ice pack applied to back of neck. O.J. given P.O. Left feeling "fine"

VAERS ID:206840 (history)  Vaccinated:2003-07-07
Age:11.0  Onset:2003-07-08, Days after vaccination: 1
Gender:Female  Submitted:2003-07-14, Days after onset: 6
Location:New York  Entered:2003-07-30, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0892AA0 LA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left upper extremity swelling, erythema. Treated with Keflex 125mg by mouth three times a day for 10 days. 07/14/2003.

VAERS ID:206870 (history)  Vaccinated:2003-04-28
Age:11.0  Onset:2003-04-28, Days after vaccination: 0
Gender:Female  Submitted:2003-06-12, Days after onset: 45
Location:New York  Entered:2003-07-31, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0987M0IMLA
Administered by: Private     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)
Write-up: Child was fine while sitting in room about 4-5 minutes after shot; she wandered away from me while I was making appointment. I heard a loud band and looked over and saw pt laying on the floor on her back, feet towards me, her eyes were open.

VAERS ID:207596 (history)  Vaccinated:2003-07-22
Age:11.0  Onset:2003-08-04, Days after vaccination: 13
Gender:Female  Submitted:2003-08-04, Days after onset: 0
Location:Maine  Entered:2003-08-08, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Cefcil, Biaxin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5385A20IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0868M0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s mother called 8/4/03 stating pt has redness and swelling around the site where the varicella injection was given. Pt denies fever or pain.

VAERS ID:207606 (history)  Vaccinated:2003-08-07
Age:11.0  Onset:2003-08-07, Days after vaccination: 0
Gender:Male  Submitted:2003-08-07, Days after onset: 0
Location:Kentucky  Entered:2003-08-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: x-ray right elbow, 1.5 cm hematoma, left occiput, heart rate 82, RR 24, blood pressure 110-80, pupils normal, EOMI, PERRL, B/L PE tubes, Patent N, chest CTA, Neuro, normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5384A20 RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0841AA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0416M0 RA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Haematoma, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Heard a ''thump'' in the hallway and came out from patient room to check. Patient laying flat appearing dazed, minor clonic tonic movements to extremities ~ 30-40 seconds, fully conscious, no emesis/cyanosis. Heart rate 80. Completely responsive once twitching over and stood up with steady gait. Mildly diaphoectic, scalp with small ~ 1.5 cm hematoma, left occiput, Heart rate 82, RR 24, blood pressure 110-80. Right elbow with tenderness-keeping it flessed. right elbow (independent review)-normal. A/P syncope, following immunizations. Cool compresses to scalp, signs of intrassanial injury including unusual sleepiness/aesoerentatrou/headache/vomiting/diptopia or other concerns. Right arm sling for comfort.

VAERS ID:207621 (history)  Vaccinated:2003-05-08
Age:11.0  Onset:2003-05-09, Days after vaccination: 1
Gender:Male  Submitted:2003-08-08, Days after onset: 91
Location:Rhode Island  Entered:2003-08-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.UNKNOWN0 RA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Decreased appetite, Influenza like illness, Nausea, Petechiae, Pyrexia, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient developed a fever of 102.2,petechiae on his upper quadrant and vomited the evening after he recieved the first of the hepatitis shots.He also developed influenza-like symptoms that lasted over 3 weeks. He seemed to recover for a few weeks and then the symptoms returned. patient has been unable to eat without feeling severe nausea and abdominal pain. He continues to loss weight and has been seen multiple times by his physician and a pediatric G.I. specialist.

VAERS ID:207661 (history)  Vaccinated:2003-07-30
Age:11.0  Onset:2003-07-30, Days after vaccination: 0
Gender:Male  Submitted:2003-08-01, Days after onset: 2
Location:Kentucky  Entered:2003-08-11, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finished Prednisone step down meds 07/30/2003
Current Illness: Recovering poison ivy
Preexisting Conditions: Allergy to sulfa meds reported 07/30/2003
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0831AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: States rash head to toe, itching, some redness at injection site.

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