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Case Details (Sorted by Age)

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VAERS ID: 426084 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2006-10-05
Onset:2011-06-09
   Days after vaccination:1708
Submitted: 2011-06-21
   Days after onset:12
Entered: 2011-06-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20018 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0211F / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Bordetella test, Cough, Exposure to communicable disease, Laboratory test, Polymerase chain reaction
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XOPENEX; PREVACID
Current Illness: mild URI
Preexisting Conditions: RAD mild intermittent; GER
Allergies:
Diagnostic Lab Data: B. pertussis, B. parapertussis PCR; Bordatello pertussis DNA
CDC Split Type:

Write-up: Seen in office 6/13/11 because exposed to 9 y/o playmate diagnosed with pertussis in past couple days. Patient complained of cough since 6/9/11. Afebrile. Up to date on vaccines. PCR done & given Rx for ZITHROMAX 240 mg x 1d & 120 mg x 4d to start. Positive PCR reported 6/16/11.


VAERS ID: 426086 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Unknown  
Vaccinated:2009-08-06
Onset:2009-08-10
   Days after vaccination:4
Submitted: 2011-06-01
   Days after onset:660
Entered: 2011-06-24
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Furuncle
SMQs:

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

Write-up: Subcutaneous boil on left shoulder, 2 weeks, received cloxacillan as treatment.


VAERS ID: 426091 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-06-20
Onset:2011-06-21
   Days after vaccination:1
Submitted: 2011-06-21
   Days after onset:0
Entered: 2011-06-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH168AB / 4 RA / IJ
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915383 / UNK LA / IJ

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity; wheezing; BOM; Heart disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling & redness at (R) and left deltoid (injection site).


VAERS ID: 426094 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: New York  
Vaccinated:2011-06-15
Onset:2011-06-16
   Days after vaccination:1
Submitted: 2011-06-16
   Days after onset:0
Entered: 2011-06-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0123 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0743Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1567Z / 2 RA / SC

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

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

Write-up: Mother called and stated the (L) upper arm was swollen approx quarter in size, was red, and hard/hot to touch. Advised mother to draw a circle around the affected area and to call back in the am if the redness/swelling was larger. Also advised to apply cold packs for 24 hrs then to switch to heat packs.


VAERS ID: 426372 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-06-24
Onset:2011-06-24
   Days after vaccination:0
Submitted: 2011-06-24
   Days after onset:0
Entered: 2011-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC26B164 / 1 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS AHIBC263BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E97564 / 5 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1567Z / 2 LL / SC

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

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

Write-up: None stated.


VAERS ID: 426185 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2011-06-20
Onset:2011-06-20
   Days after vaccination:0
Submitted: 2011-06-23
   Days after onset:3
Entered: 2011-06-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 2 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1439Z / 1 LL / SC

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

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

Write-up: Red, swollen, around injection site, fever.


VAERS ID: 426280 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-06-22
Onset:0000-00-00
Submitted: 2011-06-27
Entered: 2011-06-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 1 UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0648Z / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sodium Fluoride
Current Illness: Temp 100.2 orally
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6" x 4" induration, erythema, warmth on anterior left mid-thigh noted at return visit 6/24/11. Prescribed Cephalexin 250mg/5ml oral suspension, take 2 tsps every 12 hrs x 10 days.


VAERS ID: 426305 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2011-06-21
Onset:2011-06-22
   Days after vaccination:1
Submitted: 2011-06-22
   Days after onset:0
Entered: 2011-06-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0602Z / 2 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1514Z / 2 RL / IM

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

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

Write-up: An area of 3 x 4 cm which is raised & red, no warmth or tenderness, itches (L).


VAERS ID: 426335 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Arizona  
Vaccinated:2011-06-27
Onset:2011-06-27
   Days after vaccination:0
Submitted: 2011-06-28
   Days after onset:1
Entered: 2011-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B121BB / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: hives~Vaccine not specified (no brand name)~UN~0.00~Sibling
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient broke out in hives.


VAERS ID: 426409 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-06-29
Onset:2011-06-29
   Days after vaccination:0
Submitted: 2011-06-29
   Days after onset:0
Entered: 2011-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1070Z / 2 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915707 / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1193Z / 2 LA / SC

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

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

Write-up: Periorbital swelling and mild facial swelling and erythema. Epinephrine Auto-Injector 0.15 mg given at 10:50 am .10 mg of prednisone at 11:30 am, 12.5 mg of Diphenhydramine.


VAERS ID: 426435 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Michigan  
Vaccinated:2011-06-22
Onset:2011-06-23
   Days after vaccination:1
Submitted: 2011-06-29
   Days after onset:6
Entered: 2011-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3470DA / 5 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0330 / 4 LL / IJ
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1413Z / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1105Z / 2 LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site urticaria, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Localized allergic reaction to IPV with hives and erythema around injection site. Patient placed on BENADRYL.


VAERS ID: 426451 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2011-06-20
Onset:2011-06-21
   Days after vaccination:1
Submitted: 2011-06-30
   Days after onset:9
Entered: 2011-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3916 / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 4 UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Computerised tomogram normal, Convulsion, Electroencephalogram normal, Nuclear magnetic resonance imaging normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: Hospital conducted CAT Scan, MRI, and 24-hour EEG. All tests returned as normal. Reason for seizure was unknown.
CDC Split Type:

Write-up: Patient suffered a seizure at pre-school during nap time.


VAERS ID: 426457 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2011-06-27
Onset:2011-06-29
   Days after vaccination:2
Submitted: 2011-06-30
   Days after onset:1
Entered: 2011-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1640Z / 2 LA / SC

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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 6/22/11 CIPRODEX solution; 6/22/11 amoxicillin
Current Illness: Otitis media
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child given injection 6/27/11 - seen 6/29/11 c/o redness (4 cm area) & edema to site. (Lt) arm MMR given.


VAERS ID: 426488 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-06-27
Onset:2011-06-29
   Days after vaccination:2
Submitted: 2011-06-30
   Days after onset:1
Entered: 2011-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F13779 / 5 LL / IM

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

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

Write-up: 4 yo male received PREVNAR 13 on 27 Jun 2011. On 29 Jun started having redness/swelling in (L) thigh (whole thigh) where received vaccine. Was swollen and hard. Was given MOTRIN and seen next day at doctor office. Swelling/redness has decreased. Getting better. Pt has h/o complete PCV-7 series with last dose in 10/2007.


VAERS ID: 426493 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2010-06-27
Onset:2011-06-28
   Days after vaccination:366
Submitted: 2011-06-30
   Days after onset:2
Entered: 2011-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3514AA / 5 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1113Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1188Z / 2 RA / SC

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

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

Write-up: Swelling of right deltoid, went to ER got RX for Septra


VAERS ID: 426524 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Washington  
Vaccinated:2011-06-29
Onset:2011-06-29
   Days after vaccination:0
Submitted: 2011-06-30
   Days after onset:1
Entered: 2011-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0742Z / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E89952 / UNK RA / UN

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

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

Write-up: Pt was given DTaP, IPV, MMR, PCV-13 and Tuberculin skin test. Pt returned an estimated hour after receiving vaccines with hives all over the body. We gave him a shot of epi and a dose of BENADRYL.


VAERS ID: 426780 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Kansas  
Vaccinated:2011-06-27
Onset:2011-06-27
   Days after vaccination:0
Submitted: 2011-06-27
   Days after onset:0
Entered: 2011-06-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3869AA / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485Z / UNK LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915707 / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0036AA / UNK RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Eyelid oedema, Ocular hyperaemia, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. started scratching/itching, eyes puffy and red, c/o scratchy throat. Pt. given 0.15 EPIPEN JR. and 12.5 mg BENADRYL po. BENADRYL repeated 20 min later. Due to epi admitted for observation.


VAERS ID: 426554 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-06-07
Onset:2011-06-08
   Days after vaccination:1
Submitted: 2011-06-24
   Days after onset:16
Entered: 2011-07-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3497CA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0330 / 4 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0790Z / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915373 / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1697Z / 2 RL / SC

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

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

Write-up: Patient received vaccines on 6/7/11. Mom called on 6/8/11 and stated that the right thigh was red with approximately half dollar size around the inj. site.


VAERS ID: 426564 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-06-21
Onset:2011-06-23
   Days after vaccination:2
Submitted: 2011-06-24
   Days after onset:1
Entered: 2011-07-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007Z / 2 RA / IM

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

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

Write-up: Rt. arm (deltoid) was swollen (2-3+), red, & hot to touch.


VAERS ID: 426574 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-06-13
Onset:2011-06-15
   Days after vaccination:2
Submitted: 2011-06-23
   Days after onset:8
Entered: 2011-07-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0126AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E844910 / 4 LL / IM

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

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

Write-up: Two days after administration presented in clinic with cellulitis to injection site. Left thigh redness and warm to touch. Antibiotics given KEFLEX (250g/5ml) 5mL PO BID x 3 days.


VAERS ID: 426605 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-06-27
Onset:2011-06-29
   Days after vaccination:2
Submitted: 2011-06-29
   Days after onset:0
Entered: 2011-07-01
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916005 / 1 LA / IM

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

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

Write-up: Swelling, redness & tenderness to (L) shoulder about 12 cm x 12 cm. No fever - decreased use in arm. Mostly resolved after 2 days of ice & MOTRIN.


VAERS ID: 426611 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Alaska  
Vaccinated:2011-06-17
Onset:2011-06-20
   Days after vaccination:3
Submitted: 2011-07-01
   Days after onset:11
Entered: 2011-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B107AA / 5 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E84462 / 2 LL / IM

Administered by: Other       Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Skin reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Skin reaction to Dtap on (R) thigh 7x9 cm area swollen, red, non tender but itchy.


VAERS ID: 426615 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-06-29
Onset:2011-06-30
   Days after vaccination:1
Submitted: 2011-07-01
   Days after onset:1
Entered: 2011-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0742Z / 2 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915708 / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1369Y / 2 LA / SC

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

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

Write-up: Right upper arm with 7 x 8 cm localized area warm with erythema. Tx: ice packs, BENADRYL 12.5mg/5mL 6mL po.


VAERS ID: 426692 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Utah  
Vaccinated:2011-05-02
Onset:2011-05-03
   Days after vaccination:1
Submitted: 2011-06-27
   Days after onset:55
Entered: 2011-07-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178AA / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject has no history of adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0929587A

Write-up: This case was reported by a healthcare professional via a sales representative and described the occurrence of swelling in a 5-year-old male subject who was vaccinated with KINRIX (GlaxoSmithKline). On 02 May 2011 the subject received unspecified dose of KINRIX at 0.5 ml in the left arm. On 05 May 2011, 3 days after vaccination with KINRIX, the subject experienced swelling, erythema and fever The events were indicated to be local injections site reactions. At the time of reporting the events were resolved. In the reporter''s opinion, the events were probably related to treatment with KINRIX. Follow-up information was received on 14 June 2011. It was reported that the subject experienced a local reaction at the injection site the day following administration of KINRIX, on 03 May 2011. The reaction included swelling, erythema and fever. The events resolved by 10 May 2011. In the reporter''s opinion, the events were probably related to treatment with KINRIX.


VAERS ID: 426631 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Iowa  
Vaccinated:2011-06-30
Onset:2011-06-30
   Days after vaccination:0
Submitted: 2011-07-03
   Days after onset:3
Entered: 2011-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Abasia, Decreased appetite, Headache, Injected limb mobility decreased, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies: Amoxicillin Son was born with hydrocephalus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, poor appetite, severe leg pain. My son could not walk on it for 2 days. On the leg shot was administered, patient would not bend his knee and would keep it straight.


VAERS ID: 426713 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-06-23
Onset:2011-06-29
   Days after vaccination:6
Submitted: 2011-07-05
   Days after onset:6
Entered: 2011-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B118CA / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH265AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR D0674 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1482Z / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915707 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0028AA / 2 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO ILLNESSES AT TIME OF VACCINATIONS
Preexisting Conditions: ALLERGIC TO PEANUTS, TAMARINDO, CATS, DOGS, POLLEN, GRASS
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT HAD BIG RED ROUND MARK ON HER LEFT THIGH, WAS A BIT SWOLLEN AND SHE WAS HAVING TROUBLE WALKING BECAUSE IT WAS PAINFUL. TREATMENT WAS MOTRIN AND HEAT PATCH.


VAERS ID: 426757 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-06-09
Onset:2011-06-18
   Days after vaccination:9
Submitted: 2011-07-06
   Days after onset:18
Entered: 2011-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 LA / SC
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 3 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 RA / SC

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

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

Write-up: RASH


VAERS ID: 426770 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2011-06-15
Onset:2011-06-15
   Days after vaccination:0
Submitted: 2011-06-30
   Days after onset:15
Entered: 2011-07-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3473AA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 13212 / UNK RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had a history of gastroesophageal reflux disease (GERD), asthma, seasonal allergies and developmental delay. The patient''s concomitant medications included NEXIUM, ZYRTEC, FLONASE and PROAIR as needed (prn). The patient had no illness at the time of vaccination and it was unknown if he had an adverse event following prior vaccinations.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201103710

Write-up: This case is 1 of a cluster of 2 patients'' who experienced similar adverse events following vaccination with DAPTACEL and other product. The event for the second patient was captured in case number 2011-03709. Initial report received from a health care professional on 22 June 2011. A 4-year-old male patient with medical history of gastroesophageal reflux disease (GERD), asthma, seasonal allergies, and developmental delay, received a left deltoid intramuscular injection of DAPTACEL, sanofi pasteur Ltd. lot number C3473AA and a right deltoid subcutaneous injection of VARIVAX, Merck lot number 13212, on 15 June 2011 in the AM. The patient''s concomitant medications included NEXIUM, ZYRTEC, FLONASE and PROAIR as needed (prn). The patient had no illness at the time of vaccination and it was unknown if he had an adverse event following prior vaccinations. On 15 June 2011 in the PM, the patient developed symptoms of the left deltoid becoming hot to touch, swollen, reddened and tender. The patient was seen by a physician and diagnosed with cellulitis. He was treated with antibiotics, prednisone and BENADRYL. The outcome was reported as recovered. Documents held by sender: None.


VAERS ID: 426834 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-07-05
Onset:2011-07-06
   Days after vaccination:1
Submitted: 2011-07-06
   Days after onset:0
Entered: 2011-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3470DA / 5 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Past Hx of skin allergies / atopic rash - cheeks dryness skin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swollen & red 4cm x 4cm (L) deltoid area - around spot where shot was given - swelling and tenderness noted.


VAERS ID: 426932 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-07-06
Onset:2011-07-07
   Days after vaccination:1
Submitted: 2011-07-07
   Days after onset:0
Entered: 2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0574Z / 2 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

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

Write-up: Parent called pediatrician at 12pm reported was seen in ER last night after 3 episodes of hallucinations lasting 10 mins saw red and green lights and monsters. Attacked father trying to get rid of "monster" on face. Remembers event fully. To ER who recommended calling pediatrician to report.


VAERS ID: 426942 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-07-06
Onset:2011-07-07
   Days after vaccination:1
Submitted: 2011-07-07
   Days after onset:0
Entered: 2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3916AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0330 / 4 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1575Z / 2 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 5 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1614Z / 2 RL / SC

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

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

Write-up: Localized reaction on bilat thigh. Red, warm to touch, and swollen. Patient seen in clinic. Cool compresses instructed by physician.


VAERS ID: 427021 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-07-08
Onset:2011-07-09
   Days after vaccination:1
Submitted: 2011-07-09
   Days after onset:0
Entered: 2011-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS C3957AA0 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0037AA / 2 LL / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Convulsion, Dyskinesia, Gaze palsy, Pallor, Posture abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: No. She was fine.
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: MMR2

Write-up: Child''s face went gray, she fainted. I caught her and laid her on the floor. Her head tilted to the side and began jerking and her eyes rolled back in her head. It lasted about 10 seconds from fainting to the end of the seizure.


VAERS ID: 427042 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-07-07
Onset:2011-07-09
   Days after vaccination:2
Submitted: 2011-07-09
   Days after onset:0
Entered: 2011-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1364Z / 1 LA / UN

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

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

Write-up: Localized redness, mild induration.


VAERS ID: 427100 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-05-31
Onset:2011-06-05
   Days after vaccination:5
Submitted: 2011-07-11
   Days after onset:36
Entered: 2011-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DPP: DIPHTHERIA TOXOID + PERTUSSIS + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER E01231 / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER 16282 / UNK - / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915671 / UNK - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 10012 / UNK - / -

Administered by: Unknown       Purchased by: Private
Symptoms: Dyskinesia
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevnar 13 lot no. 915671
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neck roll with shoulder shrug throughout day. One month later instead of one at a time, he now does it three times or so when he does it, and this is throughout the day. Have made appointment with neurologist to look at him. Dr. dismissed it as emotional or Tourettes.


VAERS ID: 427111 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-07-08
Onset:2011-07-09
   Days after vaccination:1
Submitted: 2011-07-11
   Days after onset:2
Entered: 2011-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / UNK LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1600Z / 2 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1570Z / 2 RL / UN

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

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

Write-up: Redness & swelling appeared on 7/9/11 to upper (L) thigh, was painful to touch, no pain now. (1.5 cm induration & 8x4 cm erythema now). F/u w/PCP if fever or increased redness or tenderness.


VAERS ID: 427129 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2011-05-23
Onset:2011-05-24
   Days after vaccination:1
Submitted: 2011-07-08
   Days after onset:45
Entered: 2011-07-12
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3449AA / UNK RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0743Z / UNK LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1474Z / UNK LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Injection site discharge, Injection site erythema, Injection site reaction, Injection site swelling, Oedema peripheral, Secretion discharge
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No concurrent illnesses, no pre-existing medical conditions and no use of other medications. The patient had not experienced any adverse events with prior vaccinations. The patient had not received any other vaccinations with 4 weeks prior to 23 May 2011. Follow-up information was received on 05 July 2011 reported the patient''s birth weight was 6 pounds 12 ounces and he has 3 siblings.
Allergies:
Diagnostic Lab Data: None
CDC Split Type: 201103081

Write-up: Initial report received from a health care professional on 25 May 2011. A 4-year-old child (gender not reported) had received on 23 May 2011 an intramuscular right deltoid injections of DAPTACEL and IPOL (lot numbers C3449AA, and D1086-1 respectively); and subcutaneous left deltoid injections of MMR and VARIVAX (manufacturer Merck, lot numbers 0743Z and 1474Z, respectively) and overnight, the patients arm became red, swollen, and the skin in the affected area was weeping. The patient required a doctors visit; however no relevant diagnostic tests and/or laboratory data were performed. It was also not reported whether the patient had required any treatments. The patient had no concurrent illnesses, pre-existing medical conditions or use of other medications at the time of the vaccinations; and had not received any other vaccinations with 4 week prior to 23 May 2011. It was noted the patient had not experienced any adverse events with past vaccinations. At the time of this report, the patient had not recovered. Follow-up information was received from a health care professional on 05 July 2011. The birth weight of this male patient was 6 pounds 12 ounces and he has 3 siblings. It was confirmed that the patient was vaccinated on 23 May 2011 at about 12:30 PM and on 24 May 2011 (previously reported as 23 May 2011) at about 3:00 PM the whole right arm became swollen, red and weeping. On 25 May 2011 at about 11:00 AM he was seen by a physician. He was instructed to continue taking BENADRYL and apply cool compresses. The event was considered serious by the physician. It took 5 days for him to fully recover. The outcome was reported as recovered on 28 June 2011. Documents held by sender: None.


VAERS ID: 427162 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2011-06-28
Onset:2011-06-29
   Days after vaccination:1
Submitted: 2011-06-30
   Days after onset:1
Entered: 2011-07-12
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 43470CA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0023AA / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Speech delay; received EI-speech improved
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: VSS, Afeb. Received DTAP & varicella on 6/28/11. Today here with swollen (L) upper arm, sl. warm, firm but nontender. Area is red. At times itchy. Tx: BENADRYL if itchy, regular activity. Possibly premedicate with BENADRYL before TDAP at age 10 year. (Swelling at deltoid muscle area). Dad put ice on 6/29/11, seen today by MD 6/30/11.


VAERS ID: 427168 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-06-13
Onset:2011-06-14
   Days after vaccination:1
Submitted: 2011-06-15
   Days after onset:1
Entered: 2011-07-12
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 4 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB498AA / 2 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0189Z / 2 LA / SC

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

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

Write-up: Swelling erythema, patch of vesicles in deltoid area.


VAERS ID: 427196 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-07-06
Onset:2011-07-06
   Days after vaccination:0
Submitted: 2011-07-07
   Days after onset:1
Entered: 2011-07-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 5 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E03301 / 4 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007Z / 2 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1036Z / 2 LA / UN

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

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

Write-up: Right arm- delt - red, swollen, hot to touch.


VAERS ID: 427202 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2011-07-07
Onset:2011-07-07
   Days after vaccination:0
Submitted: 2011-07-12
   Days after onset:5
Entered: 2011-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3473AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1396Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 RA / SC

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

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

Write-up: (L) thigh with golf ball sized edema with central induration but non tender, no discharge. Warm to touch.


VAERS ID: 427308 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2011-07-11
Onset:2011-07-12
   Days after vaccination:1
Submitted: 2011-07-13
   Days after onset:1
Entered: 2011-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1427Z / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 17032 / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, was prescribed that day Loratadine.
Current Illness: Allergic Rhinitis
Preexisting Conditions: Allergic Rhinitis, Speech Delay (315.39)
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: As per mother, patient had a normal response to vaccine during first day. Yesterday child was refusing to walk, was limping favoring the right lower extemity. Today a rash and swelling of the thigh area was noticed. Patient states it hurts, but walks and runs. Mother was so concerned about an infectious cellulitis, that took child to ER.


VAERS ID: 427432 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2011-07-12
Onset:2011-07-13
   Days after vaccination:1
Submitted: 2011-07-14
   Days after onset:1
Entered: 2011-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / UNK LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1441Z / UNK LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E008203 / UNK RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site vesicles
SMQs:

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

Write-up: Mother of patient called 7-14-11. Stated when took band aid off 7/13/11 from vaccine (PREVNAR 13) site there was a blister at site. Told mother to apply NEOSPORIN & call if fever, worse, red/hot to touch or concern.


VAERS ID: 427494 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-07-12
Onset:2011-07-12
   Days after vaccination:0
Submitted: 2011-07-14
   Days after onset:2
Entered: 2011-07-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3842AB / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1563Z / 2 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E97569 / 6 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1395Z / 2 RL / SC

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

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

Write-up: Right leg redness, swelling 3 1/2 cm x 3 1/2 cm. Tender, mildly painful.


VAERS ID: 427499 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2011-07-12
Onset:2011-07-13
   Days after vaccination:1
Submitted: 2011-07-15
   Days after onset:2
Entered: 2011-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 5 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / 4 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1393Z / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0092X / 2 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: (R) Coxa vara; Poor growth (height)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6cm x 6cm area of macular erythema (R) shoulder, warm to touch, no pain or pus.


VAERS ID: 427527 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Washington  
Vaccinated:2011-07-13
Onset:0000-00-00
Submitted: 2011-07-15
Entered: 2011-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 5 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0330 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1395Z / 2 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1696Z / 2 LL / SC

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

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

Write-up: Redness, swelling at injection site only no SOB or systemic reaction.


VAERS ID: 427545 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-07-05
Onset:2011-07-06
   Days after vaccination:1
Submitted: 2011-07-18
   Days after onset:12
Entered: 2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LA / IM

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

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

Write-up: Left arm swollen and in pain for 3 days after immunization. Tylenol given 2 days after immunization and swelling and pain subsided on third day.


VAERS ID: 427588 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Indiana  
Vaccinated:2011-07-05
Onset:2011-07-07
   Days after vaccination:2
Submitted: 2011-07-12
   Days after onset:5
Entered: 2011-07-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B250BA / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0174Z / 1 RL / SC

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

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

Write-up: 48 hours after vaccination child became febrile. Temps ranging from 99-102 for 5 days with no other symptoms. Father spoke with Dr office over phone. No OV or treatment.


VAERS ID: 427592 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-07-01
Onset:2011-07-01
   Days after vaccination:0
Submitted: 2011-07-05
   Days after onset:4
Entered: 2011-07-18
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3916AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Eczema
Preexisting Conditions: Food All to beef; wheat; shellfish; egg; dairy; mustard
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine DTaP #5/IPV #4 given about 9:35 AM. Per mom about 15-20 min started to cough, worsening with time until brought back to office about 10:30AM. Positive wheezing. O2 sat 91%. Within 10 min, received ORAPRED, XOPENEX Neb tx, O2, Epi 1:1000 0.12cc SQ with immediate relief.


VAERS ID: 427637 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-06-20
Onset:2011-06-21
   Days after vaccination:1
Submitted: 2011-06-23
   Days after onset:2
Entered: 2011-07-18
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1045Z / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / UNK LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1492Z / 2 LA / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Injection site warmth
SMQs:

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

Write-up: Pt received vaccines on 6/20/11 in the evening of 6/21/11 leg was warm & red on 6/22/11. Mom states area larger. Cephalexin and BENADRYL prescription given.


VAERS ID: 427677 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-07-12
Onset:2011-07-13
   Days after vaccination:1
Submitted: 2011-07-14
   Days after onset:1
Entered: 2011-07-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / UNK RL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS AD02B366AA / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1642Z / 2 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0095AA / 2 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Portwine stain left side of face.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Area of erythema, warmth & minimum swelling 3x3.5 cm around site of HIB vaccine.


VAERS ID: 427723 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: New York  
Vaccinated:2011-07-19
Onset:2011-07-19
   Days after vaccination:0
Submitted: 2011-07-19
   Days after onset:0
Entered: 2011-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3497AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1068 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1059Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0837Z / 2 RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Back pain, Injection site erythema, Injection site pain, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Nut allergy/Possible egg allergic outgrown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 min later after (L) side arm developed local reddened rxn appx 3.5 x 2.5 cm (-) SOB, clear lungs, pain neck. At site of inj MMR only.


VAERS ID: 427726 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Indiana  
Vaccinated:2011-07-19
Onset:2011-07-19
   Days after vaccination:0
Submitted: 2011-07-19
   Days after onset:0
Entered: 2011-07-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0189Z / UNK RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Cough, Flushing, Injection site pruritus, Injection site reaction, Pruritus, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: hypospadias; hydrocele; dysmorphia; RAD
Allergies:
Diagnostic Lab Data: Sa O2
CDC Split Type:

Write-up: Itching of chest & injection site. Chest pain, cough, mild flush ant chest & injection site. No urticaria, stridor, retractions, SOB. Responded to 1 tsp oral BENADRYL. Mild wheezing noted after BENADRYL, O2 sats 95 to 98. Improved within 20 mins.


VAERS ID: 427748 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2011-07-12
Onset:2011-07-13
   Days after vaccination:1
Submitted: 2011-07-16
   Days after onset:3
Entered: 2011-07-20
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1068 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1644Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0026AA / 2 LL / SC

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

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

Write-up: Child noted to have 2cm x 2cm circular area with redness with hard center to (L) thigh very itchy, mildly warm to touch with mild tenderness. Cont w/ warm compresses.


VAERS ID: 427753 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Mississippi  
Vaccinated:2011-07-12
Onset:2011-07-12
   Days after vaccination:0
Submitted: 2011-07-15
   Days after onset:3
Entered: 2011-07-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1045Z / 2 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E63642 / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1275Z / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Knot~Vaccine not specified (no brand name)~UN~1.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PCV13 vaccine (L) deltoid on 7-12-11. Hot & red 4 x 3 1/2". Dtap/IPV (R) deltoid on 7-12-11. Hot & red irreg shape 2 1/4 x 4".


VAERS ID: 427757 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Michigan  
Vaccinated:2011-07-11
Onset:2011-07-12
   Days after vaccination:1
Submitted: 2011-07-13
   Days after onset:1
Entered: 2011-07-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3514AA / 5 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1083 / 4 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009AA / 2 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1700Z / 2 LL / UN

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

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

Write-up: 5 x4 1/2 cm red, warm skin lesion on the upper Rt thigh. No limping, seems fine, no fever, no adenopathy. Local reaction.


VAERS ID: 427772 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: D.C.  
Vaccinated:2011-07-06
Onset:2011-07-06
   Days after vaccination:0
Submitted: 2011-07-20
   Days after onset:14
Entered: 2011-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3801AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1596Z / 2 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0885Y / 2 LA / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Expired drug administered
SMQs:, Medication errors (narrow)

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

Write-up: Child received expired varicella vaccine (expired 06/22/2011) on 07/06/2011.


VAERS ID: 427798 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2011-07-18
Onset:2011-07-18
   Days after vaccination:0
Submitted: 2011-07-20
   Days after onset:2
Entered: 2011-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 5 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0369AA / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009AA / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0032AA / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Tethered cord at birth-surgery early infancy. Asthma. Several episodes of pneumonia
Allergies:
Diagnostic Lab Data: Was seen by Dr. in the same medical clinic where immunizations were administered. No lab or diagnostic tests were necessary.
CDC Split Type:

Write-up: Welps all over entire body. Mother reports he c/o feet itching when they left here. In a little while noticed welps all over. No wheezing or respiratory symptoms. Significant itching. Was given 18.75 mg Benadryl by mouth at 11AM. At 11:25 am gave 15 mg Orapred by mouth. Released at 12:30 pm. Welps still apparent and still no respiratory issues. Gave Rx to give Orapred ODTs 15 mg bid x 3 days. Text from mother at 2:00 pm same day (7/19/2011) and welps and redness were completely gone. Text from mother at my request 7/20/2011 at 3:00 pm - no further welps, redness or itching.


VAERS ID: 427821 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2011-06-21
Onset:2011-06-21
   Days after vaccination:0
Submitted: 2011-07-21
   Days after onset:30
Entered: 2011-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3515AA / 5 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / IM
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of vaccine. Healthy.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain and swelling at DTaP injection site with heat, redness and severe hives. Oral Benadryl giving immediately and hives improved within 15 minutes. Hives never fully resolved until 10-11 days later. Patient had to recieve oral Benadryl every 6-8 hours during this time. A mild temperature (never exceeding 101.5deg) happened 24 hours after the vaccine and lasted 2 days. Only the DTaP injection site had this reaction. The other 3 vaccine injection sites were normal.


VAERS ID: 427829 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-07-12
Onset:2011-07-13
   Days after vaccination:1
Submitted: 2011-07-15
   Days after onset:2
Entered: 2011-07-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / UNK LA / IJ
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0648Z / UNK LA / IJ
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E97564 / UNK LA / IJ

Administered by: Private       Purchased by: Public
Symptoms: Blood culture negative, Chest X-ray normal, Culture urine negative, Full blood count normal, Grand mal convulsion, Injection site erythema, Laboratory test normal, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KEPPRA
Current Illness: None
Preexisting Conditions: Seizure disorder
Allergies:
Diagnostic Lab Data: CBC, chemistry all nl; blood cx, urine cultures all neg.; CXR negative
CDC Split Type:

Write-up: Patient with seizure disorder, hx of recurrent febrile seizures, 1st seizure of life after Hep A on 8/19/08. Other seizures since. Received KINRIX/PROQUAD/PREVNAR 13 -$g developed redness at injection site, urticaria, generalized tonic-clonic seizure x 30-45 min.


VAERS ID: 427843 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Indiana  
Vaccinated:2011-07-16
Onset:2011-07-16
   Days after vaccination:0
Submitted: 2011-07-21
   Days after onset:5
Entered: 2011-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E01231 / 4 LA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1433Z / 1 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E97569 / 5 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Takes Zyrtec daily for seasonal allergies
Current Illness: None, seasonal allergies
Preexisting Conditions: Seasonal Allergies
Allergies:
Diagnostic Lab Data: Diagnosed on 7-19 with cellulitis. Given rx of Keflex 1 tsp BID
CDC Split Type:

Write-up: Mother noted redness and raised hard area on Right upper arm


VAERS ID: 427867 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-07-19
Onset:2011-07-20
   Days after vaccination:1
Submitted: 2011-07-21
   Days after onset:1
Entered: 2011-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B121BB / 5 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0741Z / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Father denies other illness at time of vaccination.
Preexisting Conditions: Report from screening questionnaire: "...has a healthcare provider told you that the child had wheezing or asthma in the past 12 months". Answer by parent: "yes". NKDA.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling on top of left leg, about 3" wide and 4-1/2" long from top of injection site. Site is red, slightly raised, tender to touch. Thought it was sunburn. Child had been outside all day in sun and swimming. Father denies fever, N/V, SOB, rash, and any other hives anywhere on body. Child is acting "normal/wild as usual". Has not seen healthcare provider. Intends to use cold compresses and advised to watch and if conditions or symptoms listed above occur or worsen, to seek prompt medical attention. Father verbalized understanding, and was "relieved" to hear information.


VAERS ID: 427904 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Kansas  
Vaccinated:2011-07-20
Onset:2011-07-21
   Days after vaccination:1
Submitted: 2011-07-22
   Days after onset:1
Entered: 2011-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B099BA / 5 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR E02041 / 4 RA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1439Z / 2 LA / SC

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

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

Write-up: Pt had local site reaction on upper outer left arm of erythema, warmth, swelling 2.5" x 2.25" and soreness upon presentation at provider facility 07/21/11 @ 1530. Per pt''s mother 7/22/11 @ 0830, pt swelling gone, slight erythema and warmth.


VAERS ID: 427926 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-07-19
Onset:2011-07-20
   Days after vaccination:1
Submitted: 2011-07-21
   Days after onset:1
Entered: 2011-07-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3514AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1068 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1696Z / 2 RL / SC

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

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

Write-up: An itchy raised and red rash on his left thigh that was noticed when the patient woke up on the morning of 7/20/11.


VAERS ID: 427965 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2011-07-05
Onset:2011-07-07
   Days after vaccination:2
Submitted: 2011-07-20
   Days after onset:13
Entered: 2011-07-22
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164CA / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0791Z / 2 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1517Z / 2 RA / SC

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

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

Write-up: Swelling and erythema to both shoulders no tenderness.


VAERS ID: 427966 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-07-19
Onset:2011-07-20
   Days after vaccination:1
Submitted: 2011-07-21
   Days after onset:1
Entered: 2011-07-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1025Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0023AA / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SINGULAIR; LANTUS
Current Illness:
Preexisting Conditions: Type I Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt has a large bump on both (R) & (L) upper thighs.


VAERS ID: 428005 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Colorado  
Vaccinated:2011-07-21
Onset:0000-00-00
Submitted: 2011-07-21
Entered: 2011-07-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E23419 / 5 RL / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1386Z / UNK LL / SC

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

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

Write-up: Made list of shots needed from pt, opened freezer grabbed ZOSTAVAX put back turned around & looked at list again did my KINRIX & PREVNAR. Went back to freezer opened & grabbed bottle to right drew up & had employee double check. Thought it was PROQUAD not ZOSTAVAX. Employee had asked me to look at the kids immun rec. to see what they needed. I made her the list of what they needed. Employee drew them up, asked me to check them I read all of them & checked dosages. For some reason it didn''t click that it was ZOSTAVAX for kids and I okay''d her. I will forever now verbally read aloud every vaccination when checking someone.


VAERS ID: 428047 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Florida  
Vaccinated:2011-07-22
Onset:2011-07-22
   Days after vaccination:0
Submitted: 2011-07-25
   Days after onset:3
Entered: 2011-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3957AA / 5 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF728AB / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 4 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915065 / 4 RL / IM

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

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

Write-up: Redness & swelling at site of injection (R) thigh, getting better.


VAERS ID: 428074 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2011-07-21
Onset:2011-07-21
   Days after vaccination:0
Submitted: 2011-07-25
   Days after onset:4
Entered: 2011-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3282CA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0407Z / 2 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 2 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1701Z / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cold sweat, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slight fever, pain & drowsiness~Vaccine not specified (no brand name)~UN~0.20~Patient
Other Medications: None per mother
Current Illness: None per mother
Preexisting Conditions: None per mother
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Perspiring, cool, clammy to touch and O2 sat from 45% -$g 100% 15 mins after vaccines administered. O2 per mask at 1.7 L until EMS arrived. O2 started by RN. Client transported to hospital ER.


VAERS ID: 428079 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Iowa  
Vaccinated:2011-07-18
Onset:2011-07-19
   Days after vaccination:1
Submitted: 2011-07-25
   Days after onset:6
Entered: 2011-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0906Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1037Z / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA110002

Write-up: Parent reports red & swollen (L) arm.


VAERS ID: 428082 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2011-07-25
Onset:2011-07-25
   Days after vaccination:0
Submitted: 2011-07-25
   Days after onset:0
Entered: 2011-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR E0330 / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR U3282CA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1600Z / 2 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0675Z / 2 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Irritability, Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Swelling - OU. Urticaria (over body) acute itching and irritability. EPI Jr 0.15 mg - BENADRYL 12.5 mg. Occurred within 30 to 40 minutes after shots.


VAERS ID: 428102 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-07-22
Onset:2011-07-23
   Days after vaccination:1
Submitted: 2011-07-26
   Days after onset:3
Entered: 2011-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS 4Z20B154AA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 14262 / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 07782 / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Rash generalised, Rash papular, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: MEDICATION ALLERGIES: AUGMENTIN/PENICILLIN/OMNICEF
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash 2-3days. started on stomach and spread all over. vaccines 4 days ago. no new food/meds. not otherwise ill. had tick bite a week ago, improving. no target rash noted. many diffuse small isolated papulovesicular red lesions over entire body. few on palms/soles. none in mouth/scalp. 1cm drying papule on center of chest at site of tick bite. no annular rash.


VAERS ID: 428129 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-07-20
Onset:2011-07-25
   Days after vaccination:5
Submitted: 2011-07-26
   Days after onset:1
Entered: 2011-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3957AA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G10831 / 4 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483Z / 2 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915707 / 5 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0090AA / 2 RL / SC

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

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

Write-up: Hives developed evening of 7/25/11, spread overnight, diffuse urticaria 7/26/11, no other symptoms. Treated 7/26/11 with zyrtec, atarax, triamcinolone topically.


VAERS ID: 428134 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2011-07-25
Onset:2011-07-25
   Days after vaccination:0
Submitted: 2011-07-26
   Days after onset:1
Entered: 2011-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 1 RL / UN

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Joint effusion, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1 day after PREVNAR 13 had moderate effusion of knee with erythema, warmth, but nontender and FROM. No objective fever. Ambulatory.


VAERS ID: 428138 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-07-26
Entered: 2011-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Anaphylactic reaction, Blood immunoglobulin E increased, Respiratory distress, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy to cow''s milk
Preexisting Conditions: Asthma; Proctocolitis
Allergies:
Diagnostic Lab Data: IgE, 82.9kIU/L
CDC Split Type: B0733764A

Write-up: This case was reported in a literature article and described the occurrence of anaphylaxis in a 4-year-old male subject who was vaccinated with DTAP vaccine (manufacturer unspecified). The subject''s medical history included asthma and proctocolitis. Concurrent medical conditions included allergy to cow''s milk. On an unspecified date, the subject received an unspecified dose of DTAP vaccine (administration site and route unknown, batch number not provided). 10 minutes after vaccination with DTAP vaccine, the subject experienced anaphylaxis, respiratory distress and diffuse hives. This case was assessed as medically serious by GSK. Milk specific IgE level was 82.9 kIU/L. The subject was treated with diphenhydramine and steroid. At the time of reporting, the outcome of the events was unspecified. This case has been linked to 7 other cases of anaphylaxis after vaccination with diphtheria, tetanus and pertussis vaccines in the same literature article: B0733765A, B0733767A, B0733779A, B0733780A, B0733781A and B0733783A. Summary of the literature article: Immediate-type hypersensitivity to cow''s milk affects approximately 1% to 2% of young children, can persist, and can be fatal. Vaccines against tetanus, diphtheria, and pertussis are routinely given to children in multiple doses throughout childhood. Anaphylactic reactions to these vaccines are rare and are generally attributed to the vaccine toxoids. The US national Vaccine Adverse Events Reporting System lists 39 anaphylactic reactions to DTaP, DTP, or Tdap vaccines for subject''s aged 0 to 17 years from 2007-2010. In this period, the authors observed 8 children in their single center with a history of anaphylactic reactions to booster doses of these vaccines. The authors noted that these vaccines are labeled as being processed in medium containing casamino acids (derived from cow''s milk), raising the concern that residual casein in the vaccines might have triggered these reactions. We are not aware of prior reports linking milk contamination to anaphylaxis from these vaccines. To investigate this possibility, the authors reviewed the medical history of the affected children and tested 8 lots of the vaccines for residual casein. These subjects were selected based on reports of anaphylactic reactions to the vaccines and not because of a history of milk allergy. Each patient had symptoms consistent with anaphylaxis within 1 hour of administration of the vaccine. Six of the subjects had prior acute allergic reactions to cow''s milk, including severe reactions in 5 subjects and reactions to trace exposures in 4 subjects. One subject was given a diagnosis of milk allergy based on serologic testing performed to evaluate atopic dermatitis, and another was given a diagnosis based on serologic testing to evaluate proctocolitis. Each of the subject''s had an increased milk-specific IgE level documented within 2 years of the reaction to the vaccine. Although milk-specific IgE levels do not necessarily correlate with severity, the recorded levels are far above those that typically correlate with reactivity. In summary, the authors identified 8 patients with severe milk allergy who reaction with anaphylaxis to Tdap or DTaP vaccines, which are processed in a broth derived from casein. They identified casein in 8 lots of the vaccines, raising the concern that residual casein in the vaccines might result in reactions for highly sensitive patients with milk allergy. Most children with cow''s milk allergy receive these vaccines without incident, but the subjects they identified have very severe milk allergy, very high milk-specific IgE levels, and, for 4 of them, past reactions to trace milk contamination. These children tolerated their initial vaccinations but reacted to booster doses. This observational is most likely explained by increasing milk sensitivity of the children as they aged, as reflected in the personal histories of several of the children. In conclusion, our novel observation raises a concern regarding booster vaccination of children with high levels of milk allergy with Tdap and DTaP. Although the children they identified appear by history and testing to be exquisitely allergic to milk, they cannot accurately define a high-risk group based on this case series. They recommended continuing the standard practice for DPT vaccination in all children, but advised caution when administering booster doses in highly sensitive milk-allergic children.


VAERS ID: 428132 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-07-25
Onset:2011-07-26
   Days after vaccination:1
Submitted: 2011-07-26
   Days after onset:0
Entered: 2011-07-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3576AA / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1395Z / 2 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1687Z / 2 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic Rhinitis; Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling to left SQ inj 25mm x 35mm. BENADRYL given by parent and ice applied to site.


VAERS ID: 428174 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-07-19
Onset:2011-07-20
   Days after vaccination:1
Submitted: 2011-07-27
   Days after onset:7
Entered: 2011-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 4 LL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX20110037PU

Write-up: PTS PARENT REPORTS NOT NOTICING REACTION UNTIL LATE AT NIGHT ON 7/20/11 WHEN BATHING PT. STATES LED WAS SWOLLEN AND RED WITH RED RASH AROUND SITE AND DOWN LEG, SITE WAS WARM AND TENDER. THEY TOOD PT TO ER IN CASE IT WAS A DANGEROUS SPIDER BITE, ETC. ER RECORD STATES PROBABLE LOCAL REACTION TO IMMUNIZATION, BACTRIM PER ER DOCTOR. RASH AND SWELLING ARE RECEDING.


VAERS ID: 428204 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2011-07-25
Onset:2011-07-26
   Days after vaccination:1
Submitted: 2011-07-27
   Days after onset:1
Entered: 2011-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1596Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1613Z / 2 LA / SC

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

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

Write-up: 7cm x 9cm red, warm macule (R) shoulder.


VAERS ID: 428222 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2011-07-25
Onset:2011-07-26
   Days after vaccination:1
Submitted: 2011-07-27
   Days after onset:1
Entered: 2011-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1396Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1606Z / 2 RL / SC

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

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

Write-up: Area of redness with increased local temp about 6 cm x 4 cm diameter l(L) mid thigh where KINRIX vaccine given IM - 0.5ml.


VAERS ID: 428275 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Illinois  
Vaccinated:2011-07-13
Onset:2011-07-15
   Days after vaccination:2
Submitted: 2011-07-21
   Days after onset:6
Entered: 2011-07-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B121BB / 5 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1280Z / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Vaccination site urticaria
SMQs:, Hypersensitivity (narrow)

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

Write-up: Urticaria to vaccination.


VAERS ID: 428323 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-06-06
Onset:2011-06-07
   Days after vaccination:1
Submitted: 2011-06-08
   Days after onset:1
Entered: 2011-07-28
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B126BA / UNK RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1395Z / UNK LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1518Z / UNK RA / SC

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

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

Write-up: 3-4 cm area around injection site of (R) arm - erythematous & firm.


VAERS ID: 428400 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Indiana  
Vaccinated:2011-07-28
Onset:2011-07-29
   Days after vaccination:1
Submitted: 2011-07-30
   Days after onset:1
Entered: 2011-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406Z / 2 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0116AA / 2 RL / IM

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

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

Write-up: Swelling, redness, high fever 102.1, Pain gave Benadryl and ER visit.


VAERS ID: 428407 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-07-18
Onset:2011-07-22
   Days after vaccination:4
Submitted: 2011-07-31
   Days after onset:9
Entered: 2011-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash~Varicella (Varivax)~2~4.00~Patient
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fine rash on trunk and itchiness reported


VAERS ID: 428435 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Delaware  
Vaccinated:2011-07-26
Onset:2011-07-29
   Days after vaccination:3
Submitted: 2011-07-29
   Days after onset:0
Entered: 2011-08-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3381AA / 5 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. O368AA / 2 RA / IM

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

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

Write-up: Patient received DTaP in right arm as well as varicella. Patient experienced slight swelling around injection area.


VAERS ID: 428444 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-07-21
Onset:2011-07-23
   Days after vaccination:2
Submitted: 2011-07-25
   Days after onset:2
Entered: 2011-08-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 5 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / 4 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1009Z / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F13779 / 4 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rxn to to PREVNAR Immuz.~Pneumo (Prevnar)~3~1.40~Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. recv''d red, hard, swollen area at injection site - right thigh.


VAERS ID: 428449 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2011-07-25
Onset:2011-07-25
   Days after vaccination:0
Submitted: 2011-07-25
   Days after onset:0
Entered: 2011-08-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 5 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1068 / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0046AA / 2 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. G000228 / 2 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Coughing and trouble breathing 4 min after injections.


VAERS ID: 428476 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-07-27
Onset:2011-07-27
   Days after vaccination:0
Submitted: 2011-08-01
   Days after onset:5
Entered: 2011-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B184AA / UNK LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E23421 / 2 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0102AA / 3 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: 4 yr well visit
Preexisting Conditions: Allergic to egg & soy
Allergies:
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Red & swollen 3 in. in diameter & warm.


VAERS ID: 428480 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-04-06
Onset:2011-04-06
   Days after vaccination:0
Submitted: 2011-08-01
   Days after onset:117
Entered: 2011-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 LL / -

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

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

Write-up: localized reaction: left leg became very hard, red, swollen and very warm to touch. the red area was about 4inches x 3inches


VAERS ID: 428505 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2011-07-29
Onset:2011-07-30
   Days after vaccination:1
Submitted: 2011-08-01
   Days after onset:2
Entered: 2011-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B196BA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1058Z / 2 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain upper, Diarrhoea, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Bright red bumps on buttocks, back, neck and limbs. Fever, stomach ache and diarrhea.


VAERS ID: 428529 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Missouri  
Vaccinated:2011-05-31
Onset:2011-06-01
   Days after vaccination:1
Submitted: 2011-07-29
   Days after onset:58
Entered: 2011-08-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB469AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1057Z / 2 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1603Z / 2 RL / SC

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

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

Write-up: Knot and swelling on right anterior thigh (treated with BACTROBAN, KEFLEX, and SEPTRA through hospital ER).


VAERS ID: 428553 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2011-07-28
Onset:2011-07-28
   Days after vaccination:0
Submitted: 2011-07-29
   Days after onset:1
Entered: 2011-08-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B114DA / 5 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0370 / 4 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1568Z / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. E008907 / 2 RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Auricular swelling, Eye swelling, Immediate post-injection reaction, Rash, Sneezing, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 7-28-11 4 yr old received DTaP, IPV, MMR & Varicella. Sneezing immed after vaccines. BENADRYL 8 ml po given 1125A. RTC 1225 with rash. Swelling around eye/ears. Positive faint wheeze. BENADRYL 6 ml IM given - 1227p. 1245 decreased swelling, decreased redness. 7-29-11 called home & father states no further rash or signs of reaction.


VAERS ID: 428627 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2011-07-26
Onset:2011-07-27
   Days after vaccination:1
Submitted: 2011-07-28
   Days after onset:1
Entered: 2011-08-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 RA / IM

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

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

Write-up: (R) arm - swelling/red, red spot - 3in long 2in wide, 1/4 in swelling - arm circ.


VAERS ID: 428634 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2011-07-25
Onset:2011-07-26
   Days after vaccination:1
Submitted: 2011-07-27
   Days after onset:1
Entered: 2011-08-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 1 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1365Z / UNK RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / 1 LL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Slight heart murmur; Premature
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom states that on Tues., July 26 around 5pm the parents noticed pt''s leg swollen, red, and hot where child received (2) shots on Monday in the (Lf) leg. States will bring child to doctor. Had appointment w/doctor 7/27/11. Doctor feels that it may be a mild allergic reaction to the shot, not an infection. 7/28/11 mom states that today lf. thigh is still hard and turning dark like a bruise.


VAERS ID: 428638 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-07-25
Onset:2011-07-26
   Days after vaccination:1
Submitted: 2011-07-28
   Days after onset:2
Entered: 2011-08-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB481BB / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0790Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1706Z / 2 LA / SC

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

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

Write-up: Red arm, welt, warm to touch.


VAERS ID: 428643 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-07-21
Onset:2011-07-22
   Days after vaccination:1
Submitted: 2011-07-26
   Days after onset:4
Entered: 2011-08-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / UN

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

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

Write-up: (L) shoulder swelling with KINRIX.


VAERS ID: 428679 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-07-26
Onset:2011-07-27
   Days after vaccination:1
Submitted: 2011-08-03
   Days after onset:7
Entered: 2011-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC1441Z / 5 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR D1086 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0229Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0027AA / 2 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX20110039PR

Write-up: REDNESS AT INJECTION SITE NOW 6-7 INCHES WIDE, WARM TO TOUCH. AREA RAISED AND SWOLLEN.


VAERS ID: 428857 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Unknown  
Location: Pennsylvania  
Vaccinated:2011-05-02
Onset:2011-05-02
   Days after vaccination:0
Submitted: 2011-07-19
   Days after onset:78
Entered: 2011-08-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA00296

Write-up: Information has been received from a licensed practical nurse concerning a 48 month old patient who on 02-MAY-2011 was inadvertently vaccinated subcutaneously with 0.65 mL of ZOSTAVAX (Merck) (Lot# and expiration not reported). No adverse effect was reported. At the time of the reporting the patient''s outcome was unknown. Additional information has been requested.


VAERS ID: 430055 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-04-05
Onset:2011-04-05
   Days after vaccination:0
Submitted: 2011-07-19
   Days after onset:105
Entered: 2011-08-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1543Z / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1104USA00710

Write-up: Information has been received from a certified medical assistant concerning a 4 year old female who on 05-APR-2011 was vaccinated with a dose of ZOSTAVAX (Merck) (lot # 669187/1543Z, expiration date 06-FEB-2012) instead of VARIVAX (Merck) (lot # not reported) mistakenly. No adverse event was seen. It was unspecified if the patient sought medical attention. All telephone attempts to obtain follow-up information have been unsuccessful. Additional information has been requested.


VAERS ID: 432952 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Unknown  
Vaccinated:2010-08-04
Onset:2010-08-04
   Days after vaccination:0
Submitted: 2011-07-19
   Days after onset:349
Entered: 2011-08-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1744Y / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1008USA00490

Write-up: Information has been received from a registered nurse concerning a 4 year old female who on 04-AUG-2010 was vaccinated subcutaneously with ZOSTAVAX (Merck) (lot number 665431/1744Y). It was reported that the patient was intended to receive the second dose of VARIVAX (Merck), and was inadvertently administered a dose of ZOSTAVAX (Merck). No adverse symptoms reported. The nurse added that the first dose of VARIVAX (Merck) was administered on 22-MAY-2007. Additional information has been requested.


VAERS ID: 428773 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Hampshire  
Vaccinated:2011-08-03
Onset:2011-08-03
   Days after vaccination:0
Submitted: 2011-08-03
   Days after onset:0
Entered: 2011-08-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20BA178DA / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1695Z / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex 24 weeker preemie/currently healthy.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Child started with sneezing and then developed a generalized rash and urticaria. Treatment included Oxygen, 18.75 mg of Diphenhydramine HCl, and ORAPRED 15mg orally. Child observed in office for over 1 hour.


VAERS ID: 428799 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-08-01
Onset:2011-08-03
   Days after vaccination:2
Submitted: 2011-08-05
   Days after onset:2
Entered: 2011-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 LA / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LA / -

Administered by: Unknown       Purchased by: Other
Symptoms: Injection site erythema, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Redness at site, swelling, fever


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