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Found 573164 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:69759 (history)  Vaccinated:1993-08-03
Age:9.4  Onset:1993-08-03, Days after vaccination: 0
Gender:Female  Submitted:1994-07-25, Days after onset: 356
Location:New York  Entered:1994-10-31, Days after submission: 98
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO4921
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST. 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash over body; treated w/DPH;

VAERS ID:69811 (history)  Vaccinated:1994-05-12
Age:9.9  Onset:1994-05-12, Days after vaccination: 0
Gender:Female  Submitted:1994-07-25, Days after onset: 74
Location:New Jersey  Entered:1994-10-31, Days after submission: 98
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No
Other Medications: RIG-Merieux lot# 08404A
Current Illness: mouse bite
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: CO5399
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.J05240IMA
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)
Write-up: diffuse hives 8 hrs p/1st dose which responded to DPH; Bitten by a field mouse while it was being released; was transporting animal in basket; It jumped out of basket & when trying ot recapture it bit the child; will not cont series;

VAERS ID:70180 (history)  Vaccinated:1993-10-11
Age:9.0  Onset:1993-10-20, Days after vaccination: 9
Gender:Male  Submitted:1993-11-11, Days after onset: 22
Location:Florida  Entered:1994-10-31, Days after submission: 354
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: 930043381
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Influenza, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax for prophylaxis & 9 days later, exp hives on neck & upper back & chest;later exp hives over entire body;exp also, back,leg & hand pain along w/ flu-like sxs;tx w/ prelone x 4 days; hives have subsided;

VAERS ID:70216 (history)  Vaccinated:1993-11-29
Age:9.1  Onset:1993-12-03, Days after vaccination: 4
Gender:Female  Submitted:1994-02-01, Days after onset: 60
Location:New York  Entered:1994-10-31, Days after submission: 272
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: 930050351
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1289A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax;exp low grade fever w/ rash at inject site,& raised hives;4dec93 itched,had urticaria lt leg & "1 hive each face";sxs tx w/ dph;t spiked x 10 days;rash on & off x 14 days;

VAERS ID:67979 (history)  Vaccinated:1994-10-26
Age:9.7  Onset:1994-10-27, Days after vaccination: 1
Gender:Female  Submitted:1994-10-27, Days after onset: 0
Location:North Dakota  Entered:1994-11-04, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD, Multivit, Ditropan, Senekot, Feosol, Dulcolax, granulex
Current Illness: recent tibia fx (healed);
Preexisting Conditions: cerebral palsy, spastic quad (closed head injury)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4948041 IMRL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0536A0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3x2 area of induration surrounding inject site (lt thigh) w/erythema & tenderness; also fever (tmax 39); rxn appeared in 24 hrs, resolved in 72 hrs;

VAERS ID:68869 (history)  Vaccinated:1994-10-21
Age:9.3  Onset:1994-10-21, Days after vaccination: 0
Gender:Female  Submitted:1994-10-24, Days after onset: 3
Location:Alaska  Entered:1994-11-22, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Suprax, Seldane, Naso-cort spray (nasal);
Current Illness: no temp elevation-rx for sinus infect
Preexisting Conditions: pt is deaf
Diagnostic Lab Data: NONE
CDC Split Type: AK94029
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES4F51030IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Condition aggravated, Gait disturbance, Hypokinesia, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recvd vax & mom reports pt went skating then 1 hrs p/inject c/o itching on feet; devel rash & joint pain; 25OCT devel joint pain in hip-that could not even walk;

VAERS ID:69314 (history)  Vaccinated:1994-09-23
Age:9.0  Onset:1994-09-26, Days after vaccination: 3
Gender:Male  Submitted:1994-10-11, Days after onset: 15
Location:Pennsylvania  Entered:1994-12-05, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp rash 23SEP94 @ 12yrs old w/Hep B vax dose 1;
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1409B20IMRA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: mom described rash as a rough sandpaper type bumps over the chest & neck area-lasting 2 wks;

VAERS ID:69503 (history)  Vaccinated:1994-11-30
Age:9.9  Onset:1994-11-30, Days after vaccination: 0
Gender:Female  Submitted:1994-12-01, Days after onset: 1
Location:Virginia  Entered:1994-12-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Gamma Globulin by Armour lot M6805;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: VA94084
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0615A1SCLA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD135065A0PO 
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Agitation
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypoglycaemia (broad)
Write-up: father called this AM stating gave APAP pt last noc pt was crying & c/o severe abdo pain all noc; told to stop APAP & contace MD to r/o other causes of abdo distress; 230PM states pt improved;

VAERS ID:71135 (history)  Vaccinated:1995-01-11
Age:9.6  Onset:1995-01-11, Days after vaccination: 0
Gender:Female  Submitted:1995-01-12, Days after onset: 1
Location:Pennsylvania  Entered:1995-01-31, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: PA9519
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0686A0 RA
Administered by: Other     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: pt recvd vax; fainted rt p/ shot; 30 secs later was completely recovered; er Dx as vaso-vagal responsse;

VAERS ID:71210 (history)  Vaccinated:1994-12-06
Age:9.5  Onset:0000-00-00
Gender:Male  Submitted:1995-01-17
Location:California  Entered:1995-02-01, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tegretol
Current Illness: NONE
Preexisting Conditions: epilepsy-father didn''t say prior to vax
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0176A0SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES3829410PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES611680IMLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: p/given vax pt fainted & then vomited; VS were stable; did not seize; father stated pt has epilepsy & sometimes does this under stress; father said pt takes Tegretol & is well controlled;

VAERS ID:71246 (history)  Vaccinated:1995-01-11
Age:9.6  Onset:1995-01-11, Days after vaccination: 0
Gender:Female  Submitted:1995-01-17, Days after onset: 6
Location:Kansas  Entered:1995-02-03, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt, bronchitis w/ 1,2,3,4 dtp at 2mo;
Other Medications: dph;
Current Illness: none
Preexisting Conditions: allergic rxn to milk,eggs,grass etc... including allergy shots;
Diagnostic Lab Data:
CDC Split Type: KS95002
Vaccination
Manufacturer
Lot
Dose
Route
Site
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0710L4PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4F610594IMLA
Administered by: Public     Purchased by: Public
Symptoms: Bronchitis, Lung disorder, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recvd vax;tired,sleepy; 4 hrs later awoke w/ chest congestion & fever 102;dph,apap given;still congested;cont apap;to MD;was given amoxicillin;mom called HD on 17jan to report pt still home w/ bronchitis;

VAERS ID:72481 (history)  Vaccinated:1994-11-03
Age:9.0  Onset:1994-11-04, Days after vaccination: 1
Gender:Female  Submitted:1994-11-04, Days after onset: 0
Location:Florida  Entered:1995-02-07, Days after submission: 95
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 894308012K
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recvd vax; next am,devel v & d;

VAERS ID:71737 (history)  Vaccinated:1994-11-29
Age:9.5  Onset:1995-01-06, Days after vaccination: 38
Gender:Female  Submitted:1995-01-17, Days after onset: 11
Location:Texas  Entered:1995-02-22, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: polymyositis/polyradiculitis
Preexisting Conditions: asthma
Diagnostic Lab Data: lumbar puncture, EMG
CDC Split Type: TX95002
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1690N  RA
Administered by: Public     Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraplegia
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: pt recvd vax;exp paralysis from waist down;GBS; polymyositis; adm to hosp 7jan95; transferred to hlth ctr 10jan95;

VAERS ID:71991 (history)  Vaccinated:1995-01-01
Age:9.3  Onset:1995-01-01, Days after vaccination: 0
Gender:Male  Submitted:1995-01-04, Days after onset: 3
Location:Colorado  Entered:1995-03-09, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: chem panel & CBC & urinalysis; IV fluids;
CDC Split Type: CO95007
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0924A1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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)
Write-up: 530PM 1JAN95 recvd vax & vomiting started MN 2JAN95 & cont all noc; devel diarrhea 2JAN95 & vomiting cont; 3JAN95 devel rash 3JAN95; to ER, tx w/IV fluids, compazine, dx rxn to MMR

VAERS ID:72657 (history)  Vaccinated:1995-01-19
Age:9.7  Onset:1995-01-19, Days after vaccination: 0
Gender:Female  Submitted:1995-03-17, Days after onset: 57
Location:New York  Entered:1995-03-31, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NYS95011
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0656A0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax; rash noted on face, neck,arms;swelling to hands;seen in hosp; dx: allergic rxn to HBV; hands still swelling;

VAERS ID:73065 (history)  Vaccinated:1995-03-14
Age:9.0  Onset:1995-03-15, Days after vaccination: 1
Gender:Female  Submitted:1995-03-30, Days after onset: 15
Location:Arkansas  Entered:1995-04-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: pcn allergy, asthma, recurrent infect;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES3909310 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax; large local rxn secondary to vax; fever, erythema, swelling of LUE x 72 hrs;

VAERS ID:75111 (history)  Vaccinated:1994-08-10
Age:9.0  Onset:1994-08-11, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:South Carolina  Entered:1995-05-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: roseola
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES94081048
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax;pharmacist reported that pt devel total body rash consisting of large bumps w/ red rings around the base & itching on 11aug94;

VAERS ID:74033 (history)  Vaccinated:1995-04-25
Age:9.6  Onset:1995-04-30, Days after vaccination: 5
Gender:Male  Submitted:1995-05-02, Days after onset: 2
Location:Florida  Entered:1995-05-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Ritalin
Current Illness: NONE
Preexisting Conditions: Ritalin for ADD/immune globulin
Diagnostic Lab Data: NONE
CDC Split Type: FL95029
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0730A1  
Administered by: Public     Purchased by: Unknown
Symptoms: Cough, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: t103.7 mom sponged pt to dec temp; 1MAY95 t103 taken to PMD; rx Cefzol, Motrin & APAP; coughing, runny nose;

VAERS ID:74680 (history)  Vaccinated:1995-06-05
Age:9.6  Onset:1995-06-05, Days after vaccination: 0
Gender:Male  Submitted:1995-06-05, Days after onset: 0
Location:Georgia  Entered:1995-06-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1649A20 LA
Administered by: Private     Purchased by: Private
Symptoms: Hypertonia, Hypotonia, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: approx 30-45 sec p/inj completed, pt slumped forward in mom''s arms, eyes open but limp & unresponsive; lifted to table & had 30sec episode of rigid posturing, head arched back, fists clenched, arms flexed to chest; pt spontaneously relaxed

VAERS ID:76013 (history)  Vaccinated:0000-00-00
Age:9.0  Onset:0000-00-00
Gender:Female  Submitted:1995-07-14
Location:California  Entered:1995-07-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0396B0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection, Pyrexia, Rash maculo-papular
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever, papule, macular, vessels, & scabs=acute varicella

VAERS ID:77035 (history)  Vaccinated:1995-05-16
Age:9.8  Onset:1995-05-16, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:1995-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95050720
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Private
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: pt recv vax 16MAY95 & immed following vax pt exp a tingling in lt arm, down to fingers; pt was observed in the ofc for approx 10-15mins during which time the sensation persisted; sx persisted for 3 hrs then subsided

VAERS ID:77049 (history)  Vaccinated:1995-05-12
Age:9.0  Onset:1995-05-22, Days after vaccination: 10
Gender:Female  Submitted:0000-00-00
Location:New Jersey  Entered:1995-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95051056
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0398B0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Pyrexia, Rash, Rash maculo-papular
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 12MAY95 & 22MAY95 pt exp rash & fever; rash consisted of more than 30 bumps & vesicles; No further details were provided;

VAERS ID:76123 (history)  Vaccinated:0000-00-00
Age:9.0  Onset:1995-06-23
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:1995-07-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ventolin, aerobid
Current Illness: asthma
Preexisting Conditions: ceclor
Diagnostic Lab Data: referred to neurologist
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: pt recv vax; vasovagal rxn immed p/ inject;

VAERS ID:76178 (history)  Vaccinated:1995-07-17
Age:9.1  Onset:1995-07-19, Days after vaccination: 2
Gender:Male  Submitted:1995-07-21, Days after onset: 2
Location:New York  Entered:1995-07-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES4A610984IMLA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1723A41IMRA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: cellulitis lt deltoid Duricef 250mg cap BID x 10day

VAERS ID:76723 (history)  Vaccinated:1995-08-08
Age:9.5  Onset:1995-08-09, Days after vaccination: 1
Gender:Female  Submitted:1995-08-15, Days after onset: 6
Location:Wisconsin  Entered:1995-08-18, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rash & itching @ 9 w/Hep dose 1
Other Medications: NONE
Current Illness: healthy
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0131B1 RA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: w/in 24 hr of vax devel rash confined to neck & chin area, no lymphadenopathy, no facial swelling noted;rash was itchy;last 1-2 days & dissipated by itself

VAERS ID:79201 (history)  Vaccinated:1995-07-19
Age:9.0  Onset:1995-08-03, Days after vaccination: 15
Gender:Male  Submitted:0000-00-00
Location:Ohio  Entered:1995-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergy,phenobarbital;allergy thorazine;polymyalgia rheumatica;palsy cerebral;sz dis; scoliosis;chromosome abn;edema chronic;rickets
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95080342
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax;3aug95 devel red area w/ 1 1/4 cm brown sore in the ctr & a rash on back & abd;devel raised red lesions over body; T 102;tx w/ dph;lesions healed by 8aug95;reporter felt chicken pox was related to vax;

VAERS ID:78407 (history)  Vaccinated:1995-10-19
Age:9.6  Onset:1995-10-20, Days after vaccination: 1
Gender:Male  Submitted:1995-10-26, Days after onset: 6
Location:North Carolina  Entered:1995-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn w/DTP
Other Medications: Ventolin syrup
Current Illness:
Preexisting Conditions: asthma-allergies (severe)
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash similar to hives appeared on thighs to ankle

VAERS ID:78833 (history)  Vaccinated:1995-10-27
Age:9.9  Onset:1995-10-27, Days after vaccination: 0
Gender:Male  Submitted:1995-10-27, Days after onset: 0
Location:New York  Entered:1995-11-08, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: NYS95063
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1662A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0924A1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Hypertonia, Hypotonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: 3-5 min /p vax pt fell to floor and had flailing movements of arms and head per mother, bp 118/82

VAERS ID:78895 (history)  Vaccinated:1995-10-30
Age:9.3  Onset:1995-10-30, Days after vaccination: 0
Gender:Female  Submitted:1995-10-31, Days after onset: 1
Location:Michigan  Entered:1995-11-13, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MI95131
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1012B0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0468B1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Buccoglossal syndrome, Gaze palsy, Hyperhidrosis, Hypertonia, Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: head fell forward, eyes rolled back, teeth clinched & then lip smacking, arms were moving rhythmically, legs stiffened out;pt moved from chair to exam table, was diaphoretic, episode lasted 2-3mins

VAERS ID:82096 (history)  Vaccinated:1994-12-28
Age:9.0  Onset:1994-12-28, Days after vaccination: 0
Gender:Female  Submitted:1995-03-15, Days after onset: 77
Location:Kentucky  Entered:1995-11-14, Days after submission: 244
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 950001801
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1471A21IMRA
Administered by: Private     Purchased by: Other
Symptoms: Hypertonia, Oedema peripheral, Rash, Sinusitis, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax & w/in 12hrs post vax pt exp hives all over body,swelling of hands & feet,stiffness of hands,& a rash on cheeks & buttocks;tx DPH;addl pt exp sinusitis 3JAN95 & began amoxicillin therapy on that day;pt seen by MD 3&4JAN

VAERS ID:78979 (history)  Vaccinated:1995-10-23
Age:9.0  Onset:1995-10-24, Days after vaccination: 1
Gender:Female  Submitted:1995-11-10, Days after onset: 17
Location:California  Entered:1995-11-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: asthma medications
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: EEG pending; CBC, chemistries nl
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49581171IMLA
Administered by: Private     Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: had sz-like activity 24hrs p/vax;also has family hx of epilepsy

VAERS ID:79024 (history)  Vaccinated:1995-10-10
Age:9.6  Onset:1995-10-10, Days after vaccination: 0
Gender:Female  Submitted:1995-10-12, Days after onset: 2
Location:Pennsylvania  Entered:1995-11-16, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: PA95209
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1382A SC 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0728D PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5C71114 IM 
Administered by: Public     Purchased by: Public
Symptoms: Angioneurotic oedema, Chest pain, Face oedema, Rhinitis, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: immed following vax pt became flushed, puffy-faced, nasal congested w/c/o heart pain;dx antio-neurotic edema

VAERS ID:79488 (history)  Vaccinated:0000-00-00
Age:9.0  Onset:0000-00-00
Gender:Female  Submitted:1995-11-14
Location:Arizona  Entered:1995-11-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Asthmacort
Current Illness:
Preexisting Conditions: hx asthma multiple allergies/mother-seizure
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F61119 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax 330PM started itching 30-min later reported to urgent care scratiching all over mild erythema, a few urticarial patches on hands;susphrine-Pred

VAERS ID:79915 (history)  Vaccinated:1995-09-20
Age:9.6  Onset:1995-09-20, Days after vaccination: 0
Gender:Female  Submitted:1995-09-27, Days after onset: 7
Location:California  Entered:1995-12-07, Days after submission: 71
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: CA95147
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1201A0 RA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0718B0PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4F610590 LA
Administered by: Public     Purchased by: Public
Symptoms: Hypertonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: per mom-pt fainted for a few seconds p/vax-followed by being very rigid-streched out arm & legs & opened eyes very wide (RN did not witness);

VAERS ID:79922 (history)  Vaccinated:1995-03-20
Age:9.9  Onset:1995-03-20, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Illinois  Entered:1995-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1645A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0969A1IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4F610593IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: pt states feels dizzy about 5mins p/vax; Epi & DPH given pt was referred to hosp

VAERS ID:80035 (history)  Vaccinated:1995-10-31
Age:9.6  Onset:1995-11-13, Days after vaccination: 13
Gender:Male  Submitted:1995-12-05, Days after onset: 22
Location:Massachusetts  Entered:1995-12-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: neg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0387B SCLA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: pt did fine-recvd vax 31OCT95 had no fever no rash at all;pt''s sister however, devel chicken pos on 13NOV;pt was the index case in kindergarden class & school;pt''s mom devel chicken pox 3DEC95

VAERS ID:81096 (history)  Vaccinated:1995-11-04
Age:9.0  Onset:1995-11-06, Days after vaccination: 2
Gender:Female  Submitted:1995-11-14, Days after onset: 8
Location:Tennessee  Entered:1996-01-23, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TN96011
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM178A21  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: mom states pt devel fines rash (feels like cornmeal) couple of days p/vax;rash began @ inj site & spread to back, chest, & neck;c/o itching;denies other sxs;

VAERS ID:81839 (history)  Vaccinated:1995-08-14
Age:9.0  Onset:1995-08-30, Days after vaccination: 16
Gender:Female  Submitted:0000-00-00
Location:Arkansas  Entered:1996-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95091571
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0410B0SC 
Administered by: 0     Purchased by: 0
Symptoms: Cough, Infection, Lung disorder, Myalgia, Pharyngitis, Pyrexia, Rash maculo-papular, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax & exp lesions that looked like pimples;pt also exp severe cold,low grade fever,body aches,cough,& congestion;pt''s MD reported pt treated w/homeopathic belladona;MD felt cough was not likely d/t varicella vax poss viral

VAERS ID:83010 (history)  Vaccinated:1995-10-16
Age:9.1  Onset:1995-10-16, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1996-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES95101043
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0434B0IM 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Coma, Conjunctivitis, Dizziness, Otitis media, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recvd vax & parent reported pt passed out 5 to 10mins p/vax in MD ofc;no fever, BP OK;MD reported that 5 mins p/vax pt fell to the floor w/a LOC for a few seconds;2hrs later pt''s mom phoned MD-dizziness, hot, clammy;dx OM & croup

VAERS ID:83196 (history)  Vaccinated:1995-11-07
Age:9.8  Onset:1995-11-16, Days after vaccination: 9
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:1996-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95111306
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0411B0  
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recvd vax 7NOV95 & 15NOV95 pt devel a rash w/21 lesions;rash looked like chicken pox;no further details were provided;

VAERS ID:82863 (history)  Vaccinated:1996-02-12
Age:9.1  Onset:1996-02-12, Days after vaccination: 0
Gender:Male  Submitted:1996-02-12, Days after onset: 0
Location:New Mexico  Entered:1996-02-21, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKDA
Diagnostic Lab Data: NONE
CDC Split Type: NM96006
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1220B0 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1165B1 RA
Administered by: Other     Purchased by: Other
Symptoms: Hypertonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: syncopal episode pt clenched fists & brought forearms close to body;eyes stayed open;responded to questions p/a few seconds on floor; VS WNL

VAERS ID:84754 (history)  Vaccinated:1995-07-07
Age:9.2  Onset:1995-07-07, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1996-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EEG unremarkable
CDC Split Type: WAES95091398
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Military     Purchased by: Other
Symptoms: Headache, Visual disturbance
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)
Write-up: pt recv vax 7JUL95 & exp sudden onset of h/a w/in 5mins of receiving the vax;h/a''s returned 3 to 4 times a day & lasted mins to an hr;lab testing & EEG were unremarkable;optometry showed the pt was sl nearsighted;

VAERS ID:84853 (history)  Vaccinated:1995-08-02
Age:9.0  Onset:1995-09-06, Days after vaccination: 35
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:1996-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95111074
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Neuropathy, Pain
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)
Write-up: pt recv vax;c/o severe arm pain,which MD determined was an axillary nerve problem resulting from myelin sheath degeneration,possibly due to multi IM inject;

VAERS ID:83587 (history)  Vaccinated:1996-02-05
Age:9.8  Onset:1996-02-06, Days after vaccination: 1
Gender:Male  Submitted:1996-03-05, Days after onset: 28
Location:Michigan  Entered:1996-03-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: hx of many ear infect;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4318030 LA
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)
Write-up: pt recvd vax; large hive like appearance on arm from shoulder to elbow;

VAERS ID:83827 (history)  Vaccinated:1995-11-01
Age:9.2  Onset:1995-11-01, Days after vaccination: 0
Gender:Female  Submitted:1995-11-03, Days after onset: 2
Location:Michigan  Entered:1996-03-22, Days after submission: 140
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vanceril inhaler;allergy shots every other
Current Illness: NONE
Preexisting Conditions: mold leaves trees ragweed
Diagnostic Lab Data:
CDC Split Type: MI96018
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49581232IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Ecchymosis, Headache, Injection site pain, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: pt c/o pain @ inj site which radiates down underside of arm & into armpit;on a scale of 1-10 pain is a 7;mom reports there is a 1" cong horizontal bruise across inj site;pt c/o frontal h/a also

VAERS ID:84052 (history)  Vaccinated:1996-01-10
Age:9.3  Onset:1996-01-22, Days after vaccination: 12
Gender:Female  Submitted:1996-03-20, Days after onset: 58
Location:Wisconsin  Entered:1996-03-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to amoxicillin
Diagnostic Lab Data: 31JAN96 MRI-WNL;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1062A1IM 
Administered by: Private     Purchased by: Private
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: pt recv vax 10JAN96 on 22JAN96 devel bell''s palsy on rt side of face;seen by MD 25JAN96 MRI performed 31JAN96 was nl;spontaneous resolution occurred over approx 2 wk;

VAERS ID:84722 (history)  Vaccinated:1996-04-04
Age:9.8  Onset:1996-04-04, Days after vaccination: 0
Gender:Female  Submitted:1996-04-04, Days after onset: 0
Location:Arizona  Entered:1996-04-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0625B1SC 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 4APR96 2PM pt recv vax 205PM c/o redness & sl swelling @ inj site;erythema approx 5 1/2cm x 5cm;induration approx 2cm x 2cm;MD notified immed;

VAERS ID:85351 (history)  Vaccinated:1995-08-03
Age:9.8  Onset:1995-11-01, Days after vaccination: 90
Gender:Female  Submitted:0000-00-00
Location:Ohio  Entered:1996-04-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: lennox-gastaut synd
Diagnostic Lab Data: 01JUN95 varicella antibody negative
CDC Split Type: WAES95121659
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0417B0  
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: pt recv vax 3AUG95&in NOV95 pt devel a classic herpes zoster rash on lt hand,which proceeded to upper arm&responded over a two-wk period to time in a classic fashion;

VAERS ID:85931 (history)  Vaccinated:1996-01-09
Age:9.0  Onset:1996-01-28, Days after vaccination: 19
Gender:Male  Submitted:0000-00-00
Location:Kansas  Entered:1996-04-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp chicken pox @ 8yr w/varivax dose 1
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96012060
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 9JAN96 & 28JAN96 pt devel chicken pox;the nurse also reported that pt brother also devel chicken pox p/vax # 96012059

VAERS ID:85937 (history)  Vaccinated:1995-08-01
Age:9.0  Onset:1996-01-15, Days after vaccination: 167
Gender:Unknown  Submitted:0000-00-00
Location:Illinois  Entered:1996-04-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96020143
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 1AUG95 & 15JAN96 pt devel chicken pox which was confirmed by a MD;

VAERS ID:85425 (history)  Vaccinated:1996-03-28
Age:9.0  Onset:1996-03-28, Days after vaccination: 0
Gender:Female  Submitted:1996-03-28, Days after onset: 0
Location:Missouri  Entered:1996-04-30, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MO96029
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0128B0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: became lightheaded, diaphoretic & fainted lasted approx 1min

VAERS ID:86294 (history)  Vaccinated:1996-05-13
Age:9.0  Onset:1996-05-13, Days after vaccination: 0
Gender:Female  Submitted:1996-05-14, Days after onset: 1
Location:California  Entered:1996-05-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: reflux ureters, ureters implant
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM78120 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: pt sitting on table to receive vax syncope, convuls 7-10min post vax

VAERS ID:86451 (history)  Vaccinated:1996-05-15
Age:9.6  Onset:1996-05-16, Days after vaccination: 1
Gender:Female  Submitted:1996-05-22, Days after onset: 6
Location:Ohio  Entered:1996-05-29, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp rxn @ 5yr w/engerix-B dose 2
Other Medications: Amoxicillin;cortisporin ear susp
Current Illness: rt otitis externa, rt otitis med,pharyng
Preexisting Conditions: allergic to eggs, amolgen & cortosporin ear susp
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2033A21 RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: erythema w/papules 2cm x 1cm @ site of inj;

VAERS ID:86501 (history)  Vaccinated:1996-04-02
Age:9.5  Onset:1996-04-02, Days after vaccination: 0
Gender:Male  Submitted:1996-04-02, Days after onset: 0
Location:Texas  Entered:1996-06-03, Days after submission: 61
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt, mild fever 1-2 yrs w/ DTP;
Other Medications: TB test by connaugt 2420-11;
Current Illness: none
Preexisting Conditions: no allergies, denies major hlth problems;
Diagnostic Lab Data: none
CDC Split Type: TX96062
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1166B2SCLA
Administered by: Public     Purchased by: Public
Symptoms: Hypertonia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Write-up: pt recv vax;jaw was clenched & fists were clenched; had glazed expression on face;

VAERS ID:87264 (history)  Vaccinated:1996-06-11
Age:9.5  Onset:1996-06-12, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:1996-06-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: BA96B012
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B1 RA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash all over the body

VAERS ID:87590 (history)  Vaccinated:1996-06-03
Age:9.4  Onset:1996-06-10, Days after vaccination: 7
Gender:Female  Submitted:1996-06-12, Days after onset: 2
Location:Washington  Entered:1996-07-08, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: molluscum contagiosum
Preexisting Conditions: NONE
Diagnostic Lab Data: Clinical exam
CDC Split Type: WA961242
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1127B0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Dermatitis bullous, Headache, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever 104, h/a, varicella rash requiring office visit & tx starting day 6, seen day 8 p/1st dose of vax

VAERS ID:87666 (history)  Vaccinated:1996-06-24
Age:9.7  Onset:1996-06-24, Days after vaccination: 0
Gender:Male  Submitted:1996-06-26, Days after onset: 2
Location:California  Entered:1996-07-09, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0175D0 LA
Administered by: Private     Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: urticarial rash began 3hrs p/vax;no new foods or new soaps;no resp problems;no hx hives in past;

VAERS ID:87850 (history)  Vaccinated:1996-07-10
Age:9.7  Onset:1996-07-10, Days after vaccination: 0
Gender:Male  Submitted:1996-07-11, Days after onset: 1
Location:New York  Entered:1996-07-15, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: OPV
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC done on adm to ped floor
CDC Split Type: BA9601
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.010700SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6A810170IMLA
Administered by: Public     Purchased by: Public
Symptoms: Conjunctivitis, Face oedema, Lacrimal disorder, Rhinitis, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: alert, emesis overfed, rt eyelids upper & lower swollen, scleral inj, profuse tearing from rt eye, lt nasal area swollen nasal stuffiness & nasal discharge, watery;

VAERS ID:87879 (history)  Vaccinated:1996-05-11
Age:9.4  Onset:0000-00-00
Gender:Male  Submitted:1996-07-10
Location:New York  Entered:1996-07-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol PO;sulphacetamide eye drop
Current Illness: URI w/conjunctivitis
Preexisting Conditions: h/o asthma;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1967A2  LA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Chills, Conjunctivitis
SMQs:, Severe cutaneous adverse reactions (broad), Guillain-Barre syndrome (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: weakness, chills, red eyes p/3-4 days of vax;

VAERS ID:88330 (history)  Vaccinated:1996-04-10
Age:9.8  Onset:1996-04-12, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Illinois  Entered:1996-07-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: granuloma annulare
Preexisting Conditions: exposure, varicella MAR96, granuloma annulare
Diagnostic Lab Data: t102.5
CDC Split Type: WAES96041686
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1501B   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Encephalitis, Hypertonia, Hypokinesia, Infection, Muscle twitching, Pain, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 10APR96 & 12APR96 pt devel severe chicken pox, felt to be a wild type;mom called MD & stated pt exp great pain in back & shoulders;could hardly walk or bend over;pt made clonic movements w/legs & jerking movements;encephalitis;

VAERS ID:88499 (history)  Vaccinated:1996-04-18
Age:9.6  Onset:1996-04-25, Days after vaccination: 7
Gender:Female  Submitted:0000-00-00
Location:Indiana  Entered:1996-07-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tagamet
Current Illness:
Preexisting Conditions: Ulcer
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES96050093
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1128B0IM 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pyrexia, Urticaria
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 18APR96 & 25APR96 pt exp hives on face & vesicles on back & fever;

VAERS ID:88556 (history)  Vaccinated:1995-07-18
Age:9.7  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1996-07-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES96050968
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0396B0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax;exp possible breakthrough chicken pox according to pt''s mom w/ about 25 pruritic pox concentrated on back, scalp, and around face; pt was not seen by MD & subsequently recovered;

VAERS ID:88684 (history)  Vaccinated:1996-05-23
Age:9.2  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:California  Entered:1996-07-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergy, sulfa;allergy, PCN
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES96060327
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: pt recv vax 23MAY96 & in 1996 pt exp a local rxn @ inj site & arm swelling;pt exp was serious enough to keep the pt home from school;

VAERS ID:88818 (history)  Vaccinated:1995-10-11
Age:9.4  Onset:1995-11-07, Days after vaccination: 27
Gender:Female  Submitted:0000-00-00
Location:Colorado  Entered:1996-07-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96061803
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11OCT95 & 7NOV95 pt exp a mild case of varicella w/a vesicular rash;there was no history of varicella exposure @ the time of vax;

VAERS ID:88040 (history)  Vaccinated:1996-07-15
Age:9.6  Onset:1996-07-15, Days after vaccination: 0
Gender:Female  Submitted:1996-07-18, Days after onset: 3
Location:Virginia  Entered:1996-07-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4333540IMA
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)
Write-up: hives appeared on upper body & upper extremities w/in 24hr p/vax;no other sx occurred;mom gave atarax & tavist which got rid of the hives;

VAERS ID:89189 (history)  Vaccinated:1996-07-16
Age:9.6  Onset:1996-07-16, Days after vaccination: 0
Gender:Female  Submitted:1996-07-17, Days after onset: 1
Location:Oklahoma  Entered:1996-08-19, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK9624
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6A81007  LA
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Myasthenic syndrome, Pallor, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: crying immed p/inj;c/o extreme muscle weakness beginning about 4PM;t102 @ 9PM along w/paleness;vomited beginning @ 11PM & cont for 12+hr;MD consulted APAP & Advil given;MD recommended reporting to clinic;

VAERS ID:89225 (history)  Vaccinated:1996-07-31
Age:9.5  Onset:1996-08-06, Days after vaccination: 6
Gender:Female  Submitted:1996-08-07, Days after onset: 1
Location:Missouri  Entered:1996-08-20, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1189B0SC 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4273274PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5C711144IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0246D0SCL
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 6AUG96 redness & swelling @ inj site;

VAERS ID:89241 (history)  Vaccinated:1996-08-15
Age:9.4  Onset:1996-08-15, Days after vaccination: 0
Gender:Female  Submitted:1996-08-15, Days after onset: 0
Location:Oregon  Entered:1996-08-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LA
Administered by: Private     Purchased by: Other
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: whole body erythema beginning 6hr p/vax;pruritis;no urticaria;no resp sx;t96.9;tx DPH;

VAERS ID:89302 (history)  Vaccinated:1996-08-15
Age:9.6  Onset:1996-08-16, Days after vaccination: 1
Gender:Female  Submitted:1996-08-20, Days after onset: 4
Location:Alaska  Entered:1996-08-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1420B1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: started w/itching & rash on back 16AUG afternoon;rash from head to toe & taken to ER hosp 830PM; given pred & sent home w/3 more doses;mom states all cleared up;

VAERS ID:90415 (history)  Vaccinated:1996-01-05
Age:9.7  Onset:1996-01-05, Days after vaccination: 0
Gender:Male  Submitted:1996-02-06, Days after onset: 32
Location:Minnesota  Entered:1996-09-11, Days after submission: 217
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tobramycin
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896043007L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4318030IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Injection site oedema, Injection site pain, Oedema, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 5JAN96 & devel an inj site rxn, characterized by edema from shoulder to elbow;the area is hot & painful to touch & looks like a giant hive;pt is having diff moving the arm d/t the pain;

VAERS ID:90104 (history)  Vaccinated:1996-07-11
Age:9.0  Onset:1996-07-11, Days after vaccination: 0
Gender:Female  Submitted:1996-09-03, Days after onset: 54
Location:Colorado  Entered:1996-09-23, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: elevated serum amylase 350;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1622B0 LA
Administered by: Private     Purchased by: Private
Symptoms: Blood amylase increased, Laboratory test abnormal, Parotid gland enlargement
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: acute parotid gland enlargement 2hr p/vax;no fever;only on rt side spontaneously resolved over next 5 days;

VAERS ID:90277 (history)  Vaccinated:1995-07-10
Age:9.5  Onset:1996-01-25, Days after vaccination: 199
Gender:Male  Submitted:0000-00-00
Location:California  Entered:1996-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: cough 1st inj
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM   A
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: p/vax pt devel a breathing problem that got worse over time;

VAERS ID:91840 (history)  Vaccinated:1996-10-15
Age:9.6  Onset:1996-10-16, Days after vaccination: 1
Gender:Male  Submitted:1996-10-18, Days after onset: 2
Location:Delaware  Entered:1996-10-02, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mantoux Tuberculin test given 15OCT96
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: DE9606
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0476D0SC 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0742B PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6F812044IM 
Administered by: Public     Purchased by: Public
Symptoms: Hypokinesia, Injection site hypersensitivity, Injection site mass, Injection site oedema, Insomnia, Oedema, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever up to 103.7 started about 22hr p/vax w/swelling around lt deltoid area;fever controlled w/APAP;16OCT96 unable to sleep, pain & fever;17OCT96 erythema, induration, swelling lt deltoid area;unable to lift arm;

VAERS ID:90477 (history)  Vaccinated:1996-08-26
Age:9.5  Onset:1996-08-26, Days after vaccination: 0
Gender:Female  Submitted:1996-08-26, Days after onset: 0
Location:California  Entered:1996-10-03, Days after submission: 38
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CA960092
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER0893D IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anaphylactoid reaction, Convulsion, Hypotonia, Injury
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: anaphylactic rxn to hep B vax <30min;fell out of chair then convulsed;

VAERS ID:90521 (history)  Vaccinated:1996-07-23
Age:9.9  Onset:1996-07-24, Days after vaccination: 1
Gender:Male  Submitted:1996-09-30, Days after onset: 68
Location:Michigan  Entered:1996-10-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MI96141
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0280D0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24hr p/vax pt devel rash;started on chest back spread to legs & arms & tops of feet;itchy;pink-red color;fine pinpoint;lasted 1-2wk;

VAERS ID:90570 (history)  Vaccinated:1996-08-22
Age:9.9  Onset:1996-08-22, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:1996-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: TX96138
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0397D1SC 
Administered by: Public     Purchased by: Public
Symptoms: Gaze palsy, Hypotonia, Injury, Pallor
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: sitting on a chair p/vax became limp, eyes rolled back, became & limp, head hit on back of chair; BP 100/60, P 70, 20R;

VAERS ID:90959 (history)  Vaccinated:1995-11-21
Age:9.1  Onset:1996-06-19, Days after vaccination: 211
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1996-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96071653
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0745B0SCA
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 21NOV95 & on 19JUN96 pt exp breakthrough varicella;

VAERS ID:91159 (history)  Vaccinated:1996-09-03
Age:9.0  Onset:1996-09-11, Days after vaccination: 8
Gender:Male  Submitted:0000-00-00
Location:Florida  Entered:1996-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: PCR analysis of specimen from pat''s lesions revealed wild-type varicella virus;
CDC Split Type: WAES96091093
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2123A20IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1658B0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Infection, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 3SEP96 & 11SEp96 pt devel a bad case of chickenpox w/over 100 lesions located on the back, trunk, extremities & face & a mild fever;

VAERS ID:91280 (history)  Vaccinated:1996-05-29
Age:9.1  Onset:1996-10-10, Days after vaccination: 134
Gender:Male  Submitted:1996-10-16, Days after onset: 6
Location:Nevada  Entered:1996-10-22, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UPJ obstruction, Lt kidney removed;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1950A20 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1659B0 RA
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster, Infection
SMQs:
Write-up: herpes zoster (rt scapular region);

VAERS ID:92978 (history)  Vaccinated:1995-07-19
Age:9.0  Onset:1995-07-21, Days after vaccination: 2
Gender:Male  Submitted:1995-09-29, Days after onset: 70
Location:Michigan  Entered:1996-10-30, Days after submission: 397
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: psychological problems;nka
Diagnostic Lab Data:
CDC Split Type: 950096711
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1722A20IMA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv one .5 cc dose; 2 days p/ exp fever. abdominal pain, vomiting; sx resolve in 2 days

VAERS ID:93007 (history)  Vaccinated:1995-08-30
Age:9.0  Onset:1995-09-04, Days after vaccination: 5
Gender:Female  Submitted:1995-10-13, Days after onset: 39
Location:New York  Entered:1996-10-30, Days after submission: 383
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: allergy shots 28AUG95
Current Illness:
Preexisting Conditions: pt recv allergy shot 28AUG96 & had a localized rxn;
Diagnostic Lab Data:
CDC Split Type: 950105511
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Asthenia, Constipation, Diarrhoea, Malaise, Somnolence, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)
Write-up: pt recv vax & 5 days post vax felt draggy, was not feeling good, was lethargic, had diarrhea, cramps, constipation & weight loss & did not want food;ER or MD visit was required;tx ATB;

VAERS ID:93468 (history)  Vaccinated:1996-06-12
Age:9.0  Onset:1996-06-29, Days after vaccination: 17
Gender:Female  Submitted:1996-08-13, Days after onset: 45
Location:Unknown  Entered:1996-10-30, Days after submission: 78
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Griseofulvin;Keflex;
Current Illness:
Preexisting Conditions: bacterial scalp infect, fungal scalp infect;
Diagnostic Lab Data:
CDC Split Type: 960116981
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1991A20IMA
Administered by: Private     Purchased by: Other
Symptoms: Eye disorder, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (broad)
Write-up: pt recv vax & 17 days post vax pt was found to have rt sided Bell''s palsy;pt was seen by MD & started on pred;pt was examined by MD 11JUL96;sx had improved somewhat but lt eye droop & facial involvement persisted;

VAERS ID:91639 (history)  Vaccinated:1996-10-01
Age:9.7  Onset:1996-10-01, Days after vaccination: 0
Gender:Female  Submitted:1996-10-23, Days after onset: 22
Location:New York  Entered:1996-11-05, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: BA96024
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0398D1 RA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0736K1PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6D811091 RA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: pt fainted for 10min p/vax;

VAERS ID:91926 (history)  Vaccinated:1996-10-16
Age:9.7  Onset:1996-10-16, Days after vaccination: 0
Gender:Female  Submitted:1996-10-16, Days after onset: 0
Location:Maryland  Entered:1996-11-14, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: EPI & DPH
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MD96038
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0385D1 LA
Administered by: Other     Purchased by: Other
Symptoms: Conjunctivitis, Hypertension, Oedema, Pruritus, Rhinitis, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 16OCT96 915AM & 10 min later began to exp runny nose, red eyes & itchy eyes;denied SOB or chest pain;VS 1128/68, 88, 20;950AM epi given & DPH;1005AM VS 118/80, 92, 20;parent notified & 911 called;redness, swelling, itching;

VAERS ID:92314 (history)  Vaccinated:1996-11-08
Age:9.7  Onset:1996-11-08, Days after vaccination: 0
Gender:Male  Submitted:1996-11-12, Days after onset: 4
Location:Illinois  Entered:1996-11-25, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to bee stings
Diagnostic Lab Data: NONE
CDC Split Type: IL97044
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Oedema peripheral, Rash maculo-papular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: swelling began 3hr p/vax & by evening shoulder to fingers were swollen;circumference 2X nl size;blotchy rash on arm & chest;given DPH x 1;rash disappeared by next AM looked better;

VAERS ID:92655 (history)  Vaccinated:1996-11-08
Age:9.7  Onset:1996-11-09, Days after vaccination: 1
Gender:Male  Submitted:1996-12-06, Days after onset: 27
Location:Illinois  Entered:1996-12-09, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: IL97045
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Oedema peripheral, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5DEC96 pt told mom arm bothers him;no pain but itches;5DEC96 samll (half dollar) reddened area on rt area w/4-5 small scabbed area;

VAERS ID:92732 (history)  Vaccinated:1996-10-23
Age:9.9  Onset:1996-10-23, Days after vaccination: 0
Gender:Male  Submitted:1996-12-04, Days after onset: 42
Location:Illinois  Entered:1996-12-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAMVHA491A91IMRL
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETH49680490IMLL
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES6F712010SCLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)
Write-up: a few hr p/vax pt devel nausea & shaking chills;

VAERS ID:92859 (history)  Vaccinated:1996-11-06
Age:9.9  Onset:1996-11-06, Days after vaccination: 0
Gender:Male  Submitted:1996-11-06, Days after onset: 0
Location:Michigan  Entered:1996-12-13, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MI96171
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2139A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Vasodilatation
SMQs:
Write-up: pt had no problems immed p/vax;@ approx 9:45 pt had confluent reddened ares on both wrists (inner aspect) L$gR;epi given into lt upper arm;EMS was activated;transferred to another hosp;

VAERS ID:93266 (history)  Vaccinated:1996-11-21
Age:9.6  Onset:1996-11-21, Days after vaccination: 0
Gender:Male  Submitted:1996-11-22, Days after onset: 1
Location:Illinois  Entered:1996-12-24, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1405B1 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Confusional state, Hyperhidrosis, Miosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Inject given in L deltoid. Laughing and talking walked back to class. Sat down. Became very pale, sweaty, disoriented. Teacher walked pt back to office. Pupils equal, very slow to respond. Parents called - talked w/mother later - no

VAERS ID:93299 (history)  Vaccinated:1996-12-13
Age:9.7  Onset:1996-12-14, Days after vaccination: 1
Gender:Female  Submitted:1996-12-16, Days after onset: 2
Location:Illinois  Entered:1996-12-27, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B1IM 
Administered by: Other     Purchased by: Public
Symptoms: Face oedema, Oedema peripheral, Pyrexia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt exp hives, swollen w/in 24 hr on hands, feet,lips; tx w/Benadryl; w/in 12 hr pt covered w/ sever welts;per mtr pt recv shot of Prednisone, Benadryl;temp of 101;sx persisted until 12/16/1996

VAERS ID:93429 (history)  Vaccinated:1996-11-25
Age:9.6  Onset:1996-11-25, Days after vaccination: 0
Gender:Female  Submitted:1996-11-26, Days after onset: 1
Location:Illinois  Entered:1996-12-30, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: IL960119
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B0 LA
Administered by: Other     Purchased by: Public
Symptoms: Skin discolouration, Vasodilatation
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax; cheeks were red and had large circular reddened area w/ in it;rxn resolved;

VAERS ID:93554 (history)  Vaccinated:1996-11-26
Age:9.6  Onset:1996-11-27, Days after vaccination: 1
Gender:Male  Submitted:1996-12-04, Days after onset: 7
Location:Illinois  Entered:1997-01-06, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1405B1IMLL
Administered by: Other     Purchased by: Unknown
Symptoms: Asthenia, Cough, Face oedema, Pyrexia, Rash maculo-papular, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: by late wed pm pt had welts all over, red spots, swollen face, fever of 101 degrees F, tired, threw up. Wed thru Mon pt had bad cough & extreme tiredness. Family refuses 3rd dose.

VAERS ID:93745 (history)  Vaccinated:1996-11-27
Age:9.2  Onset:1996-12-05, Days after vaccination: 8
Gender:Female  Submitted:1996-12-31, Days after onset: 26
Location:Michigan  Entered:1997-01-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: mold, cats
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0207D1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Hypersensitivity, Pallor, Pruritus, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4th day pale-stomachache;8th day mod rash, t99-100 10 days; rash red raised then hives lasted 5 days from head to toes all over body;less overnoc but shortly p/waking rash red all over;itchy;allergic hypersensativity to MMR;

VAERS ID:93972 (history)  Vaccinated:1997-01-15
Age:9.1  Onset:1997-01-15, Days after vaccination: 0
Gender:Male  Submitted:1997-01-15, Days after onset: 0
Location:Texas  Entered:1997-01-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data: NONE
CDC Split Type: TX97091
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0877D0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Hypertension, Syncope, Visual disturbance
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: pt recv vax & 5-6min p/vax pt couldn''t see well & felt weak then fainted for 3 seconds;BP 90/60, p96, repeat BP 92/62, p 80;pt doing fine p/15min;

VAERS ID:94349 (history)  Vaccinated:1995-08-28
Age:9.7  Onset:1996-11-26, Days after vaccination: 456
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1997-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96120291
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0404B0SC 
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Infection, Pharyngitis
SMQs:, Severe cutaneous adverse reactions (narrow), Agranulocytosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 28AUG95 & 27NOV96 pt devel a varicella-like rash w/approx 10 lesions;

VAERS ID:94407 (history)  Vaccinated:1996-12-05
Age:9.2  Onset:1996-12-15, Days after vaccination: 10
Gender:Female  Submitted:0000-00-00
Location:California  Entered:1997-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Augmentin
Current Illness: sinusitis
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96121318
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0772D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 5OCT96 & 15OCT96 pt devel a chicken pox like rash w/9 lesions that had very large (giant) clear vesicles, generalized;

VAERS ID:94988 (history)  Vaccinated:1996-10-07
Age:9.3  Onset:1996-10-07, Days after vaccination: 0
Gender:Male  Submitted:1996-10-18, Days after onset: 11
Location:Indiana  Entered:1997-02-12, Days after submission: 117
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: pt took flu vax last yr w/no problems;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER6F71248 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 7OCT96 & on 10OCT96 c/o abd pain w/vomiting;t100.3 sent to hosp for 23hr eval;c/o abd w/nausea several days;mom thought could be rxn to flu vax;

VAERS ID:95014 (history)  Vaccinated:1987-08-08
Age:9.0  Onset:1987-08-08, Days after vaccination: 0
Gender:Male  Submitted:1996-12-30, Days after onset: 3432
Location:Massachusetts  Entered:1997-02-12, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp inconsolable crying, swelling, redness, fever & twitching/jerking limb
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: ear infect, apneic episodes
Diagnostic Lab Data: Neuro eval reveals developmental delay & autisitc tendancies;
CDC Split Type: QC9632
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABDTP2570IM 
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Muscle twitching, Oedema, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recv vax & parent noticed inconsolable crying, swelling, redness, fever & twitching/jerking of limbs;sx were reported to MD but no action was taken;

VAERS ID:95015 (history)  Vaccinated:1987-08-17
Age:9.0  Onset:1987-08-17, Days after vaccination: 0
Gender:Male  Submitted:1996-12-30, Days after onset: 3423
Location:Massachusetts  Entered:1997-02-12, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp inconsolable crying, swelling, redness, fever & twitching/jerking of limb
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: ear infect, apneic episodes
Diagnostic Lab Data: neuro eval reveals devel delay & autistic tendancies
CDC Split Type: QC9632
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABDTP2571IM 
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Muscle twitching, Oedema, Pyrexia, Similar reaction on previous exposure to drug, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt exp inconsolable crying, swelling, redness, fever & twitching/jerking of limbs;sx were reported to MD but no action was taken;twitching & jerking became more pronounced p/2nd dose;

VAERS ID:95016 (history)  Vaccinated:1987-10-15
Age:9.0  Onset:1987-10-15, Days after vaccination: 0
Gender:Male  Submitted:1996-12-30, Days after onset: 3364
Location:Massachusetts  Entered:1997-02-12, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: pt exp crying, swelling, redness, fever twitching/jerking w/dose 1&2;
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: Ear infect, apneic episodes
Diagnostic Lab Data: neuro eval reveals developmental delay & autistic tendancies
CDC Split Type: QC9632
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABDTP258B2IM 
Administered by: Private     Purchased by: Public
Symptoms: Autism, Convulsion, Mental retardation severity unspecified
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: pt recv vax & was hosp for full-blown sz;pt is currently medicated & developmentally delayed;

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