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Case Details (Sorted by Age)

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VAERS ID:239349 (history)  Vaccinated:2005-05-31
Age:14.0  Onset:2005-05-31, Days after vaccination: 0
Gender:Male  Submitted:2005-05-31, Days after onset: 0
Location:Oregon  Entered:2005-06-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAMVHA844B2L1IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1212DA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dyskinesia, Musculoskeletal stiffness, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: About 3-4 minutes after Td, and Hep A vaccines, pt has upper body stiffening, his right arm flew up and eyes glazed per mom. Episode ? ? and to lie down, given juice and O2. Recovered fully.

VAERS ID:239550 (history)  Vaccinated:2005-06-07
Age:14.0  Onset:2005-06-08, Days after vaccination: 1
Gender:Male  Submitted:2005-06-09, Days after onset: 1
Location:California  Entered:2005-06-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: RAWD, URI, HA
Preexisting Conditions: Allergic to dust mites, pollen, cats
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1588AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Menactra site, given 2 days ago on 06/7/05, 5 1/2 inches wide - 10 inches long at left arm, red/heat/swelling/pain.

VAERS ID:239562 (history)  Vaccinated:2003-07-10
Age:14.0  Onset:2003-07-21, Days after vaccination: 11
Gender:Male  Submitted:2005-06-09, Days after onset: 689
Location:Virginia  Entered:2005-06-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: denies, yet had cold 2 weeks prior to booster per medical records.
Preexisting Conditions: none
Diagnostic Lab Data: 28 Feb 2005: EBNA 7.52(H) ()-0.90) EB VCA IGG 4.850 (H) (0-0.90) EBVCA IGM 0.080 CMV IgG 0.01 CMV IgM 0.11 (normal 0.90) CMP: Alb 4.8, bili 0.4, Ca 9.9, CO2 25, CL 104, Creat 0.9, gluc 87, Alk Phos 145 (H), K 4.4, TP 7.8, NA 143, ALT 11, AST 14, BUN 17 Hepatitis screen: HAV Igm, HBS AG, HCV AB, HBcAb non-reactive; HBsAb reactive by repeat verification. Thyroid Panel: Free T4 1.12 nl, TSH 1.513 CBC: WBC 7.2, RBC 5.45, plat 333, H/H 15.9/46.2 Urinalysis: normal 23 Jul 2003: EBNA 8.51 (H) EBV VCA IgG 5.34 (H) EBV VCA IgM 0.10 (nl 0.90) BMP: Ca 9.9, CO2 26, CL 100, Creat 0.7, gluc 79, K 4.3, Na 139, BUN 19, Anion gap 14 Lyme titer 0.734 (0-0.99) CBC: WBC 9.5, RBC 5.28, H/H 15.4/45.3, Plat 483, neut 70.6%, Lymph 18.8%, Mono 7 %, EOS 2.8%
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEUR    
Administered by: Military     Purchased by: Military
Symptoms: Angiopathy, Asthenia, Bradycardia, Dehydration, Diarrhoea, Dizziness, Dysgeusia, Dyskinesia, Dyspnoea, Ear pain, Erythema, Fatigue, Flushing, Gait disturbance, Guillain-Barre syndrome, Hyperaesthesia, Hypertension, Hyporeflexia, Laboratory test abnormal, Lethargy, Lung disorder, Malaise, Muscle spasms, Myasthenic syndrome, Nausea, Oral intake reduced, Otitis media, Pharyngitis, Pyrexia, Viral infection, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Malignancy related conditions (narrow), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Demyelination (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: This healthy 15 year-old received a routine tetanus-diphtheria booster on 10 July 2003. Returning from a family camping trip approximately 16-20 July 2003 he complained of fatigue with bilateral leg cramping. He initially believed this due to the drive home; however later that evening his fatigue increased with nausea, vomiting and diarrhea. His parent's state they stayed in a resort trailer, rode horses, swam and canoed at the lake. He denied any tick or mosquito bites or any illness one month prior to this illness. He awoke the next day voicing difficulty walking. He states he needed to “lock his knees” to keep from falling over and was unable to stand up straight. This condition worsened over the next two days where upon his parents sought medical treatment on 23 July 2003. The emergency room physician documented complaints of lethargy, vomiting x 1, decreased oral intake with a bad taste in the mouth, left ear pain and dizziness and not feeling well. His physical exam revealed dull left tympanic membrane and throat exudates with mild erythema, neuro grossly normal except unable to elicit reflexes on both knees with motor 5/5 and sensory intact bilaterally. His gait was questioned as dragging on left versus crossing leg. He was treated with IV NS, oral Amoxicillin 500mg TID x 10 days for a diagnosis of left otitis media, pharyngitis and dehydration. While attending a ball game that evening his parents described him as “looking like a child with cerebral palsy” due to the stiff jerking movements and weakness of his arms and legs. By 8-9 pm he returned to the emergency room with difficulty breathing despite 100% room air oxygen saturation, decreased appetite, flushed skin with hypersensitivity without evidence of a fever. Full diagnostic included a spinal tap, re-examination for ticks and laboratory evaluation revealed a diagnosis of Guillain Barré Syndrome. A neurology consult was obtained (see 23 Jul 2003 consult below) and he was admitted for two weeks. During his admission he reports having 1/3rd lung capacity with complete loss of function both legs with decreased deep tendon reflexes and gross weakness with decreased use of his arms and hands. He states he developed hypertension with bradycardia that frequently triggered the monitor alarms (Blood pressure ranged 152/90-112/53 with heart rate 66-92). IVIG factor was given on day 8-9 of admission following “confirmation” of Guillain Barré Syndrome. Two days following IVIG factor administration he reports increased use of large muscles groups with returning use of fine motor function. He reports muscular loss of function occurred in ascending order from his feet to head with return of muscular function in a descending order head to feet. Over the next 30 days, he reports increasing muscular function progressing from a wheel chair to walker to cane to walking normally. He reported a weight loss of 20 pounds while hospitalized which has resolved (111-140 Lbs). He described a reoccurrence of leg weakness with a familiar hunched position two weeks ago (Jan 2005) with marked fatigue. He was diagnosed with mononucleosis. These symptoms resolved two days later. He reports he has resume normal activities such as playing the guitar, marching band, sports (skiing) and schooling; yet his energy levels are not back to normal. His also complains of a persistent hypersensitivity to both feet and the top of his head. He was referred to the Vaccine Healthcare Center on 28 March 2005 for assistance in vaccine exemption and a VAERS filing.

VAERS ID:240131 (history)  Vaccinated:2004-04-06
Age:14.0  Onset:2004-04-08, Days after vaccination: 2
Gender:Female  Submitted:2004-08-19, Days after onset: 133
Location:New York  Entered:2005-06-10, Days after submission: 295
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: The patient had previously received five doses of DTP. The dates of vaccination were not provided.
Diagnostic Lab Data: Relevant diagnostic tests obtained included CBC, urinalysis, ANA, CSF, ESR, metabolic panel, C3 C4 complement. All tests were within normal limits.
CDC Split Type: 200401633
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1014AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Face oedema, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: From initial information received on 4/15/04 from a physician regarding an adverse event occurring in the USA, it was reported that a 14 year old female patient was administered a TD ADS ADULT booster dose, lot number U1014AA, administered in the left arm on 4/6/04 (route of administration not provided). Two days later the patient developed facial swelling, arthralgia, and a rash on arms and elbows. She also experienced fever, swelling of her lips, hives and rash. The patient called the doctor on 4/12/04 and upon examination on 4/14/04 she complained of a 101 degree F fever, lower lip swelling and generalized hives. The physician ordered Atarax. The rash was reported as persisting. From additional information received on 8/13/04 from the initial reporter, the route of vaccination was provided as IM. It was reported that the patient experienced an urticarial rash and the adverse event coding has been accordingly updated (hives and rash were changed to urticarial rash). The patient was seen by an allergy specialist on 4/22/04, who advised that the patient continue the Atarax. No labs were done at the specialist''s office, however a CBC, metabolic panel, ANA, ESR, RF, urinalysis and C3 C4 complement were completed on an unspecified date and were within normal limits. On 5/10/04, the patient discontinued the Atarax and was started on Periactin 25mg three times per day, as her urticarial rash and swelling of body parts showed up in a limited way. Per the patient''s parent, as of 5/9/04, the patient was free of rashes on Periactin and had no further episodes of rash or swelling. The patient recovered from the events. No further information is anticipated, this case is considered closed.

VAERS ID:239805 (history)  Vaccinated:2005-06-09
Age:14.0  Onset:2005-06-09, Days after vaccination: 0
Gender:Female  Submitted:2005-06-09, Days after onset: 0
Location:Indiana  Entered:2005-06-14, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;Hep B (unknown mfr);1;17;In Sibling
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)GLAXOSMITHKLINE BIOLOGICALS030AA IMRA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD125 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Paleness, nausea, vomiting, chills, cool packs to forehead, neck, sitting position, water

VAERS ID:239807 (history)  Vaccinated:2005-06-02
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2005-06-07
Location:Illinois  Entered:2005-06-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1279AA5 RA
Administered by: Private     Purchased by: Public
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness of 1/3 of right arm, non tender. Started after 24 hours; resolved after 72 hours. No treatment necessary.

VAERS ID:239846 (history)  Vaccinated:2005-06-08
Age:14.0  Onset:2005-06-08, Days after vaccination: 0
Gender:Male  Submitted:2005-06-14, Days after onset: 6
Location:Tennessee  Entered:2005-06-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1639AA0IM 
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Erythema, Fatigue, Malaise, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Severe redness 4 inches/entire deltoid muscle. Swollen arm/deltoid, painful site, anorexia $g3 meals. Over 3 day period, severe malaise and fatigue and anorexia. Rash on chest on fourth day. Not able to return to normal activities until day #5.

VAERS ID:239972 (history)  Vaccinated:2005-06-15
Age:14.0  Onset:2005-06-16, Days after vaccination: 1
Gender:Male  Submitted:2005-06-16, Days after onset: 0
Location:Louisiana  Entered:2005-06-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Nausea, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: received inj #2 Hep B on 6/15/05 at health unit, 24 hours later awoke with headache, blurred vision and nausea and vomiting, was brought to hosp er, problems had resolved by the time he was seen by physician, he was observed with no further treatment given

VAERS ID:239974 (history)  Vaccinated:2005-06-15
Age:14.0  Onset:2005-06-15, Days after vaccination: 0
Gender:Male  Submitted:2005-06-16, Days after onset: 1
Location:Texas  Entered:2005-06-16
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: ALLERGIES TO INSECT STINGS/BITES, OTHERWISE INSIGNIFICANT
Diagnostic Lab Data: NOT APPLICABLE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1639AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Fatigue, Headache, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: RCD VACCINE AT 10AM 6.15.05 AT 10PM SAME DAY DEVELOPED FINE RED RASH TO FACE, HA, VERY TIRED, VOMITING. TODAY STILL WITH HA, VERY TIRED AND WITH RASH STILL, THOUGH IT IS FAINTER.

VAERS ID:240004 (history)  Vaccinated:2005-06-13
Age:14.0  Onset:2005-06-13, Days after vaccination: 0
Gender:Male  Submitted:2005-06-15, Days after onset: 2
Location:Indiana  Entered:2005-06-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1574AA  LA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Dizziness, Feeling hot, Nausea, Pain, Pyrexia, Skin discolouration
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Immunization given on 06/13/2005 at approximately 3PM. At 6:30PM developed temperature 101, weakness and by next day pain to left arm - arm hot to touch, dizzy, pale when got up, nausea. By 06/14/2005 PM was feeling better.

VAERS ID:240025 (history)  Vaccinated:2005-06-02
Age:14.0  Onset:2005-06-02, Days after vaccination: 0
Gender:Female  Submitted:2005-06-17, Days after onset: 15
Location:South Carolina  Entered:2005-06-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: SC0508
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURERTD-1080IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Hypersensitivity, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: received Td vaccine, went home - became weak and lightheaded in the car and after getting out of car, patient passed out. She remained "out" for several minutes and then revived. Again, she became pale, light-headed. Ambulance called and EMTs assessed patient and told mother to take teen to private MD. MD stated she had an allergic reaction to the Td vaccine. Administered benadryl x 2 days

VAERS ID:240042 (history)  Vaccinated:2005-05-27
Age:14.0  Onset:2005-05-28, Days after vaccination: 1
Gender:Female  Submitted:2005-06-03, Days after onset: 6
Location:Georgia  Entered:2005-06-20, Days after submission: 17
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1512AL0 LA
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Hyperaesthesia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: Fever 103, severe weakness, sensitivity to touch for 36 hours.

VAERS ID:240224 (history)  Vaccinated:2005-06-16
Age:14.0  Onset:2005-06-16, Days after vaccination: 0
Gender:Male  Submitted:2005-06-21, Days after onset: 5
Location:Arizona  Entered:2005-06-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA018BA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1641AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Developed fever and fatigue the evening the shot was given. Also c/o mild intermittent headache. Fever was up to 102 and lasted for 5 days. Self medicated with advil prn. Patient seen today, (6/21/05) doing better with no fever so far. No further treatment given.

VAERS ID:240373 (history)  Vaccinated:2005-06-20
Age:14.0  Onset:2005-06-21, Days after vaccination: 1
Gender:Male  Submitted:2005-06-23, Days after onset: 2
Location:New York  Entered:2005-06-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Throat and urine cultures were neg(-). Chest x-ray was neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1640AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dehydration, Erythema, Haematuria, Mucous membrane disorder, Oedema peripheral, Pyrexia, Rash maculo-papular, Rash pruritic
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tubulointerstitial diseases (broad)
Write-up: Patient received Menactra 6/20/05. 1 day later developed fever 102, swelling and rednesss of hands and feet, and a diffuse maculopapular pruritic rash. 6/22 seen in ER with mild dehydration and diffuse rash. Treated with benadryl. 6/23/05 worsening rash, now over oral mucosa, persistent fever, 3+ hematuria. Admitted to hospital with R/O Stevens Johnson Syndrome 7/25/06 Medical records x 30 pgs received/reviewed. Final diagnosis was confirmed as allergic reaction to Menactra vaccine vs viral syndrome. Pt was treated with Tylenol and Benadryl while hospitalized. Throat and urine cultures were neg(-). Chest x-ray was neg. Pt to FU with PCP within 1 week. Records submitted for scanning. Paper report filed/sem

VAERS ID:240596 (history)  Vaccinated:2000-10-12
Age:14.0  Onset:2000-10-20, Days after vaccination: 8
Gender:Female  Submitted:2005-06-17, Days after onset: 1701
Location:Pennsylvania  Entered:2005-06-23, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinus infection, viral infection
Preexisting Conditions: The pt had a sinus infection/viral infection seven days prior to immunization. No problems with previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0504658A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSENG3332A90IM 
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEUR  IM 
Administered by: Private     Purchased by: Private
Symptoms: Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: This case was initially reported by a consumer and confirmed by a pediatrician and described the occurrence of Guillain Barre Syndrome in her 13 year old daughter who received Engerix-B. This case has been reported directly to VAERS. On 10/12/00, the pt received the first dose of Engerix-B, lot ENG3332A9. On the same day, the pt received an injection of TD. Eight days post-immunization. On 10/20/00, the pt experienced Guillain Barre Syndrome with partial paralysis which was considered life-threatening. The pt was seen at a physician''s office and subsequently hospitalized. On an unspecified date, the events resolved. The immunization series was delayed. The immunization series was restarted on 5/11/04 with Recombivax without inicident. The physician considered the events to be possibly related to vaccination with Engerix-B. The mother stated "Please understand, Guillain Barre Syndrome''s (sic) cause is unknown. There is no definite way to prove that it came from vaccine. There is evidence that some patients who have had the disease had a vaccine relatively soon to having the disease. My daughter had a vaccine, but also had a sinus/virus infection." The pediatrician reported that the sinus/virus infection symptoms onset on 10/4/00. Report subsequently received via Mfr. (Note: the pediatrician also submitted a report to VAERS.) Comment: Guillain Barre Syndrome was assessed as medically serious by MFR.

VAERS ID:240643 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2005-06-17
Location:New York  Entered:2005-06-23, 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: UNK
Preexisting Conditions: The pt''s medical history, concurrent conditions, and concurrent medications were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0521940A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This case was reported by a pharmacist and described the occurrence of rash in a 14 year old female pt who received Engerix B. On an unspecified date, the pt received a dose of Engerix B (dose number not specified). On an unspecified date following the administration of Engerix B, the pt experienced a "mosquito bite like" rash. The pharmacist "got the impression that the rash was not localized" but was not sure where the rash was located. The pt was seen at a physician''s office and was treated with diphenhydramine. The event resolved on an unspecified date. The vaccination with Engerix B.

VAERS ID:240389 (history)  Vaccinated:2005-06-12
Age:14.0  Onset:2005-06-13, Days after vaccination: 1
Gender:Male  Submitted:2005-06-19, Days after onset: 6
Location:California  Entered:2005-06-24, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURU1572AC0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: right deltoid with 3-4 inch of redness swelling warm to touch, fever for 24 hours none after 24 hours

VAERS ID:240720 (history)  Vaccinated:2005-06-20
Age:14.0  Onset:2005-06-21, Days after vaccination: 1
Gender:Male  Submitted:2005-06-27, Days after onset: 6
Location:Georgia  Entered:2005-06-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1588AA0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Injection site with large tender, indurated,pink area, 15 by 12 cm. Seen in office on 6/22/05. Resolution by 6/24/05 pm

VAERS ID:241198 (history)  Vaccinated:2005-05-11
Age:14.0  Onset:2005-05-17, Days after vaccination: 6
Gender:Male  Submitted:2005-05-27, Days after onset: 10
Location:Kansas  Entered:2005-07-11, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Varicella;Varicella (Varivax);1;0;In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: KS200517
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1250IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0591P0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Injection site erythema, Injection site swelling, Pruritus, Pyrexia, Skin ulcer, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Mom states child broke out with red spots 05/17/05 and they progressed to raised red spots, blistered spots, crusted lesions over face, neck, stomach, arms and legs. Itchy, 50-500 lesions; 100 temp. Information reported by mom on 05/23/05. Mom was adamant that child had not been exposed to chickenpox by another person.

VAERS ID:241222 (history)  Vaccinated:2005-06-29
Age:14.0  Onset:2005-06-30, Days after vaccination: 1
Gender:Male  Submitted:2005-07-07, Days after onset: 7
Location:Virginia  Entered:2005-07-12, 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: PPD, Aventis, C2677AA, ID, LA, 0 previously; Augmentin
Current Illness: Furuncle
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1575AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1110P0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Local swelling, redness and itching on left upper arm. Was improving when seen in office on 7/1/05.

VAERS ID:241493 (history)  Vaccinated:2005-07-18
Age:14.0  Onset:2005-07-18, Days after vaccination: 0
Gender:Female  Submitted:2005-07-19, Days after onset: 1
Location:Maine  Entered:2005-07-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Patient had a brief seizure and loss consciousness. Patient was seen by emts and taken to the hospital. Patient fainted again after about 3 hours.

VAERS ID:241568 (history)  Vaccinated:2005-07-18
Age:14.0  Onset:2005-07-19, Days after vaccination: 1
Gender:Male  Submitted:2005-07-20, Days after onset: 1
Location:California  Entered:2005-07-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well child check-up
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1211AA1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Pyrexia
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: The pt has several bug bites on arms and hands. He had a TD booster yesterday and it''s in same arm. He reacts a lot to insect bites. He has a fever of 101F.

VAERS ID:241679 (history)  Vaccinated:2005-07-07
Age:14.0  Onset:2005-07-08, Days after vaccination: 1
Gender:Male  Submitted:2005-07-13, Days after onset: 5
Location:Pennsylvania  Entered:2005-07-25, 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: Atenolol 25mg qd
Current Illness: Hypertension control with med
Preexisting Conditions: Imitrex allergy, hemolytic uremic syndrome, e-coli water-born.
Diagnostic Lab Data: Urine dip, CBC/d, lyme ab panel.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1370DA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Chest pain, Chills, Head discomfort, Malaise, Musculoskeletal stiffness, Nausea, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Pt had nausea/sick to stomach with chill at 2:30AM, temp of 103.6. Neck/head bothering, sore throat, chest tightness (sharp pain). Tylenol/Motrin given for temp. Spoke with representative. Benadryl 25mg, Compazine 5 PO q 5 as needed. Call to mom 07/14/05, Back to normal.

VAERS ID:241798 (history)  Vaccinated:2005-07-18
Age:14.0  Onset:2005-07-18, Days after vaccination: 0
Gender:Male  Submitted:2005-07-20, Days after onset: 2
Location:Missouri  Entered:2005-07-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Albuterol, MDI
Current Illness: NONE
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0202R1 RA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1662AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Injection site induration, Injection site oedema, Injection site reaction
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Induration surrounding injection site. 16 X 18cm area of edema surrounding site. Information from Follow-up report states I have received follow-up information on the VAERS report #241798. I spoke with the MD on this patient. She indicated the reaction to the Menactra vaccination. The patient tool Tylenol for 2 days, the swelling on the arm lasted for 5 days, and that the subject had guarded use of that arm. She state that he really didn''t even want to lift it, but would if he had to. No other symptoms were reported.

VAERS ID:241814 (history)  Vaccinated:2005-07-06
Age:14.0  Onset:2005-07-06, Days after vaccination: 0
Gender:Male  Submitted:2005-07-19, Days after onset: 13
Location:Virginia  Entered:2005-07-27, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1216GA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Convulsion, Dysarthria, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt became convulsive for approx. 30 seconds, then had a loss of consciousness for approx. 1 minute. After regaining consciousness he was unable to walk for approx. 5 minutes and his speech seemed to be slurred. No treatment was administered.

VAERS ID:242015 (history)  Vaccinated:2005-07-11
Age:14.0  Onset:2005-07-11, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2005-08-02
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: Asthma
Diagnostic Lab Data: EEG and EKG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1563AA0 LA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Musculoskeletal stiffness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Pt complained of feeling dizzy after vaccine was administered, approx. 11:10, while pt seemed to be fainting (falling over while sitting in chair), her extremities became ver stiff. Pt responded to verbal stimulation after 1 minute.

VAERS ID:242096 (history)  Vaccinated:2005-07-19
Age:14.0  Onset:2005-07-19, Days after vaccination: 0
Gender:Female  Submitted:2005-07-29, Days after onset: 10
Location:New Hampshire  Entered:2005-08-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Suspected seasonal and food allergies.
Diagnostic Lab Data: Allergy testing
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1572AC  RA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LAB126  LA
Administered by: Private     Purchased by: Unknown
Symptoms: Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Urticaria within 30-60 minutes of vaccine, swollen lips and hives.

VAERS ID:242306 (history)  Vaccinated:2005-07-27
Age:14.0  Onset:2005-07-29, Days after vaccination: 2
Gender:Female  Submitted:2005-07-29, Days after onset: 0
Location:California  Entered:2005-08-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSVA064AA3 LA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1589AA  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Injection site induration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left deltoid area redness, swelling induration 4 inches.

VAERS ID:242325 (history)  Vaccinated:2005-07-29
Age:14.0  Onset:2005-07-30, Days after vaccination: 1
Gender:Male  Submitted:2005-08-04, Days after onset: 5
Location:Illinois  Entered:2005-08-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic Rhinitis
Diagnostic Lab Data: Neutrophils were elevated
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1213BA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Headache, Laboratory test abnormal, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: High fever 101-102, headache, nausea and vomiting for 48 hours

VAERS ID:242419 (history)  Vaccinated:2004-12-13
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2004-12-28
Location:Arkansas  Entered:2005-08-08, Days after submission: 222
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: AR05-12
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5598A92IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Patients mother called 12/28/2004 and stated patient showed her a rash, described as whelps on arms, abdomen and a few on back. Patient not sure how long she has had rash. States injection site is clear. Denies any itching or swelling. Mother states she is trying to rule out cause of rash. Mother states she plans to call private doctor. States patient has not been in any distress.

VAERS ID:242689 (history)  Vaccinated:2005-07-29
Age:14.0  Onset:2005-07-29, Days after vaccination: 0
Gender:Male  Submitted:2005-07-29, Days after onset: 0
Location:Tennessee  Entered:2005-08-10, 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: Zyrtec 10mg
Current Illness: NONE
Preexisting Conditions: Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1675AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Fatigue, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: About 30 Minutes after MCV4 administered acute onset of diaphoresis, nausea, fatigue. No associated shortness of breath/wheeze/rash. Resolved by time of re evaluation.

VAERS ID:242693 (history)  Vaccinated:2005-08-03
Age:14.0  Onset:2005-08-03, Days after vaccination: 0
Gender:Female  Submitted:2005-08-03, Days after onset: 0
Location:New Mexico  Entered:2005-08-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: Extreme rash and hives.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSB053AA IMRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1213CA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Flushing, Malaise
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Complaint of light headedness or not feeling well. Wanted to know if could lie down. Paleness. Sitting in chair, laid down on exam table for approximately 3 to 5 minutes and stated feeling better. Still with paleness. Had her to sit in chair place head lower, then sat back up for a few minutes in chair face had color back. Took in deep relaxing breaths , ambulated out with Mother in few minutes. Continued to follow up with Mother stated okay appearance pinkish and more relaxed breathing.

VAERS ID:242804 (history)  Vaccinated:2005-08-05
Age:14.0  Onset:2005-08-06, Days after vaccination: 1
Gender:Female  Submitted:2005-08-08, Days after onset: 2
Location:Missouri  Entered:2005-08-11, Days after submission: 3
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
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1290IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Client complained of swelling and tenderness of armpit in arm vaccine was given on Saturday morning, Mother stated had given ibuprophen over the weekend. Mother reports client still having tenderness and swelling in armpit today.

VAERS ID:242808 (history)  Vaccinated:2005-08-05
Age:14.0  Onset:2005-08-05, Days after vaccination: 0
Gender:Male  Submitted:2005-08-05, Days after onset: 0
Location:Louisiana  Entered:2005-08-11, 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:
CDC Split Type: LA050801
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1215AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anaphylactic reaction, Bradycardia, Hyperhidrosis, Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Received vaccine at 12:00 received a call from RPH at 1:30 pm nurse reported on the way home blacked out, low BP. heart rate and diaphoretic upon arriving at hospital. Treated for anaphylactic reaction. 2nd observation at hospital, nurse reports he is ok. Will be hospitalizes overnight for observation. Also rash on stomach

VAERS ID:242835 (history)  Vaccinated:2005-08-02
Age:14.0  Onset:2005-08-02, Days after vaccination: 0
Gender:Male  Submitted:2005-08-03, Days after onset: 1
Location:Virginia  Entered:2005-08-12, Days after submission: 9
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC - Basic metabolic
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1515AA0 LA
Administered by: Private     Purchased by: Public
Symptoms: Abasia, Abdominal pain, Arthralgia, Chest pain, Dizziness, Fall, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Approximately 2-3 hours later patient became dizzy, nausea, chest pain, abdominal pain, leg pain, joint aches, was unable to walk alone, actually fell to the floor once and patient was admitted to hospital for 24 hours for observation. There were no other significant events to attribute to this acute change in patient''s status.

VAERS ID:242853 (history)  Vaccinated:2005-08-10
Age:14.0  Onset:2005-08-11, Days after vaccination: 1
Gender:Male  Submitted:2005-08-11, Days after onset: 0
Location:Unknown  Entered:2005-08-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin Medadate CD
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Started vomiting and has had the dry heaves since about 1:00pm central time.

VAERS ID:242973 (history)  Vaccinated:2005-08-02
Age:14.0  Onset:2005-08-08, Days after vaccination: 6
Gender:Female  Submitted:2005-08-08, Days after onset: 0
Location:Florida  Entered:2005-08-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1563AA5IMLA
Administered by: Public     Purchased by: Other
Symptoms: Feeling hot, Injection site pain, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 08/08/2005 Patient in with parent c/o pain at injection site of td given 08/02/2005 per provider pts site is warm and tender with pain radiating to hand, treated with Keflex and referred to pediatric Neurology

VAERS ID:243188 (history)  Vaccinated:2005-07-27
Age:14.0  Onset:2005-08-07, Days after vaccination: 11
Gender:Male  Submitted:2005-08-20, Days after onset: 13
Location:Missouri  Entered:2005-08-20
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PCN allergy
Diagnostic Lab Data: ITP diagnosed - initial bloodwork revealed PT 12.0, INR 1.1, PTT 30.9, Fibrinogen 214, CBC with WBC 4.3 diff: 42 Segs, 31 Lymph, 10 monos, 12 eos, 5 atyp - periphal smear nl morph, H/H of 15.1/43.5, platelet of 4, O+ coombs -, anti IGG and
CDC Split Type:
Vaccination
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HEPA: HEP A (VAQTA)MERCK & CO. INC.U1639AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR0202R0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Petechiae, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Petechiae noted on lower extremity on am of 8/7/5. Had no other URI, N/V or any other symptoms preceding this occurence. No fever.

VAERS ID:243284 (history)  Vaccinated:2005-08-18
Age:14.0  Onset:2005-08-18, Days after vaccination: 0
Gender:Female  Submitted:2005-08-18, Days after onset: 0
Location:New Mexico  Entered:2005-08-23, 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: N/A
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSA8182 IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1282AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives on both legs, 25mg Benadryl every 4 hours.

VAERS ID:243359 (history)  Vaccinated:2005-06-22
Age:14.0  Onset:2005-07-06, Days after vaccination: 14
Gender:Female  Submitted:2005-08-24, Days after onset: 49
Location:Colorado  Entered:2005-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Whole limb swelling;Td Adsorbed, Adult (no brand name);3;0;In Patient
Other Medications: None
Current Illness: Seasonal allergies - pollen, stuffy nose
Preexisting Conditions: none
Diagnostic Lab Data: None done
CDC Split Type:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.8781P0SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Hyperhidrosis, Lymphadenopathy, Malaise, Neck pain, Pyrexia, Rash papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: Two weeks after the MMR immunization was received, the child complained of severe neck pain. She developed a papular rash on her face that spread to her neck, chest, arms, then over her whole body. She experienced joint pains, and the mother reports she had pus on her right tonsil. She also had swelling of sub lingual lymph glands. She had a low grade fever, malaise and sweats. She felt sick for 5 days, but the rash didn''t clear for 14 days. She still has a slightly swollen lymph node behind her ear, but otherwise feels fine.

VAERS ID:243434 (history)  Vaccinated:2005-06-22
Age:14.0  Onset:2005-07-18, Days after vaccination: 26
Gender:Male  Submitted:2005-08-25, Days after onset: 38
Location:Louisiana  Entered:2005-08-26, Days after submission: 1
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: Penicillin allergy
Diagnostic Lab Data: Blood sugar too high. Urine - 2000 Glucose.
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURUA1659AA IM 
Administered by: Private     Purchased by: Private
Symptoms: Diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)
Write-up: Within 1 month of vaccine administration patient developed diabetes mellitus.

VAERS ID:243626 (history)  Vaccinated:2005-07-26
Age:14.0  Onset:2005-07-27, Days after vaccination: 1
Gender:Male  Submitted:2005-07-28, Days after onset: 1
Location:Indiana  Entered:2005-08-31, Days after submission: 34
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: UNK
Diagnostic Lab Data: NONE
CDC Split Type:
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS168BA1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt presented and clinic with red maculo papular rash over body with some involvement and face. No dyspnea or airway involvement treated with prednisone, 20mg bid x 4d and OTC Benadryl. Child had no previous allergies but had also eaten peanuts on 7/26/05.

VAERS ID:243649 (history)  Vaccinated:2005-08-29
Age:14.0  Onset:2005-08-29, Days after vaccination: 0
Gender:Female  Submitted:2005-08-31, Days after onset: 2
Location:Georgia  Entered:2005-08-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: slight sinus conjestion
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
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HEP: HEP B (GENHEVAC B)PASTEUR MERIEUX INST.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Chills, Dizziness, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: On the evening of the 2nd shot symptoms were dizziness, stomach ache, low grade fever and chills, went to bed real early for the night. Felt fine by morning. Didn''t get any homework done, teacher didn''t except any late work. We should have planned shot for Friday when no homework was due.

VAERS ID:243712 (history)  Vaccinated:2005-08-10
Age:14.0  Onset:2005-08-12, Days after vaccination: 2
Gender:Male  Submitted:2005-08-15, Days after onset: 3
Location:Michigan  Entered:2005-09-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MI2005027
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1492AB IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Infection, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 08/10/2005 Given Menactra intramuscularly left arm. 08/12/2005 Mom called, arm is red, slightly swollen, hot to touch. Afebrile, has not given Tylenol. PHN C/T normal potential problems. If Mom concerned more than normal call doctor. 08/12/2005 child went to doctor. He assessed not reaction to vaccine - maybe infection. He prescribed antibiotic. 08/15/2005 Mom states patient was doing better even on 08/12/2005 after seeing doctor. Doing well now, no more problems.

VAERS ID:243724 (history)  Vaccinated:2005-08-25
Age:14.0  Onset:2005-08-25, Days after vaccination: 0
Gender:Male  Submitted:2005-08-26, Days after onset: 1
Location:Washington  Entered:2005-09-01, 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: No known allergies.
Diagnostic Lab Data: Glucometer = 103
CDC Split Type:
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSA018AA IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURUE349AA SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1221CA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Headache, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: 5 minutes after vaccines patient became dizzy, complained of headache, and vomited 1 time. Hypotensive, observed in clinic for 2 hours.

VAERS ID:243855 (history)  Vaccinated:2005-09-01
Age:14.0  Onset:2005-09-02, Days after vaccination: 1
Gender:Male  Submitted:2005-09-06, Days after onset: 4
Location:Wisconsin  Entered:2005-09-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 54mg daily Prozac 10mg daily
Current Illness:
Preexisting Conditions: ADD, Depression, Anxiety
Diagnostic Lab Data:
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1768AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Hyperhidrosis, Injection site pain, Pallor, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Per telephone call from mother, pt. had swelling, redness,warmth to touch and pain from site of injection to 6 inches below site of injection in a 2 inch band nearly around the arm. Initially patient was pale and diaphoretic and this lasted about 4 hours. Per review of immunization record, most recent Td was 9/8/03.

VAERS ID:243937 (history)  Vaccinated:2005-08-23
Age:14.0  Onset:2005-08-23, Days after vaccination: 0
Gender:Female  Submitted:2005-08-26, Days after onset: 3
Location:Illinois  Entered:2005-09-08, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0616P2IMLA
Administered by: Private     Purchased by: Other
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)
Write-up: Patient fell and her head hit the chair in the waiting room, about 3 to 5 minutes after vaccination, suffer scalp laceration.

VAERS ID:243963 (history)  Vaccinated:2005-09-06
Age:14.0  Onset:2005-09-07, Days after vaccination: 1
Gender:Male  Submitted:2005-09-10, Days after onset: 3
Location:Georgia  Entered:2005-09-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1741AB  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site reaction, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Received Menactra 09/06/2005, arm became red, hard, swollen 12 hours after shot. Area swelling 6 inches from deltoid to elbow - area painful - no fever. Child given Tylenol initially 09/07/2005 - seen by doctor, 09/08/2005 started on Benadryl. On 09/10/2005 area no longer red and hard but still swollen. Advised to continue Benadryl and Tylenol as needed. Call if not better in 2 days. 09/12/05 per telephone f/u with reporter, additional symptoms included pruritus and warmth at injection site.

VAERS ID:244069 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2005-09-13
Location:Missouri  Entered:2005-09-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
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HEPA: HEP A (VAQTA)MERCK & CO. INC.1109N  LA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1219AA  RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling/itching right arm.

VAERS ID:244111 (history)  Vaccinated:2005-06-27
Age:14.0  Onset:2005-06-28, Days after vaccination: 1
Gender:Female  Submitted:2005-07-19, Days after onset: 21
Location:New York  Entered:2005-09-13, Days after submission: 56
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: She previously received five doses of DTap.
Diagnostic Lab Data:
CDC Split Type: 200501308
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1657AA IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1563DA5IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Initial report received from a health care professional on Jul 06 2005. A 14 year old female patient received an intramuscular dose of Decavac, lot number U1563DA, in the right arm and an intramuscular dose of Menactra, lot number U1657AA, in the left arm on Jun 27 2005. One day later, the injection site was red, hard and swollen. It was not reported whether the reaction occurred at the site of the Decavac or Menactra vaccine. The patient was seen by a physician and received corrective treatment with amoxicillin 500 mg. three times a day. Ice and heat were also prescribed. At the time of this report the patient had not recovered from these events.

VAERS ID:244434 (history)  Vaccinated:2005-08-17
Age:14.0  Onset:2005-08-18, Days after vaccination: 1
Gender:Male  Submitted:2005-09-20, Days after onset: 33
Location:Arizona  Entered:2005-09-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Left knee pain, chest pain
Preexisting Conditions: PCN, Erythromycin, Ceclor, Bipolar, ADHD, Tourette, Juvenile DIR mild autistic.
Diagnostic Lab Data:
CDC Split Type:
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash over entire body even inside of mouth

VAERS ID:244405 (history)  Vaccinated:2004-11-19
Age:14.0  Onset:2004-11-19, Days after vaccination: 0
Gender:Female  Submitted:2005-09-19, Days after onset: 303
Location:California  Entered:2005-09-21, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Live birth
Diagnostic Lab Data: ultrasound 03/23/2005 WNL
CDC Split Type: WAES0412USA02700
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Unintended pregnancy
SMQs:, Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a physician through a pregnancy registry concerning a 14 year old female who on 11/19/04 was vaccinated with a dose of varicella virus vaccine live. The physician believes that the patient conceived on 11/20/04. LMP was approximately 10/29/04 and the patient''s EDD 8/7/05. Unspecified medical attention was sought. At the time of this report, there was no information provided about the present status of the patient. No product quality complaint was involved. Follow up information was received from the physician containing outcome information about the 14 year old patient. It was reported that the patient gave birth to a normal live born infant on 8/1/05, 38 weeks from LMP. The birth was by cesarean section for fetal distress. It was also reported that the patient had routine prenatal diagnostic testing, including an ultrasound on 3/23/05 which was WNL. Also noted was that the patient had one previous pregnancy and one previous full-term birth. Upon internal review, the fetal distress was determined to be an other important medical event (OMIC). Additional information is not expected.

VAERS ID:244581 (history)  Vaccinated:2005-09-21
Age:14.0  Onset:2005-09-26, Days after vaccination: 5
Gender:Male  Submitted:2005-09-26, Days after onset: 0
Location:Rhode Island  Entered:2005-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Acne gel
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1675AA0 RA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt received Menactra vac on 09/21/2005 calls Monday 09/26/2005 with headaches and vomiting several times this am.

VAERS ID:244615 (history)  Vaccinated:2005-04-15
Age:14.0  Onset:2005-04-18, Days after vaccination: 3
Gender:Female  Submitted:2005-09-27, Days after onset: 162
Location:Illinois  Entered:2005-09-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none Information received from medical records states allergy. msv
Diagnostic Lab Data: EEG monitoring with video- advised not epileptic seizures Bloodwork all came back normal MRI normal CAT scan normal
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR 0IMLA
TD: TD ADSORBED (TD-RIX)SMITHKLINE BEECHAM 4IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Convulsion, Loss of consciousness, Neurosis, Speech disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 4/18/2005 Passed out at school - ongoing blackout events through June 9/12-24/05 Passed out with increase severity of convulsions. Time frame from 1 to 1.5 hours each time. 7 episodes within 13 days. Information from 60 day follow-up report states: 1/8/2006 My daughter has had episodes since she received her vaccines. She had several in April, again in June, several more in September and one again 5 weeks ago. We have been to Dr after Dr and still have not found out what is going on with her. This week she sees a Cardiologist. We have ruled out several things but still have no answer as to why these things are happening. In September the episodes were convulsive in nature. In December she passed out and was unconscious for 45 minutes and a few weeks after that she had symptoms of appendicitis. She has multiple nodules on her thyroid which we believe are benign. She has had more tests in the last year than I have had in my lifetime. And it all coincidentally began two days after her vaccination. So to answer your letter, NO she has not recovered from the adverse events that were reported. Information received from discharge summary states neurosis. Information from medical records states speech difficulty. msv

VAERS ID:244983 (history)  Vaccinated:2005-05-27
Age:14.0  Onset:2005-06-06, Days after vaccination: 10
Gender:Female  Submitted:2005-10-05, Days after onset: 121
Location:California  Entered:2005-10-05
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: Sensitive to milk (eczema), seasonal allergies.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURUNK  UN
Administered by: Private     Purchased by: Private
Symptoms: Abdominal discomfort, Diarrhoea, Fatigue, Malaise, Paraesthesia, Rash, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: 06/06 woke up with diarrhea, felt shaky, tired, recovered by afternoon, Had similar problems on 06/18. On 06/20 had a doctor visit, stool sample was taken for possible stomach virus, was off milk for 10 days. Pt is a dancer and after recitals on 06/24 and 06/25 complained that legs were really tired, felt weak and shaky. 06/28 embarged on family trip and especially during 06/23 - 06/30 complained that arms were falling sleep, tingly including legs. Malaise continued for rest of trip until 07/02. Mother attributed problems to tiredness due to trip. During early July pt had similar problems off and on (tingling) and then had gone away. Pt had stomach issues again in early September. Information from Follow-up report states: Spoke with pt''s mom. She states that pt. is doing fine. Every now and then, she still has tingling in fingers and then it goes away. She is walking with no problem. Also pt. had developed a rash between mid July to mid August on the upper arms to lower arm to fingers and mid thigh to feet. Dr office notified. Not itchy. Started on upper arm. No pain. No previous rashes. Rash cleared without problems. Mom was told by me to follow-up with PCP if she has further problems.

VAERS ID:245056 (history)  Vaccinated:2005-08-26
Age:14.0  Onset:2005-09-09, Days after vaccination: 14
Gender:Male  Submitted:2005-10-04, Days after onset: 25
Location:California  Entered:2005-10-07, Days after submission: 3
Life Threatening? No
Died? Yes
   Date died: 2005-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Used Cipro HC otic drops 8/21 -8/25/2005
Current Illness: Resolved otitis externa
Preexisting Conditions: Rash with ceclor. H/O RAD, last wheezing 12/2002
Diagnostic Lab Data: Work up negative to date. Full autopsy pending.
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2151AC0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)
Write-up: Pt died suddenly from cardiac arrhythmia while walking dog. Paramedics attempted resuscitation. Pt did not respond to resuscitation efforts in the field or in the ER. Pronounced dead at 17:45. Autopsy report rec''d 10/31/2005 -- complete as reported.

VAERS ID:245387 (history)  Vaccinated:2005-10-13
Age:14.0  Onset:2005-10-13, Days after vaccination: 0
Gender:Female  Submitted:2005-10-13, Days after onset: 0
Location:Tennessee  Entered:2005-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Respiratory;DTaP (unknown mfr);;0;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Wheat allergies osteoporosis, asthma.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1584BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Knot feeling in throat. Patient describe feeling short of breath onset 30 minutes after TD given Monitored Pt and 2 Tsp Benadryl liquid given. Discharged home in improved stable condition.

VAERS ID:245797 (history)  Vaccinated:2005-08-09
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2005-10-20
Location:Kansas  Entered:2005-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify, Trazodone
Current Illness:
Preexisting Conditions: Autism
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B0038A IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Aggression, Autism
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow)
Write-up: Within 2 weeks of getting vaccine autistic behavior increased. More self harm, more aggression against others, more melt downs.

VAERS ID:246114 (history)  Vaccinated:2005-10-14
Age:14.0  Onset:2005-10-16, Days after vaccination: 2
Gender:Female  Submitted:2005-10-17, Days after onset: 1
Location:Texas  Entered:2005-10-26, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1809AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 1 1/2 in area, tender, swollen area at site of injection.

VAERS ID:246360 (history)  Vaccinated:2005-10-24
Age:14.0  Onset:2005-10-24, Days after vaccination: 0
Gender:Female  Submitted:2005-10-26, Days after onset: 2
Location:New York  Entered:2005-10-28, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC normal, Beta HCg negative
CDC Split Type:
Vaccination
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Dose
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IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURY02981SC 
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1251IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0324R1SC 
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt c/o nausea and dizziness after the 3rd vaccine Varicella. Pt had syncopal episode lasting about 1 min. Placed in supine position. Respiratory status and V/S assessed and monitored.

VAERS ID:246851 (history)  Vaccinated:2005-09-03
Age:14.0  Onset:2005-09-04, Days after vaccination: 1
Gender:Male  Submitted:2005-11-04, Days after onset: 61
Location:Connecticut  Entered:2005-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fibercon;Miralax;Certroid vitamins
Current Illness: NONE
Preexisting Conditions: Severe Constipation
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER90734   
Administered by: Private     Purchased by: Private
Symptoms: Cardiac disorder, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Difficulty breathing, tried, weak, heart racing slight, lasted for 30 minutes then went back to sleep.

VAERS ID:247210 (history)  Vaccinated:2005-10-03
Age:14.0  Onset:2005-10-03, Days after vaccination: 0
Gender:Female  Submitted:2005-11-05, Days after onset: 33
Location:New York  Entered:2005-11-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURERU17530  
Administered by: Private     Purchased by: Unknown
Symptoms: Amnesia, Disturbance in attention, Lymphadenopathy, Pharyngolaryngeal pain
SMQs:, Dementia (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad)
Write-up: Loss of memory, concentration, sore throat, mumps gland very enlarged

VAERS ID:247652 (history)  Vaccinated:2005-11-15
Age:14.0  Onset:2005-11-15, Days after vaccination: 0
Gender:Female  Submitted:2005-11-16, Days after onset: 1
Location:California  Entered:2005-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Mild set genial allergic Roes notes
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1832BA7IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA019AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1780AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Tongue oedema, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: At 01:30, 16 1/2 hours after immunization, awoke with urticaria, generalized, and slight tongue swelling. Given Benadryl. Urticaria gave in AM. No respiratory symptoms.

VAERS ID:247668 (history)  Vaccinated:2005-11-10
Age:14.0  Onset:2005-11-11, Days after vaccination: 1
Gender:Female  Submitted:2005-11-14, Days after onset: 3
Location:Pennsylvania  Entered:2005-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Advair
Current Illness: Upper respiratory infection
Preexisting Conditions: Asthma, Seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1850AA0 LA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1768AA0 LL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0607R0 LA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Headache, Injection site induration, Nausea, Oedema, Pain, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Left upper arm became red, warm to touch swollen and sore. pt had also developed nausea, vomiting, and headache. Red area 5 inches x 7 inches indurated.

VAERS ID:247915 (history)  Vaccinated:2005-10-13
Age:14.0  Onset:2005-11-14, Days after vaccination: 32
Gender:Female  Submitted:2005-11-14, Days after onset: 0
Location:New Jersey  Entered:2005-11-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500389P0IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Cough, Lung disorder, Rhinitis
SMQs:, Anaphylactic reaction (broad)
Write-up: Since flu mist given - upper airway congestion, cough- non production intermittent cough. Worsening.

VAERS ID:248405 (history)  Vaccinated:2005-11-11
Age:14.0  Onset:2005-11-11, Days after vaccination: 0
Gender:Male  Submitted:2005-11-29, Days after onset: 18
Location:Montana  Entered:2005-11-30, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR41782AA0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2151AC0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever to 104; started same day and lasted 3 days.

VAERS ID:248772 (history)  Vaccinated:2005-11-16
Age:14.0  Onset:2005-11-16, Days after vaccination: 0
Gender:Female  Submitted:2005-11-17, Days after onset: 1
Location:Virginia  Entered:2005-12-05, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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HEP: HEP B (FOREIGN)MERCK & CO. INC.004R1 LA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Pharyngolaryngeal pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Mother reported, around 3 hours after injection - c/o fatigue, had fever (tactile est. 101 degrees) and sore throat. She slept 18 hours overnight into the day after injection. Within 24 hours of HBV, symptoms resolved. Only treatment was ASA 325 mg given by mother. (this was not advised by us)

VAERS ID:248971 (history)  Vaccinated:2005-11-21
Age:14.0  Onset:2005-11-22, Days after vaccination: 1
Gender:Female  Submitted:2005-12-02, Days after onset: 10
Location:Minnesota  Entered:2005-12-08, 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: Nasonex, Protopic, Zyrtec, Singular, Prednisone
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: Chest X ray, Albuterol and pulse and taper of steroids.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1915AA   
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1004P0  
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Injection site hypersensitivity, Injection site oedema, Lymphadenitis, Type III immune complex mediated reaction, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Arthus reactions, (redness, swelling, plus wheezing and lymphadenitis with intermittent chest pain.

VAERS ID:248976 (history)  Vaccinated:2005-12-02
Age:14.0  Onset:2005-12-02, Days after vaccination: 0
Gender:Female  Submitted:2005-12-02, Days after onset: 0
Location:New Jersey  Entered:2005-12-08, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History ITP, history of RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1782AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Eye oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Mom describes reaction occurred about 6 hours after Menactra given left eye swollen, itchy. Dad described hives, mother did not see rash, described redness from scratching give one dose of prednisone and Benadryl by dad, Seen today 12/02/2005 no rash or swelling noted.

VAERS ID:249132 (history)  Vaccinated:2005-10-17
Age:14.0  Onset:2005-10-17, Days after vaccination: 0
Gender:Male  Submitted:2005-10-19, Days after onset: 2
Location:Virginia  Entered:2005-12-12, Days after submission: 54
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: Ceclor
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1526AC0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Back pain, Chest pain, Headache, Injection site induration, Listless, Neck pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad)
Write-up: Left deltoid soreness with small area information and induration. Severe headache, backache, left shoulder, left neck pain. Left sided chest pain, pain on inspiration, listless, temp 99.1.

VAERS ID:249357 (history)  Vaccinated:2005-11-15
Age:14.0  Onset:2005-11-15, Days after vaccination: 0
Gender:Female  Submitted:2005-11-15, Days after onset: 0
Location:Oregon  Entered:2005-12-15, Days after submission: 30
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: OR200543
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2103AA0IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0562P2IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURX11892IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0295R2SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0325R SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Medication error
SMQs:
Write-up: Given DTap instead of TD no adverse reaction, Given 3rd MMR no adverse reaction should have been given 2nd Hep A.

VAERS ID:249536 (history)  Vaccinated:2005-12-12
Age:14.0  Onset:2005-12-12, Days after vaccination: 0
Gender:Female  Submitted:2005-12-15, Days after onset: 3
Location:New York  Entered:2005-12-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy shots every 6 wks for venom allergies
Current Illness: NONE
Preexisting Conditions: Allergic to white faced wasps and hornets;Amoxicillin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Route
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1916AA0 RA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Within few minutes of vaccine, patient c/o itching on her back fine flat red rash was noted covering trunk. Benadryl 25mg po given. Patient recovered without further incident.

VAERS ID:249691 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Unknown  Submitted:2005-12-07
Location:Unknown  Entered:2005-12-27, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: This vaccinee''s sibling experienced soreness at the injection site following receipt of Fluarix;Influenza (Fluarix);;0;In Siblin
Other Medications:
Current Illness: UNK
Preexisting Conditions: The subject''s medical history, concurrent conditions, and concurrent medications were not reported. The nurse reported that the subject''s sibling also inadvertently received Fluarix and experienced injection site soreness. Please see case A0578342A.
Diagnostic Lab Data: UNK
CDC Split Type: A0578343A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS 0 UN
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Medication error, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported by a nurse and described the occurrence of injection site soreness in a 14 year old subject of unspecified gender who was inadvertently vaccinated with influenza virus vaccine (Fluarix) for prophylaxis. The reporter is the mother of the subject. On an unspecified date in 2005, on or before 14 October 2005, the subject received 1st dose of Fluarix at an unspecified site of administration (lot number not provided). Fluarix is recommended for immunizing individuals 18 years of age and older. At an unspecified time following the administration of Fluarix, on or before 14 October 2005, the subject experienced injection site soreness. At the time of reporting, 14 October 2005, the outcome of the injection site soreness was not provided. Follow-up to the case will not be available.

VAERS ID:249791 (history)  Vaccinated:2005-08-31
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2005-12-13
Location:Texas  Entered:2005-12-27, Days after submission: 14
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
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1577AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None Stated

VAERS ID:249794 (history)  Vaccinated:2005-12-01
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2005-12-13
Location:Texas  Entered:2005-12-27, Days after submission: 14
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
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1577AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None Stated

VAERS ID:250004 (history)  Vaccinated:2005-11-28
Age:14.0  Onset:2005-11-28, Days after vaccination: 0
Gender:Female  Submitted:2005-12-06, Days after onset: 8
Location:Texas  Entered:2006-01-03, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX05105
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1616BA5 LA
Administered by: Public     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Per patients mother, patient received TD vaccine in afternoon, that night she broke out in a rash all over her body. Mother described the rash as looks like chicken pox, but the little bumps aren''t pussy. Mother states no change in rash since 11/28/2005.

VAERS ID:250459 (history)  Vaccinated:2005-12-13
Age:14.0  Onset:2005-12-13, Days after vaccination: 0
Gender:Male  Submitted:2005-12-20, Days after onset: 7
Location:Kentucky  Entered:2006-01-17, Days after submission: 28
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: "Fatty liver" per mom.
Diagnostic Lab Data: n/a
CDC Split Type: KY2006004
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB077CA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Feeling cold, Hot flush
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Approx 15 mins afer injection, patient reported feeling hot, then cold, alternatley had facial flushing c/o dizziness. Assisted into relining position. Vital signs WNL. Observed for 1 hour. Pt recovered.

VAERS ID:250524 (history)  Vaccinated:2006-01-17
Age:14.0  Onset:2006-01-17, Days after vaccination: 0
Gender:Female  Submitted:2006-01-18, Days after onset: 1
Location:Indiana  Entered:2006-01-18
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1519AA0IMLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB156AA1IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest pain, Dyspnoea, Heart rate increased, Vertigo
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (narrow)
Write-up: Approximately 7 hours after receiving vaccine (per mother)pt. c/o increased heart rate, chest hurting, room spinning and difficulty taking a deep breath. No tx. per mom. Still c/o increased heart rate today 1/18/2006. Advised to call family physician.

VAERS ID:250820 (history)  Vaccinated:2004-11-08
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2006-01-18
Location:Kansas  Entered:2006-01-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG5292AZ IMRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0542AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site reaction
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Client noticed red area-the following summer small indention on arm below injection site currently <1/4 cm deep under x approx 4.5 long. Denies any symptoms.

VAERS ID:251570 (history)  Vaccinated:2006-02-01
Age:14.0  Onset:2006-02-01, Days after vaccination: 0
Gender:Male  Submitted:2006-02-16, Days after onset: 15
Location:California  Entered:2006-02-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL
Current Illness: NONE
Preexisting Conditions: ASTHMA, RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1874AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Dizziness, Headache, Pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: MCV4 GIVEN ON 2-1-06 @1000. SXS OF DIZZINESS, BLURRED VISION BEGAN AT APPROXIMATELY 1730. VS T (100.9) P(120), BP(124/70), R (20). SENT TO ER WHERE HE C/O OF GENERAL ACHINESS, CHILLS AND HA. TX''D WITH MOTRIN 400MG AS DIRECTED.

VAERS ID:251623 (history)  Vaccinated:2006-02-06
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2006-02-07
Location:Missouri  Entered:2006-02-17, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MO2006003
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B005AA IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Medication error
SMQs:
Write-up: DTAP GIVEN INSTEAD OF TDAP. NO ADVERSE ACTION. NO NEED TO REPEAT PER STATE VFC.

VAERS ID:251747 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:2005-11-30
Gender:Male  Submitted:2006-02-16, Days after onset: 78
Location:Unknown  Entered:2006-02-22, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0602USA02995
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS   UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Heart rate decreased, Medication error, Rash, Respiratory rate increased
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a health authority concerning a 14 year old male, with no reported medical history, who was vaccinated with an intramuscular dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (manufacturer unknown). Concomitant vaccine included a dose of diphtheria toxoid (+) pertussis acellular 3 component vaccine (+) tetanus toxoid (Infanrix). Following vaccination, on 30-Nov-2005, the patient immediately became short of breath and his breathing became rapid. It was reported that a rash occurred on various parts of his body. His pulse was weak and was difficult to find. The patient was hospitalized and recovered on the same day. No further information is expected. The case is closed. Other business partner numbers include: E2006-00608 and ADROIT 502686.

VAERS ID:251882 (history)  Vaccinated:2006-02-23
Age:14.0  Onset:2006-02-23, Days after vaccination: 0
Gender:Female  Submitted:2006-02-24, Days after onset: 1
Location:Kentucky  Entered:2006-02-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa, Ceodon
Current Illness:
Preexisting Conditions: Bipolar, obesity/depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1741AB1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Difficulty in walking, Headache, Pharyngolaryngeal pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: Feeling well until evening of 2/23/06. Had headache when pt. went to bed, woke up with scratch throat, couldn''t walk, due to dizziness, felt hot. Came to clinic 25 min after exam pt''s gait improved pt able to walk without holding onto walls.

VAERS ID:251981 (history)  Vaccinated:2006-01-30
Age:14.0  Onset:2006-01-31, Days after vaccination: 1
Gender:Female  Submitted:2006-02-02, Days after onset: 2
Location:Wyoming  Entered:2006-02-24, Days after submission: 22
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: Asthma
Diagnostic Lab Data: As per mother patient had blood test done with white cell count, WNL and decrease in liver tests.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0332P1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Laboratory test abnormal, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient received her second Hepatitis B vaccination at 3 pm on 1/30/06. As per her mother patient exhibited nausea, vomiting and abdominal pain starting at 4:00 am on Tuesday 1/31/06. She was taken to the ER at 10:00 pm 1/31/06 an ultrasound was inconclusive. Mother reported above to public health 2/02/06.

VAERS ID:252218 (history)  Vaccinated:2006-02-17
Age:14.0  Onset:2006-02-17, Days after vaccination: 0
Gender:Male  Submitted:2006-02-21, Days after onset: 4
Location:Virginia  Entered:2006-03-02, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair;Advair;Albuterol
Current Illness: NONE
Preexisting Conditions: Sulfa, allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2384AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Torticollis
SMQs:, Dystonia (narrow), Ocular motility disorders (broad)
Write-up: Torticollis/neck pain started 2 hours after immunization given. Left neck pain no associated weakness. Treated with ibuprofen, warm compress. ROM exercises. Slight improvement day 4 of symptoms.

VAERS ID:252345 (history)  Vaccinated:2006-02-21
Age:14.0  Onset:2006-02-24, Days after vaccination: 3
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2006-03-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0783R0SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthma, Chest discomfort, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Pt had fever, headache, tightness with breathing, asthma like symptoms. Pt spoke to MD office, used albuterol inhaler and nebulizer, prednisone ordered. No hospitalization required but telephone calls, multiple time office visit.

VAERS ID:252347 (history)  Vaccinated:2006-02-14
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2006-02-28
Location:Nebraska  Entered:2006-03-06, 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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB229AA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURY03251IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0B01R1SCRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B004AB1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: Tdap given as a second dose per "Recommended Immunization Schedule for children & adolescents who start late or who are more than 1 month behind." As per CDC catch up schedule which says "Tdap may be substituted for any dose in a primary catch up series or as a booster if age appropriate for Tdap." No adverse events. No treatment

VAERS ID:252574 (history)  Vaccinated:2004-12-15
Age:14.0  Onset:2004-12-15, Days after vaccination: 0
Gender:Male  Submitted:2006-03-07, Days after onset: 447
Location:Unknown  Entered:2006-03-10, Days after submission: 3
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: UNK
Diagnostic Lab Data: NONE
CDC Split Type: WAES0502USA02549
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0367P0IM 
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Pruritus, Syncope, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a RN concerning a 14 year old male with no known drug reactions/allergies and whose mother is allergic to latex who on 15Dec04 was vaccinated IM with a first dose of hep B virus vaccine rHBsAg (yeast) (lot 643399/0367P). Suspect vaccination that day included diphtheria toxoid/tetanus toxoid (manf unk). On 15Dec04 the pt developed itchiness and raised areas like hives on his inner thighs, the back of both knees and his groin area. It was reported that the pt was afebrile. The pt was treated with diphenhydramine hydrochloride (Benadryl) capsules and cream. On 21Dec04 the pt was seen in the office with what was described as faint areas of redness but no raised areas noted. No further treatment was required. No lab diagnostic studies were performed. At the time of the report the pt had recovered. There was no product quality complaint involved. Additional information has been requested.

VAERS ID:252586 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2006-03-07
Location:Pennsylvania  Entered:2006-03-10, Days after submission: 3
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0506USA03459
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Hepatic neoplasm malignant, Hepatitis, Viral infection
SMQs:, Hepatitis, non-infectious (narrow), Lack of efficacy/effect (narrow), Malignant tumours (narrow), Liver malignant tumours (narrow)
Write-up: Information has been received from a physician concerning a 14 year old male who was vaccinated as a child with a dose of hepatitis B virus vaccine rHBsAg (yeast). Subsequently, the pt developed hepatitis B and metastatic liver cancer "as a result of vaccine failure". Unspecified medical attention was sought. At the time of this report the pt had not recovered. There was no product quality complaint involved. Additional information has been requested.

VAERS ID:252614 (history)  Vaccinated:2006-01-03
Age:14.0  Onset:2006-01-03, Days after vaccination: 0
Gender:Female  Submitted:2006-03-07, Days after onset: 63
Location:Texas  Entered:2006-03-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0601USA00202
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Muscle twitching, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Information has been received from a certified medical assistant concerning a 14 year old female pt with no allergies and no pertinent medical history, who on 03jan06 was vaccinated with 10 micrograms of hep B virus vaccine rHBsAg (yeast). There was no concomitant medication. On 03Jan06, reported as today, shortly after the pt received the vaccine, she began to twitch and shake. There were no laboratory studies performed. The adverse events did not improve and the pt''s outcome is not recovered. There was no product quality complaint reported. The pt sought unspecified medical attention. Additional information has been requested.

VAERS ID:252627 (history)  Vaccinated:2005-09-13
Age:14.0  Onset:2005-09-13, Days after vaccination: 0
Gender:Female  Submitted:2006-03-02, Days after onset: 170
Location:Nevada  Entered:2006-03-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: The subject had no pre existing medical conditions. the subjects concurrent conditions were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0574270A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHABV032AA1 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site reaction, Medication error
SMQs:
Write-up: This case was reported by a medical assistant and described the occurrence of an injection site reaction in a 13 year old female subject who was vaccinated with hepatitis A vaccine inactivated Havrix for prophylaxis. There were no concurrent medications. On an unspecified date before 9/13/2005, the subject received the 1st dose of Havrix. On 9/13/2005 the subject received the 2nd dose of Havrix in the right arm (lot AHAVB032AA). the medical assistant reported that the 2nd dose of Havrix was administered earlier then recommended. The recommended interval between the 1st and 2nd doses of Havrix is 6 to 12 months. on 9/13/2005, less than one day after vaccination of Havrix, the subject experienced an injection site reaction. At the time of initial reporting, 9/14/2005, the outcome of the injection site reaction was not reported. the healthcare professional considered the events to probably related to vaccination with Havrix.

VAERS ID:252837 (history)  Vaccinated:2006-03-06
Age:14.0  Onset:2006-03-08, Days after vaccination: 2
Gender:Female  Submitted:2006-03-15, Days after onset: 7
Location:Pennsylvania  Entered:2006-03-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidine 0.1 mg at bedtime to help induce sleep
Current Illness: none
Preexisting Conditions: Microcephaly; mild mental retardation. Hyperphenylalaninemia (no dietary restrictions).
Diagnostic Lab Data: EEG. Serum chemistries and CBC. All reported to be normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyskinesia, Headache, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad)
Write-up: Adolescent received Tdap on March 06, 2006. On morning of March 08, 2006 she was observed in school having uncontrolled movements of her left hand, a blank stare, and nearly fell over. She did not lose consciousness. No prior events. She had a headache afterwards and said she had a mild headache that morning. She was evaluated in the Emergency Department. An EEG was done and was read by the neurologist as normal. She regained full activity; neurologist noted some residual weakness in the left hand which resolved completely.

VAERS ID:252869 (history)  Vaccinated:2006-02-24
Age:14.0  Onset:2006-03-06, Days after vaccination: 10
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2006-03-16
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0549R0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Feeling hot, Injection site discolouration, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: L arm upper 4.5 cm X 2 cm erythema slight tenderness, warm to touch + blanches. No induration. 10 days after vaccination.

VAERS ID:252906 (history)  Vaccinated:2006-03-16
Age:14.0  Onset:2006-03-17, Days after vaccination: 1
Gender:Female  Submitted:2006-03-17, Days after onset: 0
Location:Oregon  Entered:2006-03-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: MINOR FLU LIKE SYMPTOMS RUNNY NOSE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURA652B0038A0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA035AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1808AA0SCLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0529P0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Hypokinesia, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: PAIN IN RIGHT ARM UNABLE TO MOVE WIITHOUT PAIN. LOSS OF APPETITE, NAUSEA, ELEVATED TEMPERATURE.

VAERS ID:252940 (history)  Vaccinated:2006-03-08
Age:14.0  Onset:2006-03-08, Days after vaccination: 0
Gender:Male  Submitted:2006-03-13, Days after onset: 5
Location:Delaware  Entered:2006-03-17, 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: Adderall XR Ritalin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EKG (pending) Blood glucose
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1978AA0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2384AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Syncope, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Diffuse hives and syncope. Hives started 3 hours after vaccines. Syncope occurred morning of 3-9-06. Occurred when pt rising from a seated position.

VAERS ID:253062 (history)  Vaccinated:2006-03-16
Age:14.0  Onset:2006-03-16, Days after vaccination: 0
Gender:Female  Submitted:2006-03-16, Days after onset: 0
Location:New Mexico  Entered:2006-03-21, 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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0914R0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt receiving varicella vaccine. Seated through injection and felt fine. Walked up to front desk for follow up appt - sudden syncope - fell without injury. Woke, and steady heart rate and resp in 230 seconds. Fine to go home in 10 min.

VAERS ID:253089 (history)  Vaccinated:2005-11-23
Age:14.0  Onset:2005-11-23, Days after vaccination: 0
Gender:Male  Submitted:2005-12-15, Days after onset: 22
Location:Unknown  Entered:2006-03-22, Days after submission: 97
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: Pt has food allergies and asthma. He is on Albuterol as needed. The pt had no illness at the time of vaccination.
Diagnostic Lab Data:
CDC Split Type: 200502615
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Feeling hot, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: A 13 yr old male pt was hot, dizzy, nauseated and his hands and legs were stiff immediately after receiving the injection of Adacel and Tubersol on 23Nov05. Lot numbers, route and site of administration not reported. The reporter is the pt''s parent. The pt had no illness at the time of vaccination. Treatment received not reported. Per the parent, the pt recovered.

VAERS ID:253090 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2006-03-22
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: 200600324
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR    
TDAP: TDAP (ADACEL)AVENTIS PASTEUR    
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Sensation of heaviness
SMQs:, Guillain-Barre syndrome (broad)
Write-up: A 14 yr old female pt had received an administration (route and site not reported) of Menactra (lot number not reported) and administration (route and site not reported) of Adacel (lot number not reported) on an unspecified date. Approx one week later she experienced weakness and heaviness in her arms. Per the reporter, the pt had recovered from this event at the time of this report.

VAERS ID:253105 (history)  Vaccinated:2006-01-30
Age:14.0  Onset:2006-01-31, Days after vaccination: 1
Gender:Female  Submitted:2006-03-07, Days after onset: 35
Location:Oregon  Entered:2006-03-22, 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: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 0200612
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0553R1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Malaise, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Noted malaise, fever 101, nausea and vomit x 1, 12 hours after vaccine. Also red quarter sized swelling over injection site that progressively grew to 12cm at 72 hours at injection. Persistent fever 100-102.1 with Tylenol. Painful left upper arm injection site.

VAERS ID:253166 (history)  Vaccinated:2006-03-20
Age:14.0  Onset:2006-03-20, Days after vaccination: 0
Gender:Male  Submitted:2006-03-20, Days after onset: 0
Location:California  Entered:2006-03-23, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0570R0IM 
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)MERCK & CO. INC.CW144B0SC 
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Headache, Hypertension, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Vomiting, dizziness, pallor, headache a few minutes after shot of Hep A. Pt given ammous inhalant. BP, Pt lying down.

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