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Case Details (Sorted by Age)

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VAERS ID:180074 (history)  Vaccinated:2002-01-02
Age:11.0  Onset:2002-01-02, Days after vaccination: 0
Gender:Female  Submitted:2002-05-07, Days after onset: 124
Location:Colorado  Entered:2002-01-17, Days after submission: 109
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: UNK
Current Illness: UNK
Preexisting Conditions: Systemic Lupus erythematous
Diagnostic Lab Data: UNK
CDC Split Type: HQ9886714JAN2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018056 IM 
Administered by: Other     Purchased by: Other
Symptoms: Blindness
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)
Write-up: A HCP reported that an 11 year old female received Flu Shield vaccine on 02-JAN-2002 at 10 AM. The pt''s concurrent illness includes Lupus. The pt was enrolled in an unidentified research study at the time of immunization. On 02-JAN-2002 at 2 PM she "lost her vision" and could only see light and dark. On 02-JAN-2002 she was admitted to the hospital and a work-up was negative. The reporter noted that this symptom may be due to a "Lupus flare up" but is not certain. The pt was discharged from the hospital and her vision is improving. No additional information was available as of the date of this report. Follow up info received 5/6/02, from healthcare provider via telephone. The pt recovered within three days of onset. She was discharged from the hospital on 1/5/02. The pt was re-admitted to the hospital for another episode of blindness due to another lupus flare-up. The reporter is "confident" the blindness was not caused by Flushield but was caused by a lupus flare-up. The pt is being treted with anti-inflammatory agents (not identified). Follow up also include dpt''s date of birth.

VAERS ID:180159 (history)  Vaccinated:2001-11-09
Age:11.0  Onset:2001-11-09, Days after vaccination: 0
Gender:Female  Submitted:2001-11-16, Days after onset: 7
Location:Massachusetts  Entered:2002-01-18, Days after submission: 63
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0754L1IM 
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LAB79 IM 
Administered by: Private     Purchased by: Public
Symptoms: Abnormal behaviour, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After vaccines, pt did not seem to be herself, quiet. Approximately 10 hours later, pt''s eye were swollen, eyes and throat became very itchy.

VAERS ID:180213 (history)  Vaccinated:2000-06-13
Age:11.0  Onset:2000-06-13, Days after vaccination: 0
Gender:Female  Submitted:2002-01-14, Days after onset: 580
Location:Pennsylvania  Entered:2002-01-22, 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:
Current Illness:
Preexisting Conditions: Not specified
Diagnostic Lab Data:
CDC Split Type: 20000275541
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Crying, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad)
Write-up: Report number 2000027554-1 describes crying in an 11 year old pt who rec''d Engerix-B. Allergies, medical history, and concomitant medications are not specified. On 6/13/00, the pt rec''d the unspecified dose of Engerix-B. Following the vaccination the pt cried for 48 hrs, and her arm was swollen 2 inches larger than the other. Unspecified medical attention was provided. As of 9/7/00, the outcome of the swollen arm is unknown.

VAERS ID:180256 (history)  Vaccinated:2000-09-28
Age:11.0  Onset:2000-09-28, Days after vaccination: 0
Gender:Female  Submitted:2000-12-11, Days after onset: 74
Location:Minnesota  Entered:2002-01-22, Days after submission: 407
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: 2000351591
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3230B90IMRA
Administered by: Public     Purchased by: Public
Symptoms: Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Write-up: Report 2000035159-1 describes sleepiness in an11 year old female who received an injection of hepatitis b vaccine (Engerix-B). The vaccinee had no concurrent medical conditions and was not taking concurrent medications. She received her first injection of Engerix-B on 28 September 2000. That evening, 2.5 hours post-immunization, she became very sleepy and went to bed early. She was well the next day. On October 2000, three days post-immunization, she "had a very tired day". She recovered without sequelae and without treatment. The vaccine provider considered the sleepiness to be possibly related to Engerix-B administration. The vaccinee received her second injection of Rngrerix-B on 09-november-2000. she had no adverse experience following receipot of this dose.

VAERS ID:180277 (history)  Vaccinated:2000-12-19
Age:11.0  Onset:2000-12-19, Days after vaccination: 0
Gender:Male  Submitted:2001-01-10, Days after onset: 22
Location:New York  Entered:2002-01-22, Days after submission: 377
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: 20010005961
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On approx. 12/19/00, the pt received his 1st IM-deltoid dose of Engerix-B. "Hours later" he developed a red area with itching at the injection site. His pediatrician dx''d the area as a "spider bite". The pt''s allergist indicated that the pt should not receive his 2nd dose at this time. As of 1/9/01, the outcome of the adverse event is ongoing.

VAERS ID:180285 (history)  Vaccinated:2000-08-16
Age:11.0  Onset:2000-08-16, Days after vaccination: 0
Gender:Male  Submitted:2001-01-24, Days after onset: 161
Location:Texas  Entered:2002-01-22, Days after submission: 363
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:
CDC Split Type: 20010018711
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3330A20  
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Report 20010018711 describes hives in an 11 year old male who received Engerix-B for prophylaxis of hepatitis B. The vaccine has no known drug allergies and denies having a medical history or taking concomitant medications. On 08/16/2000, the vaccinee received his first dose of Engerix-B. Post-vaccination, on 08/16/2000, he experienced hives and fever. An ER visit was required. the events resolved. On 09/20/2000, the vaccinee received his first done of Recombivax. Post-vaccination on 09/20/2000, he experienced fever and hives. The events resolved. As of 01/23/2001, the outcome of the events is resolved.

VAERS ID:180344 (history)  Vaccinated:2001-11-08
Age:11.0  Onset:2001-11-28, Days after vaccination: 20
Gender:Female  Submitted:2002-01-04, Days after onset: 37
Location:Wisconsin  Entered:2002-01-23, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa
Current Illness: Sore throat
Preexisting Conditions:
Diagnostic Lab Data: Strep test; TB skin test; ANA; ASO; Sed rate; Mycoplasma titer; urinalysis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5208A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema nodosum, Pain, Pharyngolaryngeal pain, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt developed ankle pain and swelling, erythema nodosum, hives on legs and inside elbows and a mild sore throat which occurred at the end of November.

VAERS ID:180402 (history)  Vaccinated:2001-05-29
Age:11.0  Onset:2001-05-31, Days after vaccination: 2
Gender:Female  Submitted:2001-06-04, Days after onset: 4
Location:New York  Entered:2002-01-24, Days after submission: 234
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: the pt rec''d not concomitant medication.
Current Illness:
Preexisting Conditions: reportedly the pt had not known allergies or medical history.
Diagnostic Lab Data:
CDC Split Type: 2001013541
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Report 200101354-1 described pulled muscle in a pt who rec''d hepatitis B vaccine recombinant (Engerix-B) for prophylaxis of hepatitis B. This report was rec''d from the pt''s mother and has not been verified by a physician or other HCP. Reportedly, the pt had no known allergies or medical history. Reportedly she rec''d no concomitant medications. reportedly, the pt had never previously experienced a pulled or painful muscle. On 5/29/01, the pt rec''d her first R deltoid dose of Engerix-B. On 5/31/01, while running in the gym, the pt reportedly experienced a pulled muscle or pain (unknown if R or L leg). Reportedly, the pt''s symptoms resolved in 24 hrs.

VAERS ID:180418 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2000-09-26
Gender:Male  Submitted:2001-07-25, Days after onset: 302
Location:Unknown  Entered:2002-01-24, Days after submission: 183
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:
Diagnostic Lab Data:
CDC Split Type: 20010176671
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3068A20IM 
Administered by: Other     Purchased by: Other
Symptoms: Angioneurotic oedema, Dry throat, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On an unspecified date, the child received an injection of Engerix-B at school; number of previous injections of Engerix-B was not reported. On 9/26/00, an unspecified amount of time, post vax, the child developed angioedema, throat itch, pruritus and urticaria. He was taken to the local ER and treated with unspecified steroids. He remained symptom-free for the next 2 weeks. The urticaria then returned. He was seen by an Allergist and was treated with Zyrtec 10mg daily, cimetidine 75mg daily and Benadryl. As of 4/01, the urticaria persisted. The reporting Allergist considered the angioedema, throat itch, pruritus and urticaria to be of moderate intensity and possibly related to Engerix-B administration.

VAERS ID:180444 (history)  Vaccinated:2001-10-10
Age:11.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-12, Days after onset: 2
Location:North Carolina  Entered:2002-01-24, Days after submission: 104
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to dog hair and dust
Diagnostic Lab Data:
CDC Split Type: 20010243821
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Flushing, Headache, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)
Write-up: On 10/10/01, the pt received his 2nd 10mcg, IM dose of Engerix-B. Ten minutes later, the pt experienced "agitation, severe headache, heat sensations, flushing" and 1 episode of "passing out". The pt received Benadryl immediately and ER observation later for a brief period. As of 10/10/01, the adverse events had resolved.

VAERS ID:180449 (history)  Vaccinated:2001-10-11
Age:11.0  Onset:2001-10-12, Days after vaccination: 1
Gender:Female  Submitted:2002-01-09, Days after onset: 89
Location:New Jersey  Entered:2002-01-24, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 2001025629
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5253E92IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 11 October 2001, the patient received her third injection of Engerix-B in her left arm. On 12 October 2001, one day post-immunization, the patient developed a three inch red, swollen band approximately 2 inches below the injection site. The area was also itching. The patient was seen by a physician. The events were "improving" as of 15 October 2001.

VAERS ID:180504 (history)  Vaccinated:2002-01-11
Age:11.0  Onset:2002-01-12, Days after vaccination: 1
Gender:Male  Submitted:2002-01-14, Days after onset: 2
Location:South Carolina  Entered:2002-01-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Negative per mother
Diagnostic Lab Data:
CDC Split Type: SC0201
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5230A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt rec''d 1st dose of Hep B on 1/11/02. Pt went to beach for weekend and upon return on (1/13/02) he reported to mother that a rash on face, chest and back began to appear on (1/2/02). Mother took pt to Dr. on 1/14/02 and is having blood work done this afternoon.

VAERS ID:180696 (history)  Vaccinated:2001-10-04
Age:11.0  Onset:2001-10-07, Days after vaccination: 3
Gender:Male  Submitted:2002-01-22, Days after onset: 107
Location:Texas  Entered:2002-01-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: cimetidine
Current Illness: Cellulitis/fasciitis
Preexisting Conditions: Periodic fever syndrome
Diagnostic Lab Data: MRI-showed intensive soft tissue swelling down to the muscle; superficial tissue interface.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1197K0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed tense, painful erythema, swelling and induration encompassing 2/3 of the circumference of the upper arm which abated slowly over several weeks. Treated with IV antibiotics in hospital for about 7 days and then with home IV antibiotics until 11/6/02.

VAERS ID:180728 (history)  Vaccinated:2002-01-24
Age:11.0  Onset:2002-01-24, Days after vaccination: 0
Gender:Female  Submitted:2002-01-24, Days after onset: 0
Location:Minnesota  Entered:2002-01-30, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5224B90IMLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure decreased, Dizziness, Heart rate decreased, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Prior to receiving immunization, the pt was tense/anxious and lightheaded. Allowed her to lay down for immunization (given at 15:00). She remained lightheaded and pale. At 15:05 her BP was 100/50, P-64 lying; at 15:07 her BP was 104/58, P-64 lying; at 15:30, her sitting BP was 90/58 and P-64; at 15:20, her sitting BP was 94/60 and P-68. She declined more juice and was accompanied to the waiting area. Supervised by physician. No loss of consciousness.

VAERS ID:180741 (history)  Vaccinated:2002-01-22
Age:11.0  Onset:2002-01-22, Days after vaccination: 0
Gender:Female  Submitted:2002-01-22, Days after onset: 0
Location:Massachusetts  Entered:2002-01-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0845L0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Coordination abnormal, Dizziness, Headache, Injection site pain, Syncope vasovagal, Visual disturbance
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: 15 minutes, post vax, the pt experienced lightheadedness, saw orange spots and had difficulty performing tasks (putting straw in bottle) and fell to hands and knees. She tried to get up and fell backwards but was caught by teacher. She experienced headache (frontal, forehead( for about 3 hours after. Her mother spoke with doctor who stated it was a vagal syncope incident. 24 hours, post vax, her arm is sore but not red.

VAERS ID:180822 (history)  Vaccinated:2000-03-29
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2000-04-19
Location:New Jersey  Entered:2002-02-04, Days after submission: 656
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U200000205
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0114BA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: It was reported that an 11 year old female received a TD-Adult vaccination in her left arm on 3/29/00. Reportedly, sometime after the vaccination, the pt developed a 3" red area, raised and warm at the area of the injection. From correspondence received on 4/19/00, additional pt information was provided.

VAERS ID:180868 (history)  Vaccinated:2000-06-12
Age:11.0  Onset:2000-06-12, Days after vaccination: 0
Gender:Male  Submitted:2000-06-15, Days after onset: 3
Location:Minnesota  Entered:2002-02-04, Days after submission: 599
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: U200000485
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEUR138BA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: It was reported that an 11-year-old boy received a TD-Adult vaccination on 12-Jun-2000. Reportedly that same day, the patient developed hives. Further information requested.

VAERS ID:180884 (history)  Vaccinated:2000-09-08
Age:11.0  Onset:2000-09-11, Days after vaccination: 3
Gender:Male  Submitted:2000-11-06, Days after onset: 56
Location:Michigan  Entered:2002-02-04, Days after submission: 455
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: U200000797
Vaccination
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TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0194AA IM 
Administered by: 0     Purchased by: 0
Symptoms: Cellulitis, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: It was reported that an 18 year old male pt received a TD Adult on 9/8/00 and on 9/11/00, the pt developed a local reaction of redness and pain at the injection site. Physician treated as cellulitis with Cefadroxil 500mg twice a day for 10 days.

VAERS ID:180911 (history)  Vaccinated:2001-11-05
Age:11.0  Onset:2001-11-05, Days after vaccination: 0
Gender:Male  Submitted:2002-01-28, Days after onset: 84
Location:Michigan  Entered:2002-02-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0600AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client c/o some itching a few minutes after shot. no redness, ice was applied to site and that stopped itching. On 11-06-01, arm was little sore , but still some soreness.

VAERS ID:180926 (history)  Vaccinated:2002-01-08
Age:11.0  Onset:2002-01-09, Days after vaccination: 1
Gender:Female  Submitted:2002-01-22, Days after onset: 13
Location:Texas  Entered:2002-02-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Benzonatate
Current Illness: Allergies (cough)
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: TX0217
Vaccination
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1335L0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1092L1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Body temperature increased, Myalgia, Photosensitivity reaction, Pruritus, Rash, Rash macular
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash; raised, blotchy, itchy. Still has temperature at or below 100.7, one time a week. Sensitive to light once a week. Muscle soreness in arms and legs 3 days a week.

VAERS ID:180977 (history)  Vaccinated:2001-01-05
Age:11.0  Onset:2001-01-07, Days after vaccination: 2
Gender:Male  Submitted:2001-07-12, Days after onset: 185
Location:Florida  Entered:2002-02-06, Days after submission: 209
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: U200100304
Vaccination
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TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURV0361AA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Face oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: From the initial report received on 01/09/2001, it was reported that an 11 year old male was given TD Adult vaccine in the left arm on 01/05/2001. On 0107/2001 at 8am, pt reportedly experienced "skin rash-exanthemas papules with some confluence over trunk and upper extremities. Mild facial swelling Rx-Prednisone taper with good results." The pt reportedly recovered. From follow up information received on 4/10/01, it was reported, "No further care required, no sequellae. Reveiwed, no additional information at this time. From mailed correspondence on 6/25/01 it was stated, "Reviewed, no additional information at this time." This case is closed.

VAERS ID:181030 (history)  Vaccinated:2001-12-07
Age:11.0  Onset:2001-12-26, Days after vaccination: 19
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2002-02-07
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: LP; Head CT; Head MRI; EEG-all negative. Skin test-(+); WBC-13.6K/UL; Neutrophils-(75.5%)
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5230A20IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1096L1SC 
Administered by: Other     Purchased by: Public
Symptoms: Anorexia, Confusional state, Fatigue, Hallucination, Headache, Laboratory test abnormal, Movement disorder, Pruritus, Psychotic disorder, Pyrexia, Sleep disorder, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: The 1st admission to ER on 12/29/01 with a sudden onset of psychosis, 2 weeks after MMR vaccine. She was treated with Xanax 0.25mg. Upon admission to hospital, she exhibited acute confusion/psychosis state. Onset of all the symptoms from 12/29/01 to 1/10/02 include, HA, blurred vision, lack of sleep and food, itching, hallucinations, disorganized, fever, fatigue and hand and leg movement. Treated with diazepam and lorazepam.

VAERS ID:181257 (history)  Vaccinated:2002-02-06
Age:11.0  Onset:2002-02-07, Days after vaccination: 1
Gender:Female  Submitted:2002-02-11, Days after onset: 4
Location:Unknown  Entered:2002-02-12, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash around injection site, face, and leg.

VAERS ID:181420 (history)  Vaccinated:2001-11-20
Age:11.0  Onset:2001-12-01, Days after vaccination: 11
Gender:Female  Submitted:2002-02-15, Days after onset: 76
Location:Nebraska  Entered:2002-02-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40180521IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction
SMQs:
Write-up: Swelling, tenderness, redness to injection site. Area felt warm to touch for several days with these symptoms.

VAERS ID:181482 (history)  Vaccinated:2002-02-08
Age:11.0  Onset:2002-02-11, Days after vaccination: 3
Gender:Male  Submitted:2002-02-13, Days after onset: 2
Location:Texas  Entered:2002-02-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM706A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Urticarial rash

VAERS ID:181811 (history)  Vaccinated:2001-12-17
Age:11.0  Onset:2001-12-29, Days after vaccination: 12
Gender:Female  Submitted:2002-02-20, Days after onset: 53
Location:Ohio  Entered:2002-02-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Diagnosed with Neutropenia at age 2 yo.
Diagnostic Lab Data: Blood work done-Severe allergic reaction to MMR vaccine.
CDC Split Type:
Vaccination
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5208A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0903L1SCRA
Administered by: Other     Purchased by: Public
Symptoms: Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed a rash that spreads all over body on 12-29-021. Rash described as blistery looking that itched intensely. Was treatment at hospital on 12/30 with steroids. taken to another hospital twice in January and treated. Taken to the hospital around January 16, 02 and was diagnosed per blood work with severe reaction to the MMR received in Dec, 01. Now on cortisone creams, Has residual white patches all over arms and legs. Rash has resolved. May have skin grafts in the future.

VAERS ID:181906 (history)  Vaccinated:1996-03-25
Age:11.0  Onset:2002-02-16, Days after vaccination: 2154
Gender:Female  Submitted:2002-02-21, Days after onset: 5
Location:Washington  Entered:2002-03-04, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1127B0SC 
Administered by: Private     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: right upper back-dermatomal distribution vesticular rash, in clusters with red base

VAERS ID:182142 (history)  Vaccinated:2001-06-21
Age:11.0  Onset:2001-07-04, Days after vaccination: 13
Gender:Female  Submitted:2002-03-04, Days after onset: 243
Location:Massachusetts  Entered:2002-03-08, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: All tests done by PCP were (-).
CDC Split Type:
Vaccination
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HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM697A20IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURT117050IMLA
Administered by: Public     Purchased by: Private
Symptoms: Decreased appetite, Dizziness, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Received pedi Hep-A vaccine and Typhium VI vaccine on 6/21/01. Pt then traveled to abroad X 3 weeks. Appox. 2 weeks, post vax, the pt developed dizziness, nausea, decreased appetite and "shakiness". Per pt''s mom, the pt was worked-up via blood and stool tests numerous times with (-) findings. Mother has questioned if these vaccines are associated with her daughter''s clinical signs and symptoms (we doubt this). Mom called on 3/4/02 to review on-going problems occurring 2 weeks, post vax. Doubt correlation.

VAERS ID:182171 (history)  Vaccinated:2002-02-26
Age:11.0  Onset:2002-03-01, Days after vaccination: 3
Gender:Female  Submitted:2002-03-07, Days after onset: 6
Location:California  Entered:2002-03-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: patient is a diabetic, on insulin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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HEPA: HEP A (VAQTA)MERCK & CO. INC.0925L0IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURUA439AA4IMLA
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUA439AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt returns on 3/6/2002 to complete travel immunization ;menomune and Typhim (pt going to Ethiopia X 2 months. Per pt''s dad, pt developed rashes 2 days after receiving the vaccines On exam, rashes noted on her forehead and trunk per dad @ no time did she have any respiratory distress. Pt did not have to take any medications for this conditions

VAERS ID:182180 (history)  Vaccinated:2002-03-01
Age:11.0  Onset:2002-03-01, Days after vaccination: 0
Gender:Female  Submitted:2002-03-07, Days after onset: 6
Location:Maine  Entered:2002-03-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash and fever;DTaP (mfr not specified);1;.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM527A24IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site mass, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness and a nodule on left thigh at site of DTAP. A large wheal, 1/2 dollar-sized appeared later the same day and continued X 3 days.

VAERS ID:182257 (history)  Vaccinated:2002-03-05
Age:11.0  Onset:2002-03-06, Days after vaccination: 1
Gender:Female  Submitted:2002-03-06, Days after onset: 0
Location:New Hampshire  Entered:2002-03-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5261A2   
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: urticaria on both side of face without respiratory distress

VAERS ID:182349 (history)  Vaccinated:2001-02-19
Age:11.0  Onset:2001-03-07, Days after vaccination: 16
Gender:Female  Submitted:2002-03-07, Days after onset: 365
Location:Unknown  Entered:2002-03-13, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01032916
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1652K0 LA
Administered by: Other     Purchased by: Other
Symptoms: Henoch-Schonlein purpura, Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 11 year old female on 02/19/2001 was vaccinated with a first dose of hep b vaccine recombinant in the left arm. On approximately on 03/07/2001 the pt experienced ecchymotic or purpuric rash on her legs only. The physician felt that the rash may be associated with some sort of vasculitis. The rash was later diagnosed as Henoch-Schonlein purpura. The pt recovered. No further info is expected.

VAERS ID:182353 (history)  Vaccinated:2001-03-09
Age:11.0  Onset:2001-03-25, Days after vaccination: 16
Gender:Female  Submitted:2002-03-07, Days after onset: 347
Location:Unknown  Entered:2002-03-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01034377
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Blister, Chills, Hepatic function abnormal, Pyrexia, Rash, Rash maculo-papular, Urticaria, Viral infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 11 year old female pt with no known allergies who on 03/09/2001 was vaccinated with the second dose of hep b vaccine recombinant. On 03/25/2001 the pt developed a pruritic red rash, plaque like blisters that were diffused. The rash was on her face, arms, and trunk. She developed fevers of 101-102F, chills, and joint aches/pains. On 03/26/2001, the pt presented to the physician''s office with a rash that was blotchy, raised, urticarial, with a few vesicles, that had no target lesions, and no mucosal lesions. There were some small lesions on the hands and feet. On 03/26/2001, laboratory values were as follows: PT normal, platelets normal, AST 216, ALT 268, alkaline phosphatase 513, and total bilirubin of 1.8. The pt did not have a coagulatiion disorder. It was initially thought since the pt had a subconjunctival hemorrhage from coughing and a large hematoma after blood was drawn, but the PT and platelets were normal. The pt was not hospitalized. Since the pt tested negative for hep a,b, and c, the physician felt the pt could have had an atypical viral syndrome. The pt was treated with prednisone and was improving. The pt will not be receiving the third dose of hep b vaccine recombinant. The pt''s liver enzymes will be followed until normal. Additional info is not expected.

VAERS ID:182363 (history)  Vaccinated:2001-04-13
Age:11.0  Onset:2001-04-14, Days after vaccination: 1
Gender:Female  Submitted:2002-03-07, Days after onset: 327
Location:Colorado  Entered:2002-03-13, 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: albuterol, Flovent, Singulair
Current Illness: NONE
Preexisting Conditions: allergy (strawberry, cat), asthma
Diagnostic Lab Data:
CDC Split Type: WAES01041940
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SCLA
Administered by: Private     Purchased by: Private
Symptoms: Alopecia
SMQs:
Write-up: Information has been received from a licensed practical nurse concerning an 11 year old female with asthma, a strawberry allergy and cat allergy who on 04/13/2001 was vaccinated with a first dose of hep b vaccine IM in the right arm. Concomitant vaccination included a dose of MMR received on 04/13/2001, SC in the left arm. Concomitant therapy included montelukast sodium, fluticasone propionate, and albuterol. There was no illness at the time of vaccination. The licensed practical nurse reported that 24 hrs after the pt received the vaccinations she experienced alopecia. The licensed practical nurse reported that the client presented on 04/16/2001 with alopecia in the center of her head. The nurse reported that this was the client''s first injection of hep b vaccine recombinant and MMR. In follow-up the licensed practical nurse reported that 24 hrs after vaccines, there was an abrupt onset of hair loss centrally, in a line along the sagittal suture. She report that the roots came out too and the area was 2-3cm wide and 5-6 cm long, total alopecia in that area. The licensed practical reported that as of 05/09/2001, the hair is starting to regrow. In follow-up the physician''s office reported that as of 09/26/2001, the hair has regrown. No further info is available

VAERS ID:182375 (history)  Vaccinated:2001-05-01
Age:11.0  Onset:2001-05-03, Days after vaccination: 2
Gender:Male  Submitted:2002-03-07, Days after onset: 308
Location:Unknown  Entered:2002-03-13, 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:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01052148
Vaccination
Manufacturer
Lot
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Headache, Injection site pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Information has been received from a health care professional concerning an 11 year old male pt who on 05/01/2001 was vaccinated with a second 10 mcg dose of hep b vaccine recombinant. There was no concomitant medication. On 05/03/2001 two days after vaccination, the pt presented to the clinic complaining of headache, pain at the injection site, chest pain and his right hand and arm were swollen. Subsequently, the pt recovered. Additional info has been requested.

VAERS ID:182384 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2002-03-07
Location:Unknown  Entered:2002-03-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01061952
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: Information has been received from a nurse concerning an 11 year old female who was vaccinated with a second dose of hep b vaccine. One week post vaccination, the pt developed mild Bell''s palsy. The pt sought unspecified medical attention. Additional info has been requested.

VAERS ID:182397 (history)  Vaccinated:2001-06-27
Age:11.0  Onset:2001-06-28, Days after vaccination: 1
Gender:Male  Submitted:2002-03-07, Days after onset: 252
Location:New Jersey  Entered:2002-03-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01071842
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning an 11 year old male child with no known allergies who on approximately 27 JUN 2001 was vaccinated with a first dose of Hepatitis B vaccine recombinant (yeast). On approximately 28 JUN 2001, 24-48 hours post dose, the child broke out in an itchy rash all over the trunk of his body. It was reported that the nurse said "it looks like an allergic reaction, but it is not hives." It was noted that the rash still persists. Unspecified medical attention was sought. Follow up information has been received and indicated that the reporter determined that the rash and the itchy allergic reaction were not related to the therapy with Hepatitis B vaccine recombinant (yeast). Additional information has been requested.

VAERS ID:182410 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2001-08-31
Gender:Male  Submitted:2002-03-07, Days after onset: 188
Location:Unknown  Entered:2002-03-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01090055
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.   LA
HEPA: HEP A (VAQTA)MERCK & CO. INC.   RA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health professional concerning an 11 year old male with no known allergies who in approximately 2001, was vaccinated in the left deltoid with hep b vaccine recombinant. Concomitant therapy included a dose in the right deltoid of hep a vaccine. Other concomitant therapy included Concerta. It was reported on 08/31/2001 that the pt "now" has a rash all over the body. Unspecified medical attention was sought. Additional info has been requested.

VAERS ID:182444 (history)  Vaccinated:2002-02-22
Age:11.0  Onset:2002-02-23, Days after vaccination: 1
Gender:Male  Submitted:2002-03-08, Days after onset: 13
Location:New Jersey  Entered:2002-03-14, 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)SMITHKLINE BEECHAM5156A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt''s father called and said child had Hep-B shot on 2/22/02 and on 2/23/02, he had a red rash all over his body. It was raised and red with white centers and itchy. It''s the first time this has happened. Father denies any previous allergic reactions. MD was notified and states this could be an allergic rash to IZ. States should not get. Father called family doctor and he ordered Benadryl.

VAERS ID:182468 (history)  Vaccinated:2001-09-15
Age:11.0  Onset:2001-09-15, Days after vaccination: 0
Gender:Female  Submitted:2002-03-07, Days after onset: 173
Location:New Jersey  Entered:2002-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01092006
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site inflammation, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a registered nurse concerning a 11 year old female who on 09/15/2001 was vaccinated with a third dose of hep b vaccine recombinant IM in the arm. On 09/15/2001, the pt experienced a localized reaction which involved a large area of the injection site and below which was quiet inflammed. The pt was treated with hiphendydramino hydrochloride and warm compresses. Additional info has been received from a registered nurse. The nurse reported that the pt had a large induration around, above and below the injection site. No further info is expected.

VAERS ID:182496 (history)  Vaccinated:2001-11-28
Age:11.0  Onset:2001-12-01, Days after vaccination: 3
Gender:Male  Submitted:2002-03-07, Days after onset: 96
Location:Unknown  Entered:2002-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0112USA0147B
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Cardiac disorder, Crying, Lethargy, Listless
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a pharmacist concerning an 11 year old male family member who on 28-2001 was vaccinated with Hepatitis B vaccine recombinant (yeast). On approximately 01-DEC-2001, the patient became tired and listless, he had a loss of appetite, he became depressed, he cried a lot, was afraid to go to school and mentioned that his heart felt funny. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:182633 (history)  Vaccinated:2002-03-07
Age:11.0  Onset:2002-03-07, Days after vaccination: 0
Gender:Female  Submitted:2002-03-07, Days after onset: 0
Location:Colorado  Entered:2002-03-19, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: CO02003
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5230A20IMRA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure increased, Dysphagia, Dyspnoea, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After the hep b vaccination, the pt complained of trouble breathing, throat swelling with trouble swallowing. The pt was given Benadryl. Her blood pressure was 110/60. She was transported to the hospital and released home.

VAERS ID:182796 (history)  Vaccinated:2002-03-14
Age:11.0  Onset:2002-03-18, Days after vaccination: 4
Gender:Male  Submitted:2002-03-21, Days after onset: 3
Location:New Jersey  Entered:2002-03-25, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: strep infection
Diagnostic Lab Data: ultrasound left testicle
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1515K1 LA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Four days after receiving MMR vaccine, the pt developed pain, swelling, redness at left testicle. Mother gave Tylenol with some relief from pain, but it became worse on 03/19/2002. Seen by family physician, referred to ER on 03/20/2002 and was seen by urologist; taking doxycycline 100 mg at this time.

VAERS ID:182831 (history)  Vaccinated:2002-02-21
Age:11.0  Onset:2002-02-21, Days after vaccination: 0
Gender:Female  Submitted:2002-03-15, Days after onset: 22
Location:Illinois  Entered:2002-03-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER5156A20 LA
Administered by: Public     Purchased by: Public
Symptoms: Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother states her face swelled up and she developed hives within less than 24 hrs. Denies any respiratory, airway involvement. Treated with Dimetapp and resolved in 48 hrs.

VAERS ID:183240 (history)  Vaccinated:2001-08-06
Age:11.0  Onset:2001-08-06, Days after vaccination: 0
Gender:Female  Submitted:2002-03-27, Days after onset: 233
Location:Texas  Entered:2002-04-08, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX02044
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.6325L0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Loss of consciousness, Nausea, Pallor, Rash
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Mom states the patient became very pale, dizzy and passed out in car on the way home. Once in house, became nauseated, pale, ongoing. Doctor notified 2 days later. Patient developed red rash on arms/stomach. Doctor notified. Mother called and reported to us on this day.

VAERS ID:183564 (history)  Vaccinated:2002-03-27
Age:11.0  Onset:2002-03-28, Days after vaccination: 1
Gender:Male  Submitted:2002-04-11, Days after onset: 13
Location:Pennsylvania  Entered:2002-04-16, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1067L1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Headache, Nausea, Pain, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Hep-B booster received at 19:30. At 01:00, child awoke yelling "everything hurts" and fever of 102.5F. Fever continued at 101F for 3 days with nausea. Fever came back over 2 weeks. Also had headache and weakness for 3 weeks and sleepiness.

VAERS ID:183647 (history)  Vaccinated:2002-03-01
Age:11.0  Onset:2002-03-02, Days after vaccination: 1
Gender:Male  Submitted:2002-04-11, Days after onset: 39
Location:New Jersey  Entered:2002-04-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt received the Hep-B vaccine and had moderate to severe swelling and tenderness at the injection site on 3/2/02. By 3/4/02, the swelling and pain decreased and the pt made a good recovery.

VAERS ID:183807 (history)  Vaccinated:2002-04-12
Age:11.0  Onset:2002-04-12, Days after vaccination: 0
Gender:Female  Submitted:2002-04-15, Days after onset: 3
Location:Virginia  Entered:2002-04-23, 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: Clarifin
Current Illness: NONE
Preexisting Conditions: Environmental alleriges, seizure disorder
Diagnostic Lab Data: NONE
CDC Split Type: VA02012
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5225A92IMLA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Psychomotor hyperactivity, Rash erythematous, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Late 04/12/2002 or early 04/13/2002 pt complained of itchy rash, about 20 mosquito bite like raised, red, some with blisters. Size about 1/4" or less. Location trunk and extremities. Mother of pt denies of any fever and fatigue. Pt was somewhat "hyper" Friday evening. Pt continues to have this rash today. May go to pmd''s if no improvements.

VAERS ID:183818 (history)  Vaccinated:2002-03-27
Age:11.0  Onset:2002-03-27, Days after vaccination: 0
Gender:Male  Submitted:2002-03-28, Days after onset: 1
Location:Tennessee  Entered:2002-04-23, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TN02010
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5272A20IMLA
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: HBV given at 10am at school. Pt arrived home at 4:30pm complained of back itching. Mom took pt to MD. Pt had urticaria on trunk and extremities. Gave IM steroid and PO Bendaryl. Pt sent home. Mom states itching resumed today at school. Resolved with bendaryl. Arrived home with face flushed this pm and possible high temp. To flu with MD.

VAERS ID:183862 (history)  Vaccinated:2002-04-09
Age:11.0  Onset:2002-04-09, Days after vaccination: 0
Gender:Male  Submitted:2002-04-16, Days after onset: 7
Location:Virginia  Entered:2002-04-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Isoniezid, PPD
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.085362 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13912 LA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESV0519AA2 RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed swelling, erythema and itch on the left upper arm the day of hep b and IPV vaccines. The swelling gradually progressed until pt was examined on 04/12/2002 (4" x 5 1/2"). There was no sign of infection. Immediate response followed Epinephria and benadryl.

VAERS ID:183900 (history)  Vaccinated:2002-04-09
Age:11.0  Onset:2002-04-09, Days after vaccination: 0
Gender:Female  Submitted:2002-04-12, Days after onset: 3
Location:Kentucky  Entered:2002-04-25, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5156A21IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.078860SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Child had initial local response of redness and white "wheel", no systemic reaction and cool compress applied. Redness resolved that night and returned next afternoon with warmth and edness on arm. Remained red and warm on 04/11/2002 am and referred to MD for treatment and evaluation of right arm.

VAERS ID:183929 (history)  Vaccinated:2002-04-18
Age:11.0  Onset:2002-04-18, Days after vaccination: 0
Gender:Female  Submitted:2002-04-22, Days after onset: 4
Location:Texas  Entered:2002-04-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5213A22IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received vaccine approx. 4:30pm and by 7pm the pt developed fever of 103 deg. F. which elevated to 104 deg. F over that evening. Tylenol/Motrin given. Ran low-grade fever 100-101 for two days after.

VAERS ID:183934 (history)  Vaccinated:2002-03-20
Age:11.0  Onset:2002-03-22, Days after vaccination: 2
Gender:Female  Submitted:2002-04-24, Days after onset: 32
Location:California  Entered:2002-04-26, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNknown
Diagnostic Lab Data: Not Known
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1067L0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Diarrhoea, Eye oedema, Eye pain, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother reported to school nurse. school nurse reported to VNA: Nausea, diarrhea, headache, bulging eyes, pain across eyes. current pain in joints. Treated by acupuncturist

VAERS ID:183971 (history)  Vaccinated:2002-04-17
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2002-04-23
Location:Nebraska  Entered:2002-04-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5230A21IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyskinesia, Eye movement disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: The pt apparently fainted, fell to floor and had strong jerking movements of arms and legs, mouth pulled up on left side, eyes rolled back for approximately 30 sec. post vaccination. Also hit back of head on uncarpeted floow when he fainted. States he felt "fine" when he regained consciousness. Upon follow-up the pt had no problems following the episode.

VAERS ID:183977 (history)  Vaccinated:2002-04-11
Age:11.0  Onset:2002-04-12, Days after vaccination: 1
Gender:Female  Submitted:2002-04-23, Days after onset: 11
Location:Pennsylvania  Entered:2002-04-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1183J2IMRA
Administered by: Private     Purchased by: Public
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: Left bell''s palsy one day after vaccination.

VAERS ID:184009 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2002-04-22
Location:Wisconsin  Entered:2002-04-30, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM6523CA22IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Anxiety, Crying
SMQs:, Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Write-up: Highly anxious approximately. 4 hrs post injection Uncontrollable crying and anxiety

VAERS ID:184019 (history)  Vaccinated:2002-04-01
Age:11.0  Onset:2002-04-01, Days after vaccination: 0
Gender:Female  Submitted:2002-04-24, Days after onset: 22
Location:Arkansas  Entered:2002-04-30, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: fever;Hep B (Engerix-B);0;0;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: AR0221
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5252A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site oedema, Injection site reaction, Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within 2 to 3 hrs after vaccination, the pt started running a fever, swelling at site and rash that went all over body with some itching. Tried Benadryl and Calomin lotion with no relief-presented to MD on 04/04/2002. Reaction to vaccine. Treated pt with medrol dose pack, adarax.

VAERS ID:184086 (history)  Vaccinated:2002-04-23
Age:11.0  Onset:2002-04-23, Days after vaccination: 0
Gender:Female  Submitted:2002-04-23, Days after onset: 0
Location:California  Entered:2002-05-01, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5295A20IMRA
Administered by: Private     Purchased by: Private
Symptoms: Fall, Hyperhidrosis, Syncope, Visual disturbance
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Syncopal episode about 10 mins after receiving vaccine. She suddenly got sweaty and vision blacked out, then fell backwards to the floor hitting her head on the wall.

VAERS ID:184160 (history)  Vaccinated:2002-04-18
Age:11.0  Onset:2002-04-19, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2002-05-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5225A92IMLA
Administered by: Other     Purchased by: Public
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 04/19, pt woke up with itchy rash on arms, legs and back. No fever, no headache or other neurological complaints. Rash progressively got worse. On 04/23, went to pediatrician. Mother states the pt was treated for scabies but he continues to itch as of 04/24.

VAERS ID:184286 (history)  Vaccinated:2002-04-16
Age:11.0  Onset:2002-04-16, Days after vaccination: 0
Gender:Female  Submitted:2002-04-17, Days after onset: 1
Location:Washington  Entered:2002-05-07, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra prn; last dose 2 weeks ago.
Current Illness: NONE
Preexisting Conditions: Allergy to cat dander and pollen; eczema
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1497L1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash described as looking like heat rash that started about 1.5-2 hours, post vax. Rash located on torso and slightly itchy. No other complaints. No fever. Rash spread to upper legs by AM of 4/17/02. Rash lasted 3 days. Client was advised to see MD.

VAERS ID:184323 (history)  Vaccinated:2002-04-01
Age:11.0  Onset:2002-04-20, Days after vaccination: 19
Gender:Male  Submitted:2002-04-29, Days after onset: 9
Location:Wisconsin  Entered:2002-05-08, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0784L0SCRA
Administered by: Private     Purchased by: Other
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt developed itchy rash on 04/20/2002-04/21/2002. The pt was seen at physician''s office on 04/23/2002.

VAERS ID:184329 (history)  Vaccinated:2002-04-27
Age:11.0  Onset:2002-04-28, Days after vaccination: 1
Gender:Female  Submitted:2002-05-01, Days after onset: 3
Location:Washington  Entered:2002-05-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1228L0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt developed upper arm swelling for two days following the vaccine administration. Redness and warmth are also present.

VAERS ID:184382 (history)  Vaccinated:2002-04-06
Age:11.0  Onset:2002-04-06, Days after vaccination: 0
Gender:Female  Submitted:2002-04-30, Days after onset: 23
Location:Wisconsin  Entered:2002-05-09, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Rabies anti-serum (HRIG), Tylenol
Current Illness: Animal bite
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt came to ER after a raccoon bite. Raccoon was unable to be found. She received vaccines at 6:30pm and returned to ER around 10pm with facial swelling and erythema on face, legs, and trunk. She was given epinephrine and Benedryl and left hospital after 1-2 hrs later. Child was bit on the left index finger. Shortness of breath was also noted.

VAERS ID:184816 (history)  Vaccinated:2002-05-08
Age:11.0  Onset:2002-05-09, Days after vaccination: 1
Gender:Male  Submitted:2002-05-11, Days after onset: 2
Location:Maine  Entered:2002-05-20, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Nasonex
Current Illness: NONE
Preexisting Conditions: Allergic rhinitis, psoriasis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0539AA5IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt developed large, hot, red circle around injection site on left arm.

VAERS ID:184831 (history)  Vaccinated:1997-02-03
Age:11.0  Onset:2001-03-19, Days after vaccination: 1505
Gender:Male  Submitted:2002-05-15, Days after onset: 421
Location:Florida  Entered:2002-05-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Cardiac disorder NOS, Down''s syndrome, amoxicillin allergy, Suprax and Extendryl allergy
Diagnostic Lab Data:
CDC Split Type: WAES01042525
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0245D0SCRA
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a licensed practical nurse concerning an 11 year old male with down''s syndrome, cardiac disorder, amoxicillin allergy, Suprax drug allergy and a Extendryl drug allergy. On 02/03/1997 the pt was vaccinated with varicella vaccine SC in the right arm. On 03/19/2001 the pt experienced chicken pox. Subsequently, the pt recovered from chicken pox. Additional info is not expected.

VAERS ID:184848 (history)  Vaccinated:1996-07-02
Age:11.0  Onset:2001-04-21, Days after vaccination: 1754
Gender:Male  Submitted:2002-05-15, Days after onset: 389
Location:New Jersey  Entered:2002-05-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01042895
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0241D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician''s office concerning a 11 year old male who on 07/02/1996 was vaccinated with the first dose of varicella vaccine SC in the arm. On 07/02/1996, the pt was also vaccinated with the third dose hep B vaccine recombinant IM in the arm. There was no illness at the time of vaccination. On 04/21/2001, the pt was diagnosed by his physician with chicken pox. In follow-up, the physician reported the pt had chicken pox on 04/25/2001. The physician reported that the pt had recovered without sequelae. No further info is available.

VAERS ID:184851 (history)  Vaccinated:1996-01-26
Age:11.0  Onset:2001-04-28, Days after vaccination: 1919
Gender:Male  Submitted:2002-05-15, Days after onset: 382
Location:Kentucky  Entered:2002-05-20, 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:
Current Illness:
Preexisting Conditions: Varicella exposure
Diagnostic Lab Data: NONE
CDC Split Type: WAES01050131
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0753B0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Malaise, Pyrexia, Rash vesicular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning her 11 year old son who on 01/26/1996 was vaccinated with the first dose of varicella vaccine in the right arm. Concomitant therapy on that day included the third dose of hep B vaccine in the left deltoid. On 04/15/2001, the pt was exposed to varicella. The physician reported that on 04/28/2001, her son developed a fever of 102 deg. F., malaise, and chills. On 04/29/2001, the pt developed 20-30 lesions characteristic of varicella. The pt subsequently recovered from the malaise, fever, chills, and varicella-like lesions. Additional info is not expected.

VAERS ID:184905 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2002-05-14
Location:Florida  Entered:2002-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES0205USA00118
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2  
Administered by: Other     Purchased by: Other
Symptoms: Blindness, Headache, Insomnia, Medication error, Pain
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Medication errors (narrow)
Write-up: Information has been received from a licensed practical nurse who is the mother of an approximately 11 year old female child with no past medical history, who in approximately 1993 or 1994 was vaccinated with the third dose of hepatitis B vaccine recombinant (yeast). There was no concomitant medication and no known allergies. The mother reported that starting the next day, following vaccination, the child began having headaches, which became more severe as time went on. She also experienced aches and pains all over her body and missed almost a year of school. It was also reported that the child sleeps poorly and is losing her eyesight. At the time of this report, the child continued to experience the aches and pains. The mother reported that the child use to be a very active, healthy child until she had the vaccination. She has been to numerous doctors over the years. The mother also reported that about one week after vaccination was given, she found out the child had received a recalled lot of vaccine. The child is reported to be still doing poorly. Upon internal review, the events of blindness, headaches and pain were considered to be other important medical events. Additional information has been requested.

VAERS ID:185062 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2002-05-15
Location:California  Entered:2002-05-22, 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: Developmental delay, eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM721A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt presented at 12:40pm with facial rash. No diagnosis at this time but advised to contact if symptoms persist.

VAERS ID:185103 (history)  Vaccinated:2002-05-07
Age:11.0  Onset:2002-05-08, Days after vaccination: 1
Gender:Female  Submitted:2002-05-13, Days after onset: 5
Location:California  Entered:2002-05-22, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1411L IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Hep-B vaccine given in right deltoid. Hep-A vaccine given in left deltoid. The next AM, had erythema and tenderness from left deltoid down. Worsened over the next 24 hours. Seen in ER and dx''d with cellulitis. Treated with IM Amox. and po flu. Seen the next day in clinic with regression of erythema.

VAERS ID:185176 (history)  Vaccinated:2001-07-06
Age:11.0  Onset:2001-07-11, Days after vaccination: 5
Gender:Male  Submitted:2002-05-15, Days after onset: 308
Location:Colorado  Entered:2002-05-23, 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: insulin,nasonex
Current Illness:
Preexisting Conditions: Type 1 diabetes mellitus
Diagnostic Lab Data: diagnostic laboratory-07/17/01-(-)- adequate specimen, no VZV identified; temperature measurement-norma; wound culture-gm-not pseudomonas
CDC Split Type: WAES01071009
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Private
Symptoms: Rash papular, Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health professional concerning a 11 year old male patient with NKDA and type I diabetes mellitus who on 07/06/01, at 4:00 pm was vaccinated SQ in the left arm with a first dose of varicella virus vaccine live. concomitant vaccine therapy that day at 4:00 pm included MMRII and hepatitis be vaccine, recombinant. Other concomitant medication included insulin and mometasone furoate (Nasonex). There was no illness at the time of vaccination. It was noted that the patient had no recent exposure to chickenpox or shingles and there was no rash at the injection site post vaccination. It was also noted that there was no immunosuppression. On 07/11/01, the patient developed a rash of approximately 50 lesions on his head, trunk, upper arms and legs. the rash was described as discrete erythematous papules and a few pustules ("not clear fluid"). He was afebrile and had no other systematic symptoms. The rash was described by the patient''s mother. It was noted that the child had not yet been seen by the doctor''s office. Follow up information has been received from a health professional who reports a skin culture was done of a pustule and grew a gram negative rod that was not a soeudomonas. A vesicle and papule were sent for VZV analysis. The specimen was adequete and there was no VZV identified. It was confirmed by Columbia University that the specimen was negative for VZV. It was noted by the reporter that he thought the patient "had a folliculitis and this rash was unrelated to the vaccine". The patient has recovered.

VAERS ID:185253 (history)  Vaccinated:1995-10-27
Age:11.0  Onset:2001-06-01, Days after vaccination: 2044
Gender:Male  Submitted:2002-05-15, Days after onset: 348
Location:Kentucky  Entered:2002-05-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES01072097
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0436B SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a health professional concerning an 11 year old male who on 10/27/95 was vaccinated with 1 dose of varicella virus vaccine live (site unk) (lot 609293/0436B). Subsequently, it was reported that in 6/01, the pt was dx''d with "a mild case of chicken pox". Unspecified medical attention was sought. It was reported that in the spring of 2001, there was a very large chicken pox outbreak in the area. It was not specified whether or not the pt had an exposure to these cases. The reporter also indicated that the vaccine was not given close to the expiration date and that vaccine lot numbers were not similar in the other cases reported. Subsequently, the pt recovered. No further information is available.

VAERS ID:185365 (history)  Vaccinated:2000-10-04
Age:11.0  Onset:2001-08-02, Days after vaccination: 302
Gender:Male  Submitted:2002-05-15, Days after onset: 286
Location:Unknown  Entered:2002-05-24, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01080999
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Rash vesicular
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning now a 12 year old male who on 10/04/2000 was vaccinated with varicella vaccine. On approximately 08/02/2001, the pt developed a vesicular rash with some water filled lesions on the right side of the trunk and right arm. He was diagnosed with varicella. There was no evidence of shingles. He was prescribed topical treatment. Additional info has been requested.

VAERS ID:185468 (history)  Vaccinated:2000-03-20
Age:11.0  Onset:2002-05-15, Days after vaccination: 786
Gender:Male  Submitted:2002-05-20, Days after onset: 5
Location:Massachusetts  Entered:2002-05-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: UNK
Preexisting Conditions: Diabetes (insulin dependent); depression; hypothyroidism; seizure
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 2  
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Rash, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt developed rash with crusted lesions on back, one small vesicle, red throat and tongue.

VAERS ID:185541 (history)  Vaccinated:2002-05-21
Age:11.0  Onset:2002-05-26, Days after vaccination: 5
Gender:Female  Submitted:2002-05-28, Days after onset: 2
Location:Unknown  Entered:2002-05-29, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt developed high fever and chills.

VAERS ID:185555 (history)  Vaccinated:2002-04-30
Age:11.0  Onset:2002-05-09, Days after vaccination: 9
Gender:Female  Submitted:2002-05-14, Days after onset: 5
Location:Ohio  Entered:2002-05-29, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;Measles + Mumps + Rubella (MMR II);1;3;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OH0017
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1376L1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Nausea, Pyrexia, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 05/09/2002, the pt developed fatigue for two days and on 05/11/2002, she developed red rash that started on face. On 05/12/2002, she presented a fever of 100 deg F and on 05/13/2002, she felt nausea (tiny red dots, some raised).

VAERS ID:185589 (history)  Vaccinated:2001-09-21
Age:11.0  Onset:2001-09-24, Days after vaccination: 3
Gender:Female  Submitted:2002-05-15, Days after onset: 233
Location:Unknown  Entered:2002-05-29, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~~9.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01101597
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0233L0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Infection, Pharyngolaryngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a licensed practical nurse concerning al 11 year old female who on 09/21/2001 was vaccinated with varicella vaccine. On 09/24/2001, the pt''s mother called the office and reported that the pt had a sore throat, fever and rash. On 09/24/2001, the pt was seen in the office and was diagnosed with full blown chicken pox with over 100 lesions. The pt had no known exposure to wild-type virus. Subsequently, the pt recovered from chicken pox. At the time of this report, the pt had not been seen in the office since 09/24/2001. Additional info has been requested.

VAERS ID:185611 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2001-10-16
Gender:Female  Submitted:2002-05-15, Days after onset: 211
Location:Unknown  Entered:2002-05-29, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01102412
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a licensed visiting nurse concerning an 11 year old female who in 1997 was vaccinated with a dose of varicella vaccine. On 10/16/2001, the pt was diagnosed with shingles. It was also reported that the pt had a fever and malaise a few days before onset of shingles. There was no medical history or other additional info available. The pt sought unspecified medical attention. On 10/19/2001, it was reported that the pt was recovering. Additional info has been requested.

VAERS ID:186021 (history)  Vaccinated:2002-02-21
Age:11.0  Onset:2002-02-23, Days after vaccination: 2
Gender:Female  Submitted:2002-05-30, Days after onset: 95
Location:Kentucky  Entered:2002-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Motrin
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1362L1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Dyspnoea, Laryngitis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: The pt develped croup-like barking cough within two days of Hep B vaccination. Treated by PMD with Prednisone, Adveer, Singulair and inhaler. Condition persisted for $g 4 weeks. The pt never had a problem prior to this event.

VAERS ID:186523 (history)  Vaccinated:2002-05-20
Age:11.0  Onset:2002-05-21, Days after vaccination: 1
Gender:Male  Submitted:2002-05-21, Days after onset: 0
Location:Georgia  Entered:2002-06-14, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: GA02039
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1238L0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RA swollen and red around injection site and warm. Instructed parent to give child Benadryl. Take Tylenol for fever. Report to PMP if site does not get any better.

VAERS ID:186525 (history)  Vaccinated:2002-02-20
Age:11.0  Onset:2002-02-20, Days after vaccination: 0
Gender:Female  Submitted:2002-02-20, Days after onset: 0
Location:Georgia  Entered:2002-06-14, Days after submission: 113
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA02041
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5228A22IMRA
Administered by: Public     Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mom stated her child was driving home from health dept when child started complaining of a rash on face that was itchy around 3:45-4pm. Mom and child came back to health dept at 4pm. Nurse saw pt came to reception window and noted chil had hives and immediately took child to see nurse practitioner. Epinephrine and Benadryl was given.

VAERS ID:186623 (history)  Vaccinated:2002-02-22
Age:11.0  Onset:2002-02-25, Days after vaccination: 3
Gender:Female  Submitted:2002-05-15, Days after onset: 78
Location:Unknown  Entered:2002-06-17, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0203USA00050
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash vesicular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from on 02/28/02 from a physician concerning an 11 year old female who 02/22/02 was vaccinated with a dose of Varivax (site unknown). On 02/26/02, it was reported that the patient was "crooping with chicken pox" all over body, and had a fever. The child was referred to a dermatologist who determined it was varicella. The patient was started on Acyclovir. Additional information has been requested

VAERS ID:186680 (history)  Vaccinated:2002-05-10
Age:11.0  Onset:2002-05-11, Days after vaccination: 1
Gender:Female  Submitted:2002-05-14, Days after onset: 3
Location:Michigan  Entered:2002-06-18, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data: Ultrasound of left hand-negative
CDC Split Type: WI0211
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5295A22IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia, Oedema, Pain, Pyrexia, Skin discolouration
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redeived Hep B 10am 05/10/02. Reported significant edema to left forearm and hand. Hand and forearm cool to touch with hand discolored. Symptoms began 05/11/02 while at school. Treated, Beandryl Sat/Sunday. C/O numbness in fingers, pain when lifting arm and low grade fever.

VAERS ID:186688 (history)  Vaccinated:2002-06-11
Age:11.0  Onset:2002-06-11, Days after vaccination: 0
Gender:Male  Submitted:2002-06-11, Days after onset: 0
Location:Connecticut  Entered:2002-06-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: CBC, Toxic screen, CT-all normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5289A90IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0568L0SCRA
Administered by: Other     Purchased by: Public
Symptoms: Convulsion, Disorientation, Dizziness, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Immediately after giving second vaccine, pt began convulsing/seizuring for 12-15 seconds after which pt was disoriented for 5 minutes. No recollection of event. Vomited x3. c/o dizziness, nausea, headache. Sent to ER. Diagnosis : new onset seizure.

VAERS ID:186860 (history)  Vaccinated:2002-06-04
Age:11.0  Onset:2002-06-05, Days after vaccination: 1
Gender:Male  Submitted:2002-06-13, Days after onset: 8
Location:New York  Entered:2002-06-20, 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: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5261A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site reaction
SMQs:
Write-up: Local reaction "palm-sized" about 4 inches above the elbow to the shoulder.

VAERS ID:186875 (history)  Vaccinated:2002-06-20
Age:11.0  Onset:2002-06-20, Days after vaccination: 0
Gender:Female  Submitted:2002-06-20, Days after onset: 0
Location:Georgia  Entered:2002-06-24, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: B/P RA $g 66/48; LMS 70/50 apical 72 reg, radial 68 reg, rev 22
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5228A20 LA
Administered by: Public     Purchased by: Public
Symptoms: Pallor, Visual disturbance, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Client became pale, a double vision change, c/o bright spots, vomiting, lips gray. Client very anxious person to injection.

VAERS ID:186916 (history)  Vaccinated:2002-05-20
Age:11.0  Onset:2002-05-20, Days after vaccination: 0
Gender:Female  Submitted:2002-06-19, Days after onset: 30
Location:California  Entered:2002-06-25, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Subjective wheezing during flu-like illness (03/19/02)
Diagnostic Lab Data: Exam only-stable
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5239A41IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Hypoventilation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (narrow)
Write-up: Chest tightness and shortness of breath especially with exerbation x 2 days. Alert, NAD RR=8 shallow, afebrile, HR 100-104 regular, chest clear to ausc. no wheezes. Cor with SE.

VAERS ID:187084 (history)  Vaccinated:2002-06-07
Age:11.0  Onset:2002-06-09, Days after vaccination: 2
Gender:Male  Submitted:2002-06-11, Days after onset: 2
Location:Texas  Entered:2002-07-01, Days after submission: 20
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: UA
CDC Split Type: TX02072
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0193M1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Body temperature increased, Diarrhoea, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Temp elevated 104.4, Small amt. diarrhea, legs hurting.

VAERS ID:187089 (history)  Vaccinated:2002-06-21
Age:11.0  Onset:2002-06-21, Days after vaccination: 0
Gender:Female  Submitted:2002-06-24, Days after onset: 3
Location:Florida  Entered:2002-07-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Cellulitis left arm
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU08244IM 
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0526AA IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0290M0SC 
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swollen, Red

VAERS ID:187216 (history)  Vaccinated:2002-06-19
Age:11.0  Onset:2002-06-19, Days after vaccination: 0
Gender:Male  Submitted:2002-06-25, Days after onset: 6
Location:Ohio  Entered:2002-07-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;Measles + Mumps + Rubella (MMR II);;0;In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT scan, lab work-neg; EEG-results pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5213A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1484L1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Mom states she and pt left the building post vaccination and pulled around the block and pt "went into a full blown seizure." Immediately drove to hospital ER. Mom states pediatrician there did not feel seizure was caused by vaccine.

VAERS ID:187359 (history)  Vaccinated:2002-06-19
Age:11.0  Onset:2002-06-20, Days after vaccination: 1
Gender:Female  Submitted:2002-06-24, Days after onset: 4
Location:Texas  Entered:2002-07-10, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: SA0103
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0910L0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Only 5/5: rash (small, red spots) initially seen on left arm. By Fri 06/21, rash had spread to right arm, face, and chest. Rash became confluent. No treatment.

VAERS ID:187381 (history)  Vaccinated:2002-06-14
Age:11.0  Onset:2002-06-14, Days after vaccination: 0
Gender:Female  Submitted:2002-07-03, Days after onset: 19
Location:Maryland  Entered:2002-07-10, 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: NONE
Current Illness: NONE
Preexisting Conditions: Dislocated hiop
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5313A20IM 
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Fainting spell lasting for about 1 minute. This happened at about 15 mins after the shot. I examined her at 1 minute was coming out of her spell. Vital signs stable. Child said she was very hungry just before the spell.

VAERS ID:187438 (history)  Vaccinated:2002-06-28
Age:11.0  Onset:2002-06-29, Days after vaccination: 1
Gender:Female  Submitted:2002-07-01, Days after onset: 2
Location:Virginia  Entered:2002-07-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nasonex for allergies, Vitamin
Current Illness: Sinusitis
Preexisting Conditions: Hyperactive
Diagnostic Lab Data: None
CDC Split Type: VA02024
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0852L2IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0524AA5IMRA
Administered by: Public     Purchased by: Public
Symptoms: Decreased appetite, Erythema, Fatigue, Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 7/01/02 PC from mother reporting client developed not, redness and itching to right upper arm at injection site area with increased warmth to touch, tired and decreased appetite. No fever. See by doctor and diagnosed with staph infection per mother and treated with augmentin 250mg for 10 days.

VAERS ID:187455 (history)  Vaccinated:2002-05-14
Age:11.0  Onset:2002-05-15, Days after vaccination: 1
Gender:Male  Submitted:2002-07-08, Days after onset: 54
Location:Indiana  Entered:2002-07-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Blood tests done; lymphocytes-low
CDC Split Type: IN200206
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5230A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1382L1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia, Lymphocyte morphology abnormal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Malignant lymphomas (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Numbness of hands, legs, began 18-20 hrs post vaccines given. Seen in ER parent told that lymphocytes were low. Recovered in 3 days.

VAERS ID:187663 (history)  Vaccinated:2002-06-04
Age:11.0  Onset:2002-06-04, Days after vaccination: 0
Gender:Male  Submitted:2002-06-13, Days after onset: 9
Location:Tennessee  Entered:2002-07-16, Days after submission: 33
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:
Diagnostic Lab Data: Magnesium-low
CDC Split Type: TN02017
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5272A21IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Convulsion, Dyskinesia, Fall
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Several hours after injection was walking in house, fell backward and to floor with jerking movements. Transported via ambulance to hospital and kept overnight. No s/s illness, fever or injury. 06*14 to have neurology consult. Mom reported that only lab that was abnormal was low magnesium. 06/17/02 p.c. to parent of pt, she states she took child to neurologist and he started tp on carbiatrol 200mg and is to take this x 3 years. Reports all test normal except low magnesium. She reports pt had seizure 3 or so hours post #2 HBV. Mother states child may had had seizure 1 x when in the 6th grade post playing basketball at school. States doctor will decide if child should get 3rd dose HBV. Will check back with parent post pt''s next visit to neurologist on the 18th.

VAERS ID:187918 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2001-06-01
Gender:Female  Submitted:2002-05-30, Days after onset: 363
Location:Unknown  Entered:2002-07-23, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Brain biopsy-10/01 dx''d with SSPE
CDC Split Type: WAES01110679
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Convulsion, Drug ineffective, Dysarthria, Encephalitis, Mental disorder due to a general medical condition, Somnolence
SMQs:, Lack of efficacy/effect (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a newspaper reporter concerning an 11 year old female who in approx. 1991, at the age of 1, was vaccinated with a 1st dose of MMRII and in approx. 1995, at the age of 5, was vaccinated with a 2nd dose of MMRII. It was reported that in approx. 6/01, the pt started having trouble in school. Prior to that she was a good student. She developed some seizures in 6/01. She was dx''d with epilepsy and placed on therapy. The pt did well for several months. In approx. 9/01, she started getting sleepy, her speech became slurred and she did not respond very well. She was hospitalized for approx. 1 week with no dx being made. She was then transferred to another hospital where she had a 1 month hospitalization. Her work-up included a brain biopsy from which a dx of subacute sclerosing panencephalitis (SSPE) was made. It was reported that the pt''s physician indicated the SSPE could have been due to an old measles infection or the the vaccine. At the time of this report, the pt was on experimental medication and was unable to walk, talk and feed herself. Additional information has been requested. A 15-day follow up report received 10/10/2002 adds: Follow-up received on 08/02/2002 reported that the brain biopsy tissue evaluated for measles virus. RTPCR and subsequent sequencing of the amplified region indicated that the child was infected with wild type measles virus. It was noted that this represents a case of wild type measles infection after primary vaccine failure. It was reported on 08/02/2002 that the pt expired "a few months ago". Additional info has been requested.

VAERS ID:187967 (history)  Vaccinated:2002-07-11
Age:11.0  Onset:2002-07-11, Days after vaccination: 0
Gender:Male  Submitted:2002-07-15, Days after onset: 4
Location:Oklahoma  Entered:2002-07-24, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
Administered by: Public     Purchased by: Other
Symptoms: Amnesia, Asthenia, Dizziness, Fall, Headache, Hyperhidrosis, Injection site pain, Loss of consciousness, Malaise, Nausea, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Dizziness, loss of consciousness, fell on his face, hit head, pale, diaphoretic, memory loss x 2 hrs. Then nausea and vomiting, malaise, weakness, headache until the next day. Both arms very sore. Contacted emergency room nurse and hospital nurse supervisor about reaction. For advise, family physician called.

VAERS ID:188152 (history)  Vaccinated:2002-07-26
Age:11.0  Onset:2002-07-26, Days after vaccination: 0
Gender:Male  Submitted:2002-07-29, Days after onset: 3
Location:Virginia  Entered:2002-07-30, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Claritin
Current Illness:
Preexisting Conditions: Environmental Allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER0853L   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Injury, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: He fainted and hit his head hard on the floor. Lost consciousness and went gray. Had a convulsion.

VAERS ID:188201 (history)  Vaccinated:2002-07-17
Age:11.0  Onset:2002-07-17, Days after vaccination: 0
Gender:Female  Submitted:2002-07-19, Days after onset: 2
Location:Oregon  Entered:2002-07-30, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cephalosporins
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1169L1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dysphagia, Oedema, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Complained of throat feeling tight; difficulty swallowing, neck edema.

VAERS ID:188253 (history)  Vaccinated:2002-07-08
Age:11.0  Onset:2002-07-08, Days after vaccination: 0
Gender:Female  Submitted:2002-07-11, Days after onset: 3
Location:California  Entered:2002-07-31, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NK
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5314A21 RA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM746A20 RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURUO523AA0 LA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash began a couple of hours after child received immunization rash under right arm, chest and stomach area

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