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Case Details (Sorted by Age)

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VAERS ID:200669 (history)  Vaccinated:2003-01-28
Age:19.0  Onset:2003-01-28, Days after vaccination: 0
Gender:Male  Submitted:2003-03-25, Days after onset: 56
Location:Wisconsin  Entered:2003-04-01, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV073   
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS    
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4020071   
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER    
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Dehydration, Orthostatic hypotension, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: VAsovagal syncope, orthostatic hypotension, dehydration.

VAERS ID:200740 (history)  Vaccinated:2003-03-20
Age:19.0  Onset:2003-03-21, Days after vaccination: 1
Gender:Male  Submitted:2003-03-22, Days after onset: 1
Location:Unknown  Entered:2003-04-02, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0652SCLA
Administered by: Military     Purchased by: Military
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Large local reaction 100mm x 165mm. Systemetic rash on both arms-topical carticosteroids and oral antihistiamines.

VAERS ID:200792 (history)  Vaccinated:2003-03-25
Age:19.0  Onset:2003-03-27, Days after vaccination: 2
Gender:Female  Submitted:2003-03-27, Days after onset: 0
Location:Washington  Entered:2003-04-02, 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: Burn of cornea ingrown toenail
Preexisting Conditions: Hydrocodone, iodine, sulfa, Tylenol, Relafen, Naproxen
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0827AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site hypersensitivity, Vasodilation procedure
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypersensitivity (narrow)
Write-up: 8 cm x 4 cm erythematous area at inject site, then 8 cm x 4 cm erythematous area medial to the inject site (2 identical areas) warm to touch.

VAERS ID:201250 (history)  Vaccinated:2003-03-19
Age:19.0  Onset:2003-03-30, Days after vaccination: 11
Gender:Male  Submitted:2003-03-31, Days after onset: 1
Location:Pennsylvania  Entered:2003-04-09, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710 LA
Administered by: Military     Purchased by: Military
Symptoms: Erythema multiforme, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Erythema multiforme without other symptoms with rash and mild pruritus

VAERS ID:201305 (history)  Vaccinated:2003-04-10
Age:19.0  Onset:2003-04-10, Days after vaccination: 0
Gender:Female  Submitted:2003-04-10, Days after onset: 0
Location:Unknown  Entered:2003-04-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: ANAPHALYSIS
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0722SCRA
Administered by: Military     Purchased by: Military
Symptoms: Anaphylactic reaction, Injection site urticaria, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: HIVES AT INJECTION SITE. HIVES SPREAD TO CHEST, NECK, AND FACE WITHIN 5 MINUTES. PT C/O TINGLING IN HANDS AND FEET.

VAERS ID:201336 (history)  Vaccinated:2003-02-09
Age:19.0  Onset:2003-02-12, Days after vaccination: 3
Gender:Male  Submitted:2003-04-06, Days after onset: 53
Location:Ohio  Entered:2003-04-11, 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:
Current Illness:
Preexisting Conditions: Allergic to codeine. Scoliosis. Neck bands
Diagnostic Lab Data: Pinched nerve, C-4 area
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS    
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Migraine, Nausea, Neuralgia, Pain
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Woke up Wed. after 1st anthrax shot around 09:00 am in the morning. Very painful. Called out of work Wed. Went to doctors due to pinched nerve in back, right next to spine. Pain in neck all the way up. Gave such bad migraine I was nauseous. Still persistent and painful.

VAERS ID:201371 (history)  Vaccinated:2003-02-20
Age:19.0  Onset:2003-03-01, Days after vaccination: 9
Gender:Unknown  Submitted:0000-00-00
Location:Unknown  Entered:2003-04-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IM 
Administered by: Military     Purchased by: Unknown
Symptoms: Cow pox, Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Blotchy slain rash developed approx 10 days after receiving vax, over chest and both shoulders. No itching or other complaints.

VAERS ID:201434 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:2003-04-06
Gender:Female  Submitted:2003-04-11, Days after onset: 4
Location:Texas  Entered:2003-04-14, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Raynaud''s syndrome
Diagnostic Lab Data: DFA/viral cx of lesion in for vaccinia
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Chills, Cough, Infection transmission via personal contact, Lymphadenopathy, Myalgia, Nasal congestion, Pyrexia, Rash pustular
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: 19 yr old female travelled to see boyfriend 3/30-03-4/3/03. Boyfriend vaccinated on 3/28/03. Pt had intermittent contact. According to LB, site covered entire time of contact but may have had contact with towels, clothes, etc. Presented to her physician on 4/10/03 with two-scabbed lesions on her chin and above her lip. Her physician notified acute disease unit that day. After consultation, it was felt the pt had probable contact vaccinia. Viral cultures wee obtained from the chin lesion and were received by public health lab for procession on 4/11/03. Her symptoms started on 4/6/03 with fevers, chills, diffuse muscle aches, cough, congestion, groin lymph node swelling. She noted a pustule on her scalp on 4/6/03 that was pruritic and scabbed over. On 4/8/03 she noted a blister on her chin with a red base that has scabbed over. She also noted a new blister above her lip today. She states she has all sites now covered with dry gauze dressing. Additionally, she has also noted some irritation on her perineum and a possible new lesion that appeared today.

VAERS ID:201461 (history)  Vaccinated:2003-04-04
Age:19.0  Onset:2003-04-12, Days after vaccination: 8
Gender:Male  Submitted:2003-04-14, Days after onset: 2
Location:Texas  Entered:2003-04-15, 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: Lipitor, Sporanox
Current Illness: NONE
Preexisting Conditions: Hypertension-Lipitor, toe nail fungal-Sporanox; history of acne
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4020070 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Dull red rash-beginning on hands day 8. Day 10 rash on arms, legs, chest and back taking Benadryl 50mg q 4 hrs. Urticarial or nonspecific rash, erythema multiforme minor.

VAERS ID:201545 (history)  Vaccinated:2003-03-07
Age:19.0  Onset:2003-03-20, Days after vaccination: 13
Gender:Male  Submitted:2003-03-25, Days after onset: 5
Location:Virginia  Entered:2003-04-15, Days after submission: 20
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: Allergy to codeine (as a child)
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IMRA
Administered by: Military     Purchased by: Military
Symptoms: Cow pox, Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: PT had adverse reaction to smallpox vax. PT has numerous red papules on the anterior and posterior regions of torso, back, forearms, and legs.

VAERS ID:201571 (history)  Vaccinated:2003-02-12
Age:19.0  Onset:2003-02-12, Days after vaccination: 0
Gender:Female  Submitted:2003-04-09, Days after onset: 55
Location:Unknown  Entered:2003-04-16, 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: Pregnancy
Diagnostic Lab Data: Urine beta-human - pregnancy confirmed.
CDC Split Type: WAES0303USA00335
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0528M1  
Administered by: Other     Purchased by: Other
Symptoms: Abortion, Unintended pregnancy
SMQs:, Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a nurse practitioner concerning a 19 year old (initially reported as a 17 year old) black female who on 2/12/03 was vaccinated with a second dose of MMR (second generation) (lot # 642700/0528) five weeks after her last menstrual period (approximately 1/8/03). The patient then found out that she was already pregnant at the time of vaccination. In approximately March 2003 a urine beta-human chorionic gonadoptropin test confirmed the pregnancy. The patient had no previous pregnancies. It was reported that no diagnostic testing was done during pregnancy and the patient had no reported illnesses or infections during pregnancy. It was reported that the patient took no prescription drugs during pregnancy. In March 200 the pregnancy ended in a spontaneous abortion 9 weeks after the last menstrual period. Unspecified medical attention was sought for the vaccine exposure during pregnancy, but it is unknown if medical attention was sought for the spontaneous abortion. No further information is expected.

VAERS ID:201660 (history)  Vaccinated:2003-03-04
Age:19.0  Onset:2003-03-20, Days after vaccination: 16
Gender:Female  Submitted:2003-03-24, Days after onset: 4
Location:Pennsylvania  Entered:2003-04-17, Days after submission: 23
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:
Diagnostic Lab Data:
CDC Split Type: PA0314
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0803M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Infection, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash appear 03/20/2003 on abdomen and spread all over body. Was dx''d as varicella disease by PMD

VAERS ID:201686 (history)  Vaccinated:2003-03-26
Age:19.0  Onset:2003-04-01, Days after vaccination: 6
Gender:Male  Submitted:2003-04-14, Days after onset: 12
Location:Maryland  Entered:2003-04-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: WBC increased/monchert neg/chem nl
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710  
Administered by: Military     Purchased by: Military
Symptoms: Pharyngolaryngeal pain, Pyrexia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever and sore throat. Increased WBC admitted to hospital x 24h. Released on antibiotic illness not thought to be related to vaccine.

VAERS ID:201752 (history)  Vaccinated:2003-04-07
Age:19.0  Onset:2003-04-16, Days after vaccination: 9
Gender:Female  Submitted:2003-04-18, Days after onset: 2
Location:Unknown  Entered:2003-04-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH  SCLL
Administered by: Military     Purchased by: Military
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on traunk and face for approximately 2 days. Associated with itching but no other consitutional symptoms; i.s. no fever, chills, n/v/d. No fever

VAERS ID:201777 (history)  Vaccinated:2003-02-13
Age:19.0  Onset:2003-02-13, Days after vaccination: 0
Gender:Female  Submitted:2003-04-14, Days after onset: 59
Location:Colorado  Entered:2003-04-18, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Chills, Tenderness
SMQs:
Write-up: Positive chills; left arm healing smallpox wound to upper humeral area; tenderness.

VAERS ID:201780 (history)  Vaccinated:2003-01-28
Age:19.0  Onset:2003-02-01, Days after vaccination: 4
Gender:Male  Submitted:2003-04-14, Days after onset: 71
Location:Colorado  Entered:2003-04-18, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Lymphadenopathy, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Myalgia, malaise left axillary adenopathy

VAERS ID:201799 (history)  Vaccinated:2003-01-27
Age:19.0  Onset:2003-01-27, Days after vaccination: 0
Gender:Male  Submitted:2003-04-14, Days after onset: 76
Location:Colorado  Entered:2003-04-18, 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: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Chills, Dizziness, Hyperhidrosis, Nausea, Photophobia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: C/o photophobia, nausea, chills/sweats, dizziness, vomited (1x only) for 2 days after smallpox vax.

VAERS ID:201971 (history)  Vaccinated:2003-02-28
Age:19.0  Onset:2003-02-28, Days after vaccination: 0
Gender:Male  Submitted:2003-03-19, Days after onset: 19
Location:Tennessee  Entered:2003-04-22, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABIE-VAX)AVENTIS PASTEURU13882 IM 
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain upper, Migraine
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Migraine headache, short time. Tylenol taken. Stomach aches till early evening after vaccination.

VAERS ID:202178 (history)  Vaccinated:2002-12-19
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2003-04-24
Location:Virginia  Entered:2003-04-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: NKDA, no hx birth defects or medical conditions.
Diagnostic Lab Data: 27 Dec pos hcg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTH    
Administered by: Military     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: Patient received vaccination of anthrax on 19 Dec 02 during first trimester of pregnancy. LMP 7 Nov 02, EDC 14 Aug 03, later changed to 25 Aug 03.

VAERS ID:202194 (history)  Vaccinated:2003-02-27
Age:19.0  Onset:2003-03-11, Days after vaccination: 12
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2003-04-25
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
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS    
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Developed flat red non-itchy, non-indurated rash in upper torso. Developed 7-10 lestions after smallpox vaccination. Rash eventually resolved by itself.

VAERS ID:202361 (history)  Vaccinated:2003-03-10
Age:19.0  Onset:2003-03-10, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Colorado  Entered:2003-04-30
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: Allergic pcn
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 2 LA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Oedema, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Rash started that night and was swollen itching and still red.

VAERS ID:202455 (history)  Vaccinated:2003-04-25
Age:19.0  Onset:2003-04-29, Days after vaccination: 4
Gender:Male  Submitted:2003-05-01, Days after onset: 2
Location:California  Entered:2003-05-01
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
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IDRA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Nausea, dizziness, headache, body ache

VAERS ID:202668 (history)  Vaccinated:2003-02-03
Age:19.0  Onset:2003-02-10, Days after vaccination: 7
Gender:Female  Submitted:2003-05-06, Days after onset: 84
Location:Georgia  Entered:2003-05-06
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
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSUNKNOWN1SCRA
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1IMRA
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1SCRA
Administered by: Military     Purchased by: Unknown
Symptoms: Abdominal pain, Erythema, Headache, Muscular weakness, Nausea, Oedema, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Patient Recieved Vaccines on 2 Feb 03. One week later c/o Rt. arm pain, swelling, redness, abdominal pain and headache. Swelling,redness and headaches resolved after 1 month. Symptoms of abdominal pain,nausea, muscle weakness of rt.arm with occ, hand swelling ongoing x 3 months.

VAERS ID:203467 (history)  Vaccinated:2003-05-07
Age:19.0  Onset:2003-05-15, Days after vaccination: 8
Gender:Male  Submitted:2003-05-15, Days after onset: 0
Location:New York  Entered:2003-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURU15112 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Pain, Paraesthesia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling right deltoid and then developed tingling/pain underside of forearm only not hands, not appearance.

VAERS ID:204441 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:0000-00-00
Gender:Male  Submitted:2003-05-30
Location:Unknown  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Platelet count: 140,000
CDC Split Type: 0301USA00319
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Information has been received from a registered nurse concerning a 19 year old male patient who was vaccinated with a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(Lot # not reported) on an unspecified date. Concomitant therapy that same day included a dose of tetanus vaccine. Subsequently the patient developed nosebleeds for about two weeks after vaccination. He had no history of nosebleeds. His platelet count was reported to be low normal at approximately 140,000 (units and normal values not reported). The patient had never had a vaccination before as he had been home schooled. In order to enter college, he needed several vaccinations. Subsequently the patient "fully recovered" from the nosebleeds. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:204471 (history)  Vaccinated:1995-04-06
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2003-05-30
Location:Unknown  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Diagnostic laboratory - failed to seroconvert
CDC Split Type: WAES0302USA02242
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Information has been received from a registered nurse concerning a 19 year old female pt who on 09/07/1989 and on 04/06/1995 was vaccinated with a first and second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot # not reported). Subsequently the pt experienced failure to seroconvert to one or more of the components. Laboratory evaluation by 2 different labs revealed failure to seroconvert. The nurse also reported that 3 other pts (ages and genders not reported) received 2 doses of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot # not reported) and failed to seroconvert to one or more of the components. (WAES #0302USA01877). Additional info has been requested.

VAERS ID:205171 (history)  Vaccinated:2003-05-26
Age:19.0  Onset:2003-06-10, Days after vaccination: 15
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2003-06-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IMLA
Administered by: Military     Purchased by: Military
Symptoms: Fatigue, Headache, Lymphadenopathy, Skin ulcer, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Received smallpox vaccine between 5/26 and 5/29. Experienced fatigue, lymphadenopathy and headaches for 2 1/2 weeks. Denies chest pain, SOB or cough. Around PM of 6/10/03, generalized symptoms had resolve4d, but noted lesions on abdomen which spread to trunk, back and extremities. Seen in clinic 1 time and ER 1 time; referred to Allergy/Immunology Clinic, where Dx''d with acute urticaria, temporally associated with smallpox vaccine. Tx''d with Allegra.

VAERS ID:205646 (history)  Vaccinated:2003-05-13
Age:19.0  Onset:2003-05-28, Days after vaccination: 15
Gender:Female  Submitted:2003-05-29, Days after onset: 1
Location:Georgia  Entered:2003-07-01, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: GA03061
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB425AA1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Running slight fever, mild rash, and severe itching.

VAERS ID:205876 (history)  Vaccinated:2003-07-01
Age:19.0  Onset:2003-07-01, Days after vaccination: 0
Gender:Female  Submitted:2003-07-03, Days after onset: 2
Location:Missouri  Entered:2003-07-07, 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: Birth Control Pills
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MO200368
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSVHA753C61IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pt''s upper lip and right arm and both thighs swelled up on Tuesday afternoon 7-1-03 has improved by 7-3-03 @ 1030 AM pt treated herself with ice packs.

VAERS ID:206040 (history)  Vaccinated:2003-06-16
Age:19.0  Onset:2003-06-25, Days after vaccination: 9
Gender:Female  Submitted:2003-06-26, Days after onset: 1
Location:Florida  Entered:2003-07-10, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho tri cyclen
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Measles IgG drawn 6/27/03 Measle -EIA (IgG - Negative 7/7/03
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1081M1SCRA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Rash with itching, low graade fever, (99). Rash started on 6/25/03 on stomach, spread all over today.

VAERS ID:206324 (history)  Vaccinated:2003-06-26
Age:19.0  Onset:2003-06-28, Days after vaccination: 2
Gender:Female  Submitted:2003-07-16, Days after onset: 18
Location:North Carolina  Entered:2003-07-16
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: No lab/diagnostic tests done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 0 RA
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH 0 LA
Administered by: Military     Purchased by: Unknown
Symptoms: Blister, Pruritus, Pyrexia, Secondary transmission
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: 06/26/03- Patient's boyfriend received primary smallpox and anthrax #1 vaccines- he did not cover his vaccinated site with a dressing- patient had a prolonged contact with the boyfriend during this time. 06/25/03- Patient noticed a “blister” on gum line under her left upper lip- patient's mother reported this event to the DoD Hotline. 07/03/03- 07/04/03- “Fever= 99.6” (max) 07/05/03- Went to ER- by the time of the visit, her fever had dissipated and her “blister” got “popped accidentally.”- was examined and was told that her “ulcer” was benign. 07/09/03- Patient noticed a cluster of “five blisters” on her right shoulder- lesions were itchy but did not scratch- went to ER again for evaluation- seen by the hospital's “infectious disease team” and was told that those lesions could “possibly be smallpox vaccine related.”- no instruction to cover the site was given and patient received no meds or treatments for those lesions. 07/16/03- Patient's “ulcer” in the mouth has now completely healed- “five blisters” on her right shoulder “almost gone.”- patient has no complaints at this time. Attachment: SUMMARY

VAERS ID:206738 (history)  Vaccinated:2003-06-30
Age:19.0  Onset:2003-07-05, Days after vaccination: 5
Gender:Male  Submitted:2003-07-08, Days after onset: 3
Location:Georgia  Entered:2003-07-29, Days after submission: 21
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: GA03081
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS753C60IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW0332 SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURW136620IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt took 2 aspirin tabs then 45 minutes later broke out in rash to left side and left arm. Rash itches and in the course of 2 days has moved from left side to back, then feet and legs, then to stomach. Rash disappears from one spot as it appears in another. No fever. Pt taken to MD 7/7/03 and put on Prednisone.

VAERS ID:206774 (history)  Vaccinated:2003-07-19
Age:19.0  Onset:2003-07-19, Days after vaccination: 0
Gender:Female  Submitted:2003-07-23, Days after onset: 4
Location:Tennessee  Entered:2003-07-29, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU0550CA0IM 
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Twenty minutes after recieving tetanus injection, she became dizzy, lightheaded and experienced loss os conc for 5 secs.

VAERS ID:206995 (history)  Vaccinated:2003-07-22
Age:19.0  Onset:2003-08-02, Days after vaccination: 11
Gender:Male  Submitted:2003-08-03, Days after onset: 1
Location:New York  Entered:2003-08-03
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMRA
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH 1 RA
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Cow pox
SMQs:
Write-up: GENERALIZED VACCINIA

VAERS ID:206996 (history)  Vaccinated:2002-07-12
Age:19.0  Onset:2002-07-12, Days after vaccination: 0
Gender:Female  Submitted:2003-06-11, Days after onset: 334
Location:Mississippi  Entered:2003-08-04, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: MS03055
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0125M1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Injection site mass, Injection site pain, Joint range of motion decreased
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Patient reported to clinic 6/11/03 complaining of tender and soreness of left arm where patient had received an MMR injection given on 7/12/2002. Also complained of tenderness when moving left arm up. All complaints started on 7/12/02 and have not sought med tx. Patient stated left arm never has been red, hard knots, or warm to the touch.

VAERS ID:207068 (history)  Vaccinated:2003-07-25
Age:19.0  Onset:2003-07-26, Days after vaccination: 1
Gender:Male  Submitted:2003-07-28, Days after onset: 2
Location:California  Entered:2003-08-05, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0823AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Woke up morning after receiving vaccine with 1/2" diameter "knot" at vaccination site. Tender to touch, no redness, no fever. By 7/28/03 at 5PM "knot" no longer noticeable, no tenderness at site. No medication taken during interval.

VAERS ID:207123 (history)  Vaccinated:2002-10-03
Age:19.0  Onset:2002-10-03, Days after vaccination: 0
Gender:Female  Submitted:2003-07-30, Days after onset: 300
Location:Iowa  Entered:2003-08-05, 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: Ortho tri-cyclen
Current Illness: UNK
Preexisting Conditions: Asplenia
Diagnostic Lab Data: NONE
CDC Split Type: 0210USA00890
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0802L1IM 
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Injection site induration, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a registered nurse concerning a 19 year old white asplenic (spleen removed 06/03/1994) female student, who on 10/03/2002 at 14:15 was vaccinated intramuscularly in the right deltoid with a second dose of pneumococcal vaccine 23 polyvalent (Lot # 637093/0802L). The first dose was administered in 1994. Concomitant therapy with the second dose included a dose of meningococcal polysaccharide vaccine and ethinyl estradiol (+) norgestimate (ortho tri-cyclen). The reporter indicated that the second dose of pneumococcal vaccine 23 polyvalent had expired on 04/14/2002. There was no illness at the time of vaccination. Subsequently, the patient had a painful reaction in the arm that received the injection. The patient stated that her "arm/armpit was very sore, hard, swollen" and that she, "could not use her arm very well". Unspecified medical attention was sought and the patient was treated with cold/warm compresses and ibuprofen (Motrin). No laboratory tests were performed. One week later the patient recovered. Additional information is not expected.

VAERS ID:207715 (history)  Vaccinated:2003-06-01
Age:19.0  Onset:2003-06-01, Days after vaccination: 0
Gender:Male  Submitted:2003-07-22, Days after onset: 51
Location:Colorado  Entered:2003-08-12, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seizure;DTaP (unknown mfr);2;1;In Patient
Other Medications: Benadryl
Current Illness: NONE
Preexisting Conditions: Hay fever
Diagnostic Lab Data: Actual temp readings 100-101 (axillary).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0835M0  
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Back pain, Cough, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Arthritis (broad)
Write-up: Received vaccine-told me (mother) it was very painful when given. Several days later began complaining of fever (noted at night), fatigue, back hurting, joint pain. Then developed an unusual, productive cough. The cough and other symptoms lasted longer than 7-10 days. (We treated at home with analgesics, rest, nebulizer treatments).

VAERS ID:207836 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:2003-07-26
Gender:Male  Submitted:2003-08-01, Days after onset: 6
Location:Unknown  Entered:2003-08-14, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Culture and touch prep pending.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Injury, Rash papular
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypersensitivity (broad)
Write-up: A 19 year old male was seen on 07/31/03. Clinical info: Rule out Smallpox Inoculation Transmission. Date of Onset: 07/26/2003. Symptoms: 6mm x 6mm annular erythematic area with a 4 x 4mm papular vesicular type lesion noted inside the 6 x 6mm erythematic area. These symptoms are localized on the distal potion of the right arm and hand. Labs: Culture and touch prep pending.

VAERS ID:207858 (history)  Vaccinated:2003-07-10
Age:19.0  Onset:2003-07-23, Days after vaccination: 13
Gender:Male  Submitted:2003-07-31, Days after onset: 8
Location:Idaho  Entered:2003-08-14, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Imitrex
Current Illness: NONE
Preexisting Conditions: 3/03 concussion (severe)
Diagnostic Lab Data: None reported from physician visit of 7/30/03.
CDC Split Type: ID03048
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS737A40IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURW13660IMLA
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB361AA0SCRA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Fall, Headache
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)
Write-up: Vaccines given 7/10/03, wisdom teeth (4) out 7/17/03 with Versed, phentenol, dumethin and droperidol given. Felt OK until 7/23/03. Felt dizzy, falling, unstable, vision- complained of "things falling in and out". Intermittent spells of dizziness continued. On 7/28/03 complained of headache-Imitrex didn''t relieve. On 7/29/30 complained of "feeling drunk", dizzy-eyes "jumpy". Today 7/30/03 complained of continued symptoms. Appt to see private physician 7/30/03.

VAERS ID:208001 (history)  Vaccinated:2003-07-25
Age:19.0  Onset:2003-07-25, Days after vaccination: 0
Gender:Female  Submitted:2003-07-29, Days after onset: 4
Location:Texas  Entered:2003-08-19, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0102N1SC 
Administered by: Private     Purchased by: Other
Symptoms: Face oedema, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Lips began to swell and tongue swelled, swallowing felt "funny". No visible swelling of tongue but pt said felt swollen. Slight swelling of upper and lower lips.

VAERS ID:208049 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:2003-08-02
Gender:Male  Submitted:2003-08-08, Days after onset: 6
Location:Unknown  Entered:2003-08-20, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Touch prep: positive
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Unknown     Purchased by: Military
Symptoms: Infection transmission via personal contact, Rash papular, Skin ulcer
SMQs:
Write-up: Pt was wrestling with a Marine who had previously been inoculated with smallpox vaccine. Pt has zero symptoms at this time. Signs of papule lesions to the neck area and behind the left ear area. Tx: dry occlusive dressing applied to lesions follow-up for dressing changes PRN.

VAERS ID:208050 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:2003-07-25
Gender:Male  Submitted:2003-08-01, Days after onset: 7
Location:Unknown  Entered:2003-08-20, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Culture and Touch prep pending
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Rash vesicular, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: A 19 year old male was seen at camp on 07/31/2003. Clinical Information: Rule out smallpox inoculation Transmission ICD-9-979.9. Date of Onset: 07/26/2003. Symptoms: 6mm x 6mm annular Erythematic area with a 4 x 4mm popular vesicular type lesion noted inside the 6 x 6mm erythematic area. These symptoms are localized on the distal portion of the right arm and hand. Local Rxn: the area was bandaged and the patient instructed on transmission precautions . Systemic Rxn: prognosis is good. The VAERS form was completed. No epidemiological assistance is required.

VAERS ID:208281 (history)  Vaccinated:2003-08-08
Age:19.0  Onset:2003-08-08, Days after vaccination: 0
Gender:Female  Submitted:2003-08-21, Days after onset: 13
Location:Georgia  Entered:2003-08-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE193619AUG03
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was considered medically important (OMIC). A father reported that his 19 year old daughter inadvertently received a dose of Prevnar on the morning of 8/8/03 and subsequently developed a fever, severe headache, and nausea. ON 8/8/03, at 4PM, his daughter began to get sick with a severe headache, nausea, and fever. She went to the emergency room and received 2 liters of IV fluid and a medication for nausea (not specified). She recovered on 8/10/03. No additional information was available at the time of this report. Follow up on 09/11/2003: "Follow up information received via a telephone conversation with the physician provided confirmation of adverse event and diagnosis details. A father reported that his 19-year-old daughter inadvertently received a dose of Prevnar on the morning of 08/08/2003. On 08/08/2003, at 4 pm, the patient presented to the ER complaining of headache, fever to 102 degrees, vomiting and myalgias. Treatment included infusion of 2 liters of IV fluid and a medication for nausea (not specified). She was not admitted to the hospital. All symptoms resolved by 08/10/2003."

VAERS ID:208311 (history)  Vaccinated:2003-06-13
Age:19.0  Onset:2003-06-22, Days after vaccination: 9
Gender:Female  Submitted:2003-06-21, Days after onset: 1
Location:Alaska  Entered:2003-08-26, Days after submission: 66
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;Varicella (unknown mfr);1;12;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: AK200323
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0568M0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large "ping pong ball sized" reaction at immunization site 12 days after shot given. Minimal tenderness, no fever. Cool compresses, ibuprofen x 48 hours. Resolved slowly in 2-3 days. Don''t give second vaccine!

VAERS ID:208342 (history)  Vaccinated:2003-08-13
Age:19.0  Onset:2003-08-14, Days after vaccination: 1
Gender:Female  Submitted:2003-08-14, Days after onset: 0
Location:California  Entered:2003-08-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CA030094
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LAB95 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: High back pain-sharp shooting pains emesis.

VAERS ID:208393 (history)  Vaccinated:2003-08-19
Age:19.0  Onset:2003-08-20, Days after vaccination: 1
Gender:Female  Submitted:2003-08-21, Days after onset: 1
Location:Virginia  Entered:2003-08-27, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
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Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0815AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm reddened and swollen area approximately 3-4 inches width; very sore. Recommended warm compresses, Tylenol or Advil.

VAERS ID:208401 (history)  Vaccinated:2003-06-16
Age:19.0  Onset:2003-06-17, Days after vaccination: 1
Gender:Female  Submitted:2003-08-25, Days after onset: 69
Location:Unknown  Entered:2003-08-27, 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: UNK
Preexisting Conditions: Infectious Mononucleosis
Diagnostic Lab Data: Platelet 16,000/mcl
CDC Split Type: MA20030457
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABIPUR)CHIRON CORPORATION3140111IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Lymphadenopathy, Pyrexia, Splenomegaly, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: A 19 year old female patient, born 8/30/83, was vaccinated IM into the left musculus deltoideus with the first dose of Rabipur (batch # 314011) on 6/9/03 in the evening. On 6/16/03 in the evening she received the second dose of Rabipur (batch # 314011, same vaccination procedure). One day after the first vaccination increase of temperature lasting for one day and swelling of cervical lymph nodes lasting for two days occurred. One day after the second vaccination increasing swelling of cervical lymph nodes reoccurred, and the patient suffered from asthenia which increased over time. Tonsillitis was diagnosed a few days later. Infectious mononucleosis was the final diagnosis, and remarkable findings were splenomegaly and a significantly reduced platelet count (up to 18000/ul). At time of reporting (25 days after the second vaccination) the patient had nearly recovered. Both the thrombocytopenia and splenomegaly had improved but not resolved. This report was made due to the fact that the reporting physician suspected the vaccination to have worsened the thrombocytopenia, which he believed to be originally caused by the infectious mononucleosis. The reporter states that the infectious mononucleosis and its related symptoms were not caused by the vaccination. Seriousness criterion: medically significant (OMIC).

VAERS ID:208562 (history)  Vaccinated:2003-08-15
Age:19.0  Onset:2003-08-21, Days after vaccination: 6
Gender:Female  Submitted:2003-08-28, Days after onset: 7
Location:North Carolina  Entered:2003-08-28
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: Occasional migraines, seasonal allergic rhinitis, frequent sinusitis, febrile seizure as an infant
Diagnostic Lab Data: MRI scheduled
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSUNKNOWN0SCRA
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETHUNKNOWN0IDLA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Hypoaesthesia, Influenza like illness, Lymphadenopathy, Nausea, Paraesthesia, Vaccination complication, Vision blurred
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: 1)Left upper extremity paresthesia-started 6 days after smallpox vaccination, describes as numb and tingling sensation from left mid-clavicular region to left mid-tricept area. Lasts approximately 1-1.5 hours and has recurred 1-2 times a day. 2)Left lower extremity paresthesia-started 7 days after smallpox vaccination, lasts 5 minutes and has recurred 1-2 times a day 3)Bilateral blurred vision-intermittent episodes that started 8 days after smallpox vaccination. 4)Has also noted several expected side effects from smallpox vaccination: flu-like symptoms, nausea, headache, supraclavicular lymphadenopathy ****Patient has family history of multiple sclerosis. Patient was referred to neurology and has an MRI scheduled. Not currently on medications.

VAERS ID:208534 (history)  Vaccinated:2003-04-30
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2003-08-20
Location:Texas  Entered:2003-08-29, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Unevaluable event
SMQs:
Write-up: Pregnancy diagnosed 06/02/2003.

VAERS ID:208652 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:2003-09-01
Gender:Male  Submitted:2003-09-02, Days after onset: 1
Location:Texas  Entered:2003-09-03, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Atopic dermatitis in childhood.
Diagnostic Lab Data: Biopsy results pending.
CDC Split Type:
Vaccination
Manufacturer
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Site
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Secondary transmission, Skin ulcer
SMQs:
Write-up: 6cm ulcerated lesion to left shoulder. Lesion biopsied, sent to pathology. Pt was in contact with friend who had been vaccinated.

VAERS ID:208682 (history)  Vaccinated:2003-08-18
Age:19.0  Onset:2003-08-20, Days after vaccination: 2
Gender:Female  Submitted:2003-08-21, Days after onset: 1
Location:Montana  Entered:2003-09-03, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD (AP) (Lot 3 C1261AB) (IM/LEFT FOREARM)
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MT0307
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB473AB0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Headache, Nasal congestion, Pharyngolaryngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: At approximately 9AM on 08/20/2003, client woke up feeling groggy with sore throat. By noon that day client felt weak with headache muscle aches, exhaustion, sore throat, chest congestion. PHN took Tympanic temperature on 08/21/2003 and read 99F. Client had been taking Vitamin C for symptoms. PHN advised fever reducer, up in liquids and if not feeling better on 08/22 to see MD as client to flying on 08/23 for college.

VAERS ID:209907 (history)  Vaccinated:2003-09-19
Age:19.0  Onset:0000-00-00
Gender:Male  Submitted:2003-09-25
Location:New York  Entered:2003-10-01, 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
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Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5385821LA 
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW00061RA 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0610N1LA 
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0839AA1RA 
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 09/23 came back to clinic; developed rash on neck and arms. No other symptoms as per patient 9/23/03. Seen in hospital for mosquito bites, and was treated with hydrocortizone cream.

VAERS ID:210090 (history)  Vaccinated:2003-09-29
Age:19.0  Onset:2003-09-29, Days after vaccination: 0
Gender:Female  Submitted:2003-09-30, Days after onset: 1
Location:Texas  Entered:2003-10-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB244AA0SCLA
Administered by: Other     Purchased by: Private
Symptoms: Chest discomfort, Flushing, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: 5 minutes after Menomune, patient complained of tightness in chest, throat closing, skin flushed. Given adrenaline, Benadryl and observed 1 hour. B/P and pulse stable throughout. After 1 hour, patient stated above symptoms had cleared. Discharged with Epipen and Medrol dose pack. Follow up 9/30/03, patient denied any symptoms and stated complete recovery.

VAERS ID:210125 (history)  Vaccinated:2003-07-17
Age:19.0  Onset:2003-07-30, Days after vaccination: 13
Gender:Female  Submitted:2003-09-25, Days after onset: 57
Location:Ohio  Entered:2003-10-08, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0155M  RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1080M  LA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0824AA  LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0974M  RA
Administered by: Public     Purchased by: Unknown
Symptoms: Agitation, Asthenia, Back pain, Condition aggravated, Dehydration, Delirium, Dermatitis bullous, Difficulty in walking, Myalgia, Neck pain, Pyrexia, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Interviewed pt on Thursday, 9/25/03 at 5pm per telephone. Pt states first three days following vaccinations felt weak, slow and slightly feverish. On the 13th day post-vaccination, pt states was not feeling well with neck and back pains, fever and chickenpox rash. Called local hospital and was directed to go to the ER, but states did not go right away. States temp was 102 degrees and was crying, delirious and seeing things happen. On the 15th day post vaccination, went to the ER. Darvocet, antibiotics, and antiviral medications were ordered for 10 days. Pt states flew for recovery period. Pt states 3 weeks later was back to the ER. States doctor stated her immune system was down. Antiviral medication was ordered along with Vicodin pain medication for muscle, lower neck and back pain and fever. States was dehydrated and received 2 liters of IV saline fluids. The pt was then referred to a physician. Temp continued to persist up to 103 deg. The pt states she was admitted on 9/5/03 and discharged the following Wednesday. States during this time received IV antibiotics, PIC line and IV antiviral medication. She was discharged on oral antiviral medication. The hospital discharge summary received on 2/19/04 states herpes simplex outbreak, urine retention, back pain and walking difficulty.

VAERS ID:210143 (history)  Vaccinated:2003-09-25
Age:19.0  Onset:2003-09-27, Days after vaccination: 2
Gender:Male  Submitted:2003-09-29, Days after onset: 2
Location:Hawaii  Entered:2003-10-08, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Throat culture
CDC Split Type:
Vaccination
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH7651411IM 
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200740  
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURW13660IM 
Administered by: Military     Purchased by: Military
Symptoms: Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt with fever, chills, viral protrome. Requiring quarters for 24 hours.

VAERS ID:210312 (history)  Vaccinated:2003-10-01
Age:19.0  Onset:2003-10-01, Days after vaccination: 0
Gender:Female  Submitted:2003-10-07, Days after onset: 6
Location:Connecticut  Entered:2003-10-13, 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: CT200316
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS535C90 LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU034820SCLA
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0184M1SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0829AA1 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0539N1SC 
Administered by: Other     Purchased by: Other
Symptoms: Coma, Dizziness postural, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Unresponsive to verbal stimuli for about 2-3 minutes. Vomited about 100 cc of injested food. Diciphoretic, felt dizzy. Checked vital signs. Monitored for one hour.

VAERS ID:210863 (history)  Vaccinated:2003-03-07
Age:19.0  Onset:2003-03-28, Days after vaccination: 21
Gender:Female  Submitted:2003-10-17, Days after onset: 202
Location:Washington  Entered:2003-10-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0660  
HEPA: HEP A (VAQTA)MERCK & CO. INC.0861L0  
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURUB245AA0  
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710  
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU0820AA4  
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURU12030  
Administered by: Military     Purchased by: Military
Symptoms: Pruritus, Skin hyperpigmentation, Skin hypertrophy, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Hypertropic scarification at smallpox site. This pt is a 19 y/o primary vaccinee who recently returned. She was referred by occupational health for evaluation of a 6x6mm hyperpigmented, circular lesion at the site of the smallpox vaccination, which she received in March 2003. She has had the lesion since the time of healing of the vaccination site. She reports it is intermittently pruritic and is tender to palpation. After dermatology consultation, it was decided the lesion was hypertrophic scarification. It was injected with kenalog today and if it does not resolve will need to be injected again in 6 months. The dermatologist is confident this treatment should reduce the lesion and eliminate the hyperpigmentation; after treatment the site should be left with the appearance of the normal smallpox vaccination scar.

VAERS ID:210872 (history)  Vaccinated:2003-10-20
Age:19.0  Onset:2003-10-20, Days after vaccination: 0
Gender:Male  Submitted:2003-10-21, Days after onset: 1
Location:Maryland  Entered:2003-10-23, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: same with fever;Hep B (Engerix-B);1;19;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5313A21IMRA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Developed headache, dizziness, nausea, vomiting and soreness in right arm. Took Tylenol and slept until 9 PM. Awoke with headache and sore arm. Vomited x2 during night and once at school this morning (10/21). Can take liquids OK, not solids.

VAERS ID:210966 (history)  Vaccinated:2003-09-17
Age:19.0  Onset:2003-10-01, Days after vaccination: 14
Gender:Male  Submitted:2003-10-04, Days after onset: 3
Location:South Carolina  Entered:2003-10-27, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH 0 LA
Administered by: Military     Purchased by: Military
Symptoms: Injection site pustule, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Received vaccine smallpox on 09/17/2003. Arrived in Africa 09/22. 11/04, has 4 day complaints of confluent papular/pustular pruritic rash bilateral arms, legs, face, mouth. No F/C.

VAERS ID:211119 (history)  Vaccinated:1993-08-01
Age:19.0  Onset:1993-08-02, Days after vaccination: 1
Gender:Male  Submitted:2003-10-23, Days after onset: 3734
Location:Unknown  Entered:2003-10-28, 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: NONE
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data: Td titer 3.75
CDC Split Type:
Vaccination
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TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Muscular weakness, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Developed fever and tingling in injected arm and weakness of grip which lasted several days. Now 10 years later fears getting booster. Titer checked and still very high. No shot given.

VAERS ID:211696 (history)  Vaccinated:2003-10-17
Age:19.0  Onset:2003-10-17, Days after vaccination: 0
Gender:Male  Submitted:2003-10-28, Days after onset: 11
Location:South Carolina  Entered:2003-11-05, 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: NONE
Preexisting Conditions: Allergic to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Unknown
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Lip became very swollen in about 2 hours.

VAERS ID:211839 (history)  Vaccinated:2003-10-24
Age:19.0  Onset:2003-10-25, Days after vaccination: 1
Gender:Male  Submitted:2003-11-05, Days after onset: 11
Location:Texas  Entered:2003-11-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURV0997AA3 LA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4933783 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0474M0 LA
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Immunization given and stated he had on 10/24/03 later next day pt developed fever (102.3) and appeared to have seizure as stated by ER note.

VAERS ID:211847 (history)  Vaccinated:2003-10-07
Age:19.0  Onset:2003-10-10, Days after vaccination: 3
Gender:Female  Submitted:2003-11-03, Days after onset: 24
Location:Kentucky  Entered:2003-11-06, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1099AA1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt received flu vaccine 10/7/03. Reports developed itchy rash 3 days later. Did not report or seek medical attention due to child in hospital. Reports was told 10/30/03 by child''s doctor to take Benadryl and use OTC cortisone cream. Presents to clinic today with red macular rash and multiple areas or ? on all limbs. Has not yet used meds.

VAERS ID:211943 (history)  Vaccinated:2003-11-04
Age:19.0  Onset:2003-11-06, Days after vaccination: 2
Gender:Female  Submitted:2003-11-07, Days after onset: 1
Location:Virginia  Entered:2003-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: SEASONAL ALLERGIC RHINITIS
Preexisting Conditions: SEASONAL ALLERGIC RHINITIS
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUNKNOWN1IMLA
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSUNKNOWN1IMRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site hypersensitivity, Injection site swelling, Nausea, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: PATIENT COMPLAINED OF NAUSEA AND VOMITTING, ALSO SWELLING AND ITCHING AT THE SITE OF INJECTION. ON EXAM THERE WAS A 5CM INDURATION ON THE DELTOID OF LEFT ARM. PATIENT WAS TREATED WITH DIPHENHYDRAMINE 25MG

VAERS ID:212033 (history)  Vaccinated:2003-10-28
Age:19.0  Onset:2003-10-30, Days after vaccination: 2
Gender:Female  Submitted:2003-11-09, Days after onset: 10
Location:Pennsylvania  Entered:2003-11-09
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: TMJ
Diagnostic Lab Data: don''t know
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: about two days after the vaccine, patient began to experience dizziness and headaches. after several days of worsening, she went to the infirmary. she received medication for motion sickness, which seemed to relieve the dizzines, to some degree. after two days the medication was used up, but the symptons persisted. she went to the hospital and received the same anti motion sickness medication. it has been about 10 days since she had the vaccine, and the problems still persist.

VAERS ID:211957 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:0000-00-00
Gender:Male  Submitted:2003-11-03
Location:Unknown  Entered:2003-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Viral culture taken from the area of the operculum: measles virus; Measles virus antibody: titer increased; Body temp 39 degrees C.
CDC Split Type: WAES0310USA03174
Vaccination
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MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Fatigue, Keratitis, Laboratory test abnormal, Lymphadenopathy, Mouth ulceration, Oral pain, Pyrexia, Rash maculo-papular, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: It was reported in a published article that a 19 year old male patient, with no significant medical history and a dental history of minor conservative treatment with no previous gingival or periodontal involvement, who was vaccinated with a dose of measles virus vaccine live when he was nine years old. Subsequently, ten years after the vaccination, the patient developed measles and was hospitalized. Upon admission, the patient was febrile (39 degrees C), fatigued, and had reported oral pain and discomfort. On examination, a maculopapular rash was noted on the trunk, body and extremities. Severe keratoconjunctivitis was present in both eyes. A few cervical and submandibular lymph nodes were enlarged and tender bilaterally. Intraorally, tiny, white plaque-like papules (Koplik spots) covered the buccal mucosae and severe oral ulcerations were present on the lip. The marginal gingiva were inflamed with microabscesses present in acute necrotizing gingivostomatitis (ANUG) -like pattern. Pericoronitis was evident bilaterally in the mandibular third molar areas. The patient reported that the oral lesions preceded the appearance of the maculopapular skin rash and keratoconjunctivitis. Viral cultures were taken from the area of the operculum and confirmed the presence of the measles virus. The diagnosis was also supported by the increased titer of the measles virus antibody. The fatigued patient was instructed to rinse with oral chlorhexidine 0.12% mouthwash twice a day and maintained a soft diet. No antibiotic treatment was recommended. One week later, all oral lesions had disappeared. At a month follow up no remaining oral signs and symptoms were present. A copy of the published article is attached as further documentation of the patient''s experience.

VAERS ID:212068 (history)  Vaccinated:2003-11-05
Age:19.0  Onset:2003-11-05, Days after vaccination: 0
Gender:Female  Submitted:2003-11-06, Days after onset: 1
Location:Washington  Entered:2003-11-11, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES7651390 LA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Pharyngeal oedema, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Throat swelled up and had difficulty breathing. Required 0.5cc Epi, Benadryl, Zantac, Prednisone.

VAERS ID:212174 (history)  Vaccinated:1991-05-15
Age:19.0  Onset:1991-05-15, Days after vaccination: 0
Gender:Male  Submitted:2003-11-11, Days after onset: 4563
Location:California  Entered:2003-11-11
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 45 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: hay fever when younger
Diagnostic Lab Data:
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS?  UN
Administered by: Military     Purchased by: Military
Symptoms: Anaphylactic shock, Arthralgia, Arthropathy, Coagulopathy, Deep vein thrombosis, Ecchymosis, Injury, Oedema, Skin ulcer
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: immediate lesion at injection site on arm, followed by lesion on left foot following day which lasted hours and prevented me to put on boot and train that day in boot camp. Heard the DI''s state that they "were glad not to be getting these shots" lesions continued througout bootcamp progressively getting more frequent predominately on legs. After completion of boot camp my DI pulled me aside to address his concerns for the reaction I had due to innoculations. I continued on in the military and so did the lesions and I have had numerous visits to base clinics for the lesions. After leaving the military, I continued the lesions which were leaving no area of my body untouched and went to numerous hospitals both emergency and non with no understanding of what the lesions were. I also had a major change in that I developed anaphalytic shock to expectorants in cold medicine (I attribute this to the major disturbances in my body due to reaction to vaccine(s)) I did in approx 93 go to the hospital to make a claim for the lesions and the hospital did say they were service-connected but not compensatable. I continued to work for the next few years until 95 when I developed dvt in my left leg in my return vein to my heart and also is the time my lesions completly disappeared ( the lesions were so detrimental physically and mentally and I thought this sickness was killing me and probably was but I was actually relieved when I got to the hospital even with the blood clot?? So basically now I have an incompetent venous system and a blocked stent and recurring ulcers on left foot which I currently do have an open ulcer that won''t heal and am currently applying for SSD benefits and reopened my VA claim with these current health problems. I feel and have felt the need to report this years ago but have been reluctant to do so because of lack of supporting evidence but now with all the stories of sickness and death or the GWS of which I am on the gulf war registry? I see too many parallels to myself through others who have determined or have been determined to have suffered reactions to the vaccines. Thank You. The discharge summary received on 3/30/04 states diagnosis of deep vein thrombosis confirmed. Add hypercoagulation syndrome, edema of left extremity, accidental electric shock, pain L ankle, stiffness L ankle and ecchymosis L leg.

VAERS ID:212734 (history)  Vaccinated:2003-11-04
Age:19.0  Onset:2003-11-15, Days after vaccination: 11
Gender:Male  Submitted:2003-11-19, Days after onset: 4
Location:Massachusetts  Entered:2003-11-19
Life Threatening? Yes
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: His Troponin Ic was reportedly 35.6 with a CPK of 434 and CKMB of 23.8. His EKG reportedly demonstrated diffuse ST segment elevations.
CDC Split Type:
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH 0IDLA
Administered by: Military     Purchased by: Military
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: This is a 19y/o who was in his usual health until 11/15/03. He received his primary Smallpox vaccination on 11/04/03. He received appropriate briefings and screening prior to the administration of his vaccination. On 11/15/03 at ~ 0900 was awakened by chest pain (3-4/10). Pain progressed to 6/10 over the next hour and he went to the Emergency Room (ER). At ER, he was given EC ASA, had cardiac monitoring and had blood drawn at this time. His pain progressed to 9/10 and he became extremely short of breath. Approximately one hour after taking the ASA his pain began to resolved and subsided. He subsequently was released to follow-up with cardiologist on 11/17/03.

VAERS ID:212806 (history)  Vaccinated:2003-11-14
Age:19.0  Onset:2003-11-15, Days after vaccination: 1
Gender:Male  Submitted:2003-11-17, Days after onset: 2
Location:Massachusetts  Entered:2003-11-21, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: ECG/CHEM 7 PANEL/ PROFILE 16 PANEL
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0801SCLA
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4030013  LA
Administered by: Military     Purchased by: Military
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Chest pain; Shortness of breath; Difficulty breathing.

VAERS ID:213006 (history)  Vaccinated:2002-06-08
Age:19.0  Onset:2002-06-15, Days after vaccination: 7
Gender:Male  Submitted:2003-01-30, Days after onset: 229
Location:Unknown  Entered:2003-11-25, Days after submission: 299
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rabies immunoglobulin; Augmentin, Haldol
Current Illness:
Preexisting Conditions: History of psychological problems and hallucinations
Diagnostic Lab Data:
CDC Split Type: U200200872
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RAB: RABIES (IMOVAX)AVENTIS PASTEUR    
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: From info received by telephone at manufacturer on 10/25/2002, it was reported by a pt''s parent that her 19-year-old son received RIG Imovax post-exposure prophylaxis vaccination series at the ER. Her son was given Augmentin and a Tetanus immunization as well because of a dog bite (animal escaped). It was also reported by the parent that her son has a history of psychological problems and experienced signs and symptoms of hallucinations after the first 2 doses of the Imovax series. He was also very anxious. The parent stated that her medical doctor doesn''t feel this is related to the vaccine, but she felt that it might be related. The series began on 06/08/2002 and all symptoms were experienced by the 2nd week of the series. Pt has a history of hallucinations and has taken Haldol. Mother does not have lot numbers for the products that were administered. It was not reported whether the pt recovered.

VAERS ID:213008 (history)  Vaccinated:2002-06-29
Age:19.0  Onset:2002-06-30, Days after vaccination: 1
Gender:Female  Submitted:2002-09-07, Days after onset: 69
Location:Unknown  Entered:2003-11-25, Days after submission: 444
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: U200200602
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RAB: RABIES (IMOVAX)AVENTIS PASTEUR 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: From telephone contact received at manufacturer on 07/31/2002, it was reported that a 19-year-old female received her last dose of the post exposure rabies series (Imovax Rabies) on 07/24/2002. The pt''s mother called to report that her daughter had just completed her post exposure rabies series. Schedule was started on 06/26/2002, 06/29/2002, 07/03/2002, 07/10/2002 and last dose was on 07/24/2002. Mother stated that pt worked in office handling animals and had been exposed to a rabid raccoon. According to mother, pt did not wear gloves and probably did not wash her hand as she should have. Also reported that it took the office personnel at least 2 weeks to begin treatment if not as long as a month. On 06/30/2002, pt went to the ER with severe pain, rated a 10 on the scale of 1-10, in her legs and lower spine. Pt also had a fever. Physician in the ER gave her Motrin and antihistamine. Mother reported that a lot of blood work including test for rabies were done at the ER before discharged her to home. Mother asked, from what has read about rabies, does her daughter have rabies because of her signs and symptoms. Mother does not have any lot numbers and was too upset to ask more info.

VAERS ID:213526 (history)  Vaccinated:2003-11-28
Age:19.0  Onset:2003-11-28, Days after vaccination: 0
Gender:Female  Submitted:2003-11-30, Days after onset: 2
Location:Wisconsin  Entered:2003-12-05, 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: Aciphex; Clarinex
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5370A21IMLA
Administered by: Other     Purchased by: Private
Symptoms: Balance disorder, Chills, Fall, Fatigue, Feeling hot, Gait disturbance, Injection site pain, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Patient was alert/responsive throughout. Several minutes after vaccine administration, patient lost balance and fell. She tried to get up, but was unable. She was helped to her feet and walked to a chair. En route, patient''s legs became weak and she was laid on floor. After several minutes, she was helped to her feet and sat in chair with head down and warm cloth on her head. Left pharmacy 17:00 under parental supervision. Complained of warmth and nausea. 19:00 mom reported chills/fatigue. 21:00 patient reported arm weakness but ok. Patient returned to work 11/29/2003, complained of injection site soreness only.

VAERS ID:214129 (history)  Vaccinated:2003-12-11
Age:19.0  Onset:2003-12-14, Days after vaccination: 3
Gender:Female  Submitted:2003-12-16, Days after onset: 2
Location:Wisconsin  Entered:2003-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC50020P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Develop hives on 12/14/2003 was seen in the clinic on 12/15/2003. Exam showed urticaria on face, arms, chest, back and legs. Lungs were clear no sign of any respiratory component. Family history positive for food allergy (mom had food allergies. The patient had never had any reaction to foods. No new foods in the last 48hrs befor her urticaria started. Patient started on prednisone 40mg PO BID for 5 days. Has recovered.

VAERS ID:214351 (history)  Vaccinated:2003-12-15
Age:19.0  Onset:2003-12-16, Days after vaccination: 1
Gender:Female  Submitted:2003-12-18, Days after onset: 2
Location:Michigan  Entered:2003-12-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair; Allegra; Keflex
Current Illness: NONE
Preexisting Conditions: Asthma, wandering atrial pacemaker, seasonal allergies
Diagnostic Lab Data: CBC, ESR, EKG, influenza titers
CDC Split Type:
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0988N0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Chest pain, Cough, Headache, Injection site reaction, Malaise, Nausea, Pyrexia, Rhinitis, Tachycardia, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Right arm cellulitis at injection site with fever, tachycardia, nausea and vomiting. The hospital discharge summary received on 1/28/04 states wheezing, headache, malaise, tachycardia, rhinitis, chest pain and cough.

VAERS ID:214359 (history)  Vaccinated:2003-11-29
Age:19.0  Onset:2003-12-02, Days after vaccination: 3
Gender:Male  Submitted:2003-12-12, Days after onset: 10
Location:Arkansas  Entered:2003-12-24, Days after submission: 12
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
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1144AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Headache, Pain, Pharyngolaryngeal pain, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Day #3 post vaccine 12/2/03: headache/sore throat. Day #4 post vaccine 12/3/03: body aches/fever. Day #5 post vaccine 12/4/03: Nasal discharge/chest congestion.

VAERS ID:214558 (history)  Vaccinated:2003-12-19
Age:19.0  Onset:2003-12-19, Days after vaccination: 0
Gender:Female  Submitted:2003-12-19, Days after onset: 0
Location:Minnesota  Entered:2003-12-31, Days after submission: 12
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
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TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)AVENTIS PASTEURU01745AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:214584 (history)  Vaccinated:1996-07-26
Age:19.0  Onset:2003-12-18, Days after vaccination: 2701
Gender:Female  Submitted:2003-12-26, Days after onset: 8
Location:Missouri  Entered:2004-01-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Infection transmission via personal contact, Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: While student teaching, exposed to chicken pox; broke out 20 spots across chest and belly 12/18/03.

VAERS ID:214670 (history)  Vaccinated:2003-12-30
Age:19.0  Onset:2003-12-30, Days after vaccination: 0
Gender:Female  Submitted:2003-12-30, Days after onset: 0
Location:Virginia  Entered:2004-01-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold symptoms
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB481AA0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Approx 10 minutes after meningococcal vaccine given, pt was waiting in line to check out, leaning against wall and suddenly fell to floor hitting chin on the counter top, pt unconscious for about 1 minutes; pt alert and oriented upon nurse arrival. Vital signs WNL. Rescue squad arrived and transported to hospital.

VAERS ID:214725 (history)  Vaccinated:2003-08-04
Age:19.0  Onset:2003-08-05, Days after vaccination: 1
Gender:Male  Submitted:2003-12-02, Days after onset: 119
Location:D.C.  Entered:2004-01-08, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Hep B (unknown mfr);MS;;0;In Patient
Other Medications: NONE
Current Illness: MS diagnosed since vaccine
Preexisting Conditions: NONE that were diagnosed at the time of vaccine
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIESUB473AB   
Administered by: Private     Purchased by: Other
Symptoms: Grand mal convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt was suspected to have MS 12/06/02. Reportedly had grand mal seizure 08/03/03.

VAERS ID:214943 (history)  Vaccinated:2003-03-20
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2004-01-09
Location:Texas  Entered:2004-01-16, 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: Hormonal contraceptives
Current Illness:
Preexisting Conditions: Pregnancy NOS; miscarriage
Diagnostic Lab Data: PN lab-normal; diabetes-normal; Triple mark-normal; ultrasound-oligo; beta-human chorionic positive; urinalysis-protein.
CDC Split Type: WAES0304USA02351
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1479L1  
Administered by: Other     Purchased by: Other
Symptoms: Abnormal labour, Bacterial infection, Infection, Proteinuria, Unintended pregnancy, Uterine disorder
SMQs:, Acute renal failure (broad), Systemic lupus erythematosus (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Chronic kidney disease (broad)
Write-up: Information has been received from a public health registered nurse concerning a 19 year old female pt with an obstetrical history that included one previous pregnancy and no live births due to a miscarriage that occurred 11 1/2 weeks from the last menstrual period and with no birth defects noted in the previous pregnancy. On 3/20/03 the pt as vaccinated with a second dose of MMR II (640237/1479L). The pt had received the first dose of MMRII on 11/15/95. The pt was instructed about pregnancy before being vaccinated and reported that she was on birth control pills. The nurse reported that the pt''s husband called the health dept on 4/16/03 and reported that they found out that the pt was pregnant. Her last menstrual period was 2/20/03. It was reported that the pt received the vaccine 4 weeks after her last menstrual period. Unspecified medical attention was sought. The pt''s pregnancy was confirmed by a positive pregnancy test, which was done on an unspecified date. The estimated date of delivery was reported to be 11/27/03. It was reported that the pt was taking prenatal vitamins-iron. Follow up info received reported that nineteen weeks from her last menstrual period the pt underwent lab evaluation which revealed that on 6/6/03 "Triple Mark-normal." Lab evaluation also revealed "PN lab-normal," "Diabetes-normal" and protein in urine toward end of pregnancy. An ultrasound done on 8/18/03 revealed oligohydramnios. It was reported that thirty four weeks after the last menstrual period the pt experienced "Group Beta Strep" which was treated with antibiotics before delivery. On 11/20/03 the pt had a "C-section due to failure to progress." She gave birth 38 weeks from her last menstrual period to a male infant whose birth weight was 7 lbs 3 oz. The infant was normal and it was reported that the infant had no congenital anomalies and he did not have any complications. Upon internal review C-section due to failure to progress was considered an other important medical event (OMIC). No further info is available.

VAERS ID:214995 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2004-01-09
Location:Unknown  Entered:2004-01-16, 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: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: 2001028862
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 1  
Administered by: Private     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Report 2001028862-1 describes hives in a 19 year old female who received hep B vaccine. Medical history, concurrent conditions, and concurrent medications were not specified. On unspecified dates, the vaccinee received her first and second injections of hep B vaccine. Following her second vaccination with hep B vaccine, she experienced hives. As of 12/4/01, the hives had resolved.

VAERS ID:215123 (history)  Vaccinated:2003-07-01
Age:19.0  Onset:2003-07-01, Days after vaccination: 0
Gender:Female  Submitted:2004-01-09, Days after onset: 192
Location:Massachusetts  Entered:2004-01-16, 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: Oral contraceptive; Salbutamol sulphate; Cetirizine hydrochloride;
Current Illness: UNK
Preexisting Conditions: Asthma; Tobacco use;
Diagnostic Lab Data: UNK
CDC Split Type: A0414829A
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5389A40 LA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: This case was reported by a physician''s assistant and described the occurrence of shortness of breath in a 19 year old female who received hepatitis B vaccine recombinant (Engerix-B) for prophylaxis. The pt''s medical history included "mild" asthma since childhood that was "generally triggered by hot weather", and tobacco use (less than one pack of cigarettes per day). Concurrent medications and unspecified oral contraceptive, salbutamol inhaler used as needed, and cetirizine (Zyrtec). On 07/01/03, the subject received her first dose of Engerix-B. On 07/002/03, the pt presented to the physician with "upper respiratory symptoms" and shortness of breath, which had begun 10 hours post-immunization. The symptoms were unresponsive to salbutamol metered-dose inhaler. Other treatment was not specified. The reporter stated that the pt did not return to the physician''s office, so the events had "likely resolved". The reporter considered the events to be possibly related to Engerix-B or to a "concurrent URI (upper respiratory infection)/mild asthma flare."

VAERS ID:215143 (history)  Vaccinated:2003-04-08
Age:19.0  Onset:2003-04-13, Days after vaccination: 5
Gender:Female  Submitted:2004-01-09, Days after onset: 271
Location:Minnesota  Entered:2004-01-16, 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: Metformin hydrochloride, Yasmin
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: A0420163A
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 0  
Administered by: Other     Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: This case was reported by a health professional and described the occurrence of chronic idiopathic urticaria in a 19 year old female pt who received hep B vaccine recombinant (Engerix B) for prophylaxis. The pt''s medical history included polycystic ovary syndrome. Concurrent medications include dmetformin and Yasmin. On 4/8/03 the pt received the 1st dose of Engerix B. On 4/13/03, five days post-immunization, the pt developed hives and rash. The pt was seen by the reporter, who made the diagnosis of chronic idiopathic urticaria. Metformin and Yasmin therapies were discontinued; the rash and hives persisted. On 8/18/03 the reporter stated, "So far, the hives have not resolved but antihistamine and Zantac will control them." The reporter stated that the events could have been associated with polycystic ovary syndrome. Yasmin therapy, or Metfromin therapy. However, he also stated that the events were possibly related to vaccination with Engerix B. The Engerix B immunization series was delayed until at least December 2003.

VAERS ID:215530 (history)  Vaccinated:2004-01-20
Age:19.0  Onset:2004-01-21, Days after vaccination: 1
Gender:Female  Submitted:2004-01-22, Days after onset: 1
Location:Maryland  Entered:2004-01-22
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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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0801IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 2 CM X 3CM ERYTHEMA AND SWELLING AND PAIN/TENDERNESS AT SITE OF 2ND ANTHRAX

VAERS ID:215558 (history)  Vaccinated:2004-01-15
Age:19.0  Onset:2004-01-15, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Louisiana  Entered:2004-01-26
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:
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1048M0 RA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Hot flush, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient complained of hot flashes, chills, nausea, vomiting approximately 10-15 minutes after receiving Hep B vaccine.

VAERS ID:215593 (history)  Vaccinated:2004-01-09
Age:19.0  Onset:2004-01-12, Days after vaccination: 3
Gender:Male  Submitted:2004-01-26, Days after onset: 14
Location:New Jersey  Entered:2004-01-26
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: No testing done
CDC Split Type:
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS235A41IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.06663N0SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0991AA0IMRA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUB421AA0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt developed a facial rash three days after receiving the vaccination. The rash was a papular rash and was located on the right side of the face. The patient was issued shaving restrictions. By January 26, the rash had improved somewhat on the R side but had spread to the L side of the fack and the anterior neck. The malar region of the face, chin and anterior neck are erythematous and there are scattered papules and pustules.

VAERS ID:215602 (history)  Vaccinated:2003-09-29
Age:19.0  Onset:2003-09-29, Days after vaccination: 0
Gender:Female  Submitted:2003-10-28, Days after onset: 29
Location:Unknown  Entered:2004-01-27, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: EM20030299
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RAB: RABIES (RABAVERT)CHIRON CORPORATION305110IM 
Administered by: Other     Purchased by: Other
Symptoms: Neurological symptom, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling all over body [Swelling NOS]. Neurological Changes [Neurological Symptoms NOS].

VAERS ID:215663 (history)  Vaccinated:2004-01-14
Age:19.0  Onset:2004-01-24, Days after vaccination: 10
Gender:Male  Submitted:2004-01-27, Days after onset: 3
Location:California  Entered:2004-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: Evaluated by Infectious Disease physician on 26Jan04.
CDC Split Type:
Vaccination
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IDLA
Administered by: Military     Purchased by: Military
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Diffuse vesicular rash on trunk and opposite arm

VAERS ID:215677 (history)  Vaccinated:2004-01-09
Age:19.0  Onset:2004-01-20, Days after vaccination: 11
Gender:Male  Submitted:2004-01-21, Days after onset: 1
Location:Kansas  Entered:2004-01-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4030013  LA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Maculopapular erythematous truncal rash

VAERS ID:215707 (history)  Vaccinated:2004-01-13
Age:19.0  Onset:2004-01-14, Days after vaccination: 1
Gender:Male  Submitted:2004-01-20, Days after onset: 6
Location:North Dakota  Entered:2004-01-28, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, BUN, Creatine, Potssium: all normal
CDC Split Type:
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5497A92IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1008M2SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0841AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dehydration, Feeling hot, Injection site erythema, Injection site pain, Nausea, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Immunization given 15:00 01/13/04 @ 14:00 01/15/04, feeling weak. Shaky and warm into studentt health, temperature 101.8F. Left arm red and sore size of baseball urged to take fluid and Ibuprofen - rest- to see MD if condition gets worse. 01/15/04 to clinic to see MD weak fever, nausea, given IV fluids for dehydration to take fluids Tylenol and rest. Possible viral syndrome. Possible vaccine reaction.

VAERS ID:215778 (history)  Vaccinated:2004-01-16
Age:19.0  Onset:2004-01-16, Days after vaccination: 0
Gender:Female  Submitted:2004-01-29, Days after onset: 13
Location:Kansas  Entered:2004-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: redness at site;Hep B (unknown mfr);1;18;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5520A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Nausea, Pruritus, Thermal burn, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: Patient''s arm became red from the shoulder to the elbow with itching and burning. She also developed nausea and vomiting with dry heaves all occurring within 15 minutes of receiving the vaccine.

VAERS ID:215787 (history)  Vaccinated:2004-01-16
Age:19.0  Onset:2004-01-27, Days after vaccination: 11
Gender:Male  Submitted:2004-01-30, Days after onset: 3
Location:New Jersey  Entered:2004-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no illnesses
Preexisting Conditions: no pre-existing
Diagnostic Lab Data: cbc - normal limits. Sed rate 38
CDC Split Type:
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40300130IDLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient started with a rash on the dordum of the hands and the distal legs on 1/27/04. By the morning of 1/28/04, the rashhad spread to the entire body sparing the plantar surfaces of the hands, feet and the face. The rash is a macular papular rash on most of the body. On the distal legs, the rash is a large erythematous, indurated placque. The rash is pruritic. The patient has been afebrile. The expiration date of the yllow fever vaccine is 2/17/04.

VAERS ID:215834 (history)  Vaccinated:2004-01-12
Age:19.0  Onset:2004-01-12, Days after vaccination: 0
Gender:Female  Submitted:2004-01-30, Days after onset: 18
Location:North Carolina  Entered:2004-01-30
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: ú 2 previous pregnancies o Probable Miscarriage at 14 yo- positive urine pregnancy test followed by irregular bleeding and then heavy bleeding 3 months later. Patient had been on Depo-Provera. She did not seek medical evaluation. o Probable Miscarriage at 16 yo-No medical evaluation. ú Denies any recurrent skin conditions, including eczema, allergies, asthma, diabetes, cancer, immunosuppression, or heart disease. Thinks that she may have had elevated blood pressure many years ago but was not diagnosed with hypertension.
Diagnostic Lab Data: ú 1/12/04 at 1026: HCG QL: Positive (***Result was reported as Negative on 1/12/04 at 1035) ú 1/14/04: HCG QN: 87.6 ú 1/15/04: HCG QN: 147.9 ú 1/18/04: HCG QN: 350.4
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSUNKNOWN2SCRA
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN0IMRA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER0981M0IMRA
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40300130IDLA
Administered by: Military     Purchased by: Military
Symptoms: Medication error, Unintended pregnancy
SMQs:, Normal pregnancy conditions and outcomes (narrow)
Write-up: Patient inadvertantly received smallpox vaccination and anthrax vaccination while pregnant. She has been enrolled in the DoD Smallpox Vaccine in Pregnancy Registry. Her EDC is 22 Sep 04. She will be followed closely by OB/GYN clinic with a level II ultrasound scheduled for 18-20 weeks. No known adverse events.

VAERS ID:216014 (history)  Vaccinated:2003-01-02
Age:19.0  Onset:2003-01-02, Days after vaccination: 0
Gender:Female  Submitted:2004-02-04, Days after onset: 398
Location:Virginia  Entered:2004-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Eczema
Preexisting Conditions: Atarax ALlergy Eczema
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0630SCRA
Administered by: Military     Purchased by: Military
Symptoms: Rash pustular
SMQs:, Hypersensitivity (narrow)
Write-up: Developed large local reaction to vaccinated arm within 12 hours and lasted 2 weeks. Developed pustular rash 48 hours after vaccination

VAERS ID:216421 (history)  Vaccinated:0000-00-00
Age:19.0  Onset:0000-00-00
Gender:Male  Submitted:2004-02-12
Location:California  Entered:2004-02-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETHUNKNOWN0IDRA
Administered by: Military     Purchased by: Unknown
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: PATIENT ARRIVES TO EMERGENCY ROOM ON FEBRUARY 5, 2004 AT 1822. PATIENT HAS SWELLING OF RIGHT ARM AROUND SMALLPOX VACCINATION SITE.

VAERS ID:216460 (history)  Vaccinated:2000-07-27
Age:19.0  Onset:2003-05-11, Days after vaccination: 1018
Gender:Female  Submitted:2004-02-13, Days after onset: 278
Location:New Jersey  Entered:2004-02-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Tested positive twice for Lyme (EIA test)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALSDO NOT KNOW #2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Feeling cold, Headache, Hot flush, Influenza like illness, Laboratory test abnormal, Vertigo
SMQs:, Vestibular disorders (narrow)
Write-up: Symptoms are: extreme fatigue, headaches,hot/cold flashes, vertigo, and flu-like symptoms

VAERS ID:216546 (history)  Vaccinated:2004-01-30
Age:19.0  Onset:2004-02-04, Days after vaccination: 5
Gender:Male  Submitted:2004-02-09, Days after onset: 5
Location:New York  Entered:2004-02-18, Days after submission: 9
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: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB487AA0 LA
Administered by: Other     Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 2/4/04 developed a raised red area midway L side of back. On 2/7/04 developed another area to the left of 1st area. Approx 2cm x 6cm of raised red bumps. Itchy but no pain. Saw MD on 2/4/04 and diagnosed as herpes zoster treated with Famuir 500mg po tid x 7 days. Currently being treated.

VAERS ID:216581 (history)  Vaccinated:2003-11-14
Age:19.0  Onset:2003-11-14, Days after vaccination: 0
Gender:Female  Submitted:2003-11-14, Days after onset: 0
Location:Unknown  Entered:2004-02-18, Days after submission: 96
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ? possible lightheadedness
Preexisting Conditions: NONE
Diagnostic Lab Data: B6:66
CDC Split Type: 200400870
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0720SCLA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUB411AA0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Accident, Loss of consciousness, Nausea, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient got car sick on the drive back home and shortly after passed out in the bathroom. No one was around to see her fall. She complained of vomiting before falling onto the floor.

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