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Case Details (Sorted by Age)

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VAERS ID: 417060 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2011-01-26
Onset:2011-02-11
   Days after vaccination:16
Submitted: 2011-02-17
   Days after onset:6
Entered: 2011-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3515AA / 5 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0907Z / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1043Z / 2 RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Blister, Pruritus, Skin lesion
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Vesicular rash beginning around 2/10/11 (+) pruritic.


VAERS ID: 417065 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-11-23
Onset:2011-02-08
   Days after vaccination:77
Submitted: 2011-02-17
   Days after onset:9
Entered: 2011-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3473AA / 5 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0674 / 4 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0544Z / 2 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: C-reactive protein normal, CSF protein normal, Gait disturbance, Guillain-Barre syndrome, Immunoglobulin therapy, Lumbar puncture normal, Red blood cell sedimentation rate normal
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LP with protein 31; ESR 5; CRP - 0
CDC Split Type:

Write-up: Guillain-Barre D 2/8. Complaint of walking problem. 1/31 initially thought boney - Reflex ok at that time onset possibly early January. Rx IVIG 2 gm/kg 4 days unit in period. No respiratory involvement.


VAERS ID: 417132 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2011-01-31
Onset:2011-02-01
   Days after vaccination:1
Submitted: 2011-02-18
   Days after onset:17
Entered: 2011-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914515 / 1 LA / IM

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

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

Write-up: 1 1/2 to 2 inch-diameter warm, firm red area at injection site. Pt also c/o increased discomfort for 3 days post-injection.


VAERS ID: 417216 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:2011-02-14
Onset:2011-02-15
   Days after vaccination:1
Submitted: 2011-02-19
   Days after onset:4
Entered: 2011-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / UN
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 LA / UN

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

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

Write-up: Received VARIVAX (L) arm 2/14 - local swelling started the following day. I saw him 2/19. Lesion was resolving/itchy. No systemic symptoms.


VAERS ID: 417215 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2011-02-16
Onset:2011-02-17
   Days after vaccination:1
Submitted: 2011-02-19
   Days after onset:2
Entered: 2011-02-21
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1366Z / 2 RA / IM

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

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

Write-up: Large pink rash in shape of a 3/4 moon with the large round edge down her right extensor upper arm in deltoid region measuring 8.5 x 7 cm. Site is warm to the touch & slightly swollen.


VAERS ID: 417268 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2011-02-18
Onset:0000-00-00
Submitted: 2011-02-18
Entered: 2011-02-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3473AA / 5 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0548 / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0576Z / 2 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0968Z / 2 RL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Itching and approx. dime size hive on right thigh about 5 mins after injection of MMR & Varicella. Hive site to the lower right of Varicella injection.


VAERS ID: 417279 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-01-26
Onset:2011-01-27
   Days after vaccination:1
Submitted: 2011-01-27
   Days after onset:0
Entered: 2011-02-21
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 5 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1398Z / 2 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0413 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0578Z / 2 LA / SC

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

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

Write-up: Mom reports (L) upper arm as red & swollen. Warm to touch. Low grade temp.


VAERS ID: 417284 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-02-18
Onset:2011-02-19
   Days after vaccination:1
Submitted: 2011-02-21
   Days after onset:2
Entered: 2011-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Excessive eye blinking, Nervous system disorder, Nervousness, Tic
SMQs:, Dyskinesia (broad), Dystonia (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at the time of the vaccination
Preexisting Conditions: Pre-existing Physician Diagnosed Allergies present (seasonal allergies to certain pollens and grasses) Medical Conditions at time of vaccination were none. Completely healthy.
Allergies:
Diagnostic Lab Data: I will be taking him to see a neurologist.
CDC Split Type:

Write-up: He started having nervous tics, he had uncontrollable eye blinking and still does today. This is neurological so there is a chance that the vaccine caused this neurological dysfunction.


VAERS ID: 417348 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Colorado  
Vaccinated:2011-02-16
Onset:2011-02-16
   Days after vaccination:0
Submitted: 2011-02-17
   Days after onset:1
Entered: 2011-02-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / UNK LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0231Z / UNK RL / UN

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

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

Write-up: 5 minutes after KINRIX & MMRV given, moc came out of room and stated "patient has a rash starting". When asked by R.N. where, moc lifted shirt. Small fine red rash on area of underpants waist, upper thighs, and 3-4 10 cent size red raised blotches on back. Sl. small area fine rash on arms. Dr. saw this. Pt. advised to wait 10 min & leave after staff d/c them.


VAERS ID: 417398 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2011-02-14
Onset:2011-02-14
   Days after vaccination:0
Submitted: 2011-02-18
   Days after onset:4
Entered: 2011-02-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 03217 / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt developed fever of 101 degrees F on day of vaccine and over 2 days fever increased to over 102 degrees F. On 2/16/11 pt developed redness to entire left arm. TYLENOL & MOTRIN given. Redness decreasing.


VAERS ID: 417482 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2011-02-11
Onset:2011-02-13
   Days after vaccination:2
Submitted: 2011-02-23
   Days after onset:10
Entered: 2011-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1510Z / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0958Z / 2 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E84462 / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0965Z / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Band neutrophil count decreased, Full blood count, Local swelling, Lymphocyte count normal, Monocyte count increased, Pyrexia, Rhinorrhoea, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Had received 2 previous doses of PCV 7.
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lymph =1905, Monocyctes = 1524, band neutrophils = 1143.
CDC Split Type:

Write-up: Three day history of fever, runny nose and swelling to bilateral jaw/neck. Mono screen and CBC completed.


VAERS ID: 417560 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Oregon  
Vaccinated:2011-02-15
Onset:2011-02-17
   Days after vaccination:2
Submitted: 2011-02-18
   Days after onset:1
Entered: 2011-02-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / UNK RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 5102 / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0959Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1188Z / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: None
CDC Split Type: OR201108

Write-up: (L) arm swelling, redness at heat at site of MMR - first noted early AM on 2/17/11... size of golf ball. By afternoon entire (L) upper arm was swollen, red, hot & tight. Saw Dr. 2/17 received rx for cellulitis. Improved by pm of 1/18/11.


VAERS ID: 417622 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2011-02-24
Onset:2011-02-25
   Days after vaccination:1
Submitted: 2011-02-25
   Days after onset:0
Entered: 2011-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0490Z / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Induration, Local swelling, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Localized swelling about 10cm of induration. No other rash. Recommended to mom to use Tylenol for pain and Benadryl for itching. If rash spreads to be reevaluated.


VAERS ID: 417702 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-02-16
Onset:2011-02-17
   Days after vaccination:1
Submitted: 2011-02-18
   Days after onset:1
Entered: 2011-02-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / 5 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0832Z / 2 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1007Z / 2 RL / UN

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

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

Write-up: Fever 2/17 - PM 101 - Rt leg extremely swollen with mild rash - inner thigh no edema or redness at knee.


VAERS ID: 417720 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-02-14
Onset:2011-02-16
   Days after vaccination:2
Submitted: 2011-02-23
   Days after onset:7
Entered: 2011-02-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH773AC / 1 LA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0485Z / 3 RA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1398Z / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Phone call from family at 2/18/11 at 4:25 pm reporting that child had started with fever (102 degrees) (highest) on Wed. 2/16/11. Also had rash and had vomited x 1. Instructed to take child to urgent care or ER. Spoke with family on 2/22/11. Child not taken to doctor & fully recovered.


VAERS ID: 417737 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-02-17
Onset:2011-02-22
   Days after vaccination:5
Submitted: 2011-02-28
   Days after onset:6
Entered: 2011-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0751Z / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: AdrenoGenital Syndrome
Preexisting Conditions: 12/31/1999
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: apparent varicella outbreak, fever


VAERS ID: 417819 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-03-01
Onset:2011-03-01
   Days after vaccination:0
Submitted: 2011-03-01
   Days after onset:0
Entered: 2011-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3514BA / 1 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E03301 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0443Z / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0344Z / 1 LA / SC

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

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

Write-up: Vaccine of MMR was given (L) arm (upper) SQ. When pt. got to our check out window her arm was swollen & red & some pain. Dr. instructed ice & BENADRYL after seeing the reaction on (L) arm.


VAERS ID: 417835 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-05-01
Onset:0000-00-00
Submitted: 2011-03-01
Entered: 2011-03-02
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / 4 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Angioedema, Cough, Skin test positive, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal allergic conditions (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201100821

Write-up: Initial report received from a physician on 23 February 2011. A 5 year-old male patient (date of birth not reported) who had no reported medical history had received in May 2010 a 4th dose of IPOL, 5th dose of DTaP (manufacturer unknown) and a dose of PREVNAR (Wyeth) vaccine. The lot numbers were not reported for any of the vaccines. Several hours post vaccination, the patient experienced coughing, wheezing, urticaria and angioedema requiring a emergency room and/or doctor visit. He subsequently had a skin test (date not reported) that was positive for DAPTACEL and FLUZONE. Treatments received and other diagnostic/laboratory test performed were not reported. Outcome was not reported. Documents held by sender: None.


VAERS ID: 417852 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: New York  
Vaccinated:2011-02-21
Onset:2011-02-23
   Days after vaccination:2
Submitted: 2011-02-24
   Days after onset:1
Entered: 2011-03-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0647Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1095Z / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Blister, Injection site erythema, Injection site induration, Injection site reaction, Injection site warmth, Skin lesion
SMQs:, Severe cutaneous adverse reactions (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: (L.) anterior thigh with a 15-20cm diameter patch of erythema, centrally with 12-15 vesicular lesions, no drainage. Area warm and indurated, but no pain on palpatation. Temp-97.7 no itching, no discomfort. Treatment - Benadryl q 6 hours PRN.


VAERS ID: 417876 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-02-16
Onset:2011-02-17
   Days after vaccination:1
Submitted: 2011-02-27
   Days after onset:10
Entered: 2011-03-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B15AA / 5 RA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB462BA / 1 LA / UN

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

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

Write-up: (R) arm red, swollen, itchy & sore.


VAERS ID: 417985 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-01-27
Onset:0000-00-00
Submitted: 2011-03-03
Entered: 2011-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B167FA / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0960Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1178Z / 2 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site extravasation, Scratch
SMQs:, Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (narrow)

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

Write-up: Child frightened, screaming. Mother holding child as directed. Attempted to comfort child & advised to be as still as possible. As paramedic administered KINRIX (L) arm child jerked causing some vaccine to be lost & also a small (1/4) superficial scratch on arm. Explained to mother both IPV & DTAP were 4th & 5th respectively vaccines received by child & no action needed other than to monitor site. Mother indicated understanding.


VAERS ID: 418021 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:2011-03-04
Onset:2011-03-04
   Days after vaccination:0
Submitted: 2011-03-04
   Days after onset:0
Entered: 2011-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3515AA / 4 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1628Z / 2 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1070Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1027Z / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cough; runny nose
Preexisting Conditions: Febrile seizure 6/07; Bell''s palsy 2/09; MRSA 3/06
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hive like rash 15 min after vaccines, also cough became worse. HR 103 O2 - 96% gave BENADRYL 12pm. At 12:05 still with same symptoms, gave EPIPEN Jr. at 12:40 pm HR 85 O2 - 98% rash cleared and cough became only occasionally, pt was resting comfortably. Doctor examined after also. Pt does have an ear infection.


VAERS ID: 418023 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Dakota  
Vaccinated:2011-03-02
Onset:2011-03-03
   Days after vaccination:1
Submitted: 2011-03-04
   Days after onset:1
Entered: 2011-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B141BA / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0662Z / UNK RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0896Z / UNK LA / SC

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

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

Write-up: 24 hrs after vaccinating 3" x 4" red, raised, hot, hard area appeared at KINRIX site. Site was also itchy and patient ran a fever of 100.9 degrees F. Mother gave TYLENOL & administered topical cortisone cream to area. 48 hrs after vaccination site remains the same. Mother taking child to pediatrician.


VAERS ID: 418044 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Idaho  
Vaccinated:2011-03-03
Onset:2011-03-05
   Days after vaccination:2
Submitted: 2011-03-05
   Days after onset:0
Entered: 2011-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164CA / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0646Z / 2 LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Chills, Decreased appetite, Injection site erythema, Injection site rash, Injection site warmth, Pyrexia, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Within 2 days pt, previously well, developed 5x8 cm red, warm rash at injection site, (L) deltoid. Also, viral syndrome with F to 102, chills, weak, vomited x one & poor appetite.


VAERS ID: 418125 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Arkansas  
Vaccinated:2010-09-22
Onset:2010-09-23
   Days after vaccination:1
Submitted: 2010-09-28
   Days after onset:5
Entered: 2011-03-07
   Days after submission:160
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0154Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0178Z / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: AR1105

Write-up: (L) arm became swollen & red from elbow to (L) deltoid then increased to swelling (L) clavicle & (L) side of face - took to MD - MD recommends no further DTPs.


VAERS ID: 418230 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2010-01-25
Onset:2010-01-26
   Days after vaccination:1
Submitted: 2010-03-24
   Days after onset:56
Entered: 2011-03-07
   Days after submission:348
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3141AA / UNK LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK RA / IM
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)) / MEDIMMUNE VACCINES, INC. - / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient''s medical history included allergic rhinitis. She had no illness at the time of the vaccination. There were no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 201000807

Write-up: Initial case received on 29 January 2010 from a healthcare professional. A 5 year old female patient received a left deltoid intramuscular injection of DAPTACEL (lot number C3141AA), a right deltoid intramuscular injection of FLUVIRIN (Novartis no lot number reported) and nasal "H1N1" (Medimmune no lot number reported) on 25 January 2010. On 26 January 2010, the patient experienced left arm swelling from the elbow to shoulder and into lower neck. There were no other complaints. The patient''s medical history included allergic rhinitis. She had no illness at the time of the vaccination. There were no known allergies and no concomitant medications. The patient was seen by a physician on 29 January 2010 and treatment included BENADRYL and ice. As of this report the patient had not recovered. Follow-up information received on 19 March 2010 from a healthcare professional. The swelling of the left arm and neck resolved by 29 January 2010. No further treatment for these adverse events was needed. No additional information was provided. Documents held by sender: None.


VAERS ID: 418158 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2011-03-02
Onset:2011-03-03
   Days after vaccination:1
Submitted: 2011-03-08
   Days after onset:5
Entered: 2011-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1250Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1326Z / 2 RA / SC

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

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

Write-up: Swollen, erythema at site, hot, tender Warm compress, Motrin, Benadryl


VAERS ID: 418167 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-03-01
Onset:2011-03-02
   Days after vaccination:1
Submitted: 2011-03-08
   Days after onset:6
Entered: 2011-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1326Z / 2 LA / SC

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

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

Write-up: left arm rash, warm, erythema, hard at site Benadryl given


VAERS ID: 418199 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-02-10
Onset:2011-02-11
   Days after vaccination:1
Submitted: 2011-03-08
   Days after onset:25
Entered: 2011-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 942440 / 5 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 09192 / 2 LL / UN

Administered by: Unknown       Purchased by: Private
Symptoms: Bacterial test negative, C-reactive protein normal, Epstein-Barr virus antibody negative, Full blood count normal, Injection site pain, Metabolic function test normal, Parvovirus B19 test negative, Pyrexia, Red blood cell sedimentation rate normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: hydronephrosis at birth treated with urethral stricture dilatation, no resultant kidney dysfunction
Allergies:
Diagnostic Lab Data: CMP, CBC, EBV titers, parvovirus, RMSF, CRP, ESR all normal
CDC Split Type:

Write-up: fever for two days, leg pain starting 2/15/2011


VAERS ID: 418260 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2011-02-24
Onset:2011-02-25
   Days after vaccination:1
Submitted: 2011-02-25
   Days after onset:0
Entered: 2011-03-09
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CBV / 5 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3728AA / 2 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1440Z / 2 UN / SC

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

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

Write-up: (L) deltoid swelling and redness.


VAERS ID: 418289 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2011-03-09
Onset:2011-03-09
   Days after vaccination:0
Submitted: 2011-03-09
   Days after onset:0
Entered: 2011-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3697AA / 1 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB462AA / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Child was examined by MD immediately prior to vaccination today. No signs of illness.
Preexisting Conditions: No known allergies for child. No history of adverse effects from vaccinations.
Allergies:
Diagnostic Lab Data: none. Parent advised not to use skin cream that she applied to the child for the first time today.
CDC Split Type:

Write-up: Child vaccinated today at Clinic about 10:30 AM after MD exam. Child was playing outside at school. Teacher noted hives on face and hands of child. Parent was notified. Mother took child directly to the Health Department for evaluation at 1:30 PM by the Public Health Nurse. Hives noted on childs face, body and limbs in a generalized fashion. No c/o itch or redness noted. Child had no respiratory distress. Dr. notified by telephone. Emergency medication protocol followed. Benadryl 30mg IM given in Rt deltoid muscle. Hives resolved within next 20 minutes time. Child observed during this time to be playing and acting normal. Mother of child advised to monitor child today at all times. If hives return and/ or any signs of respiratory distress are noted, that she must call for an ambulance to take the child to the nearest emergency room. Mother reported that the child had a new skin lotion applied to her today that the mother never used on her before. No new foods eaten lately or new laundry detergent used this week. Parent advised to wash off any skin lotion on this child with a mild soap when she arrives home. Child discharged from clinic with faint amout of hives noted on face of child only. No distress noted.


VAERS ID: 418312 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-03-02
Onset:2011-03-06
   Days after vaccination:4
Submitted: 2011-03-09
   Days after onset:3
Entered: 2011-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0141Z / 1 LL / IM

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

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

Write-up: 4 d. after administered - noticed erythematous patch - 1" x 2" - bright red (like hemangioma) mild tend. to palp. No swelling. No fever. Otherwise well. 3/9 - color starting to fade. No blanches.


VAERS ID: 418345 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-02-25
Onset:2011-02-25
   Days after vaccination:0
Submitted: 2011-02-28
   Days after onset:3
Entered: 2011-03-09
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1270Y / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1435Y / 2 LA / SC

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

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

Write-up: On 2.25.11 child given kindergarten immuns. Left deltoid & left arm area sub q. DTaP/polio- KINRIX, MMR, Varicella. Noted immediately red blotches, (L) arm, neck, shoulder, back area. Lasting 2-3 minutes then subsided. No itchiness, no SOB, not raised, no swelling. Monday 2.28.11 parent reported no further blotchiness but (L) deltoid area red, swollen, itchy lasted 2 days -2-3 inches in diameter now gone. No fever, no other symptoms noted. No redness or swelling near sub Q area.


VAERS ID: 418354 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Oregon  
Vaccinated:2011-02-23
Onset:2011-02-25
   Days after vaccination:2
Submitted: 2011-02-28
   Days after onset:3
Entered: 2011-03-09
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3282CA / 5 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH180AO / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0548 / 4 LL / UN

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

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

Write-up: Localized swelling at inj. site. 10 cm area of swelling, redness & slight induration. No proximal streaking, no fever. Rx BENADRYL 1-2 tsp q. 6 hrs. cool compress.


VAERS ID: 418373 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Idaho  
Vaccinated:2011-03-08
Onset:2011-03-08
   Days after vaccination:0
Submitted: 2011-03-09
   Days after onset:1
Entered: 2011-03-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 2 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB461AA / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0602Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08347 / 2 LL / SC

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

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

Write-up: Red, swollen, bump on (L)-(R) leg 2 cm around inj site bil.


VAERS ID: 418404 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Florida  
Vaccinated:2011-03-04
Onset:2011-03-08
   Days after vaccination:4
Submitted: 2011-03-10
   Days after onset:2
Entered: 2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / UNK LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1366Z / UNK RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Injection site warmth
SMQs:

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

Write-up: Pt. was given vaccine on 3/4/11, came back in to office 3/8/11 with approximately 4in x 4in circular - warm area to L thigh Mom said gradually got bigger over past few day. Tx with AUGMENTIN for cellulitis.


VAERS ID: 418405 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Arizona  
Vaccinated:2010-11-08
Onset:2010-11-15
   Days after vaccination:7
Submitted: 2011-03-10
   Days after onset:115
Entered: 2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH180AC / UNK RA / IM

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

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

Write-up: Received injection (flu) at school Nov 8, 2010. Had pain and a little redness at site. Mother stated about a week later a lump formed & there is pain at the lump. Went to Pediatrician and pediatrician not sure so referred to dermatologist. Waiting for approval from agency.


VAERS ID: 418449 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2011-03-04
Onset:2011-03-04
   Days after vaccination:0
Submitted: 2011-03-11
   Days after onset:7
Entered: 2011-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0693Z / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Cold sweat, Convulsion, Gait disturbance, Malaise, Pyrexia, Somnolence, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 5:30PM 3/4/11 Child was clammy and complaining that he felt sick like he was going to throw up. 6:30PM 3/4/11 Child was extremely weak and not able to walk real well so he sat down. Child burning up, parent not sure how high fever was they were away from home and did not have access to thermometer. Mother medicated child with ibuprofen. 10:30PM 3/4/11 Sibling alarmed parents that something was wrong with his brother in bed. Mother ran to him to find him convulsing and not responding to her. They were getting ready to go to ER and she picked up the child and he vomited. After that child spoke to the parents and he fell asleep. Child the next morning was otherwise sleepy, but more himself. To this date, child has been fine.


VAERS ID: 418583 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Virginia  
Vaccinated:1992-05-15
Onset:1992-05-15
   Days after vaccination:0
Submitted: 2011-03-07
   Days after onset:6870
Entered: 2011-03-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0310V / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Anti-HBs antibody negative
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: serum hepatitis B Ab, negative; serum hepatitis B Ab, 06/23/10, negative
CDC Split Type: WAES1007USA00043

Write-up: Information has been received from a physician concerning her currently 23 year old son with pertinent medical history or allergies who on 15-MAY-1992, at the age of 5 year old, was vaccinated intramuscularly with the first 0.25ml dose of RECOMBIVAX HB (lot# 602638/0310V). On 24-OCT-1992, the patient was vaccinated intramuscularly with the second 0.25ml dose of RECOMBIVAX HB (lot # 604946/1163V). On 24-FEB-1993, the patient was vaccinated intramuscularly with the third 0.25ml dose of RECOMBIVAX HB (lot # 606130/1517V). There was no concomitant medication. The physician mentioned that the patient had negative titers after received 3 dose series of RECOMBIVAX HB. On 19-MAY-2010, the patient was vaccinated intramuscularly with the fourth dose of RECOMBIVAX HB (lot # not reported) because of negative titer. The patient still had negative titers. Additional information has been requested. This is an amended report. The codes of negative titers were changed from antibody test negative to Anti-HBs antibody negative.


VAERS ID: 418496 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2011-03-04
Onset:2011-03-05
   Days after vaccination:1
Submitted: 2011-03-12
   Days after onset:7
Entered: 2011-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0674Z / 1 LA / IJ

Administered by: Unknown       Purchased by: Other
Symptoms: Mumps, Nasopharyngitis, Pyrexia, Salivary gland enlargement
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever for 5 days, cold like symptoms, on 3/12/2011, developed extreme swelling of left salivary gland and fever, liklihood case of mumps from live vaccine


VAERS ID: 418598 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:2011-03-07
Onset:2011-03-08
   Days after vaccination:1
Submitted: 2011-03-09
   Days after onset:1
Entered: 2011-03-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0831Z / 2 LL / IM

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

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

Write-up: Pain, swelling, redness at injection site. Hard and warm to the touch.


VAERS ID: 418675 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:2011-03-11
Onset:2011-03-12
   Days after vaccination:1
Submitted: 2011-03-14
   Days after onset:1
Entered: 2011-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1308Z / 2 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Urticaria diarrhea $g within 24 hrs vaccines, tx with antihistamines, ? infectious diarrhea with resultant urticaria.


VAERS ID: 418768 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2011-03-08
Onset:2011-03-09
   Days after vaccination:1
Submitted: 2011-03-10
   Days after onset:1
Entered: 2011-03-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1089Z / 2 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1307Z / 2 RL / SC

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

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

Write-up: 12cm - 15cm area of erythema, warmth & induration at injection site (R thigh) beginning approx. 30 hr after administration.


VAERS ID: 418792 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2011-03-09
Onset:2011-03-10
   Days after vaccination:1
Submitted: 2011-03-15
   Days after onset:4
Entered: 2011-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3656BA / 5 LA / IM

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

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

Write-up: rash under location of bandage, as well as proximally on shoulder. Pruritic. Was on face, but by 3/11, had cleared from face and was starting to improve. No facial swelling, SOB, D, or other systemic reactions.


VAERS ID: 418793 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:1999-06-01
Onset:1999-09-15
   Days after vaccination:106
Submitted: 2011-03-15
   Days after onset:4199
Entered: 2011-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Burning sensation, Discomfort, Nerve injury, Neuropathy peripheral, Pain, Restless legs syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: He was taking no medication at time of vaccine or after. He has tried numerous medications to try and stop pain, but nothing has helped much.
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: He has been to numerous doctors, had different probable diagnosis of neuropathy and restless leg syndrome, but the nerves are still damaged with no relief ever. He''s in constant pain and discomfort.
CDC Split Type:

Write-up: The bottom of his feet starting burning. No redness or difference to touch, he just felt it.


VAERS ID: 418735 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2011-03-09
Onset:2011-03-13
   Days after vaccination:4
Submitted: 2011-03-16
   Days after onset:2
Entered: 2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164BA / 1 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0693Z / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Hives noted (L) upper arm. Advised to give BENADRYL & go to ER if any facial swelling or itchy throat.


VAERS ID: 418808 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Montana  
Vaccinated:2011-03-07
Onset:2011-03-11
   Days after vaccination:4
Submitted: 2011-03-16
   Days after onset:4
Entered: 2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS GAC21B254BA / 2 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. G0491Z / 1 LA / UN

Administered by: Public       Purchased by: Other
Symptoms: Dizziness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sudden onset of Vomit, dizziness, high fever of about between 103-104. The fevers are continuing to happen regularly two to three times a day for five days now. Not seeing any improvement. Will be seeing a doctor today. I consider the fever life threatening if not managed properly!


VAERS ID: 418852 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2011-03-07
Onset:2011-03-08
   Days after vaccination:1
Submitted: 2011-03-09
   Days after onset:1
Entered: 2011-03-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1346Z / 2 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1182Z / 2 RL / UN

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

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

Write-up: Redness, warm to touch, hurts to apply pressure on right leg.


VAERS ID: 419038 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-01-12
Onset:2011-01-13
   Days after vaccination:1
Submitted: 2011-02-28
   Days after onset:46
Entered: 2011-03-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3470DA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0407Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0972Z / 2 RA / SC

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

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

Write-up: 10 x 14cm red histamine Rxn to immun (DTaP) no hives or systemic symptoms.


VAERS ID: 419046 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2010-08-17
Onset:2010-08-18
   Days after vaccination:1
Submitted: 2010-08-20
   Days after onset:2
Entered: 2011-03-18
   Days after submission:210
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B167FA / UNK LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB833DA / UNK LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0254Z / UNK LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0469Z / UNK RA / UN

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

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

Write-up: Softball size (big red spot) varicella right arm.


VAERS ID: 419053 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2010-08-09
Onset:2010-08-10
   Days after vaccination:1
Submitted: 2010-08-20
   Days after onset:10
Entered: 2011-03-18
   Days after submission:210
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / UNK LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0469Z / UNK RA / UN

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

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

Write-up: Had a 2cm local reaction raised area over arm with erythema (Varicella right arm).


VAERS ID: 419076 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2011-03-15
Onset:2011-03-15
   Days after vaccination:0
Submitted: 2011-03-17
   Days after onset:2
Entered: 2011-03-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3470CA / 4 RA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash~DTaP (no brand name)~3~3.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. was given a DTaP injection to (R) deltoid area on 3/15/11. On 3/16/11 pt''s mother called & stated she needed to bring her dtr. in. When she arrived, child was in no noticeable distress, but did have 7.6 x 5.6 cm red, swollen area to upper (R) arm. C/o pain & itching. Dr. examined area & instructed her mother to continue BENADRYL.


VAERS ID: 419151 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2011-03-14
Onset:2011-03-14
   Days after vaccination:0
Submitted: 2011-03-18
   Days after onset:4
Entered: 2011-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0231Z / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Immediate post-injection reaction, Injection site urticaria, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Immediate local erythema & itching with appearance of hives at injection site.


VAERS ID: 419122 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Georgia  
Vaccinated:2011-03-14
Onset:2011-03-14
   Days after vaccination:0
Submitted: 2011-03-19
   Days after onset:5
Entered: 2011-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 2 LA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0482Z / 1 RA / IM

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

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

Write-up: Received DTaP on 3/14/11. Returned to office on 3/16/11 with (L) arm - red, swollen, hot to touch x 2 days. Had 11cm x 8.5cm red, firm, slightly indurated area to (L) delt area.


VAERS ID: 419176 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Missouri  
Vaccinated:2011-03-14
Onset:2011-03-15
   Days after vaccination:1
Submitted: 2011-03-15
   Days after onset:0
Entered: 2011-03-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / 1 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1398Z / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0662Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1428Y / 2 LA / SC

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

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

Write-up: Per patients mother, patient awoke this AM with "orange sized" inflammation & "itching" at (L) delt region. Denied further c/o. Recommended Ibuprofen & cool compress, F/U with PCP if s/s persist or worsen.


VAERS ID: 419208 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2011-03-07
Onset:2011-03-08
   Days after vaccination:1
Submitted: 2011-03-11
   Days after onset:3
Entered: 2011-03-21
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3449AA / UNK RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / UNK LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0575Z / 1 LA / SC

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

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

Write-up: Child woke up in morning of March 8th, 2011 with large - approx. 5 cm edematous/erythematous, warm area on left arm. Prescribed diphenhydramine - will follow-up.


VAERS ID: 419210 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2011-03-07
Onset:2011-03-14
   Days after vaccination:7
Submitted: 2011-03-21
   Days after onset:7
Entered: 2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164AA / 1 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0192Z / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram head, Full blood count, Guillain-Barre syndrome, Immunoglobulin therapy, Lumbar puncture, Metabolic function test, Muscular weakness, Pain, Pain in extremity, Pyrexia, Restlessness, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: MIRALAX
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC; CMP; CT of brain; Spinal tap
CDC Split Type:

Write-up: Fever, vomiting, avoiding walking, bilateral foot and leg pain, restless, leg weakness. She has been dx with GUILLAIN BARRE syndrome and is currently in hospital on IVIG. (This maybe post flu and not related to shots).


VAERS ID: 419285 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Michigan  
Vaccinated:2010-07-01
Onset:0000-00-00
Submitted: 2011-03-08
Entered: 2011-03-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0228Z / UNK UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal discomfort, Diarrhoea, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received MMR vaccine on 7/1/2010. She began running a fever (104.7) on July 11th and started to develop spots (hives). She saw the doctor on July 1th, which she was diagnosed with hives at that time (they were severe). Also, on July 4th patient complained of an upset stomach and had diarrhea.


VAERS ID: 419385 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Georgia  
Vaccinated:2011-03-18
Onset:2011-03-20
   Days after vaccination:2
Submitted: 2011-03-21
   Days after onset:1
Entered: 2011-03-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3515AA / 5 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 4 LA / UN

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

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

Write-up: Rt arm with some redness & swelling 3 x 4cm no abscess 48 hrs after immunization given.


VAERS ID: 419412 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-03-17
Onset:2011-03-21
   Days after vaccination:4
Submitted: 2011-03-23
   Days after onset:2
Entered: 2011-03-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3515AA / 5 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0123 / 4 LA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0542Z / 2 LA / SC

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

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

Write-up: Pt presented to office with redness and swelling at DTaP site and varicella like lesions around site at VARIVAX.


VAERS ID: 419416 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Wyoming  
Vaccinated:2011-03-15
Onset:2011-03-17
   Days after vaccination:2
Submitted: 2011-03-24
   Days after onset:7
Entered: 2011-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (INFANRIX TETRA) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / 1 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0578Z / 2 LA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0965Z / 2 RA / -

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

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

Write-up: arm where injections given became red, hot and hard just below deltoid on right arm


VAERS ID: 419556 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2011-03-23
Onset:2011-03-25
   Days after vaccination:2
Submitted: 2011-03-25
   Days after onset:0
Entered: 2011-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / 1 RA / IM

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

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

Write-up: Soreness 3/24/11. Redness/swelling/warmth 3/25/11 AM. At time of visit with me (3/25/11 at 2:15pm, about 48h after vaccine given), local inflammatory reaction at (R) upper outer arm measures 9.5 cm vertical x 6.25 cm horizontal.


VAERS ID: 419559 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:2009-12-01
Onset:2010-01-01
   Days after vaccination:31
Submitted: 2011-03-25
   Days after onset:447
Entered: 2011-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP022AA / UNK UN / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Cataplexy, Narcolepsy
SMQs:, Convulsions (broad), Generalised convulsive seizures following immunisation (broad)

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

Write-up: Pt developed severe narcolepsy with cataplexy within one month of H1N1 vaccine. Pt. is HLADQB1*0602 (+). Treatment includes: XYREM, Imipramine, RITALIN.


VAERS ID: 419564 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:2011-02-07
Onset:0000-00-00
Submitted: 2011-03-25
Entered: 2011-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1272Z / 1 RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Death, Epilepsy, Status epilepticus, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B; LAMICTAL; KEPPRA; TOPAMAX
Current Illness: None
Preexisting Conditions: Epilepsy; Right hemiparesis; GERD; Strabismus; Cerebral Palsy
Allergies:
Diagnostic Lab Data: Known left middle cerebral artery infarct with right hemiplegia and epilepsy.
CDC Split Type:

Write-up: DTaP/IPV and VARIVAX given at 14:30 on 2/7/11 as health care maintenance. Patient found unresponsive with vomit in bed around 6 am on 2/8/11. Pronounced deceased on arrival to the ED on 2/8/11. Presumed cause of death is status epilepticus in this patient with known and worsening epilepsy. Medical Examiner involved, and no autopsy performed.


VAERS ID: 419570 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-03-23
Onset:2011-03-23
   Days after vaccination:0
Submitted: 2011-03-25
   Days after onset:2
Entered: 2011-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1510Z / 2 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0330 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1328Z / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Laboratory test normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient suffered a seizure approximately one hour after immunizations were given. Patient was evaluated in emergency dept. and discharged after 5 hours of monitoring post seizure activity.


VAERS ID: 419543 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Rhode Island  
Vaccinated:2011-03-21
Onset:2011-03-21
   Days after vaccination:0
Submitted: 2011-03-26
   Days after onset:5
Entered: 2011-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Eating disorder, Erythema, Injection site erythema, Injection site swelling, Injection site warmth, Irritability, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I can''t find what the doctor told me on your pull down menu''s. Disregard the Polio selection, she told me it was PCV1. Thank you.
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: First he complained of pain, we noticed it was very swollen, raised and red. He complained of pain throughout the day. The next morning the swelling was down but the area was bright pink in a well defined 2 inch area around the shot, and it was warm to the touch. He was a bit grumpy, and didn''t eat well for those two days. The next morning it looked fine.


VAERS ID: 419553 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Washington  
Vaccinated:2011-03-25
Onset:2011-03-27
   Days after vaccination:2
Submitted: 2011-03-28
   Days after onset:1
Entered: 2011-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: calcinosis~ ()~~0.17~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythema, induration near vaccine site


VAERS ID: 419659 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Indiana  
Vaccinated:2011-03-17
Onset:2011-03-17
   Days after vaccination:0
Submitted: 2011-03-28
   Days after onset:11
Entered: 2011-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B154AA / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0283Z / 2 RA / SC

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Cold sweat, Cough, Dyspnoea, Hyperhidrosis, Injection site pruritus, Lethargy, Oedema peripheral, Pruritus generalised, Speech disorder, Swelling face, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NOTED NEW ALLERGY TO PEANUTS SPINA BIFIDA SINCE BIRTH
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: LETHARGY, ABDOMINAL PAINS, URTICARIA, SL. DIFFICULTY BREATHING, CLAMMY, DIAPHORETIC, DIFFICULTY SPEAKING, SPASTIC COUGHING, SWELLING FACE, ARMS, ITCHING ENTIRE TORSO, ESPECIALLY ARMS, STOMACH, INNER UPPER THIGHS.


VAERS ID: 419747 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-03-21
Onset:0000-00-00
Submitted: 2011-03-23
Entered: 2011-03-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3380AA / 5 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0548 / 4 RA / SC

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

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

Write-up: Patient had Kindergarten vaccines administered on 3/21/11 in office. DTAP, IPV in (R) arm. Area became warm to touch within 24 hrs. Redness extended to elbow. Evaluated in office 3/23/11 by Dr. area 4 inch/4 inch erythema with induration. Rx AUGMENTIN for cellulitis and warm compresses to arm.


VAERS ID: 419795 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Arizona  
Vaccinated:2011-03-23
Onset:2011-03-24
   Days after vaccination:1
Submitted: 2011-03-25
   Days after onset:1
Entered: 2011-03-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172A / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1008Z / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1377Z / 2 LA / SC

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

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

Write-up: Patient presented with redness and heat on the (L) deltoid measuring 4.5 inches in width and 5 inches in length. There was swelling and minimal pain.


VAERS ID: 419809 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-03-23
Entered: 2011-03-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / 5 UN / IM
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. B01040P / UNK NS / IN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0870Y / 2 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1075Y / 2 UN / SC

Administered by: Private       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

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

Write-up: 16 pox noted on body.


VAERS ID: 419810 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-03-08
Onset:2011-03-09
   Days after vaccination:1
Submitted: 2011-03-10
   Days after onset:1
Entered: 2011-03-29
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3381A / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0413 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0811Z / 2 RA / SC

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

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

Write-up: (L) deltoid approx 4" x 5" reddened are at injection site. Warm to touch. Occurring approx 2 days after injection. Treated with ice and BENADRYL.


VAERS ID: 419941 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2011-03-25
Onset:2011-03-26
   Days after vaccination:1
Submitted: 2011-03-28
   Days after onset:2
Entered: 2011-03-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / 1 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0574Z / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Side effect leg swelling~Measles + Mumps + Rubella + Varicella (ProQuad)~1~1.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: NKA; obesity; penile adhesions; GERD; chronic bronchitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3-28-11 11:30 am: about 5 x 5 1/2 in. pink, raised, warm area of erythema to left lateral thigh, tx with diphenhydramine p.o. & hcz crm topically. 3-30-11 9:00 am: swelling has decreased per pt''s mom.


VAERS ID: 419992 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2011-03-28
Onset:2011-03-29
   Days after vaccination:1
Submitted: 2011-03-30
   Days after onset:1
Entered: 2011-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0603Z / 2 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Body temperature, Condition aggravated, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cerebral Palsy
Allergies:
Diagnostic Lab Data: H/O spastic diplegia & prior sz x 1
CDC Split Type:

Write-up: Brief seizure & Temp 1/29, local reaction.


VAERS ID: 419996 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-03-28
Onset:2011-03-29
   Days after vaccination:1
Submitted: 2011-03-30
   Days after onset:1
Entered: 2011-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1376Z / 2 UN / SC

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

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

Write-up: (L) arm red/swollen/indurated mild "itchiness" per pt mild pain no fever blisters - superficial - where band aids were applied (? latex allergy) went to ER last pm (3/29/11). Got KEFLEX & BENADRYL.


VAERS ID: 420039 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Oregon  
Vaccinated:2011-03-29
Onset:2011-03-30
   Days after vaccination:1
Submitted: 2011-03-31
   Days after onset:1
Entered: 2011-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1024Z / 2 RA / SC

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

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

Write-up: Mother notice redness & swelling on 3/30/11 on right arm. Patient is getting treated with antibiotic KEFLEX for cellulitis.


VAERS ID: 420052 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Alaska  
Vaccinated:2011-03-28
Onset:2011-03-30
   Days after vaccination:2
Submitted: 2011-03-31
   Days after onset:1
Entered: 2011-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B099BA / 4 RA / IM

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

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

Write-up: APPROX 5 CM RAISED, RED, HOT AREA WITH MILD SWELLING OF RIGHT DELTOID AT VACCINE SITE


VAERS ID: 420058 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-03-28
Onset:2011-03-30
   Days after vaccination:2
Submitted: 2011-03-31
   Days after onset:1
Entered: 2011-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164AA / UNK LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1412Z / UNK UN / SC

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

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

Write-up: Redness, swollen, hot to touch.


VAERS ID: 420059 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Idaho  
Vaccinated:2011-03-07
Onset:2011-03-09
   Days after vaccination:2
Submitted: 2011-03-31
   Days after onset:21
Entered: 2011-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B121BB / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D05487 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0811Z / 2 RL / SC

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

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

Write-up: Right thigh red/swollen. 3-9-11 ER (AUGMENTIN). 3-10-11 Dr- Cool pack, BENADRYL.


VAERS ID: 420305 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2011-03-29
Onset:2011-03-31
   Days after vaccination:2
Submitted: 2011-03-31
   Days after onset:0
Entered: 2011-04-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 5 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 4 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1471Z / 2 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Feeling hot, Induration, Local reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient had local reaction to DTaP #5: Heat redness & firm - sm. amount of swelling, redness = 10x9cm.


VAERS ID: 420334 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2011-04-01
Onset:2011-04-01
   Days after vaccination:0
Submitted: 2011-04-05
   Days after onset:4
Entered: 2011-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164BA / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0175Z / 2 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Bradycardia, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt became hypotensive, bradycardic, and diaphoretic. Monitored BP, HR, pulse ox, water, lollipop and trendelenberg about 45 min to recovery.


VAERS ID: 420344 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: West Virginia  
Vaccinated:2011-02-04
Onset:2011-02-05
   Days after vaccination:1
Submitted: 2011-04-05
   Days after onset:58
Entered: 2011-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B116CA / 5 LG / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Crying, Ear infection, Ear pain, Ear, nose and throat examination abnormal, Influenza, Influenza A virus test positive, Injection site pain, Malaise, Pyrexia, Streptococcus test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever & Rash~Hib (no brand name)~1~0.33~Sibling
Other Medications: N/A
Current Illness: No. He had his 5 year check up and everything was great.
Preexisting Conditions: No.
Allergies:
Diagnostic Lab Data: Rapid Strep Test, Strep test, Flu test, exam for ear infection.
CDC Split Type:

Write-up: Uncontrollable crying, acute ear pain, fever of 101 degrees, and pain in injected leg. Ear pain started in on ear and moved into second ear the following day. Leg pain and fever persisted into following day as well. Ibuprofen controlled fever, ear pain, and leg pain. Called doctor who recommended warm oil for ear pain, but I did not do this. On Feb. 10, 2011, became very ill with extreme temps. Took son into see doctor, but nothing was diagnosed. On 2/14/11, we went back to the doctor and patient (son) showed an ear infection and tested positive for influenza A.


VAERS ID: 420365 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2011-03-30
Onset:2011-03-31
   Days after vaccination:1
Submitted: 2011-04-04
   Days after onset:4
Entered: 2011-04-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB453AA / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1027Z / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Blister, Erythema, Rash generalised, Skin warm, Varicella
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoride; Albuterol HFA
Current Illness: None
Preexisting Conditions: Asthma; Bee sting allergy
Allergies:
Diagnostic Lab Data: Well child check 3/30/11.
CDC Split Type:

Write-up: 3/31/11 pt had a rash & mother stated felt warm. Assessed diffuse rash with streaks of papular erythema. Given BENADRYL 12.5 mg/5mL 1-2 tsp Q 6 hrs PRN. 4/4/11 pt returned to clinic rash is raised, turned yellow, filling with fluid. Dr. dx''d Varicella.


VAERS ID: 420417 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2011-04-06
Onset:2011-04-06
   Days after vaccination:0
Submitted: 2011-04-06
   Days after onset:0
Entered: 2011-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0741 / UNK - / -

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

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

Write-up: "Wheal" redness and swelling near injection site.


VAERS ID: 420432 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Missouri  
Vaccinated:2011-03-16
Onset:0000-00-00
Submitted: 2011-03-18
Entered: 2011-04-06
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3358AA / 5 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0070Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1231Y / 2 LL / SC

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

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

Write-up: Administered vaccine - didn''t check expiration date on vaccine.


VAERS ID: 420469 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-03-17
Onset:2011-03-17
   Days after vaccination:0
Submitted: 2011-03-18
   Days after onset:1
Entered: 2011-04-07
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0666Z / 2 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1053Z / 2 LL / SC

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

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

Write-up: Edema of right thigh to knee. Painful - limping - acute started evening of day received vaccine. Treatment - BENADRYL, ORAPRED & warm compresses.


VAERS ID: 420495 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2011-04-04
Onset:2011-04-05
   Days after vaccination:1
Submitted: 2011-04-07
   Days after onset:2
Entered: 2011-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1346Z / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1278Z / 2 RA / UN

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

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

Write-up: Local erythematous swelling, warm to the touch, T 99.4. Warm soaks to area/Cefdinir 250m/5ml. 6.25mg PO Daily x 10D.


VAERS ID: 420501 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Washington  
Vaccinated:2011-04-05
Onset:2011-04-06
   Days after vaccination:1
Submitted: 2011-04-07
   Days after onset:1
Entered: 2011-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 5 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB453AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0304 / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00712 / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 11872 / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine 5mg/5ml one teaspoon daily for allergies Sodium Flouride 1.1 mg chew Chew one daily
Current Illness: seasonal allergies
Preexisting Conditions: Seasonal allergies
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Right upper arm swollen size of small orange redness starts at very top of shoulder joint and goes down to just past elbow redness reaches about 3/4 of the way around the upper arm. Arm is slightly warm to touch. Patient is moving arm fine complains of mild itching.


VAERS ID: 420662 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2011-04-05
Onset:0000-00-00
Submitted: 2011-04-07
Entered: 2011-04-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROAIR; MIRALAX; SINGULAIR
Current Illness: None
Preexisting Conditions: GER; eczema; bronchiolitis; constipation; asthma; otitis media; allergic rhinitis; pes planus
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mom reports & emailed picture of swelling in her arm s/p (re same night) of her imm.


VAERS ID: 420734 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2011-04-04
Onset:2011-04-05
   Days after vaccination:1
Submitted: 2011-04-06
   Days after onset:1
Entered: 2011-04-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1273Z / 2 LL / SC

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

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

Write-up: Red raised area on left thigh. Advised cool compress, TYLENOL or MOTRIN.


VAERS ID: 420788 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Missouri  
Vaccinated:2011-04-08
Onset:2011-04-08
   Days after vaccination:0
Submitted: 2011-04-11
   Days after onset:3
Entered: 2011-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK LA / SC

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

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

Write-up: red 4 by 5 inches on deltoid


VAERS ID: 420860 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2011-03-31
Onset:2011-04-01
   Days after vaccination:1
Submitted: 2011-04-04
   Days after onset:3
Entered: 2011-04-12
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164CA / UNK RL / UN

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

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

Write-up: Rt anterior thigh with erythema & induration measuring 12cm x 13cm in diameter. Very warm & tender to touch. Discussed using ice 2-3 x a day, Ibuprofen 3 x a day & BENADRYL.


VAERS ID: 420864 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Nevada  
Vaccinated:2011-04-06
Onset:2011-04-11
   Days after vaccination:5
Submitted: 2011-04-12
   Days after onset:1
Entered: 2011-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IJ
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK AR / IJ
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK AR / IJ
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK AR / IJ

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

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

Write-up: thick hives developed at injection sites on both arms, and began to spread all over her body


VAERS ID: 421011 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:2011-04-08
Onset:2011-04-10
   Days after vaccination:2
Submitted: 2011-04-11
   Days after onset:1
Entered: 2011-04-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LA / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 1 LA / IM

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

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

Write-up: Swelling 10 x 8cm (L) deltoid with erythema. (L) axillary node 3 x 5 cm.


VAERS ID: 421052 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Missouri  
Vaccinated:2011-04-07
Onset:2011-04-09
   Days after vaccination:2
Submitted: 2011-04-14
   Days after onset:5
Entered: 2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 5 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB461CA / 2 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1442Z / 2 RA / SC

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

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

Write-up: (L) upper arm (elbow to shoulder) with tight swelling & redness; increased warmth; tender to palpation. ? Large local reaction-vs-cellulitis. Tx with BENADRYL q 6 hours; MOTRIN q 6 hours x 24 hours & DURICEF 500mg/5ml Sig $g 3ml po BID x 10d.


VAERS ID: 421061 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Missouri  
Vaccinated:2011-04-12
Onset:2011-04-13
   Days after vaccination:1
Submitted: 2011-04-14
   Days after onset:1
Entered: 2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 5 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0367U / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: ROCEPHIN (4/07) -$g hives.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6 cm x 7.5 cm erythema with induration; non-tender to palpation; no warmth at site. Imm. administered 4/12/11; seen in office r/t reaction 4/14/11. Tx: ice pack to arm & Ibuprofen.


VAERS ID: 421112 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:2011-04-06
Onset:2011-04-06
   Days after vaccination:0
Submitted: 2011-04-11
   Days after onset:5
Entered: 2011-04-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3040AA / 5 LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0480 / 4 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0603Z / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1099Z / 2 RA / UN

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

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

Write-up: Lt deltoid - dark red, warm to touch, firm & woody, tender to palpation, cellulitis, headache. Rt mid-humerus 4 cm area of induration that is blanchable & pruritic/tx with AUGMENTIN and ORAPRED.


VAERS ID: 421146 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2011-04-13
Onset:2011-04-14
   Days after vaccination:1
Submitted: 2011-04-15
   Days after onset:1
Entered: 2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB461AA / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1412Z / 1 LL / SC

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

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

Write-up: Mother called 4/15/11 at 11:05am & states "(L) leg (outer thigh) red area (size of baseball). Warm to touch at injection site of KINRIX given on 4/13/11. Recommend BENADRYL 3/4 tsp bid x 1 week. Warm bath or compress & alternate cool compress for 5-10 min. TID. Also follow up on Monday or ASAP if site does not improve. Verbal understanding acknowledged.


VAERS ID: 421195 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Kansas  
Vaccinated:2011-04-12
Onset:2011-04-13
   Days after vaccination:1
Submitted: 2011-04-15
   Days after onset:2
Entered: 2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0039AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1024Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1187Z / 2 LL / SC

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

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

Write-up: Redness and swelling at site of MMR injection. On 4-14-2011, site measured 31.2 as reported by Dr.; on 4/5 swelling down to 1 cm not red.


VAERS ID: 421215 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: California  
Vaccinated:2011-04-08
Onset:2011-04-11
   Days after vaccination:3
Submitted: 2011-04-14
   Days after onset:3
Entered: 2011-04-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1393Z / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1377Z / 2 LL / SC

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

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

Write-up: 5-7 cm erythema, (L) upper arm, non tender. Tx - OTC hydrocortisone.


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