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Case Details (Sorted by Age)

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VAERS ID: 162798 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-02-03
Onset:2000-11-20
   Days after vaccination:656
Submitted: 2000-11-22
   Days after onset:2
Entered: 2000-11-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH U38859 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1538H / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 458433 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

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: Post vax, the pt developed chicken pox approximately 25 blister lesions.


VAERS ID: 163029 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Nebraska  
Vaccinated:1997-01-08
Onset:2000-11-05
   Days after vaccination:1397
Submitted: 2000-11-11
   Days after onset:6
Entered: 2000-12-04
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1478D / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NE006

Write-up: Broke out in chickenpox with "little tiny pox" on back, few on face, legs and was febrile just under 101F on 11/5/00. As of today, they are scabbed over. Used oatmeal baths, lotion and calamine lotion.


VAERS ID: 163043 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:1995-10-19
Onset:2000-11-23
   Days after vaccination:1862
Submitted: 2000-11-28
   Days after onset:5
Entered: 2000-12-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0443B / 1 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Pharyngitis, Rash vesicular, Rhinitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (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: Cold symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Mild cold symptoms; 4-5 scabbing vesicles on trunk and legs.


VAERS ID: 163076 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2000-10-18
Onset:2000-10-28
   Days after vaccination:10
Submitted: 2000-10-30
   Days after onset:2
Entered: 2000-12-05
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 LL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX00147

Write-up: 1 inch diameter injection site, warm, red rash. No blisters noted.


VAERS ID: 163113 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-06-15
Onset:2000-11-24
   Days after vaccination:1989
Submitted: 2000-11-27
   Days after onset:3
Entered: 2000-12-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0412B / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Headache, Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: This child''s parent called from New Mexico on 11/24/00, describing fever times one day (103''s), headaches, and a circular rash. She was advised to be evaluated there. The parent called back on 11/27/00 and told us the patient was diagnosed with the chicken pox by the pediatrician there.


VAERS ID: 163166 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: West Virginia  
Vaccinated:1995-12-18
Onset:2000-11-28
   Days after vaccination:1807
Submitted: 2000-11-30
   Days after onset:2
Entered: 2000-12-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0752B / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: This child broke out with the chicken pox. This patient transferred to the us, some of the information I am not sure of.


VAERS ID: 163477 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2000-10-25
Onset:2000-10-26
   Days after vaccination:1
Submitted: 2000-10-28
   Days after onset:2
Entered: 2000-12-08
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0346AA / UNK RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 466444 / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Headache, Injection site erythema, Injection site oedema, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: mitochondria disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt experienced erythema and swelling approximately 5 cm at the site of injection. The pt also experienced a fever, headache, vomiting after 24 hour post vax. Follow up on 01/16/2001: "Call to reporter about missing data, LM w/mgr. Nurse will return call. Call back indicates this was not Prevnar but Pnu-Immune 23. The left leg site of the Pnu-Immune vaccination was involved. Child had recently completed a course of Ceftin. There is no history of vaccination adverse events, no other vaccination in the 4 months prior. Follow up complete."


VAERS ID: 163593 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: West Virginia  
Vaccinated:2000-12-04
Onset:2000-12-04
   Days after vaccination:0
Submitted: 2000-12-06
   Days after onset:2
Entered: 2000-12-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 469133 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Injection site pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (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: Claritin
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 hours post vax, the pt developed pain at injection site, fever, and shortness of breath.


VAERS ID: 163650 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Utah  
Vaccinated:2000-12-02
Onset:2000-12-04
   Days after vaccination:2
Submitted: 2000-12-05
   Days after onset:1
Entered: 2000-12-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 - / SC

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

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: history of cleft lip/palate
Allergies:
Diagnostic Lab Data: CBC-nml
CDC Split Type:

Write-up: Post vax, the pt developed nonfebrile seizure for 2-3 minutes. Evaluated at ER and released.


VAERS ID: 163908 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2000-12-07
Onset:2000-12-08
   Days after vaccination:1
Submitted: 2000-12-08
   Days after onset:0
Entered: 2000-12-19
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR L0446AA / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, 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: IGA deficiently
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Injection site was erythematous, edematous, tender to touch and warm to touch.


VAERS ID: 164053 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Virginia  
Vaccinated:1996-07-12
Onset:2000-12-10
   Days after vaccination:1612
Submitted: 2000-12-13
   Days after onset:3
Entered: 2000-12-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1653B / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: This patient got the chicken pox disease.


VAERS ID: 164069 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2000-01-31
Onset:2000-01-31
   Days after vaccination:0
Submitted: 2000-12-15
   Days after onset:319
Entered: 2000-12-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1855J / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Eye haemorrhage, Optic neuritis, Scotoma, Visual acuity reduced, Visual field defect
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Ocular infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: MRI-neg, multiple lab tests-neg; Diagnostic lab: multiple lab tests negative; Diagnostic lab: cran nerve exam: unchanged and normal; Intraocular pressure: 10-right eye; Intraocular pressure: 12-left eye; MRI: negative; Neurological exam: unchanged and normal; OP exam: decreased vision of both eyes 20/400 right and 20/150 left; OP exam: right eye: uncorr acuity 20/100-1 with no improvement; OP exam: left eye: 20/40-1 with no improvement or pinhole; OP exam: stereo testing: saw bug but none of am stereo cues; OP exam: slit lamp exam: otherwise unremarkable; OP exam: nondil fundus exam, rt disc no longer swollen; OP exam: nodil fundus inferotemp aspect elev but not swollen; OP exam: Vis acuity: 20/60-in right eye; OP exam: vis acuity: 20/40-in left eye; OP exam: slit lamp exam unchanged; OP exam: sl upper lid droop with norm levator function; OP exam: visual fields: bilat cecocentral scotomas sim to past scans; Visual field test: rt eye: dense cececentral scotoma worse temporally; Visual field test: lt eye: cececentral scotoma;
CDC Split Type: WAES00100851

Write-up: On 1/31/00, the pt experienced decreased vision of both eyes and hemorrhage of left optic nerve. He was seen by an eye doctor. The pt was hospitalized. He was dx with bilateral sequential optic neuritis. He was treated for visual field deficits, bilateral central scotoma, and optic neuropathy bilaterally. The symptoms were considered disabling. Follow up 06/26/2001: "Information has been received from a physician concerning a 7 year old Caucasian male who on 01/31/2000 was vaccinated IM with one dose of varicella virus vaccine live (Lot # 632611/1855J). There was no concomitant medication. On approximately 01/31/2000 the patient experienced decreased vision of both eyes. 20/400 right and 20/150 left, and hemorrhage of left optic nerve. He was seen by an "eye doctor". An MRI and multiple laboratory tests were negative. The patient was hospitalized. He was diagnosed with bilateral sequential optic neuritis. He was treated for visual field deficits, bilateral central acotoma and optic neuropathy bilaterally. The patient was seen in follow up on 05/11/2000. He stated he saw more black spots. Left greater than right eye for approximately one week. He was off the prednisone. He had not been playing baseball at school. Uncorrected acuity during examination was 20/100-1 with no improvement on pinhole in the right eye. In the left eye he saw 20/40-1 with not improvement on pinhole. He saw all Ishihara color plates in both eyes. The pupils were 3mm, round, and reactive to light without afferent defect. On stereo testing, he could see the bug but none of the smaller stereo cues. Intraocular pressure in the right eye was 10 and 12 on the left. Slit lamp examination was otherwise unremarkable. Nondilated fundus examination was performed. The right disc was no longer swollen. The inferotemporal aspect was somewhat elevated but not swollen. In the left eye, there may have been some shallow temporal cupping with an area of focal pallor at the temporal margin of the disc. There was no hemorrhage. His cranial nerve examination and neurological examination were otherwise unchanged and normal. Given his complaints, visual field testing was performed again and compared to prevoius examinations. In the right eye, he had a relatively dense cecocentral scotoma worse temporally which although fluctuated in location from examination to examination. Was probably similar over the previous two months but was better than the initial examination in February 2000. In the left eye, he had a cecocentral scotoma which looked like it had an inferior extension of unknown significance. He always had moderate variance with anywhere from 5-10% false positives and false negatives. The ophthalmologist believed that within the limits of the examination for his age, the fiedls were stable. The patient was reported to have acuity in both eyes which improved since the last examination. His discs were no longer swollen and were better when compared to the appearance of photographs that were performed at the onset of the event. The ophthalmologist was concerned that the left eye returned asymmetrically in the face of a moderate hyperopic refractive asymmetric situation. The patient was seen again on 08/10/2000. He was seen in follow up for his bilateral optic neuropathy which was either a primary bilateral optic neuritis, or parainfectious, or paravaccination optic neuropathy. He was also followed by another ophthalmologist who felt glasses were not necessary at the time. His visual acuity was 20/80- in the right eye without correction and 20/40 in the left eye. He saw all Ishihara color plates. The pupils were 3mm round and reactive to light without afferent defect. The slit lamp examination was unchanged with 1 mm of slight upper lid droop with normal levator function and an old resected cyst in the left lower lid. Ductions were full, although he had a flick of ET in primary. Both discs had some pallor, more inferotemporally in the right eye with possibly a slightly small nerve. The was slight RPE stippling, but otherwise the macula, retina, and vitreious were normal. Visual fields were performed and had bilateral cecocentral scotomas which were similar to past scans. The symptoms were considered disabling. He had partial recovery fromt he symptoms as of 08/13/2000. No further information is available."


VAERS ID: 164110 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Illinois  
Vaccinated:1996-03-20
Onset:2000-12-14
   Days after vaccination:1730
Submitted: 2000-12-15
   Days after onset:1
Entered: 2000-12-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0747B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (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: PPD/Connaught/239911/ID/0 previously
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Varicella rash on trunk with itching. Rx: symptomatic Tylenol and Benadryl.


VAERS ID: 164239 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:1998-10-12
Onset:2000-12-17
   Days after vaccination:797
Submitted: 2000-12-21
   Days after onset:4
Entered: 2000-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (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 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Infection
SMQs:

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: This patient has clinical chicken pox (varicella).


VAERS ID: 164466 (history)  
Form: Version 1.0  
Age: 7.6  
Gender: Male  
Location: Virginia  
Vaccinated:1995-08-30
Onset:2000-12-28
   Days after vaccination:1947
Submitted: 2000-12-29
   Days after onset:1
Entered: 2001-01-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0431B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Pruritus, Rash erythematous
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? 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: 5-7 erythematous, raised lesions on trunk and neck X 24 hours. Complaining of itching. Afebrile.


VAERS ID: 164674 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1996-05-31
Onset:2000-12-26
   Days after vaccination:1670
Submitted: 2000-12-28
   Days after onset:2
Entered: 2001-01-11
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0391B / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: Sinusitis on 5/31/96
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Varivax received on 5/31/96. On 12/28/00, exposed to varicella. Had a mild case of varicella with about 10-12 pox. Still continues with rash.


VAERS ID: 164722 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Washington  
Vaccinated:1998-05-12
Onset:0000-00-00
Submitted: 2000-10-01
Entered: 2001-01-16
   Days after submission:107
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0105E / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Coordination abnormal, Difficulty in walking, Drooling, Dysphonia, Fall, Muscular weakness, Tremor, Vocal cord paralysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: allergy to Ceclor
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx. 2-3 weeks following the 5/12/98 MMR IZ, fine tremors were noted in both hands, lasting for brief periods (less than 30 seconds). Over the next few months the hand tremors become more noticeable lasting for longer periods of time, eventually becoming constant. By November, 5 months after the immunization, episodes of leg weakness developed resulting in slow ambulation and unexplained falling to the ground. By January, 7 months after the IZ, severe leg weakness developed manifested by ataxic gait and total body collapse with inability to get off the floor. Through out the year, his condition continued to rapidly deteriorate, resulting in the loss of function in both hands, both legs, voice, and oral muscle control resulting in excessive drooling. Approx. 15 months, post vax, he was wheel chair dependent, required total assistance with feeding, toileting, and mobility. Currently his level of function continues to decline with no reversal or improvement in symptoms. Although, he has had extensive and extremely thorough medical evaluations by numerous physicians to determine the cause for this progressive demise in health and function, no medical dx has been made.


VAERS ID: 164793 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-08-24
Onset:2000-12-27
   Days after vaccination:1952
Submitted: 2001-01-08
   Days after onset:12
Entered: 2001-01-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0414B / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

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: Developmental delay, communications disorder.
Allergies:
Diagnostic Lab Data: Tzanck Smear - Positive varicella
CDC Split Type:

Write-up: This child is positive for varicella, he has 20 or more vesicles.


VAERS ID: 165032 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Florida  
Vaccinated:2000-11-14
Onset:2000-11-14
   Days after vaccination:0
Submitted: 2000-11-17
   Days after onset:3
Entered: 2001-01-22
   Days after submission:66
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Dyskinesia, Eye movement disorder, Injection site pain, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Prozac, Remeron,Tylenol
Current Illness: URI
Preexisting Conditions: Nausea; Pyrexia; Sore throat NOS; Ear infection NOS; Myringotomy
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ3780316NOV2000

Write-up: A mother reported that her 7 year old daughter received an injection of Prevnar on 11/14/00. Approx. 15 minutes, post vax, the child "fell to the floor, her eyes rolled back into her head and she was jerking". She was treated with an "ammonia inhaler". The child also developed soreness at the injection site. Follow up states the patient recovered.


VAERS ID: 165115 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1996-02-07
Onset:2001-01-09
   Days after vaccination:1798
Submitted: 2001-01-17
   Days after onset:8
Entered: 2001-01-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0751B / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~Varicella (Varivax)~1~7.00~In Sibling|~Varicella (Varivax)~1~9.00~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: This patient developed a diffuse rash over his body, varicella like. He required symptomatic treatment.


VAERS ID: 165116 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1996-02-07
Onset:2001-01-09
   Days after vaccination:1798
Submitted: 2001-01-17
   Days after onset:8
Entered: 2001-01-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0751B / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~Varicella (Varivax)~1~7.00~In Sibling|~Varicella (Varivax)~1~9.00~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: This patient developed diffuse rash (varicella) all over her body. She required symptomatic treatment.


VAERS ID: 165202 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2001-01-16
Onset:2001-01-16
   Days after vaccination:0
Submitted: 2001-01-17
   Days after onset:1
Entered: 2001-01-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MER: MEASLES + RUBELLA (MR-VAX II) / MERCK & CO. INC. 0781K / 2 RA / SC

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: Diluent Lot 1316K
Current Illness: NONE
Preexisting Conditions: Allergic to eggs and Rocephin.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within ten minutes of this patient''s vaccine, she developed facial hives and wheals.


VAERS ID: 165203 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:1996-07-16
Onset:2001-01-18
   Days after vaccination:1647
Submitted: 2001-01-18
   Days after onset:0
Entered: 2001-01-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1658B / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

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: Vaccinated 1996. Failed chicken pox vaccine. Chicken pox 01/17/01.


VAERS ID: 165376 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Unknown  
Location: Indiana  
Vaccinated:2000-05-02
Onset:2000-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2001-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 5 RL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. - / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK LL / SC

Administered by: Private       Purchased by: Other
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ6930506JUN2000

Write-up: Medical assistant reported that within 24 to 48 hours post immunization the patient developed an injection site reaction characterized by a red, warm, hard welt at the site of Acel-Imune administration. This is 1 of 6 patients from this facility who experienced this event following receipt of 3 different lots of Acel-Imune.


VAERS ID: 165484 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-11-21
Onset:2000-12-21
   Days after vaccination:1857
Submitted: 2001-01-23
   Days after onset:33
Entered: 2001-01-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: Pt had slight case of chickenpox after having varicella vaccine in 1995.


VAERS ID: 165782 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-12-21
Entered: 2001-02-05
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pain, Pyrexia
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ5048519DEC2000

Write-up: Subsequent to receiving vax, the pt developed a low grade fever (less than 100 degrees F) and general aching that persisted for one day.


VAERS ID: 166017 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2000-01-11
Entered: 2001-02-21
   Days after submission:407
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Numbness in his elbows and legs, shortness of breath, falling and incoordination.~Tetanus Toxoid (no brand name)~1~47.00~In Pati
Other Medications: UNK
Current Illness: Head Wound
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ0335706JAN2000

Write-up: A sister reported that her 7 year old brother received an injection of tetanus toxoid for a head wound in 1959 and reportedly developed complete paralysis from head to toes. He was hospitalized where a diagnosis of Guillain Barre Syndrome was made. The pt was intermittently hospitalized over 3 years. As of 1/5/00, no further information was available.


VAERS ID: 166088 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2001-01-17
Onset:2001-01-18
   Days after vaccination:1
Submitted: 2001-02-12
   Days after onset:25
Entered: 2001-02-22
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008197 / 2 LA / -

Administered by: Public       Purchased by: Other
Symptoms: Abdominal pain upper, Flatulence, Hypoaesthesia, Pharyngolaryngeal pain, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: KY2001012

Write-up: Pt''s grandmother called and stated pt took one dose of flu vaccine 1/17/01 pt now complains of stomach ache, gas and vomiting. She said that after his 1st dose of flu vaccine before Christmas, he complained numbness of left side and sore throat, he went to Dr for those complaints and was told that he did not feel it was due to flu shot. Diagnosed with positive strept throat. Took antibiotics and recovered without problems.


VAERS ID: 166287 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2001-01-29
Onset:2001-01-29
   Days after vaccination:0
Submitted: 2001-01-31
   Days after onset:2
Entered: 2001-03-01
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. R0958 / 3 RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Asthenia, Convulsion, Dizziness, Gait disturbance, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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), Vestibular disorders (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hx of CMV infection at 3 months of age.
Allergies:
Diagnostic Lab Data: H/H 35.5, WBC 11.1 (845,9L,7m), head CT scan negative.
CDC Split Type:

Write-up: Pt started on rabies vaccine prophylactic when dog not at first available for observation post dog bite .Given on 1/22, 1/25, 1/29. Had nausea after 1st two shots times 1 hour. 3rd shot had initial nausea, then 10 hrs after shot, felt weak, dizzy, achy, couldn''t walk; had possible seizure, eyes rolled up, body tremor, T100.3. Seen in ER.


VAERS ID: 166367 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Mississippi  
Vaccinated:1999-04-07
Onset:2001-02-07
   Days after vaccination:672
Submitted: 2001-02-07
   Days after onset:0
Entered: 2001-03-02
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 1522K / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0927K / UNK - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Infection
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt received the vaccines on 4/7/99. Was exposed and contracted chicken pox on 2/7/01. Very mild case.


VAERS ID: 166553 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2001-01-20
Onset:2001-01-21
   Days after vaccination:1
Submitted: 2001-02-06
   Days after onset:16
Entered: 2001-03-06
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Heart rate irregular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Cardiac arrhythmia terms, nonspecific (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: seasonal allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: One day post vax, the pt has broke out in hives and had an irregular heartbeat. She was placed on Prednisone.


VAERS ID: 166555 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-06-19
Onset:2001-02-04
   Days after vaccination:2057
Submitted: 2001-02-08
   Days after onset:4
Entered: 2001-03-06
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0404B / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The pt experienced breakthrough varicella.


VAERS ID: 166644 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:2001-01-08
Onset:2001-01-16
   Days after vaccination:8
Submitted: 2001-02-19
   Days after onset:34
Entered: 2001-03-06
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0465DA / 5 LA / IM

Administered by: Private       Purchased by: Unknown
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? 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: One week post vax, the pt experienced hives.


VAERS ID: 167496 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2000-05-09
Onset:2000-05-10
   Days after vaccination:1
Submitted: 2001-03-07
   Days after onset:301
Entered: 2001-03-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cellulitis, Injection site erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00051272

Write-up: Information has been received from a healthcare professional concerning a 7 year old female who on 5/9/00 was vaccinated with a 2nd dose of Hep-B. On 5/10/00, the pt developed hives, mild redness at the injection site and a cellulitis-type reaction. The pt remained afebrile. The pt sought unspecified medical treatment. Additional information has been requested.


VAERS ID: 167255 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: North Dakota  
Vaccinated:2001-02-28
Onset:2001-02-28
   Days after vaccination:0
Submitted: 2001-03-01
   Days after onset:1
Entered: 2001-03-19
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0716K / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 4 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0826K / 1 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0343AA / 4 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Dysphagia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pepcid, cortisone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 1/2 hrs post vaccine pt developed hives on body, vomiting,difficulty swallowing. ER visit times 2, treated with Benadryl.


VAERS ID: 167586 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2000-10-27
Onset:2000-10-28
   Days after vaccination:1
Submitted: 2001-03-14
   Days after onset:137
Entered: 2001-03-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0299BA / 5 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The patient had redness, swollen right arm, erythematous area of 5 cm diameter around the site of injection.


VAERS ID: 167603 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2001-01-30
Onset:2001-02-01
   Days after vaccination:2
Submitted: 2001-03-14
   Days after onset:41
Entered: 2001-03-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0301AA / 4 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1028K / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0485 / 3 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Tic
SMQs:, Dyskinesia (broad), Dystonia (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: Medicated for ADD
Current Illness:
Preexisting Conditions: History of Autism, ADD, Tics
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt''s mother stated he displayed marked increase in tics, post vax. He had tics prior to vaccines. Affect of increased tics more noticeable after environmental stimulation. In clinic only minimal evidence of tics activity on 3/13/01. Note: mother believes older sibling had permanent (neurologic) changes following immunizations.


VAERS ID: 167743 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2001-03-14
Onset:2001-03-14
   Days after vaccination:0
Submitted: 2001-03-16
   Days after onset:2
Entered: 2001-03-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Private       Purchased by: Private
Symptoms: Infection
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Mom called on 3/14/01 and stated child broke out with chickenpox, about 15 total.


VAERS ID: 167864 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-08-07
Onset:2001-03-01
   Days after vaccination:2033
Submitted: 2001-03-02
   Days after onset:1
Entered: 2001-03-27
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0426B / UNK - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Drug ineffective, Infection, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), 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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The mom called on 3/1/01 and stated the child broke out with chicken pox. The pt also had a fever.


VAERS ID: 168183 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Utah  
Vaccinated:1995-05-23
Onset:2001-03-26
   Days after vaccination:2134
Submitted: 2001-03-29
   Days after onset:3
Entered: 2001-04-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0405B / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection, Pyrexia, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~1~7.00~In Patient|~Varicella (Varivax)~1~4.00~In Sibling
Other Medications:
Current Illness: upper respiratory infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child exposed to sibling with chicken pox 2 weeks ago. Now has developed low grade fever and about 200 lesions in past 3 days.


VAERS ID: 168186 (history)  
Form: Version 1.0  
Age: 7.8  
Gender: Male  
Location: Missouri  
Vaccinated:1996-03-22
Onset:2001-03-28
   Days after vaccination:1832
Submitted: 2001-03-29
   Days after onset:1
Entered: 2001-04-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

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: No data provided.


VAERS ID: 168315 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:1999-02-22
Onset:2001-03-27
   Days after vaccination:764
Submitted: 2001-03-30
   Days after onset:3
Entered: 2001-04-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1171H / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 456265 / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 165914 / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Rash
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started breaking out on 3/27/01, spots on face, back, chest.


VAERS ID: 168549 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:2000-06-21
Onset:2000-07-04
   Days after vaccination:13
Submitted: 2001-01-10
   Days after onset:190
Entered: 2001-04-09
   Days after submission:88
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES P13822 / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Blood bilirubin increased, Jaundice
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (narrow), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2000006660

Write-up: It was reported that a 7 year old male patient received a Typhim VI vaccination. Reportedly sometime after the vaccination the patient experienced increased bilirubin and scleral jaundice. No specifics were provided. Further info requested. From additional correspondence received on 10/20/00, it was reported, "Child was in Guatemala when ill. The family reported the patient recovered - has since moved." From additional correspondence received on 04/17/01, it was reported, no further information is available regsarding this patient or this case. This case is closed.


VAERS ID: 168641 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Utah  
Vaccinated:1995-09-13
Onset:2001-04-05
   Days after vaccination:2031
Submitted: 2001-04-07
   Days after onset:2
Entered: 2001-04-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0405B / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: NONE
Current Illness: probable croup
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The child was exposed to a friend who had chickenpox and then developed a fever and broke out with lesions the next day. Has 20+ lesions at present.


VAERS ID: 168668 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-07-24
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2001-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Rash papular
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? 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: Rash (red papules and ruptured blisters with red base) all over the body.


VAERS ID: 168774 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Illinois  
Vaccinated:2001-03-15
Onset:2001-03-25
   Days after vaccination:10
Submitted: 2001-04-10
   Days after onset:15
Entered: 2001-04-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1335K / 1 RA / -

Administered by: Military       Purchased by: Public
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: Positive chicken pox, less than 50 vesicles, no fever. The patient received Varicella immunization on 03/15/01. The mother broke out approximately 03/24/01, 2 other siblings broke out, then the patient, then 1 other sibling, and a housemate.


VAERS ID: 168782 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2001-03-31
Submitted: 2001-04-03
   Days after onset:2
Entered: 2001-04-17
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1262 / UNK LL / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This patient had a varicella rash, noted on 03/31. Seen in the office today 04/03.


VAERS ID: 169107 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Illinois  
Vaccinated:1997-03-12
Onset:2001-03-02
   Days after vaccination:1451
Submitted: 2001-03-10
   Days after onset:8
Entered: 2001-04-26
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0768D / 1 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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:
CDC Split Type:

Write-up: This child received Varivax 03/12/97. He had the chicken pox outbreak starting 03/02/01. Approximately 25 lesions.


VAERS ID: 169462 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1996-03-09
Onset:2001-04-25
   Days after vaccination:1873
Submitted: 2001-04-26
   Days after onset:1
Entered: 2001-05-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1128B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: Post nasal drip
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child developed chickenpox. Child had varivax vaccine on 3/9/1996.


VAERS ID: 169510 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:1997-09-16
Onset:2001-04-12
   Days after vaccination:1304
Submitted: 2001-04-30
   Days after onset:18
Entered: 2001-05-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0082 / UNK LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt was vaccinated on 7/16/1997. On 4/01, she was with a cousin who was symptomatic with varicella. Pt then developed about 8 discrete varicella pox lesions, about 2 weeks later. Symptoms were treated symptomatically with Aveeno baths, Calamine lotion and Atarax prn.


VAERS ID: 169608 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2001-04-30
Onset:2001-04-30
   Days after vaccination:0
Submitted: 2001-04-30
   Days after onset:0
Entered: 2001-05-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1589K / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Eyelid oedema, Hypoxia, Injection site erythema, Respiratory distress, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), 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:
Other Medications: albuterol, pulmocort
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt experienced respiratory distress, nasal flaring, O2 sat at 94%, erythema at the injection site and abdomen, erythema and swelling of bilateral eyelids and neck. Respiratory rate is 60 with inspiratory and expiratory wheezing.


VAERS ID: 169780 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:1997-02-11
Onset:2001-05-02
   Days after vaccination:1541
Submitted: 2001-05-03
   Days after onset:1
Entered: 2001-05-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1400D / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: UNK
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The pt developed chicken box on 5/2/01.


VAERS ID: 170010 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2001-04-25
Onset:2001-05-06
   Days after vaccination:11
Submitted: 2001-05-11
   Days after onset:5
Entered: 2001-05-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1248K / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, 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? 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: This child had 5.5 x 4.5 cm warmth, red, and tender area of right deltoid; cellulitis. Treated with Cephalexin for 10 days.


VAERS ID: 170298 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1996-05-23
Onset:2001-05-15
   Days after vaccination:1818
Submitted: 2001-05-18
   Days after onset:3
Entered: 2001-05-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1662D / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed 1 spot on leg on 5/15/01, spread overnight. Seen today, 5/17/01, in office with multiple vesicles on back, stomach and legs.


VAERS ID: 170398 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2001-05-03
Onset:2001-05-11
   Days after vaccination:8
Submitted: 2001-05-22
   Days after onset:11
Entered: 2001-05-31
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0299BA / 5 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Pancytopenia, Purpura, Thrombocytopenia
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Myelodysplastic 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis S/P corrected
Allergies:
Diagnostic Lab Data: CBC/Diff; PT/INR/PTT
CDC Split Type:

Write-up: On 5/11/01, mother noted bruising, small purpuric lesions of legs, trunk and face. Pt was admitted to a hospital for 2 days. Given IV therapy. diagnosed with thrombocytopenia and pancytopenia


VAERS ID: 170743 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Utah  
Vaccinated:2000-01-11
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1364J / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Erythema
SMQs:, Severe cutaneous adverse reactions (narrow), 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00040943

Write-up: Information has been received from a physician''s office concerning a 7 year old male patient who on 01/11/00 was vaccinated with a 1st dose of Varicella virus vaccine live SC in the right arm. Subsequently, the patient developed "multiple lesions, some became red with green pus." The patient was placed on amoxicillin trihydrate (+) clavulanate potassium (Augmentin) chewable tablets for 10 days. Two weeks post-onset, the patient recovered from multiple skin lesions. The reporter felt that the patient experienced an Other Important Medical Event. Additional information has been requested.


VAERS ID: 171013 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-05-31
Onset:2000-02-26
   Days after vaccination:1732
Submitted: 2001-05-15
   Days after onset:443
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1660B / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Drug ineffective, Infection, Pruritus, Rash, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00033231

Write-up: Varicella- information has been received from a licensed practical nurse concerning a 7 year old female who on 31 May 1996 was vaccinated with one dose of varicella viurs vaccine live SC in the left arm. On 28 feb 2000 the patient experienced a varicella rash on the legs, chest, back, buttocks, and neck. The lesion were itchy and fluid-filled. Diphenhydramine HCL (Benadryl) was prescribed. Subsequently, the patient recovered.


VAERS ID: 171181 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:1996-03-28
Onset:2000-03-27
   Days after vaccination:1460
Submitted: 2001-05-15
   Days after onset:413
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1508B / 2 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00040261

Write-up: vesiculobullous rash - information has been received from a woman in a physician''s office concerning a 7 year old female patient who on 28 mar 1996 was vaccinated with a second dose of varicella virus vaccine live (lot 616866/1508b) It was noted that the office did not state which arm. On 27 mar 2000 the patient developed a vasicular rash on her right trunk that consisted of more than 50 that were 2 inches apart.


VAERS ID: 171191 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-05-25
Onset:2000-04-02
   Days after vaccination:313
Submitted: 2001-05-15
   Days after onset:407
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / UNK - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Dermatitis bullous, Drug ineffective, Herpes simplex, Infection, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: test: diagnostic laboratory, date: 04/10/2000, normal range: -, Comment- DPA --too few cells for reliable interpretation, Test: herpes simple virus, Date: 04/10/00, Normal Range -, comment - final isolation negative at 96 hours, Test- serum varicella zoster, Date: 04/10/00, normal range: -, comment: final isolation negative at 96 hours.
CDC Split Type: WAES00040521

Write-up: Vesiculobullous Rash - Information has been received from a physican''s office concerning a 7 year old caucasian female patient who on 26 May 1999 was vaccinated sc in the left arm with one dose of varicella virus vaccine live (lot 629163/0308J) On 02 apr 2000 the patient experienced a vasicular rash. It was noted that the patient had no recent varicella exposure. On 03 Apr 2000 the patient was seen by a physican . A swab of lesion was obtained to rule out varicella. follow up information reported that DFA and culture for herpes simplex and varicella zoster virus were obtained. Preliminary isolation was negative at 24 hours on 06 Apr 2000 and negative at 48 hours on 07 Apr 2000. Final isolation result was negative at 96 hours. The DFA result on 10 Apr 2000 revealed too few cells for reliable interpretation.


VAERS ID: 171240 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:1997-05-01
Onset:2000-04-20
   Days after vaccination:1085
Submitted: 2001-05-15
   Days after onset:390
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Rash
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00042325

Write-up: Exanthema - Information has been received from a health care professional concerning a 7 year old female patient who on 01 Jun 1997 was vaccinated with one dose of varicella virus vaccine live. On 20 Apr 2000 the patient developed a varicella rash with about 40 to 50 lesions and no fever. The patient sought medical attention. No further information is available.


VAERS ID: 171248 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:2000-04-07
Onset:2000-04-24
   Days after vaccination:17
Submitted: 2001-05-15
   Days after onset:386
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1462J / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Infection
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: ~Vaccine not specified (no brand name)~1~5.00~In Sibling
Other Medications: UNk
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00042506

Write-up: Varicella - Information has been received from a medical assistant in a doctor''s office concerning a 7 year old female who on 07 Apr 2000 was vaccinated with one dose of varicella virus vaccine live lot 632370/1462J site unknown. On 24 Apr 2000 the patient developed chicken pox with an unknown amount of lesions. The patient sought unspecified medical attention. Also reported was a male sibling who was vaccinated and experienced similar events (waes 000423367)


VAERS ID: 171257 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:1996-01-01
Onset:2000-04-27
   Days after vaccination:1578
Submitted: 2001-05-15
   Days after onset:383
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: ~Vaccine not specified (no brand name)~~5.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00042793

Write-up: Varicella - Information has been received from a registered nurse concerning a 7 year old male who at the age of 3 was vaccinated with one dose of varicella virus vaccine live (unknown site ). on 27 apr 2000. the reporter indicated that the patient has now developed varicella with < 100 lesions. The patient sought unspecified medical attention. Also reported was the patient''s sister who was vaccinated and experienced a similar event (wases 00051832)


VAERS ID: 171260 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:1995-06-21
Onset:2000-04-26
   Days after vaccination:1771
Submitted: 2001-05-15
   Days after onset:384
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0399B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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:
Preexisting Conditions: Concurrent Conditions; Varicella exposure
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00042820

Write-up: Varicella - Information has been received from a licensed visiting nurse concerning a 7 Year old caucasian male patient who on 21 Jun 1995 was vaccinated with first dose of varicella virus vaccine live sc. There was no concomitant medication. On 26 Apr 2000, The patient was diagnosed with varicella. The number of lesions was not documented and the patient was afebriale. Follow up information from a licensed visiting nurse indicated that nearly every student in the patient''s class had chickenpox. The patient had chickenpox for only 2 and a half days without; fever. The patient''s twin sibling and older sibling never developed symptoms. Additional information has been requested.


VAERS ID: 171273 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1996-02-29
Onset:2000-04-28
   Days after vaccination:1520
Submitted: 2001-05-15
   Days after onset:382
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Infection, Skin ulcer
SMQs:, 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: UNK
Current Illness:
Preexisting Conditions: concurrent conditions; amoxicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00050250

Write-up: varicella - Information has been received from a consumer concerning her 7 year old daughter with an amoxicillin allergy who on 29 Feb 1996 was vaccine vaccinated with one dose of varicella virus vaccine live (site unkown). On 28 apr 2000 the patient developed a mild case of chickenpox with approximately 30 plus pox on the back, chest, arms, legs, foot and forehead. She presented to a pediatrician''s office that same day and was treated with diphenhydramine HCL (Benadryl). She was uncomfortable on that day, but was playing normally on 29 apr 2000 and 30 apr 2000 she did not attend school on 01 may 2000. follow up information received from a physician indicated that on 20 apr 2000 the patient developed mild chicken pox with less than 50 vesicular, pruritic lesions. On an unspecified date, the patient recovered. no further information is expected.


VAERS ID: 171274 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2000-04-18
Onset:2000-04-30
   Days after vaccination:12
Submitted: 2001-05-15
   Days after onset:380
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0445J / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Infection, Skin ulcer
SMQs:, 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: ~Vaccine not specified (no brand name)~1~10.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: concurrent conditions: varicella exposure
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00050291

Write-up: Varicella - Information has been received from a physician concerning a 7 year old white female who on 18 Apr 2000 was vaccinated with the first dose of varicella virus vaccine live sc in the left deltoid lot 631065/04453 . The reported stated that on 19 Apr 2000 the patients was exposed to wild type varicella by her brother who had devloped wild type chicken pox and chicken pox is going through the school right now. On 10 Apr 2000 the patient developed chicken pox with multiple lesion ($g 100) with fever for 2 days. the patient sought unspecified medical attention on 10 may 2000 the patient recovered. also reported was the patients sister who was vaccinated and experienced similar evernts (waes 00030236.)


VAERS ID: 171295 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:2000-03-27
Onset:2000-04-03
   Days after vaccination:7
Submitted: 2001-05-15
   Days after onset:407
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: rash~Measles + Mumps + Rubella (no brand name)~~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history; rash
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00051059

Write-up: Cough, Fever - Information has been received from a health care professional concerning a 7 year old female with a history of a rash after vaccination with measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (Waes 00032638) who on 27 Mar 2000 was vaccinated with a second dose of varicella virus vaccine live (site unknown). On 03 Apr 2000 the patient developed a possible reaction described as fever and cough. Additional information has been requested


VAERS ID: 171304 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2000-04-25
Onset:2000-05-11
   Days after vaccination:16
Submitted: 2001-05-15
   Days after onset:369
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1851J / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Blister, Hypersensitivity, Pruritus, Pyrexia, Rash, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: UNK
Current Illness:
Preexisting Conditions: concurrent conditions; sulfonamide allergy
Allergies:
Diagnostic Lab Data: temperature measurement 06-11-00, value unite 99.6f, normal range -,
CDC Split Type: WAES00051299

Write-up: Rash, Blister, Fever, Skin Lesion, Pruritus, Fustule - Information has been received from a registered nurse concerning a 7 year old white female student with sulfunamide allergy who on 25 Apr 2000 was vaccinated with the first dose of varicella virus vaccine live (632612/1851j) in the right arm. On 11 May 2000 the patient developed a rash on her chest that looked like little pinpoints littel pustules, and some little vesicles. The reporter indicated that the patient had 6-8 lesions around one nipple and 10-12 lesions around the other and a slight fever of 99.6 F. The reporter also indicated that the rash was itchy, the patient sought unspecified medical attention. follow up information was received on 21 Aug 2000 from a registered nurse indicated that on 11 May 2000 the patient came into the school clinic with a rash. The nurse''s concern was whether the patient was contagious to other students at school if the rash was caused by the varicella virus vaccine live. The rash appeared somewhat similiar to chickenpox and occurred aproximately three weeks after receiving varicella virus vaccine live. The patient did not appear ill and said her mom had already seen the rash. The patient came to the school clinic with the chief compaint of itching. It was noted that the patient had skin lesions, itchy rash, vesicles, pustules and a 99.6 degree oral temperature. The patient was not in distress. On an unspecified date. the patient recovered.


VAERS ID: 171347 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2000-05-15
Submitted: 2001-05-15
   Days after onset:365
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Pyrexia, Viral infection
SMQs:, Lack of efficacy/effect (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~~11.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00052280

Write-up: Information has been received from a physician concerning a patient who in approximately 1996 was vaccinated with a first dose of varicella virus vaccine live. On approximately 05/15/2000, the patient developed a "severe case of chickenpox including a high fever that resulted in being absent from school for 1 week and loss of work for his parents. The patient sought unspecified medical attention. Subsequently, the patient recovered. The patient''s brother had a similar experience following exposure to varicella virus vaccine live.


VAERS ID: 171356 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1998-12-09
Onset:2000-05-22
   Days after vaccination:530
Submitted: 2001-05-15
   Days after onset:358
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1340H / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Nasal congestion, Otitis media, Pharyngolaryngeal pain, Psychomotor hyperactivity, Skin ulcer
SMQs:, Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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: nasal congestion: otitis media, sore throat
Preexisting Conditions: concurrent condition: drug allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00052598

Write-up: Varicella - Information has been received from a registered nurse concerning a 7 year old caucasian female patient with an allergy to carbofed hyperactive and congestion including a stuffy nose. r otitis media, and sore throat at the time of vacccination who on 09 Dec 1998 was vaccinated with a first dose of varicella virus vaccine live (lot 628243/1340H) sc in the left arm. there were no concomitant medications. On 22 May 2000 the patient developed 6-10 lesions but no fever. The patient sought unspecified medical attention. Follow up information from a registered nurse indicated that on 22 May 2000 the patient was diagnosed with varicella. Subsequently the patient recovered.


VAERS ID: 171434 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-08-03
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00080542

Write-up: In April, 2000 the patient developed chicken pox. The patient sought unspecified medical treatment. Additionally it was noted that two other patients also developed similar reactions. Additional information has been requested.


VAERS ID: 171456 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Viral infection
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: UNK
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES00061188

Write-up: The patient was vaccinated in 1996 with a first dose of varicella virus vaccine live. Subsequently, the patient experienced mild chickenpox. On an unspecified date the patient recovered. Two other patients had similar experiences following exposure to varicella virus vaccine live.


VAERS ID: 171467 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:1996-01-09
Onset:2000-06-13
   Days after vaccination:1617
Submitted: 2001-05-15
   Days after onset:336
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 5 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0593E / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776D / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1101E / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00061442

Write-up: Information has been received concerning a pt who had been vaccinated with varicella vaccine and 2 years the pt developed chickenpox that consisted of approximately 10 lesions and no fever. It was not known if the pt was exposed to wild type varicella virus. It was reported that the pt sought unspecified medical attention. Follow up information from the mother indicated that her daughter broke out into a fluid filled rash all over her body. The pt was never seen in physician''s office but the pt did recover.


VAERS ID: 171492 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Michigan  
Vaccinated:1996-04-09
Onset:2000-06-15
   Days after vaccination:1528
Submitted: 2001-05-15
   Days after onset:334
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1499B / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (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:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00062875

Write-up: Information has been received concerning a pt who on 04/09/1996 was vaccinated with first dose of varicella vaccine. On 06/15/00 the pt developed a rash consistent with varicella. It was noted that this experience did not require prescription drug treatment and that the pt''s rash is still being treated.


VAERS ID: 171506 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2000-06-01
Submitted: 2001-06-15
   Days after onset:379
Entered: 2001-06-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00064475

Write-up: Information has been received concerning a pt who was vaccinated with one dose of varicella vaccine. In June 2000 the pt developed chicken pox. the pt sought unspecified medical attention.


VAERS ID: 171678 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Rhode Island  
Vaccinated:1997-05-22
Onset:2000-08-25
   Days after vaccination:1191
Submitted: 2001-05-15
   Days after onset:263
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Blister, Herpes zoster, Pain, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (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: NONE
Allergies:
Diagnostic Lab Data: DNA - PCR - positive for OKA strain VZV
CDC Split Type: WAES00083073

Write-up: In August 2000, the patient developed shingles on his torso and down his leg. He was seen by his physician who initially diagnosed him with a rash and on a second visit, diagnosed his with shingles. The patient had severe pain which started 08/25/2000 and was treated with Tylenol with codeine and an unspecified cream. On 08/31/2000, a sample was sent for PCR analysis. Follow up information states the patient developed sever zoster with hundreds of vesicles, confluent in many areas, distributed on the right abdomen, back and upper thigh with an abrupt stop at midline. The patient was stated to have severe pain. It was reported that the patient has not had recent exposure to chickenpox or shingles. By 09/28/2000 the patient had completely recovered from the experience. The physician reported that some scarring was noted. No further information is expected.


VAERS ID: 171727 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2000-08-24
Onset:2000-09-21
   Days after vaccination:28
Submitted: 2001-05-15
   Days after onset:236
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Rash
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00091848

Write-up: On 09/21/2000 the patient experienced generalized rash. The patient does not have a fever. Medical attention was sought.


VAERS ID: 171737 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1997-03-11
Onset:2000-09-15
   Days after vaccination:1284
Submitted: 2001-05-15
   Days after onset:242
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00092082

Write-up: On 09/15/2000, the patient presented with chickenpox that consisted of greater than 50 lesions. Unspecified medical attention was sought. Additional information has been requested.


VAERS ID: 171792 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Michigan  
Vaccinated:1995-10-06
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6093020443B / 2 LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00100193

Write-up: On 10/06/1995 the patient was vaccinated with a second dose of varicella virus vaccine live. Subsequently, the patient developed "typical chickenpox". Unspecified medical attention was sought. Additional information has been requested.


VAERS ID: 171795 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00100359

Write-up: The patient was vaccinated at 18 months of age. Subsequently, at 7 years of age, the patient developed varicella with more than 100 lesions. The patient sought unspecified medical attention. Also reported were other patients who were vaccinated and experienced similar events. Additional information has been requested.


VAERS ID: 171797 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (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: ~Varicella (Varivax)~1~5.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00100398

Write-up: The patient was vaccinated with 1 dose of varicella virus vaccine live in 1998. In approximately September 2000, the patient experienced chickenpox. He was covered with chickenpox. The patient''s brother had a similar experience following vaccination with varicella virus vaccine live. Medical attention was sought. No further information is available.


VAERS ID: 171817 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Georgia  
Vaccinated:1996-03-27
Onset:2000-10-09
   Days after vaccination:1657
Submitted: 2001-05-15
   Days after onset:218
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6189961500B / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Rash, Rash maculo-papular, Rash pruritic, Viral infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00100995

Write-up: On 10/09/2000 the health professional stated the patient "has varicella" with 12 lesions, 5 macular, papular and 6 crusted. Follow up information stated "pruritic fluid filled, red based lesions erupted on her face, back and groin. The patient has recovered.


VAERS ID: 171827 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-07-28
Onset:2000-09-30
   Days after vaccination:1891
Submitted: 2001-05-15
   Days after onset:227
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6085840412B / 2 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Pyrexia, Viral infection
SMQs:, Lack of efficacy/effect (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00101531

Write-up: On 09/10/2000 the patient was diagnosed with a "mild case of varicella in the office. The number of lesions was not documented. the patient''s temperature was 99.1 orally. In follow up, the physician reported that the patient was seen on 09/30/2000 with "mild varicella". The physician reported that the patient recovered. No further information is available.


VAERS ID: 171844 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Viral infection
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00102358

Write-up: Post vax, the patient developed chicken pox. Unspecified medical attention was sought. Two other patients had a similar experience following exposure to varicella virus vaccine live. Additional information has been requested.


VAERS ID: 171859 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:1995-06-13
Onset:2000-10-01
   Days after vaccination:1937
Submitted: 2001-05-15
   Days after onset:226
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0412B / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Drug ineffective, Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (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: ~Varicella (Varivax)~0~5.00~In Sibling|~Varicella (Varivax)~0~5.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: Drug allergy, pollen allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00110148

Write-up: In October 2000, the patient began experiencing chicken pox. Many lesions are noted, over 50, "peppered with lesions". The patient''s sister had a similar experience following exposure to varicella virus vaccine live. Follow up information from the NP indicated that the patient developed varicella greater than 100 lesions, "peppered" in October 2000. The patient subsequently recovered in November 2000. No further information is available.


VAERS ID: 171887 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:1999-04-06
Onset:2000-11-16
   Days after vaccination:590
Submitted: 2001-05-15
   Days after onset:179
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6269570838 / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Rash
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00111540

Write-up: On 11/16/2000 the patient developed chicken pox. Unspecified medical attention was sought. In follow up, the physician''s office indicated that the patient developed a rash and not chicken pox. No further information was reported.


VAERS ID: 171901 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-07-10
Onset:2000-10-19
   Days after vaccination:1928
Submitted: 2001-05-15
   Days after onset:208
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6085890416B / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pharyngolaryngeal pain, Rash, Viral infection
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~1~9.00~In Sibling|~Varicella (Varivax)~1~9.00~In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00111719

Write-up: On approximately 10/19/2000 the patient had strep throat. On approximately 11/14/2000 the patient developed ver mild chicken pox with approximately 20-30 lesions and no other signs or symptoms. Unspecified medical attention was sought. Additionally, it was reported that the patient had 2 brothers who also developed chicken pox. The patient''s mother was vaccinated on 07/10/1995, and at the time of this report had not developed any lesions or other signs or symptoms. Additional information has been requested.


VAERS ID: 171903 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Illinois  
Vaccinated:1995-07-31
Onset:2000-11-18
   Days after vaccination:1937
Submitted: 2001-05-15
   Days after onset:177
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6189971658B / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Skin ulcer, Viral infection
SMQs:, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00111765

Write-up: On 11/18/2000 the child presented with 19-20 chicken pox lesions. Unspecified medical attention was sought. The nurse reported that the patient recovered from the chicken pox. No further information is available.


VAERS ID: 171927 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:2000-11-11
Onset:2000-11-18
   Days after vaccination:7
Submitted: 2001-05-15
   Days after onset:177
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Herpes zoster, Skin ulcer
SMQs:, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00120927

Write-up: On 11/18/2000 the patient presented to the physician''s office with "4 lesions with crusting, all on her right side". The lesions did not cross the patient''s midline. The physician stated that she did not actually see the patient, but that another physician saw the patient and diagnosed herpes zoster. As of 12/12/2000 the patient recovered from her herpes zoster lesions/scabs. Additional information has been requested.


VAERS ID: 171962 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-09-26
Onset:2000-12-16
   Days after vaccination:1908
Submitted: 2001-05-15
   Days after onset:149
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6092880431B / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Rash maculo-papular, Rash vesicular, Viral infection
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00122195

Write-up: Post vax, on 12/16/2000 the patient broke out in a maculopapular vesicular rash with an erythemous base on his abdomen, back, face and extremities. The reported stated that the impression was chicken pox. The patient was treated with Zovirax for 5 days but the patient''s symptoms persisted. Unspecified medical attention was sought. Additional information has been requested.


VAERS ID: 172062 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-08-20
Onset:2000-12-29
   Days after vaccination:497
Submitted: 2001-05-15
   Days after onset:136
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Rash vesicular, Viral infection
SMQs:, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01010999

Write-up: On 12/29/2000 the patient developed chicken pox that included 50-100 vesicular lesions distributed across his chest, back and extremities. Unspecified medical attention was sought. Additional information has been requested.


VAERS ID: 172085 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-06-09
Onset:2001-01-17
   Days after vaccination:2049
Submitted: 2001-05-15
   Days after onset:117
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 608319/0404B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Skin ulcer, Viral infection
SMQs:, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01011862

Write-up: On 01/17/2001 the patient developed the "worst case" of chicken pox that the physician had ever seen in an immunized child. The child had pox all over her face, trunk, arms, legs, scalp and mucous membrane. The patient was treated with Benadryl. Additional information has been requested.


VAERS ID: 172087 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Colorado  
Vaccinated:2000-12-11
Onset:2000-12-11
   Days after vaccination:0
Submitted: 2001-05-15
   Days after onset:154
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01011967

Write-up: The patient developed a rash of about 20 ''spots'' on the day after being vaccinated, reported by the health care professional on 12/11/2000. The parents of the patient have called weekly reporting that the rash returns weekly since vaccination and resolves each time within 3 days. It was suggested the patient be taken to see her primary care physician. The patient did not have a rash at the time of the visit. On 02/08/2001 the mother stated that the child continued to have intermittent rashes of 1 to 5 spots that appeared like "chicken pox". The spots go away quickly but are raised blister like spots that itch. The patient has no other history of reactions or health problems. On 02/22/2001 the nurse reported the patient continues to break out every 7 to 14 days with 5 to 10 lesions that resolve several days later. Additional information has been requested.


VAERS ID: 172093 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New York  
Vaccinated:1998-08-03
Onset:2001-01-19
   Days after vaccination:900
Submitted: 2001-05-15
   Days after onset:115
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 626968/0837H / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Pyrexia, Skin ulcer, Viral infection
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Asthenia/fatigue~Varicella (Varivax)~~0.00~In Patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01012210

Write-up: On 01/19/2001 the child broke out in chicken pox. The mother reported that he had "hundreds of lesions from the top of his head to the top of his foot and that almost all the lesions were small and crusty, however 10-20 were large, sore, with scabs. The child also had a fever on 01/19/2001 and 01/20/2001. Subsequently, the patient''s fever resolved. The physician reported that the child''s chicken pox rash resolved on 01/30/2001. The patient sought unspecified medical attention. The reporter also reported the experiences of her daughter after vaccination with varicella virus vaccine live. Additional information is not expected.


VAERS ID: 172122 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:1995-09-21
Onset:2001-02-03
   Days after vaccination:1962
Submitted: 2001-05-15
   Days after onset:100
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0420B / UNK - / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Viral infection
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES01020383

Write-up: On 02/04/2001 the patient developed chicken pox with a fever of 101F. Additional information has been requested. FOLLOW-UP information has been received from a health professional that states the patient recovered. FOLLOW-UP information has been received from a physician who is the mother of the patient. She reported that the patient broke out with the chicken pox on 02/03/00. It was reported that she had about five pox on her face, multiple across her chest, abdomen, back and down in her vulvar area and some scattered on her arms and legs. It was reported that she would "judge to be mild to moderate case". Unspecified medical attention sought. No further information is expected.


VAERS ID: 172229 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:2001-02-20
Onset:2001-03-02
   Days after vaccination:10
Submitted: 2001-05-15
   Days after onset:73
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Fatigue, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01030516

Write-up: Ten days post vax the patient experienced a low grade fever and tiredness. On approximately 03/06/2001, the patient developed a rash all over her body. Unspecified medical attention was sought. Additional information has been requested.


VAERS ID: 172242 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-06-20
Onset:2000-12-07
   Days after vaccination:1997
Submitted: 2001-05-15
   Days after onset:158
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Headache, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01030924

Write-up: Information has been rec''d from the mother of a 7 yo male consumer who on 6/20/95 was vaccinated with varicella virus vaccine live. There no concomitant medication. On 12/7/00 the pt developed a mild rash primarily on his trunk, a fever and headache. The itching lasted approximately 2 days. The mother also reported that her other son had a rash after vaccination with varicella virus vaccine live (MSD) (WAES01030915) Additional information has been requested.


VAERS ID: 172251 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:1997-07-15
Onset:2001-03-14
   Days after vaccination:1338
Submitted: 2001-05-15
   Days after onset:61
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1550D / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Drug ineffective, Infection, Pharyngolaryngeal pain, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01031770

Write-up: Information has been rec''d from hlth professional concerning a pt who on 7/15/97 was vaccinated with 1 dose of varicella virus vaccine live. On 3/14/01 the pt experienced chicken pox with a fever of 101F, sore throat, and approximately 10 lesions. Medical attention was sought. F/U 6/18/01: The pt had no known allergies. The varicella vaccine lot (621192/1550D) SC in the left arm. He had approx. 50 lesions. On 3/20/01, the pt recovered from her chickenpox. Additional info is not expected.


VAERS ID: 170566 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Florida  
Vaccinated:2001-05-11
Onset:2001-05-20
   Days after vaccination:9
Submitted: 2001-05-26
   Days after onset:6
Entered: 2001-06-05
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 474735 / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1888K / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Dermatitis bullous, Injection site erythema, Injection site pain, Injection site reaction, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: Singulair, Claritin, Albuterol
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The pt experienced a varicella like rash (erythematous maculo-papular) developed around the injection site seven to ten days post vax. Also developed pruritis, soreness and redness around the injection site. Treated with Augmentin and Acyclovir.


VAERS ID: 170571 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2000-11-28
Onset:2000-11-29
   Days after vaccination:1
Submitted: 2001-05-31
   Days after onset:182
Entered: 2001-06-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0417AA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 469133 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site oedema, Injection site pain
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: Claritin, Singulair, Intal, Volmax
Current Illness: NONE
Preexisting Conditions: allergies, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt experienced a swollen, erythematous and tender injection site occurring 12 hours post vax.


VAERS ID: 170611 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-07-10
Onset:2001-05-31
   Days after vaccination:2152
Submitted: 2001-05-31
   Days after onset:0
Entered: 2001-06-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0412B / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Dermatitis bullous, Infection, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (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: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt experienced a varicella infection, 5 lesions on face, 3 on back, several on buttocks, one on chest, one on scalp. Lesions are in various stages. Infected lesion on back treated with Bactroban.


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