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Case Details (Sorted by Age)

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VAERS ID:375279 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:Ohio  Entered:2009-12-29, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP008AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Student fainted in chair after receiving vaccine. Transported by W/C to RN''s office. Popsicle given, ice given. Rested x 30 min. Ret. to class.

VAERS ID:375280 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:Ohio  Entered:2009-12-29, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP008AA0UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted in hallway after receiving vaccine. Walked to RN office. Rested x 15 minute. Popsicle given. Ret. to class.

VAERS ID:375337 (history)  Vaccinated:2009-12-08
Age:14.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Female  Submitted:2009-12-08, Days after onset: 0
Location:Ohio  Entered:2009-12-29, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: no
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102129P1 UNRA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Headache, Hot flush
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Headache; lightheaded; hot flashes

VAERS ID:375354 (history)  Vaccinated:2009-12-16
Age:14.0  Onset:2009-12-17, Days after vaccination: 1
Gender:Female  Submitted:2009-12-29, Days after onset: 12
Location:Massachusetts  Entered:2009-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic reaction to unidentified food.
Diagnostic Lab Data: Administered Benadryl - reduced hives
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP051AA0UNAR
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500723P2IN 
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives outbreak on back, belly, upper arms and thighs (mild).

VAERS ID:375379 (history)  Vaccinated:2009-12-17
Age:14.0  Onset:2009-12-17, Days after vaccination: 0
Gender:Female  Submitted:2009-12-17, Days after onset: 0
Location:Virgin Islands  Entered:2009-12-29, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500835P IN 
Administered by: Other     Purchased by: Other
Symptoms: Headache
SMQs:
Write-up: Headache.

VAERS ID:375492 (history)  Vaccinated:2009-12-28
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2009-12-30
Location:California  Entered:2009-12-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: rapid strep negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Laryngitis, Myalgia, Pharyngitis, Pyrexia, Streptococcus identification test
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: 2 days developed fever to 102, muscle aches, pharyngitis, and laryngitis.

VAERS ID:375522 (history)  Vaccinated:2009-12-11
Age:14.0  Onset:2009-12-14, Days after vaccination: 3
Gender:Male  Submitted:2009-12-14, Days after onset: 0
Location:Kentucky  Entered:2009-12-30, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102133P10IMAR
Administered by: Other     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Student c/o dizziness after H1N1 vaccine given. Sprite given, but student continues to c/o dizziness. Mom called. Student left with mom in no apparent distress.

VAERS ID:375661 (history)  Vaccinated:2008-02-14
Age:14.0  Onset:2009-08-20, Days after vaccination: 553
Gender:Female  Submitted:2010-01-02, Days after onset: 135
Location:Florida  Entered:2010-01-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: My daughter receive her last HPV Vaccine on 2/14/2008.She felt like she was going to faint when she got up. She is now suffering from Partial Complex Seizure and she is on Lamictal 200gram.
Preexisting Conditions: None
Diagnostic Lab Data: MRI/several EEG''s blood work
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0524U0IJLA
Administered by: Private     Purchased by: Other
Symptoms: Blood test, Complex partial seizures, Electroencephalogram, Nuclear magnetic resonance imaging, Speech disorder
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: My daughter started having issue, when she would speak, she would stop talking and also when she was reading she couldn''t make out the words. this was happening like once in a while for several months after her HPV Vaccine.then she was getting these episode several times a day (4-6) we took her to 2 neurologists. Dr. diagnose my daughter with Partial Complex seizure and she is now taking Lamictal for the rest of her life.

VAERS ID:375732 (history)  Vaccinated:2009-12-10
Age:14.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2010-01-04, Days after onset: 25
Location:Texas  Entered:2010-01-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ALLERGIES TO CATS, ROACHES, SOY PRODUCTS
Diagnostic Lab Data: NONE
CDC Split Type: TX20090108PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102124P10IMRA
Administered by: Other     Purchased by: Public
Symptoms: Flushing, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: VISITED SCHOOL NURSE SHORTLY AFTER RECEIVING VACCINE WITH COMPLAINT OF "ITCHY" THROAT, NEED TO CLEAR THROAT AND FLUSHED CHEEKS. NO RASH NOTED TO FACE/TRUNK/EXTREMITIES. EVEN RESP., NO WHEEZING/RALES. NO REDNESS/EDEMA NOTED TO TONGUE/ORAL MUCOSA/TONSILS. NO DYSPHAGIA REPORTED. NO COMPLAINT OF STOMACH ACHE/NAUSEA. ALERT, ORIENTED X3. NO HEADACHE/DIZZINESS. GIVEN BENADRYL 50 MG AT 12:08 PM PER STANDING ORDER. (DID NOT TAKE SCHEDULED ALLEGRA BEFORE SCHOOL) PARENT PICKED UP, TOOK HOME TO REST.

VAERS ID:375771 (history)  Vaccinated:2009-12-16
Age:14.0  Onset:2009-12-16, Days after vaccination: 0
Gender:Male  Submitted:2010-01-04, Days after onset: 19
Location:South Carolina  Entered:2010-01-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: SC1001Pan
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102145P10IMLA
Administered by: Other     Purchased by: Public
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: Student complained of ringing in the right ear. Ringing lasted for about 10 minutes. Monitored student for a hour for futher symptoms.

VAERS ID:375861 (history)  Vaccinated:2009-11-04
Age:14.0  Onset:2009-11-05, Days after vaccination: 1
Gender:Female  Submitted:2009-12-27, Days after onset: 52
Location:Maryland  Entered:2010-01-05, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: 11/9/09 Biopsy of one bump, "inconclusive"; Blood work (WBC slightly increased)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Biopsy, Rash, Rash pruritic, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow)
Write-up: Pt developed a rash that started on arms (worse on arm shot given) very itchy. Spread to neck, face - (more on side shot given) and then hands - few on torso. None on legs or feet. Saw PCP, then saw urgent care when spread to face - Prednisone, ATARAX given - on 11/7. Saw dermatologist - blood work and biopsy done. Saw dermatologist again - not much improvement, saw dermatologist a 3rd time - felt it was getting better.

VAERS ID:375981 (history)  Vaccinated:2009-08-26
Age:14.0  Onset:2009-12-01, Days after vaccination: 97
Gender:Female  Submitted:2010-01-05, Days after onset: 35
Location:Virginia  Entered:2010-01-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None.
Diagnostic Lab Data: MRI.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0381X0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3030AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Myelitis transverse, Nuclear magnetic resonance imaging
SMQs:, Demyelination (narrow)
Write-up: Transverse myelitis.

VAERS ID:376071 (history)  Vaccinated:2009-12-15
Age:14.0  Onset:2009-12-16, Days after vaccination: 1
Gender:Female  Submitted:2010-01-06, Days after onset: 21
Location:California  Entered:2010-01-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Dev disorder with speech delay
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPO22AA1UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0672Y2UNLA
Administered by: Private     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:
Write-up: Pt was to be given 3rd HPV and H1N1. Pt''s sibling was also going to get same vaccines. Pt. was agittaged because she didn''t want to get shots. LVN gave pt 2 injections on left deltoid. He immediately told RN that he accidently gave pt. 2 HPV''s instead of H1N1 and HPV. Mother was notified MD notified. No adverse reaction. Pt received 2 HPV''s and (H1N1).

VAERS ID:376103 (history)  Vaccinated:2010-01-06
Age:14.0  Onset:2010-01-06, Days after vaccination: 0
Gender:Male  Submitted:2010-01-06, Days after onset: 0
Location:Michigan  Entered:2010-01-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline (Antibiotic)
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102139P10IM 
Administered by: Other     Purchased by: Other
Symptoms: Pallor, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Administered shot, patient turned pale after about 5 to 10 minutes Began to exhibit problems breathing after abtou 15 more minutes- gave 1 epi-pen a 3mg shot. Patient responded within a few minutes with more relaxed feeling and decreased throat problems.

VAERS ID:376205 (history)  Vaccinated:2009-11-28
Age:14.0  Onset:2009-12-01, Days after vaccination: 3
Gender:Male  Submitted:2010-01-07, Days after onset: 37
Location:New York  Entered:2010-01-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Nasal congestion, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Stuffy nose, runny nose and fever/chill for several days. Follow-up - Patient''s name updated.

VAERS ID:376266 (history)  Vaccinated:2009-12-31
Age:14.0  Onset:2009-12-31, Days after vaccination: 0
Gender:Male  Submitted:2009-12-31, Days after onset: 0
Location:California  Entered:2010-01-08, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP087AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: The patient recieved an H1N1 IM injection. The patient fainted approximately 1 minute after the vaccine was given. His sister caught him. We carefully layed him on the floor. We called 911 immediately. The patient was unconscious for approximately 30 seconds. When the pt came to he said he was ok. The paramedics arrived in 3 minutes and took the pt to the ER. The patient returned later and is ok.

VAERS ID:376314 (history)  Vaccinated:2009-11-16
Age:14.0  Onset:2009-12-03, Days after vaccination: 17
Gender:Male  Submitted:2010-01-08, Days after onset: 36
Location:New York  Entered:2010-01-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx Asthma.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102126P1A IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Clonus, Hypoaesthesia, Muscular weakness, Pyrexia, Urinary incontinence
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt with vaccines two weeks prior, presented with numbness and weakness in both legs, had urinary incontinence, fever 101 degree F, clonus.

VAERS ID:376414 (history)  Vaccinated:2007-09-10
Age:14.0  Onset:2009-12-19, Days after vaccination: 831
Gender:Female  Submitted:2010-01-10, Days after onset: 22
Location:Massachusetts  Entered:2010-01-08, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU239BA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2824AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1028U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Rash vesicular, Scab, Skin lesion, Varicella
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt developed lesions on her shoulder, abdomen, and scalp, lesions will vesicular w/clear fluid, some being crusted over. Lesions were itchy per pt. Dx mild case of varicella.

VAERS ID:376440 (history)  Vaccinated:2010-01-05
Age:14.0  Onset:2010-01-06, Days after vaccination: 1
Gender:Female  Submitted:2010-01-08, Days after onset: 2
Location:Washington  Entered:2010-01-11, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102124P10IMLA
Administered by: Private     Purchased by: Public
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Body rash from H1N1 injection.

VAERS ID:376524 (history)  Vaccinated:2008-08-27
Age:14.0  Onset:2008-12-25, Days after vaccination: 120
Gender:Female  Submitted:2010-01-11, Days after onset: 382
Location:Illinois  Entered:2010-01-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Stroke at birth nothing else
Diagnostic Lab Data: Spoke with Dr Dec 10 2009. We discussed it as side effects from GARDASIL, she advised to report it here
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0845X0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Body temperature decreased, Erythema, Pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Dec 25 2008 hot shower, produced red itchy welts. Jan 1st 2009 to present time. Cold temp 35 degrees or below when outside for more than a few minutes. Red welts that are itchy and painfully appear. Last about 30 mins after body warms up.

VAERS ID:376541 (history)  Vaccinated:2009-11-30
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2010-01-11
Location:Unknown  Entered:2010-01-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0312Y1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3010AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3029BA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Within 12 hours of giving vaccines pt developed abdominal cramping. Parents beleive it was the day after the vaccines were given that the pt developed an itchy diffuse red rash on left arm about the size of an adult hand that resembled a "wind burn"

VAERS ID:376597 (history)  Vaccinated:2009-12-28
Age:14.0  Onset:2009-12-28, Days after vaccination: 0
Gender:Male  Submitted:2010-01-05, Days after onset: 8
Location:Unknown  Entered:2010-01-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PREDNISONE
Current Illness:
Preexisting Conditions: None known
Diagnostic Lab Data: Bells palsy, CT scan neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500849P1IN 
Administered by: Other     Purchased by: Other
Symptoms: Computerised tomogram normal, Eye disorder, Facial palsy, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Bells palsy- Severe headache, tingling of left side of face, trouble closing left eye progressed to left face palsy.

VAERS ID:376761 (history)  Vaccinated:2010-01-10
Age:14.0  Onset:2010-01-10, Days after vaccination: 0
Gender:Female  Submitted:2010-01-10, Days after onset: 0
Location:California  Entered:2010-01-13, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: dizziness
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP087AA0IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Disorientation, Dizziness, Heart rate increased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt experience dizziness and fainting upon minutes after receiving H1N1 vaccine. 911 was called. BP of pt. checked adn found to be 116/78, with fast pulse. Pt. talking and smiling but a little disoriented. Taken to ER for observation.

VAERS ID:376848 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2010-01-13
Location:Texas  Entered:2010-01-14, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1001USA00262
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Corneal lesion, Multiple sclerosis, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Corneal disorders (narrow)
Write-up: Information has been received from a physician concerning a 14 year old female patient who was vaccinated with 3 doses of GARDASIL. Physician stated client went to his office in October 2009 presenting muscle weakness and a patch on her cornea, unspecified cornea. The physician reported that at that time, the patient''s mother told her child was healthy until then. The physician stated that the client may have developed Multiple Sclerosis. Client was referred to neurologist. The patient outcome is unknown. Patient sought medical attention. Upon internal review, Multiple Sclerosis was considered to be an other important medical event. Additional information has been requested.

VAERS ID:376908 (history)  Vaccinated:2010-01-14
Age:14.0  Onset:2010-01-14, Days after vaccination: 0
Gender:Female  Submitted:2010-01-14, Days after onset: 0
Location:Texas  Entered:2010-01-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101329590IMRA
Administered by: Other     Purchased by: Public
Symptoms: Hypoaesthesia, Injection site pain, Muscular weakness, Pallor, Paraesthesia, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Approx. 5 min after injection, patient reports tingling, numbness to right hand with pain in right arm when attempting to straighten elbow. V/s 11/64. SS 20; Hand grasp weaker on right than on left. nail bed pink, blanching b/c skin warm; improving with ice applied to injection site no redness, no swelling hand grasp improving within minutes of applying cold packs; able to move arm and straighten elbow.

VAERS ID:376910 (history)  Vaccinated:2009-12-01
Age:14.0  Onset:2009-12-01, Days after vaccination: 0
Gender:Female  Submitted:2009-12-01, Days after onset: 0
Location:North Carolina  Entered:2010-01-14, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500801P0IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Headache
SMQs:
Write-up: Headache within a few minutes of receiving vaccine.

VAERS ID:376942 (history)  Vaccinated:2010-01-11
Age:14.0  Onset:2010-01-11, Days after vaccination: 0
Gender:Female  Submitted:2010-01-14, Days after onset: 3
Location:New York  Entered:2010-01-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Received shot 1.11.10 @ 4pm and reported fever (103.2) and vomiting at about 9pm. Message taken at 9a 1.12.10

VAERS ID:377099 (history)  Vaccinated:2010-01-13
Age:14.0  Onset:2010-01-13, Days after vaccination: 0
Gender:Female  Submitted:2010-01-15, Days after onset: 2
Location:Texas  Entered:2010-01-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102145P10IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU30668AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3352AA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0800Y1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 1 1/2" across and 2" long - raised, red, warm whelp itchy at site of VARIVAX.

VAERS ID:377117 (history)  Vaccinated:2009-12-14
Age:14.0  Onset:2009-12-15, Days after vaccination: 1
Gender:Female  Submitted:2010-01-15, Days after onset: 31
Location:Unknown  Entered:2010-01-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Juvenile idiopathic arthritis; Ulcerative colitis
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0839470A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dehydration, Vaccination complication, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was reported by a healthcare professional via a manufacturer and described the occurrence of reaction to flu vaccination in a 14-year-old female subject who was vaccinated with influenza virus vaccine (Seasonal Influenza vaccine, manufacturer unspecified). Co-suspect medication included ENBREL injection. Concurrent medical conditions included juvenile idiopathic arthritis and ulcerative colitis. The length of disease was 8.5 years. In 2003 the patient started etanercept (subcutaneous at an unspecified dosage and increased to 50 mg weekly approximately 2.5 years age. On 14 December 2009 the subject received unspecified dose of Seasonal Influenza vaccine(unknown). On 15 December 2009, 1 day after vaccination with Seasonal Influenza vaccine and approximately 2.5 years after starting etanercept 50 weekly, the subject experienced vomiting, dehydration and reaction to flu vaccination. This report was received from a manufacturer, is a solicited report sourced from the enhanced drug safety surveillance project for subject with Juvenile Idiopathic arthritis (JIA). A 14-year-old subject began receiving ENBREL 7 years ago at an unspecified dose, which was increased to current dose, 50 mg subcutaneous weekly, 2.5 years ago. The subject received the seasonal flu shot on 14 December 2009. On 15 December 2009, the subject developed severe vomiting and dehydration. The reported serious adverse event was severe reaction to influenza vaccine, which was medically significant. The subject was hospitalized for three days on IV fluids. Etanercept was held that week and restarted three days before the time of this report to a manufacturer (04 January 2010). The duration of the event severe reaction to influenza vaccine was from 15 December 2009 to 18 December 2009. The subject was hospitalized for 3 days and the healthcare professional considered the events were clinically significant (or requiring intervention). The subject was treated with IV fluids. On 18 December 2009, the vomiting, dehydration and reaction to flu vaccination were resolved. The healthcare professional considered the events were probably related to vaccination with Seasonal Influenza vaccine and unlikely related to therapy with etanercept.

VAERS ID:377217 (history)  Vaccinated:2009-11-18
Age:14.0  Onset:2009-11-19, Days after vaccination: 1
Gender:Female  Submitted:2010-01-18, Days after onset: 60
Location:Arizona  Entered:2010-01-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hay fever, Allergic to Penicillin
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500804P IN 
Administered by: Public     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on buttocks the morning after injection

VAERS ID:377357 (history)  Vaccinated:2010-01-05
Age:14.0  Onset:2010-01-07, Days after vaccination: 2
Gender:Male  Submitted:2010-01-11, Days after onset: 4
Location:Maine  Entered:2010-01-19, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidene; Risperadol; Proair inhaler; Motrin; Focatin XR; Cefrizine
Current Illness:
Preexisting Conditions: Aspergers; ADHD; Asthma; allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500849P0IN 
Administered by: Private     Purchased by: Public
Symptoms: Decreased appetite, Lethargy, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient received his first H1N1 intranasal on 1/5/10 and became sick two days later with fever, vomiting, lethargy, decreased eating and drinking and extreme nausea.

VAERS ID:377400 (history)  Vaccinated:2010-01-07
Age:14.0  Onset:2010-01-16, Days after vaccination: 9
Gender:Female  Submitted:2010-01-19, Days after onset: 3
Location:Texas  Entered:2010-01-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergic to dust and dust mites and cockroaches
Diagnostic Lab Data: Had a full battery of tests run at hospital but was not tested for H1N1. Doctors said it was from a UTI and gave fluids. None of us even thought it could be that until my youngest started vomiting and displaying exactly the same symptoms 8 hours later. Now I am positive it is from the vaccine and not a UTI. I am livid.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500802P0IN 
Administered by: Public     Purchased by: Other
Symptoms: Dehydration, Diet refusal, Fatigue, Hypoaesthesia, Immediate post-injection reaction, Laboratory test abnormal, Lethargy, Paraesthesia, Pyrexia, Urinary tract infection, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), 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)
Write-up: Patient suddenly became tired and lethargic and refused to eat then she began vomiting over and over again. She dehydrated very quickly. Ran only a low grade fever. Complained constantly that her hands were tingly and her fingers were completely numb. She also got a bad UTI, however I dont know if that is related to the vaccine or not. She Required IV fluids. She has not been around anyone that was ill so I looked online and found that TONS of people have become ill from these vaccines, especially the live vaccine given in the nose which is what was given to patient. People are complaining of the exact same symptoms anywhere from one day to a month after receiving the H1N1 vaccine.

VAERS ID:377533 (history)  Vaccinated:2010-01-12
Age:14.0  Onset:2010-01-13, Days after vaccination: 1
Gender:Female  Submitted:2010-01-14, Days after onset: 1
Location:Indiana  Entered:2010-01-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102041P10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Injection site ulcer, Skin ulcer
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Rcvd H1N1 vaccination @ school clinic on 1/12/10, 1/13/10 felt tired and began small, open sores around injection site and spreading to neck and face.

VAERS ID:377804 (history)  Vaccinated:2010-01-21
Age:14.0  Onset:2010-01-21, Days after vaccination: 0
Gender:Female  Submitted:2010-01-22, Days after onset: 1
Location:California  Entered:2010-01-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Hypoacusis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Approx. 5 minutes after administration of Gardasil vaccine, patient left doctors office with her mom, she suddently said I feel everywhere is white then she felt that she is not hearing anything, she said I feel dizzy and then she fainted for about 5 seconds. Her mom held her and avoided her collapse.

VAERS ID:377838 (history)  Vaccinated:2009-12-29
Age:14.0  Onset:2010-01-04, Days after vaccination: 6
Gender:Male  Submitted:2010-01-22, Days after onset: 18
Location:Colorado  Entered:2010-01-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: possible GBS?
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER665210200100IJRA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Blood test, Chest pain, Dyspnoea, Ear infection, Electrocardiogram normal, Gallbladder disorder, Myalgia, Pharyngitis, Respiratory tract infection, Rhinitis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Gallbladder related disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Took to emergency, had 2 ear infections, throat infection, respiratory infection, gave antibiotic, sudefed, and mucinex. 2nd time at ER complaining of chest pain, did EKG, took blood, xray-nothing, went to doctor with chest pain, had nose infection, said just sore muscles, said to take motrin. 2nd time at doctors 01/21/2010-had chest pain, hard to breathe, weak-gave motrin and musle relaxants--said sore muscles from coughing.

VAERS ID:377873 (history)  Vaccinated:2009-11-19
Age:14.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 0
Location:Rhode Island  Entered:2010-01-22, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NK
Preexisting Conditions: NK
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS10212980IMRA
Administered by: Other     Purchased by: Public
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt complains of itchiness, lightheaded, administered 25 mg followed by 12.5 mg. Pt stated relief. O2 10L NRB. Pt then stated she was having hard time breathing. Pt transported by Resc.

VAERS ID:377876 (history)  Vaccinated:2009-12-04
Age:14.0  Onset:2009-12-04, Days after vaccination: 0
Gender:Male  Submitted:2009-12-04, Days after onset: 0
Location:Rhode Island  Entered:2010-01-22, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None known.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1083261P0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Erythema, Pallor, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Pt. presented with severe rash and pallor-$gnoticed blotching and red areas on back, chest and extremities-$gpt. also c/o of dizziness; no SOB or edema in/within airway-$gadministered 50 mg. BENADRYL-$gcontinued to monitor pt for D-$gincluding BLVS and continuing VS-$gadministered 0.3 EPI 1:1K L Deltoid-$gcalled rescue-$gtransferred care.

VAERS ID:377899 (history)  Vaccinated:2009-11-19
Age:14.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 0
Location:Rhode Island  Entered:2010-01-22, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102129P10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: 13 yo female who was c/o pain of 6 out of 10 mid sub sternal chest pain. VS were stable 110/70, 70, 18. Grandmother picked her up.

VAERS ID:377921 (history)  Vaccinated:2009-10-29
Age:14.0  Onset:2009-11-03, Days after vaccination: 5
Gender:Female  Submitted:2009-11-07, Days after onset: 4
Location:California  Entered:2010-01-22, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS100813  LA
Administered by: Public     Purchased by: Other
Symptoms: Confusional state, Fatigue, Headache, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Retinal disorders (narrow)
Write-up: 5 days after vaccine got severe fatigue, headache, period of confusion and episode of tunnel vision. Sx''s resolved after 2 days.

VAERS ID:378021 (history)  Vaccinated:2009-12-07
Age:14.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Female  Submitted:2010-01-25, Days after onset: 49
Location:Puerto Rico  Entered:2010-01-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PR0980
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP00211A0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Hypoaesthesia, Muscle rigidity, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: PATIENT FAINTED, HAD RIGIDITY IN HANDS, NUMBNESS AND BLURRED VISION.

VAERS ID:378064 (history)  Vaccinated:2009-05-20
Age:14.0  Onset:2009-05-21, Days after vaccination: 1
Gender:Unknown  Submitted:2010-01-20, Days after onset: 244
Location:California  Entered:2010-01-25, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2827CA0IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Chills, soreness

VAERS ID:378065 (history)  Vaccinated:2009-05-20
Age:14.0  Onset:2009-05-21, Days after vaccination: 1
Gender:Male  Submitted:2010-01-20, Days after onset: 244
Location:California  Entered:2010-01-25, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2827CA0IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Pain in extremity, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 6:41 PM left arm very sore and patient very sleepy.

VAERS ID:378173 (history)  Vaccinated:2009-11-30
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2009-12-02
Location:North Carolina  Entered:2010-01-26, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NC10004
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500687P IN 
TDAP: TDAP (ADACEL)SANOFI PASTEURC3248AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:
Write-up: Seasonal Flu mist given instead of H1N1 mist (dispensed by pharmacy - packaging very similar)

VAERS ID:378174 (history)  Vaccinated:2009-11-30
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2009-12-02
Location:North Carolina  Entered:2010-01-26, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NC10005
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500687P IN 
TDAP: TDAP (ADACEL)SANOFI PASTEURC3248AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: Seasonal FLUMIST given instead of H1N1 mist. (dispensed by pharmacy, packaging very similar).

VAERS ID:378213 (history)  Vaccinated:2010-01-21
Age:14.0  Onset:2010-01-21, Days after vaccination: 0
Gender:Male  Submitted:2010-01-22, Days after onset: 1
Location:New Hampshire  Entered:2010-01-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Rhinitis; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102123P10IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0622Y0IMLL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Eye swelling, Immediate post-injection reaction, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Administered H1N1 vaccine to right deltoid- Patient immed started to turn red over entire body. Stated he felt his throat felt funny like it was closing- his eyes began to swell- immediately got MD for help AM + then got Benadryl BP 124/56 and he began to return to natural color- gave 25mg Benadryl and patient stated he felt better- waited 15min caller turned + BP 100/56 Pt left facility.

VAERS ID:378361 (history)  Vaccinated:2009-08-31
Age:14.0  Onset:2009-09-09, Days after vaccination: 9
Gender:Female  Submitted:2010-01-26, Days after onset: 139
Location:Ohio  Entered:2010-01-26
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergic to tree pollen. small windpipe. vasovagal syncope.
Diagnostic Lab Data: EKG, EEG, vEEG, CT Scan, lots of blood work.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0315Y0IJLA
Administered by: Unknown     Purchased by: Other
Symptoms: Chest pain, Convulsion, Dyspnoea, Endotracheal intubation, Iron deficiency anaemia, Oxygen saturation decreased, Paralysis, Resuscitation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad)
Write-up: 9/9/90-seizure like activity lasted 20 minutes, taken home from school. 9/14/09-seizure like act.,lasted 40 minutes,taken by squad to ER found out that Hemaglobins were 8.0 and she now had severe iron defiency anemia,and released. 9/21/09-chest pain/ER visit released. 9/22/09 seizure like act. for 2 hrs.-squad to ER and Admitted for 4 days. 10/1/09-seizure like act, lasted 2 1/2 hrs.squad to Er admitted 3 days. 10/2/09-seizure like act.lasted 45 min. in hospital. 10/28/09-seizure like act.-last 3hrs. taken home. 12/27/09-seizure like act,trouble breathing, ER visit released. 1/2/10-seizure like activity, stopped breathing, CPR performed,paralises for 15 minutes, Squad to ER/released. 1/14/10-seizure like act,trouble breathing,tubed because oxygen level below 70%,squad to ER/transported to another hospital admitted and released after 1 day.

VAERS ID:378373 (history)  Vaccinated:2010-01-26
Age:14.0  Onset:2010-01-26, Days after vaccination: 0
Gender:Female  Submitted:2010-01-26, Days after onset: 0
Location:Alabama  Entered:2010-01-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Mild nasal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICSUP063AA0IJLA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Face became very red and splotchy... lasting more than 6 hours. Called family doctor and was advised to come to office. Doctor confirmed as vaccine reaction and advised Benadryl.

VAERS ID:378412 (history)  Vaccinated:2010-01-26
Age:14.0  Onset:2010-01-26, Days after vaccination: 0
Gender:Male  Submitted:2010-01-27, Days after onset: 1
Location:North Carolina  Entered:2010-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3367AB0IMRA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB767BA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD005220SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1016Y0SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3046AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF499BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1167Y0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Per family pt grabbed his head and family held him up to keep from falling. Placed on bench with feet elevated. Vital signs taken, Pt given drink and brownie, mom stated he had not eaten since breakfast. Pt stated no longer dizzy after eating. Pt left facility.

VAERS ID:378517 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2010-01-27
Location:Louisiana  Entered:2010-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: No Known Drug Allergy
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500802P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt received H1N1 nasal mist appx 9:50am. When went back to class became faint. Removed from class, given juice and snack and felt better with good color. BP 112/56, Pulse 56.

VAERS ID:378518 (history)  Vaccinated:2010-01-27
Age:14.0  Onset:2010-01-27, Days after vaccination: 0
Gender:Male  Submitted:2010-01-27, Days after onset: 0
Location:Louisiana  Entered:2010-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: pollen; dust mites; pets and tree allergies
Diagnostic Lab Data: none
CDC Split Type: LA100112
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500802P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: After receiving H1N1 nasal mist - had nausea and headache. Mom picked from school @ 11:15 am. Received imm appx 10:am. Mom states has low grade temp at this time (2:48 pm)

VAERS ID:378799 (history)  Vaccinated:2008-10-13
Age:14.0  Onset:2008-10-13, Days after vaccination: 0
Gender:Female  Submitted:2010-01-28, Days after onset: 472
Location:Unknown  Entered:2010-01-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy NOS (LMP = 10/20/2008); Hypertension
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0812USA03199
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0229X0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abortion spontaneous, Drug exposure during pregnancy, Menstruation irregular
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Fertility disorders (broad)
Write-up: Information has been received from a nurse practitioner for the pregnancy Registry for GARDASIL concerning a 14 year old female patient with hypertension who on 13-OCT-2008 was vaccinated with her first dose of GARDASIL (Lot#660612/0229X) by intramuscular route and a dose of VARIVAX (lot and route not reported). Concomitant therapy included influenza virus vaccine (unspecified) and DTaP (unspecified). On 09-DEC-2008 the patient received her second dose of GARDASIL (Lot# 660612/0229X). As of 15-DEC-2008, the patient was eight weeks pregnant (LMP 20-OCT-2008, EDD 27-JUL-2009). The patient reported no symptoms. Follow up information has been received for a health care professional who clarified the patient''s EDD of 27-JUL-2009 from the initial report. 09-DEC-2009, the patient received her second dose of GARDASIL and shortly after that the patient had a miscarriage. It was also reported that the patient had some irregular periods and got pregnant again (WAES# 1001USA03249). The patient did not have any GARDASIL between the pregnancies and will have her third dose when the patient returns to the office and it is confirmed that she is not pregnant. Additional information is not expected.

VAERS ID:378833 (history)  Vaccinated:2010-01-27
Age:14.0  Onset:2010-01-28, Days after vaccination: 1
Gender:Male  Submitted:2010-01-29, Days after onset: 1
Location:Georgia  Entered:2010-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: Called parent to check on child, no answer. left message
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP050AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Child woke up with mild fever of 99 faren. and sore throat

VAERS ID:378916 (history)  Vaccinated:2010-01-28
Age:14.0  Onset:2010-01-29, Days after vaccination: 1
Gender:Female  Submitted:2010-02-01, Days after onset: 3
Location:Maryland  Entered:2010-02-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500735P IN 
HEPA: HEP A (VAQTA)MERCK & CO. INC.1259Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3057AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Area of induration, 3cm x 2cm, on R deltoid at presumed site of MENACTRA administration. Rx given for KEFLEX 500 mg 3 x daily x 7 days.

VAERS ID:379022 (history)  Vaccinated:2009-10-28
Age:14.0  Onset:2009-10-29, Days after vaccination: 1
Gender:Male  Submitted:2009-10-30, Days after onset: 1
Location:California  Entered:2010-02-01, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB326AA1UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURV299DAA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.OL63Y1UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red raised area on R D approx 50 mm in size c/o pain @ site and warm to touch Temp 97.5 TWIN #1

VAERS ID:379023 (history)  Vaccinated:2009-10-28
Age:14.0  Onset:2009-10-29, Days after vaccination: 1
Gender:Male  Submitted:2009-10-30, Days after onset: 1
Location:California  Entered:2010-02-01, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB3326AA1UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURV299DAA1UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0663Y1UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Rash papular
SMQs:
Write-up: Red raised area on RD approx 40mm in size temp 98 (Twin #2).

VAERS ID:379081 (history)  Vaccinated:2009-12-07
Age:14.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Male  Submitted:2009-12-07, Days after onset: 0
Location:Rhode Island  Entered:2010-02-02, Days after submission: 57
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1009225P0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Hands, arms itchy-raised hives hands, neck itchy, resp difficulty. 10:15 Mom notified of transport. Transported via rescue.

VAERS ID:379205 (history)  Vaccinated:2010-01-14
Age:14.0  Onset:2010-01-14, Days after vaccination: 0
Gender:Male  Submitted:2010-01-14, Days after onset: 0
Location:Louisiana  Entered:2010-02-03, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None Reported
Diagnostic Lab Data:
CDC Split Type: LA100108
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500853P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Cold sweat, Dry skin, Flushing, Headache, Nausea, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: Nasal H1N1 administered. Remained in administration area for 15 min. No problems - returned to class. Return ~ 30 min later c/o headache, nausea- skin cool & clammy. Face flushed. Cold pack applied back of neck. Vitals stable, B/P 110/82 P84 R16 & clear. After 30 min skin warm, dry - no further flushing. Major complaint nausea - Returned to class.

VAERS ID:379370 (history)  Vaccinated:2009-09-01
Age:14.0  Onset:2009-09-01, Days after vaccination: 0
Gender:Female  Submitted:2010-01-25, Days after onset: 146
Location:Florida  Entered:2010-02-04, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.U206Y0UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y1UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0848Y1UNRA
Administered by: Private     Purchased by: Public
Symptoms: Rash, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient received 1st dose of HPV on 6/9/09 broke out w/rash. 0 complications pt. recovered. Patient received 2nd dose of HPV on 09-01-09 w/rash more severe occurring within 2 hours of injection D/C series of HPV per Dr.

VAERS ID:379472 (history)  Vaccinated:2010-01-25
Age:14.0  Onset:2010-01-26, Days after vaccination: 1
Gender:Female  Submitted:2010-02-04, Days after onset: 9
Location:North Carolina  Entered:2010-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Possible latex allergy.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB342AA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0100Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3062AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B047EA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1079Y1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 3.5cm red raised area at Varicella site. BENADRYL, MOTRIN, Prednisone, ZYRTEC.

VAERS ID:379912 (history)  Vaccinated:2009-11-13
Age:14.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-12-18, Days after onset: 35
Location:Maine  Entered:2010-02-09, Days after submission: 53
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain upper, Dizziness, Fatigue
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: B/P 130/70 9:45. Stomach ache. Dizziness. Tired. Follow up information received. Date of vaccination 11/13/09 at 10AM - Adverse event onset 11/13/09 at 11AM.

VAERS ID:379917 (history)  Vaccinated:2009-11-10
Age:14.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 2
Location:Maine  Entered:2010-02-09, Days after submission: 89
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain upper, Headache
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: headache, stomachache

VAERS ID:379939 (history)  Vaccinated:2010-02-08
Age:14.0  Onset:2010-02-08, Days after vaccination: 0
Gender:Female  Submitted:2010-02-10, Days after onset: 2
Location:Indiana  Entered:2010-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Examination in ER.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3080AA0UNLA
Administered by: Unknown     Purchased by: Private
Symptoms: Arthralgia, Back pain, Headache, Hypoaesthesia, Immediate post-injection reaction, Nausea, Photophobia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Numbness in hands and arms almost immediately after vaccine. Pains in joints and headache with nausea began within 8-12 hours after vaccine. Severe headache, back pain, photophobia, hand and arm numness continued into next day, 2/9/2010, culminating in ER visit evening of 2/9/2010.

VAERS ID:380047 (history)  Vaccinated:2010-02-02
Age:14.0  Onset:2010-02-02, Days after vaccination: 0
Gender:Female  Submitted:2010-02-11, Days after onset: 9
Location:Missouri  Entered:2010-02-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y0IMRA
Administered by: Public     Purchased by: Other
Symptoms:
SMQs:
Write-up: Grand mal seizure activity. By the time parent reported the situation to the health dept on 2/11/2010, the parent reported that the child had 88 seizures.

VAERS ID:380310 (history)  Vaccinated:2010-02-10
Age:14.0  Onset:2010-02-10, Days after vaccination: 0
Gender:Female  Submitted:2010-02-14, Days after onset: 4
Location:Texas  Entered:2010-02-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF544AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Dizziness, Headache, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: fever to 102.8, myalgias, dizziness, headache, weakness, nausea, vomiting x 4.

VAERS ID:380366 (history)  Vaccinated:2010-01-15
Age:14.0  Onset:2010-01-20, Days after vaccination: 5
Gender:Male  Submitted:2010-02-08, Days after onset: 19
Location:Florida  Entered:2010-02-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Panhypopituitarism
Diagnostic Lab Data: CT Head - negative in ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3260BH UNRA
Administered by: Private     Purchased by: Private
Symptoms: Ataxia, Computerised tomogram normal, Gait disturbance, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Five days after receiving Flu vaccine, pt. experienced bilateral lower extremity weakness, gait disturbance and ataxia. Per Dr. pt was sent to ER for eval. Father had stroke after receiving H1N1 vaccine.

VAERS ID:380387 (history)  Vaccinated:2010-01-27
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2010-02-15
Location:New York  Entered:2010-02-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP031AA UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:380398 (history)  Vaccinated:0000-00-00
Age:14.0  Onset:2010-02-02
Gender:Female  Submitted:2010-02-12, Days after onset: 10
Location:Unknown  Entered:2010-02-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1002USA00790
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a registered nurse concerning a 14 year old female who on an unspecified date was vaccinated with second dose of GARDASIL (dose, route and lot number not reported). The registered nurse stated that after her second dose of GARDASIL, on 02-FEB-2010, she fainted and had seizure like movements. the patient sought unspecified medical attention. Upon internal review, seizure like movements was determined to be an other important medical event. Additional information has been requested.

VAERS ID:380416 (history)  Vaccinated:2010-01-16
Age:14.0  Onset:2010-01-19, Days after vaccination: 3
Gender:Male  Submitted:2010-02-04, Days after onset: 16
Location:Tennessee  Entered:2010-02-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data: Precautionary= Azithromycin 250mg po 2pk/Hydrocortizone applied to elbows.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: (L) arm pain. Redness on elbow bilateral. Tx below 12 pres. antibiotic and hydro cort.

VAERS ID:380445 (history)  Vaccinated:2010-02-10
Age:14.0  Onset:2010-02-11, Days after vaccination: 1
Gender:Female  Submitted:2010-02-15, Days after onset: 4
Location:Iowa  Entered:2010-02-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Normal MRI brain/spine; normal EEG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0672Y2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Electroencephalogram normal, Headache, Nuclear magnetic resonance imaging brain normal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)
Write-up: GARDASIL #3 on 2/10/10. R arm tremors, headache, dizziness began 2/11/10.

VAERS ID:380458 (history)  Vaccinated:2010-02-15
Age:14.0  Onset:2010-02-15, Days after vaccination: 0
Gender:Female  Submitted:2010-02-15, Days after onset: 0
Location:Texas  Entered:2010-02-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CT of head
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0087Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3013AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Computerised tomogram head, Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt. had Hgb checked in room-then was administered MCV4 and HPV vaccines. Shortly after rcving vaccines was talking-then fainted fell off exam table and fell onto floor hitting her head. LOC-20 sec. 911 called. Sent to ER-DC''ed after CAT scan.

VAERS ID:380468 (history)  Vaccinated:2010-02-01
Age:14.0  Onset:2010-02-01, Days after vaccination: 0
Gender:Female  Submitted:2010-02-02, Days after onset: 1
Location:Louisiana  Entered:2010-02-16, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: c/o sore throat
Preexisting Conditions: Allergic erythromycin
Diagnostic Lab Data:
CDC Split Type: LA100115
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500853P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Headache, Hypersensitivity, Immediate post-injection reaction, Nausea, Pharyngeal erythema, Pharyngeal oedema, Pruritus, Urticaria, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Within 30 min child returned c/o H.A., nausea and slight dizziness, hives to upper chest and back-throat red-swollen with white patch L side-c/o slight itching off and on-beginning to scratch-Mom contacted-arrived-50 mg BENADRYL IM L deltoid-hives and rash becoming less noticeable-sent to ER with Mom-Dx as allergic reaction to H1N1-placed on steroids and BENADRYL with FU x 5-10 days.

VAERS ID:380566 (history)  Vaccinated:2010-01-28
Age:14.0  Onset:2010-01-28, Days after vaccination: 0
Gender:Male  Submitted:2010-01-28, Days after onset: 0
Location:North Carolina  Entered:2010-02-17, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3010AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1079Y0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Anxiety, Fear, Immediate post-injection reaction, Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad), Hypersensitivity (narrow)
Write-up: Immediately following administration of MENACTRA in left deltoid and VARIVAX in upper left arm involuntary twitching of left arm. Patient very anxious and scared. Deep breathing and relaxation encouraged. Twitching lasted approximately 3 minutes.

VAERS ID:380572 (history)  Vaccinated:2010-02-17
Age:14.0  Onset:2010-02-17, Days after vaccination: 0
Gender:Female  Submitted:2010-02-17, Days after onset: 0
Location:Massachusetts  Entered:2010-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1130X0IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Felt dizzy in elevator leaving office, per mom almost fainted. Came upstairs. No syncope or vomiting. Laid down, given juice, observed, did fine.

VAERS ID:380656 (history)  Vaccinated:2009-12-17
Age:14.0  Onset:2009-12-17, Days after vaccination: 0
Gender:Female  Submitted:2010-02-17, Days after onset: 62
Location:Wisconsin  Entered:2010-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500822P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Headache, stomach ache, nausea, gave 50 of liquid BENADRYL and observed and monitored vital signs for one hour.Then they felt better and she went home with her dad.

VAERS ID:380814 (history)  Vaccinated:2010-02-18
Age:14.0  Onset:2010-02-19, Days after vaccination: 1
Gender:Female  Submitted:2010-02-19, Days after onset: 0
Location:Texas  Entered:2010-02-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none known
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500853P0IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.148740IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Dysphagia, Erythema, Swelling face, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Facial swelling with erythma no SOB, wheezing, swallowing difficulty, pt. give Benedryl & prednisolone PO. Observed in office for 15 minutes, no further symptoms developed, slight improvement noted.

VAERS ID:381063 (history)  Vaccinated:2009-11-03
Age:14.0  Onset:2009-11-05, Days after vaccination: 2
Gender:Female  Submitted:2009-12-21, Days after onset: 46
Location:Georgia  Entered:2010-02-23, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR  UNUN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500707P0IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: Had immunizations Hep A, GARDASIL, IPV, MCV, MMR 9/30/09 1 month later had problems breathing at night and when exercising. Went to MD - given antibiotics and it cleared up. On 11/3/09 -received FLUMIST and H1N1, GARDASIL- 2days later 11/5/09 breathing problems returned went to Dr and got antibiotics but when did not clear the breathing problems up. Still has problems when exercising. Mom said also the afternoon she received immunizations on 11/3/09 client had pain on left thigh lasted a couple of days better now. I told mom to go back to the physician regarding difficulty breathing. No respiratory difficulty noted now.

VAERS ID:381186 (history)  Vaccinated:2010-01-29
Age:14.0  Onset:2010-02-08, Days after vaccination: 10
Gender:Male  Submitted:2010-02-08, Days after onset: 0
Location:New Mexico  Entered:2010-02-24, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No acute illness
Preexisting Conditions: No pre-existing condition
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1204X0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Varicella
SMQs:
Write-up: Pt has a full chicken pox break out, which includes 500+ pox. Patient has no fever or other symptoms.

VAERS ID:381194 (history)  Vaccinated:2010-01-09
Age:14.0  Onset:2010-02-21, Days after vaccination: 43
Gender:Male  Submitted:2010-02-24, Days after onset: 3
Location:Florida  Entered:2010-02-24
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol only at the time
Current Illness: slight asthma flare
Preexisting Conditions: Had recent acute gastrointestinal infection w diarrhea as well. Approx date of seasonal flu immunization above.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR100922 1P UNUN
Administered by: Unknown     Purchased by: Other
Symptoms: Guillain-Barre syndrome, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow)
Write-up: Muscle weakeness/Guilliam Barre Syndrome.

VAERS ID:381311 (history)  Vaccinated:2010-01-07
Age:14.0  Onset:2010-01-07, Days after vaccination: 0
Gender:Female  Submitted:2010-02-25, Days after onset: 49
Location:Florida  Entered:2010-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Diagnosed with asthma at 2001 Born abroad diagnosed with "clicky hips" at birth per mother, no problems resulted
Diagnostic Lab Data: MRI, EEG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyskinesia, Electroencephalogram, Muscle twitching, Nuclear magnetic resonance imaging brain abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Uncontrollable twitching and jerking per Mom. Was transported to hospital by EMS. Treated with Xanax and Zofran and released. Multiple ER visits since. EEG 1/20/10. Currently under the care of Neuro Dr. MRI shows back right side of brain abnormalties per Mom. Appointment scheduled for 48 hour EEG on 03/03/10. Currently taking Tinex 1/2 mg twice a day. No shaking episodes since 02/16/10 per Mom.

VAERS ID:381327 (history)  Vaccinated:2009-12-03
Age:14.0  Onset:2009-12-03, Days after vaccination: 0
Gender:Female  Submitted:2010-02-25, Days after onset: 84
Location:New Jersey  Entered:2010-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102125P1 UNLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainting. B/P 120/70. Ammonia Inhalant used. Alerted. Left arm no redness.

VAERS ID:381358 (history)  Vaccinated:2010-02-23
Age:14.0  Onset:2010-02-24, Days after vaccination: 1
Gender:Female  Submitted:2010-02-26, Days after onset: 2
Location:Arkansas  Entered:2010-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1059Y1SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3027AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B041BA4IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0925Y1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) Arm noted 3.5cm x 3cm round. Red, slightly raised area at presumed injection site.

VAERS ID:381429 (history)  Vaccinated:2010-02-25
Age:14.0  Onset:2010-02-25, Days after vaccination: 0
Gender:Female  Submitted:2010-02-26, Days after onset: 1
Location:Tennessee  Entered:2010-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.666201/1538Y0IMRL
HPV4: HPV (GARDASIL)MERCK & CO. INC.662629/13170 RL
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR43080AA0IMLL
TDAP: TDAP (ADACEL)SANOFI PASTEURC3352AA IMLL
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Dizziness, Dysstasia, Ear pain, Hypersensitivity, Nausea, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: ears started hurting, eyes bloodshot, weakness,dizziness,nausea, unable to get up without help. Call Dr. then 911 and went by ambulance to ER. They gave her meds to counter allergic reation. Observed for several hours at ER and was sent home, with prescription for Epi Pen and Zyrtec, Benedryl.

VAERS ID:381558 (history)  Vaccinated:2010-02-22
Age:14.0  Onset:2010-02-22, Days after vaccination: 0
Gender:Female  Submitted:2010-03-01, Days after onset: 7
Location:Texas  Entered:2010-03-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: PCOS
Diagnostic Lab Data: blood work so far.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1IJRA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Blood test, Dyspnoea, Headache, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: 101 fever, stomach ache, headache, hurting all over. Since had rash that appears in evenings, shortness of breath, constant headache and stomach ache.

VAERS ID:381605 (history)  Vaccinated:2009-08-17
Age:14.0  Onset:2009-08-18, Days after vaccination: 1
Gender:Female  Submitted:2010-02-24, Days after onset: 190
Location:Connecticut  Entered:2010-03-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to PCN; sour apple candy and chocolate pop tarts (hives)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0381X0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3011AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B033BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe abd pain the next day after receiving the first two doses of GARDASIL on 8-17-09 and 10-21-09. Not reported to us after 1st dose or 2nd dose.

VAERS ID:381707 (history)  Vaccinated:2009-12-10
Age:14.0  Onset:2009-12-11, Days after vaccination: 1
Gender:Female  Submitted:2010-03-02, Days after onset: 81
Location:Unknown  Entered:2010-03-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2010TW11428
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Diabetic ketoacidosis, Pneumonia, Type 1 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Eosinophilic pneumonia (broad)
Write-up: Initial health authority report received on 05 Jan 2010: This patient was vaccinated with H1N1 influenza virus vaccine (manufacturer unknown) on 10 Dec 2009. After vaccination, the patient suffered from pneumonia, type-1 diabetes mellitus and diabetic ketoacidosis since 11 Dec 2009. Outcome of the events was not reported. Follow up received on 05 Mar 2010: As the case as received form webiste of local centers for disease control, no further information was available. Follow-up report received from local health authority on 30 Mar 2010: The patient did not receive Novartis vaccine FOCETRIA. Therefore, this case became invalid and would be deactivated.

VAERS ID:381837 (history)  Vaccinated:2007-11-26
Age:14.0  Onset:2008-08-01, Days after vaccination: 249
Gender:Female  Submitted:2010-03-03, Days after onset: 579
Location:Texas  Entered:2010-03-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma; Bronchitis
Preexisting Conditions: Gastrointestinal pain; Gastrooesophageal reflux
Diagnostic Lab Data: diagnostic laboratory, negative
CDC Split Type: WAES1002USA03728
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0263U0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Gait disturbance, Laboratory test normal, Muscular weakness, Myalgia, Oedema peripheral, Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from an office Manager concerning a 15 year old female with asthma and bronchitis, and a history of upper gastrointestinal pain and reflux, and no known allergies, who on 26-NOV-2007 was vaccinated with the first standard dose of GARDASIL, IM. The vaccination dates of the second dose and the third dose were not reported. Concomitant therapy included montelukast sodium, albuterol and PREVACID. In August 2008, after completing the GARDASIL series the patient experienced general muscle weakness, muscle pain, leg pain, leg swelling and syncope. The patient had difficulty walking due to the leg swelling. She sought medical attention via office visit. The patient was hospitalized, but reporter did not know how long the patient was hospitalized. Lab and Diagnostic Studies were done but the Office worker did not know exactly what studies were completed. Patient was seen by Cardiology and Neurology Specialist for intervention to to prevent serious criteria and all findings so far were negative. It was reported that the patient was still following up with various physicians and did not know if the symptoms had resolved at this time. General muscle weakness, muscle pain, leg pain, leg swelling, syncope and difficulty walking were considered to be other important medical events. Leg swelling and difficulty walking were considered to be disabling by the reporter, since the patient had difficulty walking due to the leg swelling. Additional information has been requested.

VAERS ID:381918 (history)  Vaccinated:2009-11-30
Age:14.0  Onset:2009-12-02, Days after vaccination: 2
Gender:Male  Submitted:2010-02-01, Days after onset: 61
Location:Massachusetts  Entered:2010-03-05, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: KEPPRA; ATIVAN; Amoxicillin; PREVACID; CARNITOR; multivits
Current Illness: None
Preexisting Conditions: Mitochondrial disorder; seizure disorder
Diagnostic Lab Data: Patient is at baseline severely handicapped mentally and physically has a mitochondrial disorder and seizure disorder. Essentially non verbal, unsteady gait.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3356AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Condition aggravated, Convulsion, Disability, Gait disturbance, Intensive care, Mental impairment, Pyrexia, Status epilepticus
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Tdap on Monday 11-30-09. Fever 101.5 2 days later and off and on for a few days. Began having more than usual seizures then, gradually getting worse, culminating in status 10 days later on 12/10/09. Went to local ER, transferred to PICU at hospital. Stayed in at hospital 3 days. Seizure meds adjusted. No specific infection identified. Remained "off" with more seizures than usual for another 10 days or so. Finally back to baseline by 12/25/09. "Has not been this bad for the past 12 years" per mom. She was wondering if could be related to Tdap. I wasn''t sure, but agreed with her that we should let you know especially in light of research on children with mitochondrial disorders and adverse reactions to vaccines.

VAERS ID:382019 (history)  Vaccinated:2010-02-15
Age:14.0  Onset:2010-02-22, Days after vaccination: 7
Gender:Female  Submitted:2010-03-07, Days after onset: 13
Location:Indiana  Entered:2010-03-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None.
Diagnostic Lab Data: Negative Holter, ECHO, CT of head, MRI of head and EEG Negative CBC, CMP, TSH.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood thyroid stimulating hormone normal, Computerised tomogram normal, Echocardiogram normal, Electrocardiogram ambulatory normal, Electroencephalogram normal, Full blood count normal, Metabolic function test, Nuclear magnetic resonance imaging normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncompal episode- daily.

VAERS ID:382122 (history)  Vaccinated:2010-03-08
Age:14.0  Onset:2010-03-08, Days after vaccination: 0
Gender:Female  Submitted:2010-03-08, Days after onset: 0
Location:Georgia  Entered:2010-03-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: GA10017
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1968U0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Immediate post-injection reaction, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Stood up from mtrs lap, with 1 min after vaccination pt fainted, caught before hitting floor by nurse. while lying on floor, pt experienced violent head shaking of arm less than 5 secs. BP 100/60, coke given alert within 1 min left within 30 min.

VAERS ID:382163 (history)  Vaccinated:2010-03-03
Age:14.0  Onset:2010-03-03, Days after vaccination: 0
Gender:Female  Submitted:2010-03-04, Days after onset: 1
Location:Virginia  Entered:2010-03-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: UPT +, Contraindication for vaccine.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0940X1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Contraindication to vaccination, Drug exposure during pregnancy, Pregnancy test urine positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Gave client vaccine; she denied any sexual activity since starting DMPA 12/09. Found out approx 20 min later that client had + UPT when preparing to give 2 DMPA injection.

VAERS ID:382197 (history)  Vaccinated:2010-03-06
Age:14.0  Onset:2010-03-06, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:California  Entered:2010-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP083AA0UNLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB246AA1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Fall, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: After immunization of H1N1 2, HAV 2 a few minutes later while child was standing fainted and fell down. After elevated legs resumed normal condition.

VAERS ID:382216 (history)  Vaccinated:2008-09-10
Age:14.0  Onset:2010-01-20, Days after vaccination: 497
Gender:Female  Submitted:2010-02-23, Days after onset: 34
Location:Louisiana  Entered:2010-03-09, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Motor and sensory deficit in extremities.
Preexisting Conditions: Migraine headaches.
Diagnostic Lab Data: MRI - brain, upper and lower spine, normal; Lumbar puncture, normal; EMG-Nerve conduction study - Slow L Sural Nerve.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.063X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Body temperature increased, Electromyogram abnormal, Headache, Hypoaesthesia, Lumbar puncture normal, Muscular weakness, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Paraesthesia, Rash erythematous, Weight bearing difficulty
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow)
Write-up: Numbness, paresthesias and weakness in lower extremities. Erythematous rash lower extremities. Difficulty bearing weight. Lower back pain, headache, low grade temperature.

VAERS ID:382469 (history)  Vaccinated:2010-03-08
Age:14.0  Onset:2010-03-09, Days after vaccination: 1
Gender:Male  Submitted:2010-03-12, Days after onset: 3
Location:Indiana  Entered:2010-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hereditary Pancreatitis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Pain, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 3-9-10 patient awoke in am and had severe body aches all day. On 3/10/10 and 3/11/10 itchy rash on neck, face, scalp, arm and soles of feet. Mom gave patient Benadryl with some relief. Rash and itchiness came back.

VAERS ID:382746 (history)  Vaccinated:2009-10-20
Age:14.0  Onset:2009-11-04, Days after vaccination: 15
Gender:Male  Submitted:2009-11-06, Days after onset: 2
Location:Michigan  Entered:2010-03-16, Days after submission: 129
Life Threatening? No
Died? Yes
   Date died: 2009-11-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Developmental delay (severe); strabismus
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB707AA1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD00520SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0153Y1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3027AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3250AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1046Y0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Drug exposure during pregnancy, Foetal heart rate decreased, Unevaluable event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)
Write-up: Unknown.

VAERS ID:382830 (history)  Vaccinated:2009-12-01
Age:14.0  Onset:2009-12-01, Days after vaccination: 0
Gender:Female  Submitted:2010-02-02, Days after onset: 63
Location:Pennsylvania  Entered:2010-03-17, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None revealed
Preexisting Conditions: None revealed
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB729AA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD00520SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0855Y0SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3246BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6005Y0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None stated Patients father denied pregnancy at time of immunization. This is atreoretical risk!

VAERS ID:382908 (history)  Vaccinated:2010-03-16
Age:14.0  Onset:2010-03-17, Days after vaccination: 1
Gender:Female  Submitted:2010-03-17, Days after onset: 0
Location:Arkansas  Entered:2010-03-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: None.
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1353Y0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Headache, Pain
SMQs:
Write-up: Pt complained of headache and body aches.

VAERS ID:383009 (history)  Vaccinated:2010-01-25
Age:14.0  Onset:2010-01-27, Days after vaccination: 2
Gender:Male  Submitted:2010-03-18, Days after onset: 49
Location:Missouri  Entered:2010-03-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol 90mcg inhaler
Current Illness: No
Preexisting Conditions: asthma, migraines
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (TENIVAC)SANOFI PASTEURU3005BA  RA
Administered by: Public     Purchased by: Private
Symptoms: Muscle spasms, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient returned to ED after recieved Td. Complaints of right arm pain, spasms, and fever.

VAERS ID:383047 (history)  Vaccinated:2010-03-11
Age:14.0  Onset:2010-03-11, Days after vaccination: 0
Gender:Female  Submitted:2010-03-11, Days after onset: 0
Location:Ohio  Entered:2010-03-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: environmental allergies; No asthma
Diagnostic Lab Data: BP, 120/80; P, 72 - regular; resp, 16 easy, regular.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500822P0IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Abdominal pain upper, Nausea, Paraesthesia, Throat irritation
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 3/11/10 @ 1350 "stomach hurts". Sent by nurse to clinic to rest. PHN to clinic - for monitoring pt and her S/Sx. Pt reported then slightly nauseous and anterior thighs/posterior calves tingling. V S normal. Pt then clearing throat, reporting "feels scratchy". Administered BENADRYL 50 mg PO and called mom. No SOB. No swelling, no itching. Scratchy throat resolved. Pt home with mom.

VAERS ID:383088 (history)  Vaccinated:2010-03-17
Age:14.0  Onset:2010-03-17, Days after vaccination: 0
Gender:Male  Submitted:2010-03-19, Days after onset: 2
Location:Texas  Entered:2010-03-19
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: austism, SEIZURE DISORDER, DERMOID LESION IN OCCIPITAL BONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURU3035AA1IMLA
Administered by: Private     Purchased by: Other
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)
Write-up: seizures

VAERS ID:383155 (history)  Vaccinated:2009-08-21
Age:14.0  Onset:2009-08-21, Days after vaccination: 0
Gender:Male  Submitted:2010-03-22, Days after onset: 213
Location:Texas  Entered:2010-03-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B046BA  LA
Administered by: Military     Purchased by: Military
Symptoms: Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash initially at site which spread to other parts of body

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