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Case Details (Sorted by Age)

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VAERS ID:510015 (history)  Vaccinated:2010-10-07
Age:17.0  Onset:2011-06-26, Days after vaccination: 262
Gender:Female  Submitted:2013-10-28, Days after onset: 855
Location:Indiana  Entered:2013-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LOESTRIN 24 FE
Current Illness: Oral contraception; Codeine, Drug hypersensitivity
Preexisting Conditions: Codeine, Drug hypersensitivity
Diagnostic Lab Data: Beta-human chorionic gonadotropin test (unspecified) on 01-NOV-2010 showed positive; 11/16/2010, Ultrasound scan, Viable pregnancy, EDD: 27-JUN-2011
CDC Split Type: WAES1011USA03446
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0331Z1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Caesarean section, Dyspnoea, Exposure during pregnancy, Feeding disorder neonatal, Foetal heart rate deceleration, Human chorionic gonadotropin positive, Laryngomalacia, Ultrasound antenatal screen normal
SMQs:, Anaphylactic reaction (broad), Congenital and neonatal arrhythmias (broad), Congenital, familial and genetic disorders (narrow), Tumour markers (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Functional lactation disorders (narrow), Foetal disorders (narrow), Neonatal disorders (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product, concerning a 17 year old female patient, with codeine allergy, who on 14-JUN-2010 was vaccinated with the first dose of GARDASIL (Lot # and expire date not reported), 0.5 ml, intramuscularly. On 07-OCT-2010 the patient was vaccinated with the second dose of GARDASIL (Lot # 666929/0331Z and expire date 20-NOV-2012), 0.5 ml, intramuscularly. Concomitant therapy included unspecified birth control pills hormonal. The patient became pregnant "sometime around 01-NOV-2010" and on 01-NOV-2010 a pregnancy test was given to the patient in the office. The patient''s last menstrual period was on 20-SEP-2010 and the estimated delivery date is on 27-JUN-2011. Follow up information has been received from the registered nurse concerning the female patient with no previous pregnancies. The estimated conception date was 04-OCT-2010. It was reported that other medications used during this pregnancy included LOESTRIN 24 FE, daily for oral contraception and was discontinued on 01-NOV-2010. On 16-NOV-2010 an ultrasound was performed and the result showed a viable pregnancy and a EDD (reported as EDC): 27-JUN-2011. Follow up information has been received via telephone call from a registered nurse who reported that the patient delivered a full term infant "with no problems" on 26-JUN-2011. She confirmed that the baby had no congenital anomalies. Also, it was reported that the patient had a C-section because the baby "just did not want to come out" and that it was "nothing related to GARDASIL". At the time of the report, the patient recovered from the C-section. Follow up information has been received from a pediatric medical center. They stated that the mother was not one of their patients. They saw the child but not the mother. Upon internal review, C-section was determined to be an other important medical event. Follow up information has been received. The patient agree to participate in the Pregnancy Registry for GARDASIL. Pediatric medical records were received and reviewed; no adverse experiences related to the prenatal exposure or to other Merck Products. The following experience was identified: on 26-JUN-2011, at a gestational age of 39.6 weeks the baby male was born via C-section for fetal decelerations with a weight of 4.040 kg, length of 52.07 cm, OFC of 34.93 cm, APGAR 1 minute was 7 and 5 minutes was 9. The baby was given aqueous vitamin K 1mg, erythromycin 0.5% in each eye and dose 1 of HepB (manufacturer unknown) vaccine 0.5 ml was given. The baby''s oxygen saturation was 100/98; SBP/DBP/MEAN was 69/41/52. The baby was hospitalized for 3 days following birth because he had initial difficulty breathing and feeding. On 27-JUN-2011, the baby underwent a circumcision procedure. Baby''s initial exam was normal except for irregular heart beat. Subsequently, he had a normal heartbeat and a normal ECHO. On 28-JUN-2011, discharge exam was normal. On 01-AUG-2011, a month exam was performed. The patient experienced laryngomalacia. The patient was referred to speech therapy for possible aspiration. Preventive medicine was discussed with his parents. The patient''s vital signs, review of systems and general examination were normal. On 29-AUG-2011, the patient was vaccinated with dose 2 of HepB (manufacturer unknown) in the left thigh, dose 1 of PENTACEL in the right thigh, dose 1 of PREVNAR 13 in the left thigh and dose 1 of ROTATEQ. On 02-SEP-2011, the patient was admitted to hospital for feeding intolerance. Video-feeding study was performed which showed aspiration with thin and semi-thickened liquids. The patient was hospitalized for training of NG feeds due to failed video feeding. On 03-SEP-2011, the patient was discharged from hospital with a normal discharge physical examination and was prescribed simethicone 20 mg p.o and a diet with SIMILAC. The patient''s discharge weight was 6.04 kg. On 20-OCT-2011, the patient had a doctor visit. The patient''s d

VAERS ID:510153 (history)  Vaccinated:2013-10-22
Age:17.0  Onset:2013-10-23, Days after vaccination: 1
Gender:Female  Submitted:2013-10-24, Days after onset: 1
Location:Iowa  Entered:2013-10-29, 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: WELLBUTRIN; Triazolam; CONCERTA; birth control
Current Illness: None
Preexisting Conditions: Asthma; NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH906AE1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Induration, Oedema, Skin warm, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Got injection on 10/22/13. No problems for 24 hours. Then red, swollen, firm, and hot area 3 inches x 2 inches. Ice applied which seemed to lessen the area redness and edema.

VAERS ID:510256 (history)  Vaccinated:2013-10-10
Age:17.0  Onset:2013-10-15, Days after vaccination: 5
Gender:Female  Submitted:2013-10-29, Days after onset: 14
Location:New York  Entered:2013-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA009356
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0092431IMUN
Administered by: Other     Purchased by: Other
Symptoms: Oropharyngeal pain, Pharyngeal erythema, Pharyngeal oedema, Tonsillitis
SMQs:, Agranulocytosis (broad), Angioedema (narrow), Oropharyngeal infections (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: This spontaneous report as received from a nurse refers to a 17 year old female patient with no pertinent medical history. On 10-OCT-2013, the patient was vaccinated with GARDASIL (lot #J009243, exp. date: 23-APR-2016) second dose, 0.5 ml, intramuscular. There was no concomitant medication. On 15-OCT-2013, about 5 days after onset of therapy, the patient experienced tonsillitis like symptoms with sore throat, redness and swelling of throat. The patient sought for medical attention (office visit). No lab diagnostics studies performed. Treatment was given for the events (unspecified antibiotic in case symptoms persisted). The outcome of the events was not reported. This is one of several cases received from the same source. Additional information has been requested.

VAERS ID:510270 (history)  Vaccinated:2012-07-09
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-10-29
Location:Texas  Entered:2013-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins (unspecified)
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Routine prenatal lab work (unknown date) no results provided; Standard DB tests (2013), all of which were with normal limits (WNL)
CDC Split Type: WAES1211USA003156
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, Laboratory test normal, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a Nurse Practitioner, for varicella virus vaccine live, a Pregnancy Registry product concerning a female patient of unknown age with none of pertinent medical history and none of drug reactions/allergies. The patient''s history of previous pregnancies and live birth was not known. On 09-JUL-2012 the patient was vaccinated with VARIVAX (Merck) (dose and lot # were not provided) while pregnant (the gestation was 20 weeks). Concomitant therapies included vitamins (unspecified) (prenatal vitamins). The LMP was 19-JUN-2012 and EDD was 26-MAR-2013 (also reported as "20-MAR-2013"). The patient was exposed to VARIVAX (Merck) during trimester 2. No adverse effect reported. Routine ultrasound test on 01-NOV-2012 and Route prenatal labs were performed which result not provided. The patient saw the Nurse Practitioner to seek medical attention. Follow up information was received from a Pediatrician. On 16-MAR-13 at 39 weeks gestation, the patient delivered a normal male infant (weight: 15 oz. The pregnancy outcome was live birth-full-term. Standard DB tests were performed which showed all of which were with normal limits (WNL). Additional information is not expected.

VAERS ID:510284 (history)  Vaccinated:2013-10-10
Age:17.0  Onset:2013-10-15, Days after vaccination: 5
Gender:Female  Submitted:2013-10-29, Days after onset: 14
Location:New York  Entered:2013-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity
Preexisting Conditions: Amoxicillin, Drug hypersensitivity
Diagnostic Lab Data:
CDC Split Type: WAES1310USA008531
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0092431IMUN
Administered by: Other     Purchased by: Other
Symptoms: Oropharyngeal pain, Pharyngeal erythema, Pharyngeal oedema, Tonsillitis
SMQs:, Agranulocytosis (broad), Angioedema (narrow), Oropharyngeal infections (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: This spontaneous report as received from a nurse refers to a 17 year old female patient with allergy to Amoxicillin. On 10-OCT-2013, the patient was vaccinated with GARDASIL (lot # J009243, exp. date: 23-APR-2016) second dose, 0.5 ml, intramuscular. There was no concomitant medication. On 15-OCT-2013, about 5 days after onset of therapy, the patient experienced tonsillitis like symptoms with sore throat, redness and swelling of throat. The patient sought for medical attention (office visit). No lab diagnostics studies performed. Treatment was given for the events (unspecified antibiotic in case symptoms persisted). The outcome of the events was not reported. This is one of several cases received from the same source. Additional information has been requested.

VAERS ID:510415 (history)  Vaccinated:2013-10-28
Age:17.0  Onset:2013-10-28, Days after vaccination: 0
Gender:Female  Submitted:2013-10-30, Days after onset: 2
Location:Maine  Entered:2013-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient has insulin pump
Current Illness: None
Preexisting Conditions: Type I Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BJ2014 IN 
Administered by: Public     Purchased by: Public
Symptoms: Blood glucose increased, Contraindication to vaccination
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)
Write-up: Pt. visit school nurses office with elevated blood sugars. It was then discovered pt. had type 1 diabetes and received the Flumist. Vaccinator was not informed of diagnosis.

VAERS ID:510533 (history)  Vaccinated:2013-10-22
Age:17.0  Onset:0000-00-00
Gender:Unknown  Submitted:2013-10-30
Location:Unknown  Entered:2013-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA011256
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.H012250 UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to a 17 year old patient of unknown gender. Medical history and drug allergies were not reported. On 22-OCT-2013, the patient was vaccinated with RECOMBIVAX HB lot # H012250, expiration date 06-FEB-2015 (concentration, dose and indication were not reported) that was exposed to three low temperature excursions of 28F for 24 hours, 31F for 24 hours and 30F for 96 hours. No adverse effect has been observed or reported. This is one of several reports from the same source. Additional information is not expected.

VAERS ID:510537 (history)  Vaccinated:2013-10-22
Age:17.0  Onset:0000-00-00
Gender:Unknown  Submitted:2013-10-30
Location:Unknown  Entered:2013-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA014406
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.H012250 UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to a 17 year old patient of unknown gender. Medical history and drug allergies were not reported. On 22-OCT-2013, the patient was vaccinated with RECOMBIVAX HB lot # H012250, expiration date 06-FEB-2015 (concentration, dose and indication were not reported) that was exposed to three low temperature excursions of 28F for 24 hours, 31F for 24 hours and 30F for 96 hours. No adverse effect has been observed or reported. This is one of severeal reports from the same source. Additional information is not expected.

VAERS ID:510504 (history)  Vaccinated:2013-06-11
Age:17.0  Onset:2013-08-01, Days after vaccination: 51
Gender:Male  Submitted:2013-10-30, Days after onset: 90
Location:Pennsylvania  Entered:2013-10-31, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 29 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Well visit; Psoriasis
Preexisting Conditions: Psoriasis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4588AD0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Muscular weakness, Neuromyelitis optica, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (narrow), Demyelination (narrow)
Write-up: Patient had MENACTRA on 6/11/13. Developed complaints of leg and arm weakness, tingling first week of August 2013. Diagnosed with neuromyelitis optica in mid August, between 8/16 and 8/20/13.

VAERS ID:510724 (history)  Vaccinated:2013-01-01
Age:17.0  Onset:2013-03-01, Days after vaccination: 59
Gender:Female  Submitted:2013-10-31, Days after onset: 243
Location:Unknown  Entered:2013-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity
Preexisting Conditions: Penicillin, drug hypersensitivity
Diagnostic Lab Data:
CDC Split Type: WAES1310USA007735
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Alopecia, Autoimmune thyroiditis, Blood test, Decreased appetite, Pain in extremity, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Hypothyroidism (broad), Hyperthyroidism (broad)
Write-up: This spontaneous report has been received from a mother who was referring to her daughter. The patient was an approximately 17 years old, not pregnant female with unspecified allergic reaction to penicillin, which started on unspecified date in the past, and with no pertinent medical history. In January 2013, reported as sometime in 2013, the patient was vaccinated with GARDASIL (lot not reported #) first dose, intramuscular (dose, strength not reported). There were no concomitant therapies. It was reported that after the daughter was administered the vaccine she was diagnosed with Hashimoto''s thyroiditis, she experienced soreness of the arm, lost twenty pounds and she was losing her hair and appetite, adverse events onset date was reported as March 2013. It was reported that the patient was being monitored and she had blood drawn every sixty to ninety days (no results provided). The patient sought medical attention by office visit on unspecified dates. The patient did not recover from the adverse events. The relatedness between the adverse event and GARDASIL was not assess by the reporter. Additional information has been requested.

VAERS ID:510915 (history)  Vaccinated:2013-11-01
Age:17.0  Onset:2013-11-01, Days after vaccination: 0
Gender:Female  Submitted:2013-11-01, Days after onset: 0
Location:New Hampshire  Entered:2013-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARITIN D; RITALIN
Current Illness: None
Preexisting Conditions: ADD; Asthma; Allergic rhinitis; Gluten intolerance; Lactose intolerance
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSJ2B320IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS4735D0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0037270IMRA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:511129 (history)  Vaccinated:2013-09-23
Age:17.0  Onset:2013-09-26, Days after vaccination: 3
Gender:Female  Submitted:2013-10-18, Days after onset: 22
Location:Tennessee  Entered:2013-11-04, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPAKOTE
Current Illness: None
Preexisting Conditions: Seizures; Allergic to sulfa drugs
Diagnostic Lab Data:
CDC Split Type: TN13010
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4445AB1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Vaccine given 9/23/13, pt started having a rash on 9/26/13 and was sent to PCP. Rash and whelps were over large areas of body, esp trunk, arms, and legs. PCP determined it was reaction to vaccine.

VAERS ID:511227 (history)  Vaccinated:2013-11-04
Age:17.0  Onset:2013-11-04, Days after vaccination: 0
Gender:Female  Submitted:2013-11-04, Days after onset: 0
Location:Pennsylvania  Entered:2013-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH910AC IMLA
Administered by: Other     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: She fainted while receiving the vaccine.

VAERS ID:511508 (history)  Vaccinated:2009-12-09
Age:17.0  Onset:2010-01-19, Days after vaccination: 41
Gender:Male  Submitted:2013-11-05, Days after onset: 1386
Location:Virginia  Entered:2013-11-05
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Doxycycline
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Patient has chronic pericarditis and is still on medicine to treat the illness
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500824P IN 
Administered by: Public     Purchased by: Private
Symptoms: Intensive care, Pericardial drainage, Pericardial effusion, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad)
Write-up: Large pericardial effusion who had to be admitted to the ICU and a pericardiocentethesis was performed.

VAERS ID:511512 (history)  Vaccinated:2013-10-22
Age:17.0  Onset:2013-10-22, Days after vaccination: 0
Gender:Male  Submitted:2013-10-31, Days after onset: 9
Location:Maine  Entered:2013-11-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH926AA1IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS55RX21IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0026412IMRA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Fall, Gaze palsy, Pallor
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt was given 3 vaccines, pt turned pale, pt set in chair had fell back, eyes rolled back into head and looked like having seizure. Went and got Dr to evaluate and within 2 minutes pt was alert and was made to lay down for 20 minutes and given water. Dr re-evaluated and pt was released.

VAERS ID:511657 (history)  Vaccinated:2013-10-07
Age:17.0  Onset:2013-10-08, Days after vaccination: 1
Gender:Male  Submitted:2013-11-06, Days after onset: 29
Location:Indiana  Entered:2013-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergies: sulfa, bees, wasp
Diagnostic Lab Data: Blood work showed inflammation, elevated white blood cell and anemia. Stool sample showed blood (from both Pediatrician and Gastroenterologist). Colonoscopy showed inflammation of entire colon.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH894AB0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood test abnormal, Colitis ulcerative, Colonoscopy abnormal, Diarrhoea, Fatigue, Haematochezia, Muscle spasms, Night sweats, Pyrexia, Stool analysis abnormal, White blood cell count increased, X-ray gastrointestinal tract normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)
Write-up: Patient exhibited fatigue, diarrhea, cramps, fever, blood in stool, night sweats. Patient met with Pediatrician on 10/21/2013. Blood and stool samples taken. Pediatrician recommended patient see a Gastroenterologist. Patient met with Gastroenterologist on 10/25/2013. Blood and stool samples taken. Physician felt patient showed signs of Ulceration Colitis. Patient received colonoscopy and upper GI on 10/30/2013. Colonoscopy showed inflammation of the entire colon. Upper GI was normal. Patient was diagnosed with ulcerative colitis. Patient given Prednisone and Balsalazidr disodium. Symptoms finally started improving on 11/1/2013. As of today, 11/6/2013, patient still has diarrhea. Symptoms continued for almost a month.

VAERS ID:511893 (history)  Vaccinated:2013-11-06
Age:17.0  Onset:2013-11-07, Days after vaccination: 1
Gender:Female  Submitted:2013-11-07, Days after onset: 0
Location:Montana  Entered:2013-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medroxyprogesterone
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH899AC UNLA
Administered by: Private     Purchased by: Public
Symptoms: Headache
SMQs:
Write-up: Severe sudden onset of HA 4-5 on 1-10 scale.

VAERS ID:511942 (history)  Vaccinated:2013-10-21
Age:17.0  Onset:2013-10-21, Days after vaccination: 0
Gender:Male  Submitted:2013-11-07, Days after onset: 17
Location:Missouri  Entered:2013-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH921AA1IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0003660IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0037270IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4512AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0054161SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Drooling, Gaze palsy, Pallor, Posture abnormal, Snoring, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: PT RECEIVED HPV#1 LAST AND THEN BECAME VERY PALE AND STATED HE FELT LIGHT HEADED. PT THEN FAINTED WHILE SITTING IN THE CHAIR AND HIS HEAD FELL FORWARD. PT WAS STABILIZED BY 2 NURSES AND WHEN HIS HEAD WAS LIFTED UP HIS EYES WERE ROLLED BACK IN HIS HEAD, HE WAS DROOLING AND MAKING "SNORING" SOUNDS AND THEN STARTED SHAKING.

VAERS ID:512078 (history)  Vaccinated:2013-10-30
Age:17.0  Onset:2013-10-31, Days after vaccination: 1
Gender:Female  Submitted:2013-11-04, Days after onset: 4
Location:Georgia  Entered:2013-11-08, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine; FLONASE; Doxycycline; Tretinoin gel; Benzoyl peroxide
Current Illness: None
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data: EEG ordered result pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BJ20090IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AB1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Electroencephalogram, Muscle twitching, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: 10/31/13 4 AM - shaking, twitching arms, legs $g 1 hour, EMS came, advised to see MD.

VAERS ID:512210 (history)  Vaccinated:2013-07-07
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-11
Location:West Virginia  Entered:2013-11-11
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Alopecia, Anaemia, Anxiety, Back pain, Depression, Fatigue, Fungal infection, Headache, Hyperhidrosis, Insomnia, Irritable bowel syndrome, Lymphadenopathy, Oropharyngeal pain, Palpitations
SMQs:, Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Noninfectious diarrhoea (broad)
Write-up: Anemia, IBD, anxiety attacks, depression, back pain, hair loss, insomnia, racing heart, sore throat, sweats, fatigue, swollen nodes, yeast infection in breasts, headaches.

VAERS ID:512391 (history)  Vaccinated:2013-10-02
Age:17.0  Onset:2013-10-02, Days after vaccination: 0
Gender:Female  Submitted:2013-11-11, Days after onset: 40
Location:Michigan  Entered:2013-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0073541UNLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: HPV # 2 - pt had at 8:30/AM - went to school - at 11 AM c/o being lightheaded and nausea. Mother states "had similar reaction" with HPV #1, but did not report. Increased fluids - pt had no further problems.

VAERS ID:512402 (history)  Vaccinated:2013-11-05
Age:17.0  Onset:2013-11-05, Days after vaccination: 0
Gender:Male  Submitted:2013-11-06, Days after onset: 1
Location:Arizona  Entered:2013-11-11, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: BP, others unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS13097010IMLA
Administered by: Other     Purchased by: Other
Symptoms: Concussion, Head injury, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient passed out/fainted, after shot and walking hit his head. Patient was taken to ER via ambulance and had a concussion. Pt was doing okay the next day.

VAERS ID:512453 (history)  Vaccinated:2013-10-25
Age:17.0  Onset:2013-10-27, Days after vaccination: 2
Gender:Female  Submitted:2013-11-04, Days after onset: 8
Location:Nebraska  Entered:2013-11-12, 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: None
Preexisting Conditions: Gastroparesis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH898AB IMUN
Administered by: Public     Purchased by: Unknown
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Vaccine received on Friday 10/25/12 over noon hr. Itching began Sunday evening 10/27/13 and by Monday morning rash/hives appeared. Patient was seen by PCP and was told to take benadryl.

VAERS ID:512482 (history)  Vaccinated:2013-07-29
Age:17.0  Onset:2013-07-29, Days after vaccination: 0
Gender:Male  Submitted:2013-11-11, Days after onset: 105
Location:Louisiana  Entered:2013-11-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311USA003400
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from a physician via representative refers to a 17 year old male patient. On 07-AUG-2012 the patient was vaccinated with his first dose of GARDASIL (injection, strength, lot#, dose and route were unspecified). On 29-JUL-2013 the patient was vaccinated with his second dose of GARDASIL (injection, strength, lot#, dose and route were unspecified). Physician reported that patient received his third dose of GARDASIL (injection, strength, lot#, dose and route were unspecified) "too early", on 08-OCT-2013. HCP planned to give the fourth dose of GARDASIL per CDC protocol. This fourth dose has not occurred yet. Patient had not had any side effects from receiving a third dose early. Patient did not seek medical attention as this was paperwork identified event. No lab diagnostics studies were performed and not treatment was given for the event. Therapy was continued and outcome was unknown. Additional information has been requested.

VAERS ID:512724 (history)  Vaccinated:2013-10-08
Age:17.0  Onset:2013-10-15, Days after vaccination: 7
Gender:Female  Submitted:2013-11-12, Days after onset: 28
Location:Maryland  Entered:2013-11-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Lyme (-); LP (-); MRI (-); CBC CMP TSH (-)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH891AA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0062360IMRA
Administered by: Private     Purchased by: Private
Symptoms: Blood thyroid stimulating hormone normal, Borrelia test negative, Diplopia, Full blood count normal, Headache, Intraocular pressure increased, Lumbar puncture normal, Metabolic function test normal, Musculoskeletal stiffness, Nuclear magnetic resonance imaging normal
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (narrow), Ocular motility disorders (broad), Arthritis (broad)
Write-up: Had GARDASIL and flu shot 10/8/13 came home school headache stiff neck on 10/15/13 -$g ER seen 10/18/13 in office stiff neck - given muscle relaxer 10/21/13 follow up with double vision - sent to neuro ophthal increase pressure ocular -$g MD - LPC-7 lab MRI (-) D/C home now fine.

VAERS ID:512847 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-13
Location:Unknown  Entered:2013-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA009382
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Winged scapula
SMQs:
Write-up: This spontaneous report has been received from a patient''s father concerning to a 17 year old female patient. Current conditions, medical history and drug reactions/allergies were not reported. On an unknown date, the patient was vaccinated with GARDASIL, first dose, (dose, lot# and route not reported). Concomitant medication was not reported. On an unknown date, reported as after first GARDASIL dose, the patient experienced a scapular winging. The reporter stated that the patient was going to physical therapy. The outcome of a scapular winging was unknown. Additional information has been requested.

VAERS ID:513123 (history)  Vaccinated:2013-11-10
Age:17.0  Onset:2013-11-10, Days after vaccination: 0
Gender:Male  Submitted:2013-11-14, Days after onset: 4
Location:California  Entered:2013-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None disclosed.
Current Illness: None known.
Preexisting Conditions: None disclosed.
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH898AB IMLA
Administered by: Unknown     Purchased by: Private
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: Approximately 2 minutes after administration, the patient fainted in our store twice, but immediately recovered consciousness both times. His parents were with him. We offered paramedics but they refused. We gave him water and let him sit for 15 minutes. Afterward, the patient felt better and they left our store.

VAERS ID:513233 (history)  Vaccinated:2011-05-19
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-15
Location:Illinois  Entered:2013-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Pregnancy test: Positive
CDC Split Type: WAES1106USA02501
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Maternal exposure before pregnancy, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a physician for GARDASIL, a Pregnancy Registry product, concerning a 17 year old female pregnant patient with no pertinent medical history and no drug reactions or allergies, who on 31-AUG-2010 was vaccinated with the first 0.5 ml dose of GARDASIL intramuscularly (lot number not reported). Then on 09-NOV-2010 and 19-MAY-2011 she received her second and third 0.5 ml doses (lot numbers not reported), respectively. There was no concomitant medication. It was stated that on 13-JUN-2011, the patient reported that she was pregnant. A monoclonal pregnancy test was performed on an unspecified date. Follow-up information has been received for GARDASIL, a Pregnancy Registry product, in which the estimated due date was reported as approximately March 2012. Last menstrual period (LMP) was approximated to an unknown date in 2011. Additional information has been requested.

VAERS ID:513369 (history)  Vaccinated:2013-11-06
Age:17.0  Onset:2013-11-09, Days after vaccination: 3
Gender:Male  Submitted:2013-11-15, Days after onset: 6
Location:California  Entered:2013-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Asthma (mild, never has had an ''attack'' but tends to wheeze with upper respiratory infections, no meds needed in last 3 years); seasonal allergies; Hereditary Multiple Exostoses (HME) (Benign bone tumors)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Public
Symptoms: Abnormal sensation in eye, Cough, Decreased appetite, Eye pain, Headache, Malaise, Myalgia, Nausea, Ocular hyperaemia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad)
Write-up: Very red sore eyes without discharge x 6 days, pressure in eyes, headache, fever 101F, cough, muscle aches, malaise, loss of appetite, nausea.

VAERS ID:513482 (history)  Vaccinated:2013-10-15
Age:17.0  Onset:2013-10-15, Days after vaccination: 0
Gender:Female  Submitted:2013-11-17, Days after onset: 33
Location:Unknown  Entered:2013-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: On 15-OCT-2013, urine pregnancy test which was negative; On 29-OCT-2013, urine pregnancy test positive
CDC Split Type: WAES1311USA002317
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J002641 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, No adverse event, 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: This spontaneous prospective pregnancy report as received from a Healthcare Worker refers to a 17 year old female patient. On 15-OCT-2013 the patient received a urine pregnancy test which was negative for pregnancy. After the test, the patient received vaccinated with GARDASIL (lot # J002641, intramuscular, exp 10-DEC-2013) that day. There was none concomitant medication and none medical history. The patient had none drug reactions. On an unspecified date "about 2 weeks later", the patient had another urine pregnancy test which was positive for pregnancy. The EDD was 18-JUN-2014. Initial exposure to GARDASIL was at 5 week(s). The pregnancy outcome was outcome pending. The patient went to see the nurse practitioner. No known adverse effects. Additional information has been requested.

VAERS ID:513640 (history)  Vaccinated:2013-11-11
Age:17.0  Onset:2013-11-11, Days after vaccination: 0
Gender:Male  Submitted:2013-11-18, Days after onset: 7
Location:California  Entered:2013-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH899AB0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0037270IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU446AC1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Blood pressure decreased, Feeling cold, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient had fainting spell turning cold and sweating with B/P 60/40. Patient had been putting on sitting position and then staff lied him down on the treatment bed. After 15 min., patient felt better without any medication.

VAERS ID:513735 (history)  Vaccinated:2012-05-08
Age:17.0  Onset:0000-00-00
Gender:Unknown  Submitted:2013-11-19
Location:New Jersey  Entered:2013-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311USA007736
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from an office manager refers to an 18 year old patient (gender not specified). No information regarding the patient medical history was provided. On 06-MAR-2012 the patient was vaccinated with GARDASIL injection dose 1. Route not specified. On 08-MAY-2012 the patient received the second dose and on 18-NOV-2013 the patient was in the office to receive the third dose. No concomitant medication was reported. No adverse effect was reported. Additional information has been requested.

VAERS ID:514070 (history)  Vaccinated:2013-01-21
Age:17.0  Onset:2013-01-21, Days after vaccination: 0
Gender:Male  Submitted:2013-01-21, Days after onset: 0
Location:Texas  Entered:2013-11-20, Days after submission: 303
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DORYX
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED07449211A0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Gaze palsy, Immediate post-injection reaction, Pallor, Seizure like phenomena
SMQs:, Anticholinergic syndrome (broad), Convulsions (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Immediately after giving the injection the patient said he felt like he was going to pass out. His head went back and his eyes rolled up in his head and it looked like he was having a seizure. It lasted for a few seconds and he looked pale. He put his head between his legs til he felt better. I called 911.

VAERS ID:514134 (history)  Vaccinated:2013-11-11
Age:17.0  Onset:2013-11-11, Days after vaccination: 0
Gender:Female  Submitted:2013-11-20, Days after onset: 9
Location:Unknown  Entered:2013-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311USA006122
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Immediate post-injection reaction, Syncope, Tinnitus, Tonic clonic movements
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: This spontaneous report as received from healthcare student refers to a 17 year old female patient. On 11-NOV-2013, the patient was vaccinated with a first dose of GARDASIL (lot # and expiration date not reported), 0.5 ml, subcutaneous. There was no concomitant medication, pertinent medical history, drug reactions or allergies. On 11-NOV-2013, immediately after administering GARDASIL, the patient began to have ringing in her ears and then experienced tonic clonic jerking and syncope. She was assisted to lie down and her head was lowered. These adverse events were occurred when she was at physician''s office. The patient recovered immediately and was able to walk out of the physician''s office on her own. No treatment was given for adverse event. None lab diagnostics studies were performed. Upon internal review, tonic clonic jerking was considered as medically significant. Additional information has been requested.

VAERS ID:514412 (history)  Vaccinated:2013-11-19
Age:17.0  Onset:2013-11-20, Days after vaccination: 1
Gender:Female  Submitted:2013-11-22, Days after onset: 2
Location:Texas  Entered:2013-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS37R990UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4648AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0041611SCUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling, redness, itching (L) SQ - day after varicella injection. Patient took BENADRYL OTC 1 cap. Wed night. Today Fri 11-22-2013 pt has a half dollar size reaction with slight itching. PA told patient till take BENADRYL for reaction.

VAERS ID:514649 (history)  Vaccinated:2013-11-25
Age:17.0  Onset:2013-11-25, Days after vaccination: 0
Gender:Male  Submitted:2013-11-25, Days after onset: 0
Location:Arizona  Entered:2013-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0084230UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AB1UNRA
Administered by: Private     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was given GARDASIL on left - arm, subsequently, given MCV4 on right arm. Patient was fine. I stepped out and 10 seconds later Mom yelled patient had fainted. He quickly recovered. Dr immediately evaluated, was given ice pack and watched over a period of 15 mins. Orthostatics were taken and was discharged by Dr.

VAERS ID:514652 (history)  Vaccinated:2013-11-05
Age:17.0  Onset:2013-11-11, Days after vaccination: 6
Gender:Male  Submitted:2013-11-26, Days after onset: 15
Location:Puerto Rico  Entered:2013-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Eye pain; Pain; Nausea
Preexisting Conditions:
Diagnostic Lab Data: 11/2013, Lumbar puncture, used to reduce intracranial pressure; 11/13/2013, Nuclear magnetic resonance imaging, Showed inflammation; 11/2013, Visual field tests, some loss of vision was noted
CDC Split Type: WAES1311USA009315
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED09149221A UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.J006236 UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blindness, Eye inflammation, Eye pain, Intracranial pressure increased, Lumbar puncture, Nausea, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Pain, Visual field tests abnormal
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Corneal disorders (broad), Retinal disorders (narrow), Ocular infections (broad)
Write-up: This spontaneous report as received from a consumer refers to a 17 year old male patient (consumer''s son). On 01-NOV-2013 the patient was vaccinated with GARDASIL (dose, route of administration and lot #batch# were not reported). No medical history and concomitant medication were reported. On 11-NOV-2013, the patient experienced pain, vision loss and nausea after receiving the GARDASIL. It was reported that the patient could open his eyelids but experienced pain when he tried to move his eyes. On an unknown date of November 2013, he was seen by an ophthalmologist, who diagnosed as optic neuritis and inflammation of the optic nerve for both eyes. He was referred to a neurologist. On an unknown date of November 2013, a vision field test was done and some loss of vision was noted. On 13-NOV-2013, the patient was taken to see a neurologist and an MRI was done and it showed inflammation. The patient then underwent a lumbar puncture to decrease the intracranial pressure (dates unspecified, November 2013). The patient sought medical attention (office visit). The patient was also given intravenous steroid therapy at the hospital (name of hospital not provided). It was reported that the patient was not admitted to the hospital but goes almost daily for treatments. The consumer also reported that as a consequence of the lumbar puncture, the patient experienced increased pain and nausea. The patient eye pain has increased since it was first noticed. The outcome of the reported events was reported as not recovered. It was also reported that both physicians have stated optic neuritis and inflammation of the optic nerve for both eyes have developed from receiving the GARDASIL. Upon internal review the event ''vision loss'' was considered to be medically significant. Additional information has been requested.

VAERS ID:514798 (history)  Vaccinated:2013-08-15
Age:17.0  Onset:2013-08-18, Days after vaccination: 3
Gender:Female  Submitted:2013-11-26, Days after onset: 100
Location:Iowa  Entered:2013-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: Not known
Preexisting Conditions: Not known
Diagnostic Lab Data: Both platelets and prothrombin time were within normal limits
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Henoch-Schonlein purpura, Hypoaesthesia, Musculoskeletal pain, Pain in extremity, Petechiae, Platelet count normal, Prothrombin time normal, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: On 8/18 pt started getting back pains at T8 that spread down her spine to sacram. Also had pain and numbness spreading to the left leg and part of right leg. Also had pruritis with pain and diffuse petechiae on both upper later/posterior legs and shoulder/upper arms. On 8/20 was admitted to observation. Diagnosed with Menactra induced Henoch-Schonlein Purpura.

VAERS ID:514827 (history)  Vaccinated:2009-12-01
Age:17.0  Onset:2010-01-09, Days after vaccination: 39
Gender:Female  Submitted:2013-11-26, Days after onset: 1417
Location:Ohio  Entered:2013-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Celiacs Disease
Diagnostic Lab Data: Cat scan, blood draws, IV for fluids. They discovered that I had an autoimmune disorder called Ulcerative Colitis.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101326 3P0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Blood test, Chills, Colitis ulcerative, Computerised tomogram, Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal ulceration (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)
Write-up: Chills, fevers (would fluctuate between the two), vomiting, terrible stomach pains (like a knife was being pushed into my stomach over and over again). Was forced to go into the hospital for a 2-night stay. Got a little better after that but then a week later ended up in the hospital again and this time for different symptoms: vomiting, uncontrollable diarrhea, fevers, chills. Was diagnosed with Ulcerative Colitis.

VAERS ID:514900 (history)  Vaccinated:2013-11-21
Age:17.0  Onset:2013-11-21, Days after vaccination: 0
Gender:Female  Submitted:2013-11-27, Days after onset: 6
Location:Unknown  Entered:2013-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311USA010831
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0097882UNLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Headache, Hypoaesthesia oral, Neck pain, Toothache
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: This spontaneous report as received from a health care worker refers to a 17 year old female patient. The patient was allergic to amoxicillin. The patient had no other pertinent medical history. On 01-APR-2013, the patient was vaccinated with GARDASIL dose 1 (Lot # H020002). On 17-JUL-2013, the patient was vaccinated with GARDASIL dose 2 (Lot # H017698). No adverse events were reported with dose 1 and 2. On 21-NOV-2013 the patient was vaccinated with GARDASIL dose 3 (Lot # J009788). The patient was not on any concomitant medications. On 21-NOV-2013, the patient felt dizzy about 5 minutes following the vaccination and the patient was kept at the office for duration of 15 minutes. The patient reproted that on 21-NOV-2013, she developed headache on the left side and neck pain on the left side (same side as GARDASIL vaccination) after the patient left the office. On 22-NOV-2013 when the patient woke up, she experienced numbness of lower lip and teeth pain (teeth hurt). The patient sought medical attention. No treatment was rendered for the event. No lab tests were performed. The outcome of neck pain on the left side (same side as GARDASIL vaccination), teeth pain and numbness of lower lip was reproted as not resolved. The outcome of headache was unknown. The outcome of patient felt dizzy was reported as resolved on 21-NOV-2013. Additional information has been requested.

VAERS ID:514981 (history)  Vaccinated:2013-11-25
Age:17.0  Onset:2013-11-25, Days after vaccination: 0
Gender:Male  Submitted:2013-11-27, Days after onset: 2
Location:Texas  Entered:2013-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: BP 5min after syncope 146/94 Pulse 69
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0062360IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4561AA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure increased, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt experienced Z dizziness and syncope in office after vaccination. Occurred at approx 7:45 pm, held pt due to elevated BP until 9:00 pm. No treatment necessary, record BP for 10 days and report to us.

VAERS ID:515015 (history)  Vaccinated:2013-11-26
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-27
Location:Florida  Entered:2013-11-27
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
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK20620IN 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSYG4XA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM120970IMRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU4165BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0037051SCLA
Administered by: Military     Purchased by: Military
Symptoms: Migraine, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Patient woke up next morning on 11/27/2013 after receiving vaccines complaining of a migraine. Migraine per mother led to blurry vision and nausea.

VAERS ID:515223 (history)  Vaccinated:2013-09-13
Age:17.0  Onset:2013-09-13, Days after vaccination: 0
Gender:Male  Submitted:2013-09-14, Days after onset: 1
Location:Connecticut  Entered:2013-12-02, Days after submission: 79
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Isoniazid
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CT Scan of Head in E.D. (-)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALSTP2250UNLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0068790UNLA
Administered by: Private     Purchased by: Private
Symptoms: Computerised tomogram head normal, Road traffic accident
SMQs:, Accidents and injuries (narrow)
Write-up: Patient had MVA after leaving drs office ? of syncopal episode while driving. Timing not perfectly clear from ED report - seems to be 20 -40 minutes post vaccine administration. Pt had been fine - alert active jocular when left office and throughout procedure before leaving.

VAERS ID:515827 (history)  Vaccinated:2013-10-24
Age:17.0  Onset:2013-11-01, Days after vaccination: 8
Gender:Female  Submitted:2013-12-06, Days after onset: 35
Location:Michigan  Entered:2013-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Apri 0.15-30 mg/mcg oral tablet
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Pt was given a chest xray at the ER dept
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4445AB IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Chest X-ray, Feeling abnormal, Lymphadenopathy, Vaccination complication
SMQs:, Dementia (broad)
Write-up: Pt did not feel good and had swollen lymph nodes. Mom took her to been seen and was told it was all caused by MCV4 vaccine which she had previously gotten the week before.

VAERS ID:516080 (history)  Vaccinated:2012-11-26
Age:17.0  Onset:2012-12-23, Days after vaccination: 27
Gender:Male  Submitted:2013-12-09, Days after onset: 351
Location:Georgia  Entered:2013-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 150 days
    Extended hospital stay? Yes
Previous Vaccinations: ~HPV (Gardasil)~~17.17~Patient
Other Medications: None
Current Illness: No completely healthy. (Took HPV shots)
Preexisting Conditions: None
Diagnostic Lab Data: EKG, EEG, MRI, blood work, CAT-scans, etc...
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0555AE2UNUN
Administered by: Unknown     Purchased by: Other
Symptoms: Blood test, Central nervous system inflammation, Computerised tomogram, Convulsion, Electrocardiogram, Electroencephalogram, Nuclear magnetic resonance imaging, Paralysis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Seizures, inflammation on the brain, paralyze all body functions.

VAERS ID:516136 (history)  Vaccinated:2011-11-10
Age:17.0  Onset:2012-02-01, Days after vaccination: 83
Gender:Female  Submitted:2013-12-10, Days after onset: 678
Location:California  Entered:2013-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Dr has all medical exam, blood work showing before and after vaccines
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.DR OFFICE HAS0SYRUN
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Blood test abnormal, Muscle atrophy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Loss of energy, blood work decline. Prior to shot, Blood work done for NCAA athlete. After 2 shots of Gardasil, child became weak, no energy, loss of muscle, blood work came back horrible where blood work prior to vaccine, showed perfect athlete.

VAERS ID:516142 (history)  Vaccinated:2013-12-04
Age:17.0  Onset:2013-12-05, Days after vaccination: 1
Gender:Female  Submitted:2013-12-10, Days after onset: 5
Location:Maryland  Entered:2013-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA130120IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Received MENVEO injection and PPD 12/4/13. Pt. started to complain of dizziness about 18 hours after injection. Denied cold symptoms, fever, vomiting, diarrhea. Mother felt dizziness was related to vaccine. Follow-up the next day - pt. had recovered completely.

VAERS ID:516336 (history)  Vaccinated:2012-04-13
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-12-12
Location:California  Entered:2013-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Pregnancy test, Positive
CDC Split Type: WAES1205USA01138
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, No adverse event, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a physician for VARIVAX (Merck), a Pregnancy Registry product, concerning a 17 year old female patient, who on 13-APR-2012 was vaccinated with a "booster" dose of VARIVAX (Merck) (dose route and lot number not reported). Other suspect therapy included third dose of GARDASIL, administered on the same day. It was reported that the patient was due to begin her menstrual cycle on approximately 16-APR-2012. The patient notified the physician on 23-APR-2012 that she took a home pregnancy test which was positive. No adverse effect was reported. The date of the patient''s last menstrual period was approximately 16-MAR-2012 and estimated delivery date is due on 21-DEC-2012. Follow up stated no additional information could be provided since the reporting physician retired the previous year. The pregnancy outcome has been updated to lost to follow up. Additional information is not expected.

VAERS ID:516356 (history)  Vaccinated:2013-12-04
Age:17.0  Onset:2013-12-06, Days after vaccination: 2
Gender:Male  Submitted:2013-12-09, Days after onset: 3
Location:Pennsylvania  Entered:2013-12-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0068501IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood alcohol, Blood magnesium, Computerised tomogram head, Drug screen, Full blood count, Syncope, Tonic clonic movements, Unresponsive to stimuli, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Drug abuse and dependence (broad), Guillain-Barre syndrome (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: Working a gas station at register became unresponsive collapsed into cigarette rack, seen in ER. Tonic clonic motor activity as per witnesses.

VAERS ID:516416 (history)  Vaccinated:2013-10-23
Age:17.0  Onset:2013-10-24, Days after vaccination: 1
Gender:Female  Submitted:2013-10-29, Days after onset: 5
Location:Virginia  Entered:2013-12-12, Days after submission: 44
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: DULERA; PATANASE; Albuterol; PREVACID; PROVENTIL
Current Illness:
Preexisting Conditions: Exercise induced asthma
Diagnostic Lab Data: Blood work at hospital
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4772AA3IMRA
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.J0029334IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.J0103320SCLA
Administered by: Private     Purchased by: Private
Symptoms: Blood test, Cellulitis, Erythema, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Vaccines given 10/23/13. (L) arm pain 10/24/13, redness and swelling 10/25, to ER 10/26, admitted to hospital 10/27/13. Dx: cellulitis to (L) arm. IV clindamycin and Vancomycin in hospital. Discharged 10/30/13, on oral BACTRIM now. See hospital notes.

VAERS ID:516432 (history)  Vaccinated:2013-12-03
Age:17.0  Onset:2013-12-04, Days after vaccination: 1
Gender:Female  Submitted:2013-12-12, Days after onset: 8
Location:Colorado  Entered:2013-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: No
Preexisting Conditions: Asthma
Diagnostic Lab Data: Ultrasound arm negative; WBC 13,500; CRP - 156
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH900AE5UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4633BA0UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.J0043870UNLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURJ05200UNRA
Administered by: Private     Purchased by: Private
Symptoms: C-reactive protein increased, Cellulitis, Headache, Injection site pain, Injection site swelling, Local swelling, Myalgia, Pain in extremity, Pyrexia, Ultrasound scan normal, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: Left deltoid swelling pain, fevers 102.6, myalgias, headache, vomiting for 2 days than (L) arm swelling cellulitis, pain for one week.

VAERS ID:516443 (history)  Vaccinated:2013-11-19
Age:17.0  Onset:2013-11-19, Days after vaccination: 0
Gender:Male  Submitted:2013-12-13, Days after onset: 24
Location:Unknown  Entered:2013-12-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1312USA001333
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a licensed practical nurse refers to a 16 year old male patient. Medical history and drug reactions/allergies were not reported. On 15-NOV-2012, the patient was vaccinated with GARDASIL lot # J007354 expiry date 20-FEB-2016 first dose, 0.5 ml, intramuscular in the left deltoid. On 19-NOV-2013, the patient was vaccinated with GARDASIL second dose, (lot, dose and route not reported). Concomitant medication was not reported. On 19-NOV-2013, the patient was vaccinated with improperly stored GARDASIL, this was the patient second dose in the series. No adverse effects. Additional information is not expected.

VAERS ID:516544 (history)  Vaccinated:2013-12-05
Age:17.0  Onset:2013-12-05, Days after vaccination: 0
Gender:Male  Submitted:2013-12-09, Days after onset: 4
Location:Texas  Entered:2013-12-13, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH718AB0UNRA
Administered by: Private     Purchased by: Public
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pruritic rash occurring after vaccine was administered. Pt not allergic to eggs and did not eat any new foods or medications.

VAERS ID:516665 (history)  Vaccinated:2013-10-02
Age:17.0  Onset:2013-10-02, Days after vaccination: 0
Gender:Female  Submitted:2013-12-14, Days after onset: 73
Location:Unknown  Entered:2013-12-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SPRINTEC
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1312USA002366
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0037270IMUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: This spontaneous report as received from a certified medical assistant refers to a 17 year old female patient. There was no pertinent medical history and no drug reactions or allergies. On 02-OCT-2013, the patient was vaccinated with GARDASIL lot # J003727 expiry date 07-NOV-2015, first dose, (dose and route not reported) to prevent human papillomavirus (HPV). Concomitant therapies included ethinyl estradiol, SPRINTEC. On 02-OCT-2013, 6 hrs after onset of therapy, the patient experienced dizziness and shortness of breath. The patient did not report these symptoms to anyone prior to her appointment in the office on 03-DEC-2013 when she came in to receive her second dose of GARDASIL. No treatment given for the events. No lab diagnostics performed. The outcome of shortness of breath and dizziness was reported as recovered on 02-OCT-2013. Additional information has been requested.

VAERS ID:517086 (history)  Vaccinated:2013-10-01
Age:17.0  Onset:2013-10-20, Days after vaccination: 19
Gender:Female  Submitted:2013-12-19, Days after onset: 60
Location:Montana  Entered:2013-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hair loss~HPV (Gardasil)~2~17.08~Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: NONE
Diagnostic Lab Data: Thyroid test-normal. Has an appointment with an Endocrinologist.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNRA
Administered by: Public     Purchased by: Private
Symptoms: Alopecia, Thyroid function test normal
SMQs:
Write-up: My daughter starting losing large amounts of hair a couple weeks after her second Gardasil shot. It is still falling out in large amounts. The doctor checked her thyroid which tested normal. A perfectly healthy girl that does not take any medication. Never sick. Hasn''t changed her lifestyle. Hair loss began shortly after second shot.

VAERS ID:517112 (history)  Vaccinated:2013-12-17
Age:17.0  Onset:2013-12-17, Days after vaccination: 0
Gender:Female  Submitted:2013-12-19, Days after onset: 2
Location:New Hampshire  Entered:2013-12-19
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4574BA1UNRA
Administered by: Public     Purchased by: Public
Symptoms: Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt. received Meningococcal 12/17 and w/i one hour dev. hive/swelling. Has periodically been taking BENADRYL. F/U 12/19 hive continues - tx. BENADRYL and Loratadine. F/U 12/23 and PRN.

VAERS ID:517159 (history)  Vaccinated:2013-12-17
Age:17.0  Onset:2013-12-18, Days after vaccination: 1
Gender:Male  Submitted:2013-12-19, Days after onset: 1
Location:Missouri  Entered:2013-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS 0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0UNRA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site pruritus, Injection site urticaria, Injection site warmth, Malaise
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Hives, itching, warmth around injection site. General ill feeling. Given Motrin 600 mg at onset. Applied OTC Cortisone 10 cream in late PM and in AM of 12/19/13. Gave Benadryl 25 mg at bedtime on 12/18/13.

VAERS ID:517778 (history)  Vaccinated:2013-11-18
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2013-12-27
Location:Unknown  Entered:2013-12-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity
Preexisting Conditions: AUGMENTIN
Diagnostic Lab Data:
CDC Split Type: WAES1312USA010984
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Headache
SMQs:
Write-up: This spontaneous report as received from a consumer regarding her granddaughter a 17 year old female patient with AUGMENTIN allergy. In the middle of October 2013, patient receive her first dose of GARDASIL (dose, concentration, and lot number not reported). On 18-NOV-2013, the patient was vaccinated with her second dose of GARDASIL (dose, concentration and lot number not provided). No concomitant therapy was reported. Approximately on November 2013, the patient experienced headache after received the second shot of GARDASIL. The reporter stated that the patient has not yet received a third shot of GARDASIL. The outcome of headache was unknown. Additional information has been requested.

VAERS ID:517822 (history)  Vaccinated:2001-06-30
Age:17.0  Onset:2001-06-30, Days after vaccination: 0
Gender:Female  Submitted:2013-12-28, Days after onset: 4564
Location:Utah  Entered:2013-12-28
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
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Fever of 103.5, fatigue, dizziness lasting 3-4 days.

VAERS ID:518004 (history)  Vaccinated:2013-12-18
Age:17.0  Onset:2013-12-18, Days after vaccination: 0
Gender:Female  Submitted:2013-12-30, Days after onset: 12
Location:Ohio  Entered:2013-12-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough; Congestion
Preexisting Conditions: Tramadol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0068502UNRA
Administered by: Public     Purchased by: Public
Symptoms: Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Patient developed hive-like rash, abdomen, back, both arms both feet and legs.

VAERS ID:518121 (history)  Vaccinated:2013-12-23
Age:17.0  Onset:2013-12-24, Days after vaccination: 1
Gender:Male  Submitted:2013-12-29, Days after onset: 5
Location:Oregon  Entered:2013-12-31, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine; Prazosin; Loratadine
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: OR201329
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.H0181821SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0187891SCRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Local reaction to (R) upper arm with 3" induration and firmness diameter and 4" diameter of redness and increased temperature. C/O pain and itching at site.

VAERS ID:518606 (history)  Vaccinated:2014-01-03
Age:17.0  Onset:2014-01-03, Days after vaccination: 0
Gender:Male  Submitted:2014-01-03, Days after onset: 0
Location:Puerto Rico  Entered:2014-01-07, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4686AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALST25EG IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J007021 SCLA
Administered by: Unknown     Purchased by: Private
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Patient mentions itchiness on the hands, feet and the posterior part of the thighs. Five minutes after the administration of MCV, Tdap and Varicella.

VAERS ID:518695 (history)  Vaccinated:2014-01-06
Age:17.0  Onset:2014-01-07, Days after vaccination: 1
Gender:Female  Submitted:2014-01-08, Days after onset: 1
Location:California  Entered:2014-01-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: None indicated
Preexisting Conditions: None indicated
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH899AB IMLA
Administered by: Public     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash to face/head and neck. Parent denied any other Sx''s parent advised to take her daughter to a urgent care walk-in clinic for further evaluation, or to her PCP. Mother agreed.

VAERS ID:518730 (history)  Vaccinated:2014-01-07
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-01-08
Location:Idaho  Entered:2014-01-08
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 known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS010011A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age
SMQs:
Write-up: Flucelvax flu vaccine approved for 18 and older and was administered to 17 year old.

VAERS ID:518787 (history)  Vaccinated:2013-10-01
Age:17.0  Onset:2013-11-02, Days after vaccination: 32
Gender:Male  Submitted:2014-01-07, Days after onset: 66
Location:Iowa  Entered:2014-01-09, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone
Current Illness: None
Preexisting Conditions: Tourette''s syndrome
Diagnostic Lab Data: MRI brain
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED08449221A UNUN
Administered by: Other     Purchased by: Other
Symptoms: Nuclear magnetic resonance imaging brain, Nystagmus
SMQs:, Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)
Write-up: Nystagmus.

VAERS ID:518902 (history)  Vaccinated:2013-12-31
Age:17.0  Onset:2013-12-31, Days after vaccination: 0
Gender:Male  Submitted:2014-01-09, Days after onset: 9
Location:North Carolina  Entered:2014-01-09
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH894AA UNLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt felt light headed pt sat down, we have him H2O.

VAERS ID:519278 (history)  Vaccinated:2014-01-06
Age:17.0  Onset:2014-01-06, Days after vaccination: 0
Gender:Male  Submitted:2014-01-14, Days after onset: 8
Location:Washington  Entered:2014-01-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS01011WA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age
SMQs:
Write-up: NONE.

VAERS ID:519314 (history)  Vaccinated:2013-12-05
Age:17.0  Onset:2013-12-08, Days after vaccination: 3
Gender:Female  Submitted:2014-01-14, Days after onset: 37
Location:West Virginia  Entered:2014-01-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Mother states none.
CDC Split Type: WV1401
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0026410IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4445AB0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSP572X0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Ear infection, Headache, Upper respiratory tract infection, Urinary tract infection, Vertigo, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow)
Write-up: Within 2-4 days of GARDASIL vaccine - blurred vision bilateral, room spinning - continuous. 3 wks after vaccine - went to ER with dx UTI, URI, ear inf. - and room spinning was relieved. Appt. being made with eye doctor today. Date to be determined. Also c/o headache - intermittent relieved by Ibuprofen.

VAERS ID:519370 (history)  Vaccinated:2014-01-07
Age:17.0  Onset:2014-01-07, Days after vaccination: 0
Gender:Male  Submitted:2014-01-08, Days after onset: 1
Location:Washington  Entered:2014-01-15, 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: STRATTERA
Current Illness: None
Preexisting Conditions: ADHD; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH907AC1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0084230IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood pressure decreased, Dizziness, Hypoacusis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: Dizziness, decreased hearing, decreased blood pressure while leaving building soon after vaccine administration.

VAERS ID:519384 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2014-01-15
Location:Unknown  Entered:2014-01-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA006185
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Uveitis
SMQs:, Ocular infections (broad)
Write-up: Information has been received from a literature article concerning a 17 year old female patient developed uveitis following administration of GARDASIL. A total of 24 cases of uveitis occurred following administration of GARDASIL; the gender in all cases was female. The median age was 17 (range 12-29). The median time from vaccination to onset of ADRs was 30 days (range 0-476); time to onset was unknown in this case; the time to onset in this case was 7 days from vaccination. There was one reported rechallenged of the GARDASIL vaccine. In 13 of the 24 cases other ocular side effects were noted including 3 case reports of papillitis, 2 case reports of retinitis and 1 case report of papilledema. Systemic side effects were noted in 9 of the 24 cases and included 2 cases of arthralgia. In 2 case reports multiple vaccines were administered simultaneously. According to World Health Organization Causality Assessment Guide of Suspected Adverse Reactions, the relationship between human papilloma virus vaccine and uveitis was "possible". Causality assessments are based on the time relationship of drug administration, uveitis development and rechallenge data. This is one of several reports from the same literature source. Additional information has been requested.

VAERS ID:519385 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2014-01-15
Location:Unknown  Entered:2014-01-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA006184
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Corneal deposits, Eye naevus, Macular oedema, Uveitis
SMQs:, Corneal disorders (narrow), Retinal disorders (narrow), Ocular infections (broad)
Write-up: Information has been received from a literature article concerning a 17 year old female patient developed uveitis, corneal deposits, choroidal nevus and macula edema following administration of GARDASIL. A total of 24 cases of uveitis occurred following administration of GARDASIL; the gender in all cases was female. The median age was 17 (range 12-29). The median time from vaccination to onset of ADRs was 30 days (range 0-476); time to onset was unknown in this case; the time to onset in this case was 7 days from vaccination. There was one reported rechallenged of the GARDASIL vaccine. In 13 of the 24 cases other ocular side effects were noted including 3 case reports of papillitis, 2 case reports of retinitis and 1 case report of papilledema. Systemic side effects were noted in 9 of the 24 cases and included 3 cases of arthralgia. In 2 case reports multiple vaccines were administered simultaneously. According to World Health Organization Causality Assessment Guide of Suspected Adverse Reactions, the relationship between human papilloma virus vaccine and uveitis was "possible". Causality assessments are based on the time relationship of drug administration, uveitis development and rechallenge data. This is one of several reports from the same literature source. Additional information has been requested.

VAERS ID:519421 (history)  Vaccinated:2013-11-22
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-01-15
Location:Washington  Entered:2014-01-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS006011A IMLA
Administered by: Other     Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: Flucelvax was administered to a 17 years old. No adverse reactions noted.

VAERS ID:519492 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2014-01-15
Location:Unknown  Entered:2014-01-16, 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: No other medications
Current Illness: Unknown
Preexisting Conditions: Rheumatoid arthritis
Diagnostic Lab Data: Best corrected visual acuity at the time was 20/20 in the right eye and 20/25 in the left eye. Magnetic Resonance Imaging of brain and orbits with gadolinium contrast was unremarkable. Cerebrospinal fluid analysis was unremarkable. CSF test, Unremarkable; Nuclear magnetic resonance imaging, Of brain and orbits was Unremarkable; Visual acuity tests, 20/20; Visual acuity tests, 20/25, Left eye
CDC Split Type: WAES1401USA005340
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Angiogram abnormal, CSF pressure normal, CSF test normal, Conjunctival hyperaemia, Eye complication associated with device, Inflammation, Keratitis, Nuclear magnetic resonance imaging brain normal, Serology negative, Slit-lamp tests abnormal, Uveitis, Visual acuity tests abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (narrow), Optic nerve disorders (broad), Corneal disorders (narrow), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad)
Write-up: Information has been received from a literature article concerning a 17 healthy year old female patient developed conjunctival hyperemia of her right eye and was treated with topical VIGAMOX by her primary care physician. Her optometrist diagnosed contact lens associated keratitis and prescribed loteprednol etabonate, ZYLET. On subsequent examination bilateral anterior uveitis grade as 2+ cell and 1 + flare was noted. Tropicamide 1% TID and PRED FORTE Q1 hour along with dexamethasone, TOBRADEX at bedtime were then prescribed. Reduction of inflammation was noted in one week, however the inflammation recurred as topical corticosteroid therapy was tapered. She was referred for systemic evaluation after six weeks because the inflammation remained active. Physical examination and serologic evaluations were performed by her primary care physician and a rheumatologist; however no underlying cause for her uveitis was discovered. Her maternal grandparents had rheumatoid arthritis. Four months after onset of her symptoms she was referred for uveitis consultation due to persistent inflammation despite PRED FORTE OU BID. History obtained at the time disclosed her initial GARDASIL was administered 2 weeks prior to onset of uveitis and her second vaccination was temporally associated with a flare of uveitis when her topical corticosteroid dose was reduced to twice daily. The patient and her family elected to defer the third vaccination in the series. Best corrected visual acuity at the time was 20/20 in the right eye and 20/25 in the left. The conjunctiva was not injected. The cornea was normal in appearance without evidence of scarring or keratic precipitates. The anterior chamber reaction was graded as 3+ cell in both eyes. Trace vitreous cells were present in both eyes on slit lamp bio microscopy, and fluorescein angiography demonstrated late hyperfluorescence of the optic discs. Additional serologic work-up did not disclose any significant abnormalities. Magnetic resonance imaging of brain and orbits with gadolinium contrast was unremarkable. Lumbar puncture was performed with a normal opening pressure. Cerebrospinal fluid analysis was unremarkable. She was treated with CELEBREX 200mg twice daily and topical steroid therapy was eliminated. A trace amount of cells were observed intermittently in the anterior chamber over the course of the next three years without symptoms or sequelae of uveitis Glaucoma consultation was obtained and co-morbid pigment dispersion syndrome was excluded. CELEBREX was discontinued after 32 months of therapy and uveitis symptoms have not recurred after an additional 20 months. Best corrected visual acuity remained 20/20 in both eyes more than 4 years after onset of her symptoms. A total of 24 cases of uveitis occurred following administration of GARDASIL; the gender in all cases was female. The median age was 17. The median time from vaccination to onset of ADRs was 30 days; time to onset was unknown in 1 case; the time to onset in this case was of 14 days from vaccination. There was one reported rechallenge of the GARDASIL. In 13 of the 24 cases other ocular side effects were noted including 3 case reports of papillitis, 2 case reports of retinitis and 1 case report of papilledema. According to World Health Organization Causality Assessment Guide of Suspected Adverse Reactions, the relationship between human papilloma virus vaccination and uveitis was "possible" Causality assessments are based on the time relationship of drug administration, uveitis development and rechallenge data. This is one of several reports form the same literature source. Additional information has been requested.

VAERS ID:519872 (history)  Vaccinated:2014-01-13
Age:17.0  Onset:2014-01-13, Days after vaccination: 0
Gender:Unknown  Submitted:2014-01-20, Days after onset: 7
Location:Michigan  Entered:2014-01-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA006705
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J012212 UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a healthcare worker refers to a 17 yeas old patient. The reporter stated that a shipment of GARDASIL that was shipped from company on 08-JAN-2014 was received at her facility on 13-JAN-2014. One dose of GARDASIL (lot # J012212 exp. date. 18-FEB-2016, dose, route and site of administration not reported) was administered to a patient on 13-JAN-2014 before the status of the shipment was realized. The healthcare worker did not believe that GARDASIL was exposed to temperatures out of the recommended range for longer than 72 hours. No adverse effect had been observed or reported. Additional information has been requested.

VAERS ID:519890 (history)  Vaccinated:2013-12-20
Age:17.0  Onset:2013-12-30, Days after vaccination: 10
Gender:Female  Submitted:2014-01-20, Days after onset: 21
Location:New York  Entered:2014-01-20
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
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.  IN 
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Abdominal pain upper, Asthenia, Blindness, Dizziness, Hypoaesthesia, Immediate post-injection reaction, Malaise, Muscle contractions involuntary, Mydriasis, Skin discolouration
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Patient immediately began to feel sick she said she felt like she was going to faint. She sat down and began saying that she couldn''t see yet her eyes were wide open. I watched her turn grey and her pupils dilate. She then said that she could not feel her legs. She was very weak. She started getting severe stomach pains. After about 10 mins we managed to move her to an exam room where she could lie down. At this point her hands locked into claws. They remained locked for about 15 mins. The PA gave her a can of ginger ale. After about 20 mins after she drank it her color returned to her face, she began to feel her legs and her hands unlocked. Total time from start to finish was approx 1 hour.

VAERS ID:520090 (history)  Vaccinated:2014-01-21
Age:17.0  Onset:2014-01-21, Days after vaccination: 0
Gender:Male  Submitted:2014-01-21, Days after onset: 0
Location:California  Entered:2014-01-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH907AC1IMUN
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURUH4446AC1IMUN
Administered by: Other     Purchased by: Public
Symptoms: Dyspnoea, Pallor, Slow response to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: C/O unable to breathe and slow to respond color pale.

VAERS ID:520195 (history)  Vaccinated:2014-01-21
Age:17.0  Onset:2014-01-22, Days after vaccination: 1
Gender:Female  Submitted:2014-01-22, Days after onset: 0
Location:Maine  Entered:2014-01-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None. Mother will call if symptoms persist or worsen.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0068504IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Slight fever.

VAERS ID:520324 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-01-22
Location:Unknown  Entered:2014-01-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA004739
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a medical assistant refers to currently 17 year male patient. The reporter stated that on an unknown date, the patient was administered the GARDASIL that was exposed to a temperature excursion (30 degrees Fahrenheit for 2 hours) (lot number and expiration date unknown), dose, route, anatomical location and dose number were not reported for an unknown indication. No adverse effect was reported. At the time of the report, date administered, vaccine lot number and expiration date, any treatment received, or possible hospital stay were not available. This is one of several reports from the same source. Additional information has been requested.

VAERS ID:520696 (history)  Vaccinated:2013-12-29
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-01-24
Location:Oregon  Entered:2014-01-24
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
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS010011A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: No adverse event. This vaccine was indicated for 18 years and older. Patient was under that age.

VAERS ID:520700 (history)  Vaccinated:2014-01-07
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2014-01-24
Location:Oregon  Entered:2014-01-24
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
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS010011A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: No adverse event. Patient received a vaccine that was indicated for 18 years and older.

VAERS ID:520819 (history)  Vaccinated:2014-01-22
Age:17.0  Onset:2014-01-24, Days after vaccination: 2
Gender:Male  Submitted:2014-01-24, Days after onset: 0
Location:Colorado  Entered:2014-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDR56608 IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt got 2 hives on front chest and 2 hives on his back - said he felt tingling in the area on his back prior to getting the shot.

VAERS ID:520720 (history)  Vaccinated:2013-11-18
Age:17.0  Onset:2013-11-24, Days after vaccination: 6
Gender:Male  Submitted:2014-01-25, Days after onset: 62
Location:New York  Entered:2014-01-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Healthy Dr visit
Preexisting Conditions: Allergic to amoxicillin
Diagnostic Lab Data: Spinal tap, MRI, blood work
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH926AA5IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood test, Lumbar puncture, Malaise, Nuclear magnetic resonance imaging
SMQs:
Write-up: Stated not feeling well, waited a few days took him to Dr. on Wednesday 11/27/2013 went back to Dr. several different times until December 7, 2013 admitted to medical center.

VAERS ID:520737 (history)  Vaccinated:2013-12-30
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-01-26
Location:Oregon  Entered:2014-01-26
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
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS0066011A1IMRA
Administered by: Other     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None.

VAERS ID:520751 (history)  Vaccinated:2013-11-05
Age:17.0  Onset:2013-11-05, Days after vaccination: 0
Gender:Female  Submitted:2014-01-27, Days after onset: 83
Location:Unknown  Entered:2014-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data: 01/22/2014, Pregnancy test, urine, positive; 01/22/2014, Ultrasound scan, pregnancy of 19 weeks 3 days gestation
CDC Split Type: WAES1401USA010963
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, No adverse event, Pregnancy test urine positive, Ultrasound antenatal screen normal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: This spontaneous prospective pregnancy report as received from a nurse practitioner refers to a 17 year old female patient. On 05-NOV-2013 the patient was vaccinated with VARIVAX (Merck) by her unspecified general health care provider. No concomitant medications, pertinent medical history or drug allergies. The patient was subsequently determined to be pregnant. The date of last menstrual period was 08-SEP-2013 and estimated date of delivery was 15-JUN-2014. Initial exposure to VARIVAX (Merck) was at 8 week(s). The pregnancy outcome was pending. The patient had her first obstetrical evaluation with the nurse practitioner on 22-JAN-2014. On 22-JAN-2014, the patient had a positive pregnancy urine test, an ultrasound revealed a pregnancy of 19 weeks 3 days gestation. No problems reported. No treatment was provided. The patient sought medical attention by making an office visit. Additional information has been requested.

VAERS ID:520816 (history)  Vaccinated:2014-01-17
Age:17.0  Onset:2014-01-18, Days after vaccination: 1
Gender:Female  Submitted:2014-01-21, Days after onset: 3
Location:Arizona  Entered:2014-01-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0032191SCUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient states varying degrees of edema and redness at site since injection. Currently minimal swelling with very faint redness appx 70mm in diameter.

VAERS ID:520895 (history)  Vaccinated:2014-01-11
Age:17.0  Onset:2014-01-11, Days after vaccination: 0
Gender:Female  Submitted:2014-01-12, Days after onset: 1
Location:California  Entered:2014-01-27, Days after submission: 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS13415P0UNLA
Administered by: Other     Purchased by: Private
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: After administration of the vaccine (about 5 min) pt experienced an episode of syncope. Pt regained consciousness after a few seconds w/out further complaints.

VAERS ID:521005 (history)  Vaccinated:2014-01-21
Age:17.0  Onset:2014-01-21, Days after vaccination: 0
Gender:Male  Submitted:2014-01-27, Days after onset: 6
Location:Colorado  Entered:2014-01-28, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Diagnostic Lab Data: UNK
CDC Split Type: 2014SA009039
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH900AE IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.J0065112IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4657AA1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Fall, Nausea, Salivary hypersecretion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Initial report was received on 22 January 2014 from a health care professional. A 17 year-old male patient with no known allergies and no medical history had received the following vaccines on 21 January 2014: a dose two intramuscular left deltoid injection of MENACTRA, lot number U4657AA, an intramuscular left deltoid injection of FLUZONE, lot number UH900AE (number of previous doses for FLUZONE was reported as several) and dose three right arm injection of Hepatitis B, lot number J006511 (manufacturer not reported) and an unspecified amount of time later after the patient received MENACTRA vaccination "slumped over but caught by nurse and returned to position". The patient was observed for 15 minutes and no other symptoms were noted and the patient left facility for home. The next day patient reported experiencing nausea, increased salivation and shortness of breath. The patient was to be evaluated by a physician assistant. Outcome was not recovered. Documents held by sender: none.

VAERS ID:521197 (history)  Vaccinated:2013-11-11
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-01-29
Location:Alaska  Entered:2014-01-29
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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUC3: INFLUENZA (SEASONAL) (FLUCELVAX)NOVARTIS VACCINES AND DIAGNOSTICS  IMLA
Administered by: Other     Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: PATIENT RECEIVED FLUCELVAX WHILE UNDER THE AGE OF 18 WITH NO ADVERSE EVENT REPORTED.

VAERS ID:521199 (history)  Vaccinated:2014-01-27
Age:17.0  Onset:2014-01-27, Days after vaccination: 0
Gender:Female  Submitted:2014-01-29, Days after onset: 2
Location:California  Entered:2014-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AC1SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: No lightheadedness after vaccination but in the car became sweaty and then took a gasp and passed out.

VAERS ID:521202 (history)  Vaccinated:2014-01-02
Age:17.0  Onset:2014-01-02, Days after vaccination: 0
Gender:Female  Submitted:2014-01-29, Days after onset: 27
Location:California  Entered:2014-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No only vaccines were given on that day
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Getting biopsy on bump
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0090981UNLA
Administered by: Unknown     Purchased by: Other
Symptoms: Erythema, Rash generalised, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Itchy red bumps all over her body! Given steroid pills, shot, creme for itching. Still on her body and it has been 1 month.

VAERS ID:521338 (history)  Vaccinated:2014-01-30
Age:17.0  Onset:2014-01-30, Days after vaccination: 0
Gender:Male  Submitted:2014-01-30, Days after onset: 0
Location:California  Entered:2014-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.517130SYRUN
Administered by: Private     Purchased by: Private
Symptoms: Seizure like phenomena
SMQs:, Convulsions (narrow)
Write-up: Seizure-like side effect about 10:15 (5 min) after vaccine was given. Pt was laid down and observed in knee-chest position for 15 - 20 min.

VAERS ID:521371 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:0000-00-00
Gender:Unknown  Submitted:2014-01-31
Location:Unknown  Entered:2014-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA014445
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report was received from a pharmacist via company representative refers to a 17 year old patient of unknown demography. On an unknown date the patient was vaccinated with PNEUMOVAX23 (dose and frequency was not reported). It was reported that the 17 year old patient has been receiving PNEUMOVAX23 every three years since an unspecified date. No adverse effect reported. Additional information has been requested.

VAERS ID:521434 (history)  Vaccinated:2013-09-24
Age:17.0  Onset:2013-09-25, Days after vaccination: 1
Gender:Female  Submitted:2014-01-31, Days after onset: 128
Location:Texas  Entered:2014-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Thalassemia
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA010428
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Dyspnoea, Influenza, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad)
Write-up: This spontaneous report as received from a consumer (patient''s mother) refers to a 17 year old female patient with thalassemia and no drug reactions or allergies. Concomitant medications were not specified by the reporter. On 24-SEP-2013 the patient was vaccinated with GARDASIL (lot number, expiration date, dose and strength were not reported) intramuscularly. On 25-SEP-2013 the patient developed flu, trouble breathing, fever, shakes and shivers. The patient went to the emergency room. On 26-SEP-2013 the patient recovered from the events. The patient sought medical attention - went to the emergency room at hospital, the patient was not hospitalized. The relatedness between the events and GARDASIL was not reported. Additional information is expected.

VAERS ID:521448 (history)  Vaccinated:2014-01-21
Age:17.0  Onset:2014-01-25, Days after vaccination: 4
Gender:Male  Submitted:2014-01-27, Days after onset: 2
Location:Maine  Entered:2014-01-31, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PROZAC; ADDERALL XR
Current Illness:
Preexisting Conditions: ADHD; depressive disorder
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK20642IN 
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis
SMQs:
Write-up: Pt received FLUMIST on 1/21/14 and developed nasal cellulitis on 1/26/14 and was treated.

VAERS ID:521627 (history)  Vaccinated:2014-01-27
Age:17.0  Onset:2014-01-27, Days after vaccination: 0
Gender:Female  Submitted:2014-01-27, Days after onset: 0
Location:Michigan  Entered:2014-02-03, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK20630IN 
Administered by: Private     Purchased by: Private
Symptoms: Expired drug administered
SMQs:
Write-up: Vaccine expired 1/20/2014; looked at vial but must not have registered the date - until writing down after given.

VAERS ID:521751 (history)  Vaccinated:2014-01-28
Age:17.0  Onset:2014-01-28, Days after vaccination: 0
Gender:Male  Submitted:2014-01-30, Days after onset: 2
Location:Ohio  Entered:2014-02-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VYVANSE; ALLEGRA
Current Illness: None
Preexisting Conditions: Seasonal allergic rhinitis; Eczema; ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4608A11IMLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Received Menactra approximately 10 AM on 1/28/14. Noted hives on legs later that evening. Gave Benadryl - hives improved. Hives became progressively worse over next 24-48 hrs.

VAERS ID:521781 (history)  Vaccinated:0000-00-00
Age:17.0  Onset:2012-06-30
Gender:Male  Submitted:2014-02-04, Days after onset: 584
Location:Unknown  Entered:2014-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrogen peroxide sol.
Current Illness: Pain; Puncture wound
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0964166A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Muscle tightness, Pleuritic pain, Tetanus
SMQs:, Dystonia (broad)
Write-up: This case was reported in a literature article and described the occurrence of tetanus in a 17-year-old male subject who was vaccinated with Diphtheria tetanus acellular pertussis, manufacturer unspecified). The subject''s ethnicity was stated and he was homeschooled at the time of the event. On 26 June 2012 he had stepped on a rusty boat anchor and sustained a puncture wound to his foot while working outdoors for a sailing program. He had cleaned the wound with hydrogen peroxide. He had experienced mild pain but no local erythema, swelling or drainage from the wound. No further information on his medical family history or concurrent medication is available. On an unspecified date, the subject might have received an unspecified dose of Diphtheria tetanus acellular pertussis (administration site and route unknown, batch number not provided) during childhood. However, there was no record of him receiving any vaccination in his school, primary care physician''s office or in the state immunisation registry. On 30 June 2012, at an unspecified time after vaccination with Diphtheria tetanus acellular pertussis, the subject experienced tightness of neck muscles and jaw. The symptoms had worsened during the day and he had developed pleuritic chest pain too. The subject was hospitalised for 5 days. No details of any laboratory tests or diagnostic procedures have been provided. Diagnosis was tetanus infection. Initial treatment consisted of wound cleaning and administration of 250 U of human tetanus immune globulin, tetanus toxoid vaccine, and 500 mg of metronidazole. He was then transferred to a tertiary medical centre where he received 2 mg of lorazepam and was admitted to the general paediatric ward. During his hospitalization there, he received 500 mg of metronidazole every 8 hours for 5 days and an additional 6000 U of human tetanus immune globulin. Outcome was complete recovery with discharge from the hospital without sequelae on 4 July 2012. The author''s conclusion stated that because immunization rates among homeschooled children are largely unknown, this population might be considered at higher risk for contracting more prevalent communicable vaccine preventable diseases.

VAERS ID:521842 (history)  Vaccinated:2014-01-30
Age:17.0  Onset:2014-01-30, Days after vaccination: 0
Gender:Female  Submitted:2014-02-04, Days after onset: 5
Location:Arizona  Entered:2014-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA000497
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.J007206 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: This spontaneous report as received from a licensed practical nurse refers to a 17 year old female patient. Pertinent medical history, drug allergies or reactions were not reported. On 30-JAN-2014, the patient was vaccinated with PROQUAD (Merck), 0.5 ml, subcutaneous (lot # reported as "J007206", expiry date: 20-DEC-2014) for prevention of measles, mumps, rubella and varicella. the nurse stated that the patient received PROQUAD (Merck) in place of MMR II and VARIVAX (Merck). No adverse event reported. Additional information is not expected.

VAERS ID:521917 (history)  Vaccinated:2013-11-25
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-05
Location:Indiana  Entered:2014-02-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine Hcl
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Noen
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0097881UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Continued tenderness left deltoid, no swelling or redness.

VAERS ID:521975 (history)  Vaccinated:2014-01-03
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-06
Location:Missouri  Entered:2014-02-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0035280SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

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