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Case Details (Sorted by Vaccination Date)

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VAERS ID:294043 (history)  Vaccinated:2007-10-17
Age:25.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-22, Days after onset: 4
Location:Minnesota  Entered:2007-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to Amoxicillin, Penicillin, Avelox, benzoin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS78749 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Depressed level of consciousness, Dizziness, Feeling of body temperature change, Headache
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Vaccine 10:30 a.m. on 10/17/07 "Could hardly wake up" on morning on 10/18/07. "It was like I took a sleeping pill, and I had a strange headache." felt hot and cold. (Did not take temperature.) "Dizzy" on 10/19/07 and stayed home from work. 10/22 at work and feels fine.

VAERS ID:294104 (history)  Vaccinated:2007-10-17
Age:4.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-10-17, Days after onset: 0
Location:Wisconsin  Entered:2007-10-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diamond - Blackfan anemia - Trisomy 15 - ASD - Aortic valve insufficiency. PMH: Trisomy 15, Diamond Blackfan anemia, severe developmental delay, s/p aortic valve insufficiency, ASD, club foot repair, hip dysplasia, ventriculomegaly, nasolacrimal duct obstructions, retinopathy of prematurity
Diagnostic Lab Data: Liver functions - Strep - CMP Panel; CBC; Glucose; Urinalysis (results enclosed). Labs and Diagnsotics: CMP and UA unremarkable. UC no growth. Rapid strep (-).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB206BA0UNRL
Administered by: Private     Purchased by: Private
Symptoms: Blood glucose, Culture urine negative, Decreased activity, Erythema, Full blood count, Hypersomnia, Lethargy, Listless, Liver function test, Metabolic function test normal, Pallor, Streptococcus identification test, Streptococcus identification test negative, Swelling face, Urine analysis normal, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Hospitalization - 3 hrs after immunization. Vomiting, lethargy. After 24 hrs - pt back to normal. 11/06/2007 MR received for o/n observation 10/16/2007 for c/o Lethargy and vomiting. Several hours after Hep A vax child developed redness and swelling of the R cheek. Activity level was decreased and pt slept during the day which is unusual for her. Later she appeared listless and pale. Taken to PCP office where she vomited several times. Admitted to hospital for observation. PE (+) for pallor.

VAERS ID:294106 (history)  Vaccinated:2007-10-17
Age:68.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-23, Days after onset: 5
Location:Michigan  Entered:2007-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: HTN, CAD, COPD, bladder CA, depression, thyroid, MI x2, AAA, smoker. Allergies: Wellbutrin. PCN.
Diagnostic Lab Data: Labs and Diagnostics: EKG WNL. CXR (+) for hyperinflation and flattening of the diaphragm suggestive of COPD. Troponin 1 (-)x3. Otherwise unremarkable.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA294EA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Blood pressure increased, Chest X-ray abnormal, Condition aggravated, Cough, Dizziness, Dyspnoea, Electrocardiogram normal, Erythema, Hypertension, Immunisation reaction, Incorrect route of drug administration, Injection site bruising, Injection site pain, Nausea, Pain in extremity, Troponin
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient presented a new rx for Prednisone on 10/21/07 and asked if I remembered giving her a flu shot on 10/17/07. She said the day after the shot she had bruising and tenderness at the site of injection. Two days after the shot the bruising worsened and the entire left arm was red. She was experiencing shortness of breath, light headness, and elevated blood pressure (178/91). Upon the urging of her daughter she went to the hospital ER on 7/19/07. The medical staff told her that I had hit a vein during the injection. She stayed in the hospital overnite and was treated with IV steroids. 11/09/2007 MR received for ER visit 10/19-20/2007 for c/o lightheadedness, nausea, and SOB and L arm pain. Pt had been experiencing nausea r/t "nerves, weakness, SOB-taking increased nebs, and cough x 1 week. Per pt sx worsened following flu shot. BP noted to be elevated in ER. Cardiac consult with impression: Nausea, SOB, lightheadedness. R/O 2'' to HTN vs influenza vaccine reaction. CAD with previous angioplasty x2. Cardiac status is stable and pt ok for D/C

VAERS ID:294109 (history)  Vaccinated:2007-10-17
Age:0.2  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-10-18, Days after onset: 1
Location:Massachusetts  Entered:2007-10-23, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B090BA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF064AA0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB08679K0IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1165F0PO 
Administered by: Private     Purchased by: Public
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)
Write-up: Inconsolable crying for 3 hours within 24 hours of administration

VAERS ID:294125 (history)  Vaccinated:2007-10-17
Age:35.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-10-18, Days after onset: 1
Location:Illinois  Entered:2007-10-23, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS99897 UNLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 10-17-07 Client received flu vaccine at 900 a.m. and started having swelling and redness and chills (did not take temp). Back of neck was hot. Had redness on abdomen and legs. Took 1 cap Benadryl. Redness and swelling were approx 1-2m above right elbow. 10/18/07 redness and swelling reported. 10/18/07 no chills.

VAERS ID:294138 (history)  Vaccinated:2007-10-17
Age:49.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-23, Days after onset: 5
Location:South Carolina  Entered:2007-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zovia (BCP)
Current Illness: None. I have not been sick in years.
Preexisting Conditions: Septra, Celebrex, Cefzil, Minocin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS804350IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Cough, Drug hypersensitivity, Headache, Malaise, Nasal congestion, Nasopharyngitis, Pain, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Hypersensitivity (narrow), Respiratory failure (broad)
Write-up: I developed respiratory symptoms within 48 hours (starting the evening of 10/18/2007)of receiving the vaccine. I am now on my 5th day of "cold-like" viral symptoms; e.g. coughing spasms, malaise, nasal congestion, headache, and achy feeling. I still have these symptoms presently.

VAERS ID:294190 (history)  Vaccinated:2007-10-17
Age:70.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:Wisconsin  Entered:2007-10-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2450AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1132U0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient complained of pain in arm and redness and heat down back of arm from shoulder to elbow.

VAERS ID:294192 (history)  Vaccinated:2007-10-17
Age:79.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:Wisconsin  Entered:2007-10-23, Days after submission: 4
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2464AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pain and redness - 4" x 2" area - located 1"-2" below injection site - (L) deltoid.

VAERS ID:294236 (history)  Vaccinated:2007-10-17
Age:0.5  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-10-22, Days after onset: 5
Location:Massachusetts  Entered:2007-10-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B127AA2UNRL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU245BA0UNRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF192AA2UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB47300F2UNRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0408U2PO 
Administered by: Private     Purchased by: Public
Symptoms: Abdominal X-ray, Abdominal pain, Barium enema, Blood alkaline phosphatase increased, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Monocyte percentage increased, Neutrophil percentage increased, Oral intake reduced, Platelet count increased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Urine analysis normal, Vomiting
SMQs:, Liver related investigations, signs and symptoms (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow)
Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

VAERS ID:294242 (history)  Vaccinated:2007-10-17
Age:30.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-10-18, Days after onset: 1
Location:Michigan  Entered:2007-10-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Lexapro, Acyclovir, Birth Control Pills
Current Illness: None
Preexisting Conditions: Lupus
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2440AA1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chest pain, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Client received flu vaccine at Emergency Management Drill. She reported no hx of egg or latex allergy and no reaction from previous flu shots. She did report being allergic to sulfa and augmentin. She was instructed to wait 15" after vaccine, but chose to drove off. She then developed SOB, chest pain, and nausea, and returned to clinic site. She was then transported to ER by ambulance, where she received Epinephrine and oral steroids. She was d/c''d from ER after 45 minutes.

VAERS ID:294270 (history)  Vaccinated:2007-10-17
Age:68.0  Onset:2007-10-19, Days after vaccination: 2
Gender:Male  Submitted:2007-10-24, Days after onset: 5
Location:Washington  Entered:2007-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vasotec 20 mg/day
Current Illness: none
Preexisting Conditions: sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURTX 1845211 IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Chills, Headache, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: 2 days after Fluzone was given I developed severe chills and fever and severs uncontrolable shaking of my head, upper limbs, and headache. the next day the symptoms were gone. I am a retired physician and in good health and feel the the above was directly related to the fluzone.

VAERS ID:294280 (history)  Vaccinated:2007-10-17
Age:69.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-10-24, Days after onset: 7
Location:Illinois  Entered:2007-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid
Current Illness: no
Preexisting Conditions: hypothyroid
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0958F1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Injection site pain, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)
Write-up: fever 101. for 48 hours not relieved by asprin. Pain at RT Deltoid site lasting for 48 hours. Palpatations, difficulty breathing on onset lasting for 3-4 hours. Condition resolve after 50 hours.

VAERS ID:294304 (history)  Vaccinated:2007-10-17
Age:10.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Male  Submitted:2007-10-24, Days after onset: 6
Location:New Hampshire  Entered:2007-10-24
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: NH0742
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2507AA3IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSB186BO0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0781V1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 6" diameter area of induration, tenderness at site of Varivax #2 shot 18-48 hours afterward.

VAERS ID:296590 (history)  Vaccinated:2007-10-17
Age:65.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-11-05, Days after onset: 19
Location:Michigan  Entered:2007-11-13, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2505AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0061U0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling of right arm, pain. Patient became lethargic.

VAERS ID:296627 (history)  Vaccinated:2007-10-17
Age:72.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-11-09, Days after onset: 23
Location:Kansas  Entered:2007-11-14, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DIOVAN; ENALAPRIL; SYNTHROID; VITORIN; DICLOFENAC; NASONEX
Current Illness:
Preexisting Conditions: The patient was allergic to Darvocet, Percocet, codeine, streptomycin and Sporanox. Concomitant medications were Diovan, enalapril, Synthroid, Vitorin, diclofenac and Nasonex; however, indication were not reported. The patient denied having any illness at the time of vaccination and denied receiving any other vaccines on 17 October 2007. She also denied receiving any other vaccinat
Diagnostic Lab Data: Normal results for chest x-ray, EKG, CT scan and blood work.
CDC Split Type: 200703697
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNLA
Administered by: Public     Purchased by: Other
Symptoms: Blood test normal, Chest X-ray normal, Computerised tomogram, Cough, Dyspnoea, Electrocardiogram normal, Vaccine positive rechallenge, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Initial report received from a patient on 01 November 2007. A 73-year-old female with history of allergies to multiple medications had received a left deltoid injection of Fluzone SV 2007-2008 (lot number and route of administration unknown) on 17 October 2007. Soon after (exact date not reported), the patient experienced difficulty breathing that worsened over the next two weeks. The patient also had wheezing and a cough. On 28 October 2007, the patient went to the emergency room where results were normal for a chest x-ray, EKG, CT scan and blood work. The patient was discharged from the emergency room and was subsequently seen by her physician who ordered prednisone. At the time of the report, the patient indicated that she was still very short of breath with coughing and wheezing, but also stated that it was improving. The patient reported having the same symptoms last year after receiving a flu vaccine (unknown brand) at the same location. The patient was scheduled to follow-up with her physician on 05 November 2007. The reporter of this case is the same as for case 2007-03698, which involves difficulty breathing, cough and wheezing experienced by the same patient last year following receipt of a flu vaccine (unknown brand).

VAERS ID:296845 (history)  Vaccinated:2007-10-17
Age:52.0  Onset:0000-00-00
Gender:Male  Submitted:2007-11-15
Location:Oklahoma  Entered:2007-11-15
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone+salmeterol; Salbutamol sulphate; Naproxen
Current Illness: Unknown
Preexisting Conditions: Asthma; Disc Herniation
Diagnostic Lab Data: UNK
CDC Split Type: A0694604A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA307DA UNUN
Administered by: Public     Purchased by: Other
Symptoms: Drug administered at inappropriate site, Injected limb mobility decreased, Pain
SMQs:
Write-up: This case was reported by a consumer and described the occurrence of pain in a 52-year-old male subject who was vaccinated with (Fluarix, GlaxoSmithKline) for prophylaxis. The reporter is the wife of the subject. A physician or other health care professional has not verified this report. The subject''s medical history included asthma and disc herniation. Concurrent medications included Fluticasone propionate+salmeterol xinafoate (Advair), Salbutamol sulphate (Albuterol) and Naproxen. The subject had received influenza virus vaccine in previous years and experienced minor soreness at injection site. The subject had no adverse events following receipt of any other type of immunizations. On 17 October 2007 at 1:12 p.m., the subject received unspecified dose of Fluarix. The consumer reported that the subject inadvertently received this dose of Fluarix in the "joint space of the shoulder instead of the deltoid." As a result of this inadvertent administration into the joint space of the shoulder, the subject experienced drug administered at inappropriate site. The consumer reported on 09 November 2007, that the initial reaction was severe pain followed by barely being able to move the arm. The reporter also noted that the subject "Was initially put on light duty at work." The date of onset of these adverse events was not reported. The subject was seen at a physician''s office. The consumer considered the events to be disabling and to jeopardize the subject or require intervention. At the time of reporting the pain and difficulty moving the arm were unresolved.

VAERS ID:296860 (history)  Vaccinated:2007-10-17
Age:60.0  Onset:2007-10-25, Days after vaccination: 8
Gender:Female  Submitted:2007-11-06, Days after onset: 12
Location:Ohio  Entered:2007-11-15, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Heart attack May 26, 07 1/15/08-records received-PMH: acute myocardial infarction, percutaneous transluminal coronary angioplasty stent. Gastroesophegeal reflux, cholecystectomy.
Diagnostic Lab Data: All testing, blood work etc. once again could not find anything wrong 1/15/08-records received-EKG: normal sinus rhythm. WBC 12.7. Echocardiography, left ventricular systolic function is low normal to mildy reduced. Ejection fraction 50-55%, trivial pericardial effusion. troponin 0.06
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Blood test normal, Chest discomfort, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram normal, Mobility decreased, Pain in jaw, Pericardial effusion, Sinus rhythm, Troponin, Urticaria, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Hives, felt like I could not breathe. It was very difficult to do anything. Could not bend forward, lay down in bed (flat), could not turn to my right side or left side in bed. Sitting up was an effort. I have allergic reactions to meds. Told ER I thought this was all from the "PPV" shot. 1/15/08-rcords received for DOS 11/26-11/27/07-Seen in ED for C/O sudden onset of substernal pain radiation to jaw, chest heaviness. No nausea no vomiting. Pain increased with movement including laying down and moving the chest. Impresssion: atypical chest pain rule out myocardial infarction. Follow-up: Back to the hospital 11/25/07. Many tests - same as hospital stay. Put me back on med pack last for 5 days. Have had every symptom of pneumonia. After 2 months I''m still having problems. My family Dr. and 2 heart Dr.''s agree all problems point to pnuemonia vaccine.

VAERS ID:296891 (history)  Vaccinated:2007-10-17
Age:0.7  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-10-17, Days after onset: 0
Location:Arizona  Entered:2007-11-15, Days after submission: 29
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:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, Medication error, Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Maculopapular rash - face. No fever, no respiratory or circulatory compromise.

VAERS ID:296956 (history)  Vaccinated:2007-10-17
Age:62.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-11-06, Days after onset: 19
Location:California  Entered:2007-11-15, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: asthma - sulfa drug - aspirin- laminaria - keratoconus
Diagnostic Lab Data: EKG; Mammogram; CAT SCAN twice - Chest Xray - Sonargram; Blood drawn 3 times
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS798980UNUN
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Blood test, Chest X-ray, Chest pain, Computerised tomogram, Electrocardiogram, Mammogram, Muscle spasms, Ultrasound scan
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: extreme back pain so severe went to ER: extreme chest pain so severe went to ER; continuing pain and muscle spasms for nearly 3 weeks; continued testing, medication, and phy. visits; off of work on sick LEAVE (necessary

VAERS ID:299675 (history)  Vaccinated:2007-10-17
Age:14.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-11-14, Days after onset: 28
Location:North Carolina  Entered:2007-11-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None; Asthma; Hypersensitivity
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA04833
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMAR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNAR
Administered by: Other     Purchased by: Other
Symptoms: Injection site urticaria, Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: This is in follow-up to report(s) previously submitted on 11/14/2007. Information has been received from a pharmacist concerning a 14 year old female with a history of asthma and multiple allergies (dust mites, grass, weeds, and others) who on 14-OCT-2007 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Concomitant therapy included influenza virus vaccine (unspecified) and meningococcal ACYW conj vaccine (dip toxoid) (MENACTRA) in the other deltoid. On 17-OCT-2007 the patient experienced a minor rash. On 18-OCT-2007 the rash increased to go all over the patient''s body and she was given Benadryl. The hives were reappearing on and off by day 5. On 19-Oct-2007 the patient was ok, however later that evening the patient got hives and took BENADRYL again. The patient was taken to the pediatirician on 20-Oct-2007 and was told to take BENADRYL "around the clock". On 22-OCT-2007 the patient got hives again, and one big hive, "the size of a pencil eraser" appeared at the injection site. After an additional dose of BENADRYL, the hives resolved. MENACTRA and flu vaccines were administered in the other deltoid at the same visit. The patient has not been tested for any yeast allergies. Additional information has been requested.

VAERS ID:299754 (history)  Vaccinated:2007-10-17
Age:20.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2008-01-07, Days after onset: 82
Location:Connecticut  Entered:2007-11-15, Days after submission: 53
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: Syncope vasovagal
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA05702
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1061U0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Dyskinesia, Head injury, Hyperhidrosis, Loss of consciousness, Pallor
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), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a health professional concerning a 20 year old female with a history of syncope vasovagal, "patient has passed out seven times in her life", who on 17-OCT-2007 was vaccinated with the first dose of Gardasil vaccine. Shortly after the vaccination the patient passed out. The patient remained unconscious for approximately one minute. The same day the patient felt light-headed and she had a decreased in her blood pressure. Unknown medical attention was sought. The patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. This is in follow-up to report(s) previously submitted on 11/14/2007. Information has been received from a health professional concerning a 21 year old female with a history of syncope vasovagal who on 17-OCT-2007 was vaccinated with the first dose of GARDASIL. Shortly after the vaccination the patient became lightheaded and passed out in the mid sentence. Hit her head, became very pale. Started jerking movements as if it was a seizure. She was sweating. Blood pressure went low and very hard to sit and back up again without being dizzy. Medical attention was sought. The patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.

VAERS ID:298533 (history)  Vaccinated:2007-10-17
Age:50.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-31, Days after onset: 13
Location:Florida  Entered:2007-12-03, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Allegra, prednisone, Zyrtec, benazapril
Current Illness: None
Preexisting Conditions: allergic rhinitis, HTN, contact dermatitis
Diagnostic Lab Data: skin allergy test
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2457HA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Skin test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Developed hives after receiving the flu vaccine. Has hx of allergy to thimerosal, no allergy to egg/egg products.

VAERS ID:298967 (history)  Vaccinated:2007-10-17
Age:85.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-11-14, Days after onset: 28
Location:Wisconsin  Entered:2007-12-06, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: To use heat or ice 3-4 x 1 day No marks, redness, swelling, nodules
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS80062 UNRA
Administered by: Other     Purchased by: Unknown
Symptoms: Hypokinesia, Injected limb mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: Had significant pain in arm 1st few days after vaccine administered. Pain continues like "dull tooth ache deep down to bone" intermittently and when present affects ability to raise arm (right). She was instructed to see MD

VAERS ID:300513 (history)  Vaccinated:2007-10-17
Age:25.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-12-14, Days after onset: 58
Location:New Jersey  Entered:2007-12-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA03914
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1263U0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Incorrect route of drug administration, Injection site reaction, Pain, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Information has been received from a licensed practical nurse concerning 4 females (age not reported) with no pertinent medical history or drug reactions/allergies who on an unspecified date were vaccinated with Gardasil (lot # unknown). There was no concomitant medication. The nurse reported that 4 patients received Gardasil due to a nursing error. Each patient received 0.25 mL dose of Gardasil given subcutaneously near the wrist on 17-Oct-2007. The person who administered the doses split a 0.5 mL dose of Gardasil equally among the 4 patients. They were supposed to receive a tuberculin test. The day after administration, each patient developed an injection site reaction right above the wrist. The injection site was red, hard to the touch and painful. One of these patients was seen by the nurse and the other 3 patients called her office. Medical attention was sought. At the time of reporting the patient had not recovered. Follow-up information was received. A 25 year old white female patient who on 17-Oct-2007 was vaccinated with Gardasil (lot #658282/1263U). On 18-Oct-2007 the patient was given a 1/4 dose of Gardasil by mistake. The patient was to receive a tuberculin test instead. On an unspecified date one week later the patient recovered. Follow-up information was received from a licensed practical nurse. The LPN reported that one vial of purified protein derivative (PPD) was delivered to one office one day. On the following day one vial of Gardasil was delivered to the same office. The medical assistant who was located in the office, in error drew the medication that would be used for the PPD test from the Gardasil vial instead of the prescribed PPD vial. The LPN stated that the error was not due to Product Confusion. As a result of this error, the Gardasil vaccination would only be administered at another office and not in the current office to assure that this error would not occur again. The patient that received Gardasil was treated with cold/warm compresses and recovered. Addition

VAERS ID:302186 (history)  Vaccinated:2007-10-17
Age:76.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-12-21, Days after onset: 65
Location:Arizona  Entered:2007-12-28, Days after submission: 7
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: None
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA03785
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Information has been received from a patient who was vaccinated with a dose of varicella virus vaccine live (Oka/Merck). It was reported that the patient was vaccinated for prevention of shingles. A product quality complaint was not involved. Additional information has been requested. 05/16/2008 Information has been received from a patient with no pre-existing allergies, birth defects or medical conditions, who on 17-OCT-2007 was vaccinated with a dose of VARIVAX (Oka/Merck). It was reported that the patient was vaccinated for prevention of shingles. There was no relevant diagnostic tests and laboratory data. There were no adverse events following prior vaccination. There was no illness at time of vaccination. There was no adverse experience. A product quality complaint was not involved. Additional information has been requested. Follow-up information was received from a physician indicating that the patient called his office greatly concerned about the varicella injection he had received. He stated the shot he received was called ZOSTAVAX (Oka/Merck). He expressed his frustration about the error and wanted answers. The physician explained that the varicella vaccine he received was actually ordered for another patient who was scheduled for an appointment that day. When this patient walked in on their busiest day of the week without an appointment, wanting the shot right then, he was inadvertently confused with the other patient. The office did their best to accomodate the patient. The physician told the patient that it was not usual and customary to drop in a medical office without an appointment, for routine medical care. The patient was overly concerned that it would cause harm to him. The physician explained that "shingles" is cause by the varicella virus, the same virus that causes chickenpox. The vaccine ZOSTAVAX (Oka/Merck) is actually a boosted dose of the chickenpox vaccine currently given to children. The physician told the patient that since he had the chickenpox and the vaccines in the past, it should not cause an adverse effect on him. The physician informed the patient that he would call the manufacturer to confirm that information. He patient indicated that he already called but would do more research to find out himself. The physician indicated to the patient that he did not carry ZOSTAVAX (Oka/Merck) and that he would have to obtain it elsewhere. The patient indicated that he already scheduled an appointment with his wife''s physician. The patient indicated that he was "sorry that he had to turn him into the insurance company". The patient expressed gratitude for all the previous medical care the physician rendered and requested that the physician forward the patient''s medical record to the other physician. No other information was provided.

VAERS ID:302187 (history)  Vaccinated:2007-10-17
Age:  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-12-21, Days after onset: 65
Location:Unknown  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA03816
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Varicella
SMQs:
Write-up: Information has been received from a consumer regarding a female patient who on 17-OCT-2007 was vaccinated with a 0.65 ml dose of ZOSTAVAX. On approximately 17-OCT-2007 the patient developed chicken pox. The consumer could not tell how may lesions there were. It was unknown whether medical attention was sought. The outcome was unknown. There was no product quality complaint. No further information is available.

VAERS ID:302206 (history)  Vaccinated:2007-10-17
Age:77.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-12-21, Days after onset: 64
Location:Unknown  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA03969
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0744U UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Information has been received from a registered nurse concerning a 77 year old female who on 17-OCT-2007 was vaccinated with one 0.65 ml dose of ZOSTAVAX (Oka/Merck) (lot# 658082/0744U). On 18-OCT-2007 the patient experienced 3 blisters, one close to the injection site, one on both her left and right arm. The right ring finger blister was described as a scaly patch. The patient called the physician''s office for medical attention. "The spots have all since cleared up therefore no sample will not be sent." The patient was recovered. There was no product quality complaint. Additional information has been requested.

VAERS ID:302209 (history)  Vaccinated:2007-10-17
Age:40.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-12-21, Days after onset: 65
Location:Oklahoma  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Shingles
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA04010
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Inappropriate schedule of drug administration, Injection site erythema
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: Information has been received from a medical assistant concerning an approximately 40 year old female with a history of recurring shingles who on 17-OCT-2007 was vaccinated with a dose of ZOSTAVAX. It was noted that the patient did not have an active case of shingles at the time of vaccination. On 18-OCT-2007 the patient experienced redness at the injection site and some dizziness. Subsequently, the patient recovered. Unspecified medial attention was ought. No product quality complaint was involved. Additional information has been requested.

VAERS ID:302215 (history)  Vaccinated:2007-10-17
Age:63.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-12-21, Days after onset: 65
Location:North Carolina  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA04263
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0620U0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a 63 year old female consumer with a penicillin allergy and no other pertinent medical history who on 17-OCT-2007 was vaccinated in the left arm with a dose of ZOSTAVAX. Concomitant therapy included SYNTHROID, meloxicam, an unspecified medication for "when your arteries get clogged up" and vitamins (unspecified). Subsequently the injection site became reddish, the area was the size of a quarter. Medical attention was not sought. There were no lab studies performed. At the time of the report the patient had not recovered. There was no product quality complaint involved. No further information was provided. Additional information has been requested. This is in follow-up to report(s) preciously submitted 12/21/2007. Information has been received from a 63 year old female consumer with a PENICILLIN allergy and no other partinent medical history who on 17-OCT-2007 was vaccinated in the left arm with a dose of ZOSTAVAX (Merck). Concomitant therapy included SYNTHROID, MELOXICAM, an unspecified medication for "when your arteries get clogged up" and vitamins (unspecified). Subsequently the injection site became reddish, the area was the size of a quarter. Medical attention was not sought. There were no lab studies performed. At the time of the report the patient had not recovered. There was no product quality complaint involved. No further information was provided. Follow-up information was received from someone in the physician''s office. The patient was vaccination IM in the left deltoid with a first dose of ZOSTAVAX (Merk) (lot #657766/0920U) on 17-OCT-2007. Subsequently the patient developed a red reaction the size of a 50 cent piece. The patient''s outcome was not reported. No further information was provided. Additional information has been requested.

VAERS ID:302287 (history)  Vaccinated:2007-10-17
Age:60.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-12-21, Days after onset: 64
Location:New Hampshire  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Medical History: Sulfonamide allergy; Allergic reaction to antibiotics; Hypertension; Asthma; Cholesterol high; birth defects
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA06054
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0888U UNRA
Administered by: Private     Purchased by: Other
Symptoms: Blister, Erythema induratum, No reaction on previous exposure to drug, Skin warm, Tenderness
SMQs:, Severe cutaneous adverse reactions (broad), Vasculitis (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a nurse practitioner concerning a 60 year old female with preexisting allergies, birth defects, and medical conditions to sulfonamide allergy, allergic reaction to antibiotics such as Keflex and Terramycin, hypertension, asthma and high cholesterol who on 17-OCT-2007 was vaccinated in the right deltoid with a dose of zoster vaccine live (Oka/Merck) (lot number: 658084/08880). There was no concomitant medication. There was no illness at time of vaccination. There was no adverse events following prior vaccination. There were no relevant diagnostic test and laboratory data. On 19-OCT-2007, the patient experienced circular erythematous induration with vesicular lesions in the center 232 mm in size with mild pink peri-induration, warmth with mild tenderness. Additional information has been requested.

VAERS ID:302355 (history)  Vaccinated:2007-10-17
Age:65.0  Onset:2007-10-22, Days after vaccination: 5
Gender:Male  Submitted:2007-12-21, Days after onset: 60
Location:Kansas  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0711USA01594
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0620U SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a nurse concerning a 65 year old white male patient with no known drug allergies or illnesses at the time of vaccination who on 17-OCT-2007 was vaccinated subcutaneously in the left deltoid with the first dose of ZOSTAVAX (Oka/Merck) (Lot # 657766/0620U). Concomitant vaccination included sterile diluent (Lot #3035U). The reporter indicated that the patient complained of rash on legs beginning on 27-Oct-2007. The rash was mildly itchy, non-tender, but the patient knew they were there. There was no rash at the site of injection. There were four scattered light erythematous papules on his leg. There was no discharge or vesicles noted. No laboratory diagnostic tests were performed. The patient outcome is recovered. It was noted that on 18-SEP-2007, the patient was vaccinated with the first dose of Pneumovax (Lot # 657526/0555U). No reaction was attributed to any of the vaccines. Follow-up information has been received from a registered nurse indicating that the patient only received one dose of Pneumovax (MSD) (lot # 657526/0555U) on 18-SEP-2007 and no previous vaccinations were given of this vaccine as previously reported. The adverse events resolved (no dates provided). The treating physician did not consider the events to be related to any of the therapies (zoster vaccine live (Oka/Merck), sterile diluent or Pneumovax). No further information is available. This is in follow-up to report previously submitted on 12/21/2007. This is an amended report. One dose of pneumococcal 14v polysaccharide vaccine now reads pneumococcal 23v polysaccharide vaccine (MSD) (lot # 657526/0555U) instead of pneumococcal 14v polysaccharide vaccine (MSD). No further information is available.

VAERS ID:302395 (history)  Vaccinated:2007-10-17
Age:60.0  Onset:0000-00-00
Gender:Female  Submitted:2007-12-21
Location:Kentucky  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness: Concurrent Conditions: Penicillin allergy; Shellfish allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA02549
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Lip swelling, Pharyngeal oedema, Rash, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from an approximately 60 year old female consumer with allergies to penicillin and shellfish (crab meat), who on 17-OCT-2007 was vaccinated with a dose of zoster vaccine live (Oka/Merck). Concomitant drug therapy included other unspecified medications, but no new medications. Subsequently, the patient developed lip swelling, throat swelling, a rash on her chin and irritation in her mouth. Medical attention was sought in the physician''s office on 12-NOV-2007. The patient was treated with Valtrex. The patient was not recovered at the time of this report. There was no product quality complaint. It was noted that the patient was scheduled for a follow-up visit with her health care provider on 14-NOV-2007. Additional information has been requested.

VAERS ID:301421 (history)  Vaccinated:2007-10-17
Age:0.2  Onset:2007-10-20, Days after vaccination: 3
Gender:Female  Submitted:2007-12-27, Days after onset: 68
Location:Arizona  Entered:2008-01-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: Eczema
Preexisting Conditions: GERD
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2762AA0IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0016U0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA011120SCLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB070280IMRL
Administered by: Private     Purchased by: Public
Symptoms: Abnormal behaviour, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Within 24 hrs reported-acting "zonedout" quiet with Tylenol given 48 hrs after went to ER with hives (Lasting 4 hours given Atarax) Specific onset unknown

VAERS ID:303386 (history)  Vaccinated:2007-10-17
Age:  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-10-17, Days after onset: 0
Location:Unknown  Entered:2008-01-23, Days after submission: 98
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) (FLUZONE)SANOFI PASTEURU2524AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Patient came back with rash on hands after 1/2 hr. and complain about having nausea after 1 & 1/2 hr. (90 minutes).

VAERS ID:306612 (history)  Vaccinated:2007-10-17
Age:4.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Male  Submitted:2007-10-17, Days after onset: 0
Location:New York  Entered:2008-03-06, Days after submission: 141
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2607AA IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0170 IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0281U SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1324U SCLA
Administered by: Private     Purchased by: Public
Symptoms: Dyspnoea, Eye swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt developed swollen eyelid with breathing difficulty.

VAERS ID:306833 (history)  Vaccinated:2007-10-17
Age:3.0  Onset:2007-12-13, Days after vaccination: 57
Gender:Male  Submitted:2008-03-05, Days after onset: 83
Location:Colorado  Entered:2008-03-11, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Serial Platelet Counts. 3/24/08-records received- WBC 4.0. Peripheral blood smear shows normochromic normocytic Red cells with normal numbers. Morphology of white cells with many atypical lymphoctyes. Visual acuity exam 28/6/08- 20/30 each
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA4UNRL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2437AA2UNLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB182AA1UNLL
Administered by: Private     Purchased by: Private
Symptoms: Contusion, Epistaxis, Hypermetropia, Idiopathic thrombocytopenic purpura, Lymphocyte morphology abnormal, Petechiae, Platelet count decreased, Visual acuity tests normal, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Malignant lymphomas (broad)
Write-up: Petechia and Bruising - idiopathic Thrombocytopenia; 12/13/07 Platelets 5,000; 2/27/08 Platelets 276,000; no medications 3/24/08-records received-Consultation report for 12/14/07-Assessment:ITP platelet count of 4000 with skin bleeding. Bruises for 1 weeks and nose bleeds on and off for past week. Petechia.

VAERS ID:309840 (history)  Vaccinated:2007-10-17
Age:64.0  Onset:2007-10-24, Days after vaccination: 7
Gender:Female  Submitted:2008-03-26, Days after onset: 154
Location:California  Entered:2008-04-16, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hyperlipidaemia; Rhinitis allergic; Osteoarthritis; Irritable bowel syndrome; Cervical disc degeneration; Glucose intolerance; Drug hypersensitivity.
Diagnostic Lab Data: None
CDC Split Type: WAES0712USA06536
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0882U UNUN
Administered by: Other     Purchased by: Other
Symptoms: Varicella
SMQs:
Write-up: Information has been received from a physician concerning a 64 year old female with a history of hyperlipidaemia, allergic rhinitis, osteoarthritis, irritable bowel syndrome, cervical disc degeneration disease, glucose intolerance and drug reactions/allergies to anesthetics, who on 17-OCT-2007 was vaccinated with a dose of ZOSTAVAX (lot number: 658085/0882U). Concomitant therapy included multi-vitamins daily, calcium 600mg twice daily, vitamin D 400 IU daily, cyanocobalamin 500mg daily, ibuprofen as needed and "amitriptyline" 10mg daily. On 24-OCT-2007 the patient developed varicella lesions on both her thighs and legs after receiving the vaccine. No further information was available. There were no lab diagnostic studies performed. Unspecified medical attention was sought via the telephone. The outcome was reported as recovering. There was no product quality complaint. The physician is not interested in the VZV analysis by PCR (Polymerase Chain Reaction). Additional information has been requested.

VAERS ID:316849 (history)  Vaccinated:2007-10-17
Age:19.0  Onset:2007-10-21, Days after vaccination: 4
Gender:Female  Submitted:2008-06-13, Days after onset: 236
Location:Pennsylvania  Entered:2008-06-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ascorbic acid; cyanobobaalamin; YAZ; iron (unspecified); omega-3 marine triglyercides
Current Illness: Pregnancy NOS (LMP = 2/21/2008); Asthma; Scoliosis
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0805USA02878
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Menstruation irregular, Metrorrhagia, Ultrasound scan
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Fertility disorders (broad)
Write-up: Information has been received from a Licensed Practical Nurse for the Pregnancy Registry for GARDASIL, concerning her 19 year old daughter with asthma and scoliosis who on 17-OCT-2007 was vaccinated intramuscularly with a first dose of GARDASIL (lot # not reported). The nurse reported that her daughter received her first dose of GARDASIL and afterwards experienced irregular period with spotting. On 23-JAN-2008 the patient was vaccinated intramuscularly with her second dose of GARDASIL (lot # not reported) and the patient reported that her period was "not right". The patient believes her LMP was 21-FEB-2008. Concomitant therapy included YAZ, ascorbic acid, cyanocobalamin, omega-3 marine triglycerides and iron (unspecified). The patient also reported that she took YAZ at night time and she forgot to take it one night but then took it the next morning. The patient''s mother believes that the birth control failed because of GARDASIL. The mother also reported that the patient was taking YAZ while she was pregnant. An ultrasound on 13-MAY-2008 showed that the patient was 8 weeks 4 days pregnant. Additional information has been requested.

VAERS ID:317539 (history)  Vaccinated:2007-10-17
Age:14.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2008-06-25, Days after onset: 252
Location:Maryland  Entered:2008-06-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy NOS (LMP = 6/30/2007); Rhinitis allergic
Preexisting Conditions: Tinea versicolour
Diagnostic Lab Data: ultrasound, 01/02/08, single live, intra-uterine pregnancy of 26wks; ultrasound, 01/11/08, follow up - normal progression of pregnancy; urine beta-human, 11/02/07, positive
CDC Split Type: WAES0711USA00896
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0515U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Caesarean section, Drug exposure during pregnancy, Foetal movements decreased, Hypertension, Pyrexia, Ultrasound scan, Urine human chorionic gonadotropin positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tumour markers (narrow), Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Initial and follow up information has been received from a registered nurse through the Pregnancy Registry for GARDASIL concerning a 14 year old female with a history of tinea versicolour and allergic rhinitis who on 17-OCT-2007 was vaccinated with her first dose of GARDASIL IM (lot# 657872/0515U) and was pregnant. Concomitant therapy included CLARITIN as needed for nasal symptoms. The patient sought unspecified medical attention in the office on 01-NOV-2007. On 02-NOV-2007 the patient had a positive urine pregnancy test (LMP reported as end of June 2007). The patient will be followed by her pediatrician. On 02-JAN-2008 the patient had an ultrasound which showed a single live intra-uterine pregnancy of 26 weeks. It was suggested she have another ultrasound for fetal anatomy. On 11-JAN-2008 the patient had a follow up ultrasound which showed normal progression of pregnancy. On 08-APR-2008, the patient had a fever of 102.5 and hypertension. It was also reported that the patient received prenatal care late. On 08-APR-2008 (39 weeks from LMP) the patient delivered a female infant weighing 6lbs. 8oz. There was "decreased fetal movement" detected and a caesarean section was performed. The child was sent to the NICU after delivery, the nurse suggested that it might have been precautionary, given the mother''s health problems before delivery. The child being sent to the NICU after delivery and and decreased fetal movement were considered to be an other important medical event. Additional information has been requested. Initial information and follow up has been received from a nurse for the Pregnancy Registry for GARDASIL concerning a 14 year old female with a history of tinea versicolour and allergic rhinitis who on 17-OCT-2007 was vaccinated with her first dose of GARDASIL IM (lot# 657872/0515U) and was pregnant. Concomitant therapy included CLARITIN as needed for nasal symptoms. The patient sought unspecified medical attention in the office on 01-NOV-2007. On 02-NOV-2007 the patient had a positive urine pregnancy test (LMP reported as end of June 2007). The patient will be followed by her pediatrician. On 02-JAN-2008 the pateint had an ultrasound which showed a single live intra-uterine pregnancy of 26 weeks. It was suggested hse have another ultrasound for fetal anatomy. On 11-JAN-2008 the patient had a follow up ultrasound which showed normal progression of pregnancy. Subsequently, on 08-APR-2008 (39 weeks from LMP) the patient delievered a female infant weighing 6lbs. 8oz. The child was sent to the NICU after delivery for unknown reasume. On 08-APR-2008 the patient had a fever of 102.5 and hypertension. It was also reported that the patient received prenatal care late. The child being sent to the NICU after delivery was considered to be an other important medical event. Additional information has been requested.

VAERS ID:344932 (history)  Vaccinated:2007-10-17
Age:40.0  Onset:2007-11-01, Days after vaccination: 15
Gender:Male  Submitted:2009-04-27, Days after onset: 543
Location:California  Entered:2009-04-27
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole , Simvastatin. 5/28/09 Medical records received DOS 3/11/08 to 2/2/09. omeprazole, simvastin, clonazepam, acetaminophen, corticosteroids. Medical records received DOS 3/11/08 to 2/2/09. Prenisone eye drops, ibuprofen.
Current Illness: Hyperlipidemia , GERD
Preexisting Conditions: Medical records received DOS 3/11/08 to 2/2/09. Orchidectomy for undescended testicle. 6/8/09 Hospital record (Multiple Sclerosis Center) received DOS 4/1/09. Uveitis, Mycarditis.
Diagnostic Lab Data: Lumbar puncture 2 times within 9 months interval was negative for possible MS panel. Four more Brain MRIs were negative for new lesions. EMG and NCV were Normal. Visual evoked potential was normal. Lumbar puncture did not show any elevated
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS208326481IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Asthenia, CSF protein normal, CSF white blood cell count negative, Demyelination, Dyspnoea, Electrocardiogram ambulatory abnormal, Electromyogram normal, Extremity contracture, Hypoaesthesia, Lumbar puncture normal, Motor dysfunction, Muscle twitching, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain abnormal, Spine malformation, Tachycardia, Ventricular extrasystoles, Visual evoked potentials normal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Congenital, familial and genetic disorders (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Demyelination (narrow)
Write-up: After I received the flu shot I developed sever numbness on my extremities witihn 2-3 weeks. After that I developed severe weakness, loss of motor power mostly on the right hand and leg, tachycardia, sever muscle twitches, contracture on right lower extremity, difficulty breathing because of tachycardia. I was diagnosed as Acute dissemintaed encephalomyelitis (ADEM) and my Brain MRI showed diffuse demyelinization of the brain. I recovered mostly. I report this after I finished my follow up with neurology departmnts to make sure it is not a presentation of MS. I received 2 courses of steroids meanwhile that was not helpful. I still have numbness on my right leg and foot and muscle twitches. 5/28/09 Medical records received DOS 3/11/08 to 2/2/09. FINAL DIAGNOSIS: Acute disseminated encephalomyelitis, cervical stenosis. Post vaccination presented with numbness of hands feet face. Generalized weakness and fatigue. Shortness of breath, tachycardia, PVCs. Multifocal muscle twitching. 6/8/09 Hospital record (Multiple Sclerosis Center) received DOS 4/1/09. FINAL DIAGNOSIS: Acute disseminated encephalomyelitis, cervical stenosis. Follow up exam received. No new codes other than patient reports uveitis treated with prednisone eye drops in June 2008 and pericarditis treated with ibuprofen in July 2008./ksk

VAERS ID:384048 (history)  Vaccinated:2007-10-17
Age:62.0  Onset:2009-11-25, Days after vaccination: 770
Gender:Female  Submitted:2010-04-01, Days after onset: 126
Location:Tennessee  Entered:2010-04-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 37 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Inderal every day, Elavil 25mg/3 times day, verapamil 80 mg/2 times a day Darvocet for headaches, Vytorin 10-20 mg daily, Trilitix 135 mg/daily hydrocodeine 500mg 1-3 times a day.
Current Illness: None
Preexisting Conditions: Migraines, High B/P, Cholesterol/Triglycerides Issues
Diagnostic Lab Data: Spinal Tap, Nerve Shock Test, IV''s, Morphine lab work. Rehabilitation for Physical therapy.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98433P1  LA
Administered by: Other     Purchased by: Other
Symptoms: Fall, Guillain-Barre syndrome, Malaise, Mobility decreased, Sensation of heaviness, Skin discolouration, Wheelchair user
SMQs:, Peripheral neuropathy (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Accidents and injuries (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: Started getting sick around Thanksgiving my feet started getting numb and I started to fall (at least 3 times) My legs wouldn''t work. My son had to carry me so I could get around. I got a wheelchair in order to get to the Doctor''s office. Dr. did tests and I was hospitalized. My Left big toe went black. I need rehab and I can''t be left alone. My arms are heavy and they don''t always work either. My fingers get numb alot. My doctor told me I had Guillian-Barre Syndrome. I had no idea what that was.

VAERS ID:415834 (history)  Vaccinated:2007-10-17
Age:19.0  Onset:2010-11-01, Days after vaccination: 1111
Gender:Female  Submitted:2011-01-27, Days after onset: 87
Location:Unknown  Entered:2011-01-31, Days after submission: 4
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: Asthma
Diagnostic Lab Data: Colposcopy, positive; Pap test, 11/16/10, positive; Pap test, 10/17/07, negative; Pap test, ?/?/09, negative
CDC Split Type: WAES1101USA02218
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0930U2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Colposcopy abnormal, Human papilloma virus test positive, Neoplasm, Papilloma viral infection, Precancerous cells present, Smear cervix abnormal
SMQs:, Tumours of unspecified malignancy (narrow)
Write-up: Information has been received from a registered nurse concerning a 22 year old female patient with asthma in 2007 and no allergies, who on 02-MAR-2007 was vaccinated with a first 0.5 ml dose of GARDASIL (Lot# 654510/0962F), IM. On 24-MAY-2007 was vaccinated with a second 0.5 ml dose of GARDASIL (lot# 654510/0962F), IM, and on 17-OCT-2007 was vaccinated with a third 0.5ml dose of GARDASIL (Lot# 658488/0930U), IM. Concomitant therapy included DEPO-PROVERA which was reported that she re-started on 04-JAN-2011 and it was not taken in 2010. On 17-OCT-2007 and in 2009 Papanicolaou test were performed and both were negative. The nurse reported that on 16-NOV-2010 a human papilloma virus test was performed that was positive and the patient was sent to a gynecologist. The patient on unspecified date had a colposcopy that was positive for HPV neoplasia. The nurse also stated that this was not present prior to receiving GARDASIL. The nurse reported that these events were related to "pre cancer". The nurse reported that the patient would have a loop electrosurgical excision procedure (LEEP) at the gynecologist''s (date not reported). At the time of the report the patient had not recovered from these events. Upon internal review "pre-cancer" was considered to be an other important medical event. The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:445232 (history)  Vaccinated:2007-10-17
Age:10.0  Onset:2007-12-01, Days after vaccination: 45
Gender:Female  Submitted:2011-12-06, Days after onset: 1466
Location:Missouri  Entered:2011-12-13, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None at time
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1063U2UNUN
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Crohn's disease, Metal poisoning, Pain, Vaccination complication
SMQs:, Dementia (broad), Gastrointestinal premalignant disorders (narrow), Ischaemic colitis (broad)
Write-up: Patient developed life threatening Crohn''s Disease after this vaccine. For 2 years she was unable to function normally - incurred school, daily pain, hospitalized twice, searched for alternative medicine treatments, they found one that works now off allopathic drugs - functioning normal for most part! She is not getting chelation treatment for mercury toxicity related to all of her vaccines!! 2 years of pure hell for our family!!

VAERS ID:445771 (history)  Vaccinated:2007-10-17
Age:1.5  Onset:2011-03-21, Days after vaccination: 1251
Gender:Female  Submitted:2011-11-02, Days after onset: 226
Location:Nebraska  Entered:2011-12-19, Days after submission: 47
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: None
Diagnostic Lab Data: None
CDC Split Type: WAES1104USA02289
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0612U1SCUN
Administered by: Other     Purchased by: Other
Symptoms: Varicella
SMQs:
Write-up: Information has been received from a registered nurse concerning an 18 month old female patient with no known drug reactions, allergies and medical history who on 16-APR-2007, was vaccinated with the first dose of PROQUAD (Merck) (lot number, dose and site of administration not reported) and the second dose on 17-OCT-2007 of PROQUAD (Merck) (Lot number 657782/0612U, expiration date: 05-OCT-2008), subcutaneously (dose not reported). Secondary suspect vaccines also included Hepatitis A vaccine (manufacturer unknown) and influenza vaccine (manufacturer unknown) administered the same day of the second dose of PROQUAD (Merck). Concomitant vaccines included "DTaP", on the same date of the second dose of PROQUAD (Merck). On 21-MAR-2011, the patient developed chickenpox. The patient received unspecified medical attention. No treatment was given for the adverse event. No lab diagnostics were performed. At the time of the report, the patient was recovering. Additional information has been requested.

VAERS ID:498271 (history)  Vaccinated:2007-10-17
Age:  Onset:2007-10-17, Days after vaccination: 0
Gender:Unknown  Submitted:2013-08-01, Days after onset: 2115
Location:Unknown  Entered:2013-08-01
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: WAES1307USA017319
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
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 licensed practical nurse refers to a patient of unknown age (gender not reported). The patient was vaccinated with the first, second and third dose of GARDASIL (lot #, route, dose not reported) on 12-JUN-2007, 13-AUG-2007 and 17-OCT-2007 respectively. No adverse effects reported. It was unspecified if the patient seek medical attention or not. Additional information has been requested.

VAERS ID:293590 (history)  Vaccinated:2007-10-18
Age:27.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-18, Days after onset: 0
Location:Alabama  Entered:2007-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: went to her doctor
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS79718 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: had severe arm pain radiating to neck, no swelling,no itching,no rash,no trouble breathing

VAERS ID:293594 (history)  Vaccinated:2007-10-18
Age:70.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Male  Submitted:2007-10-18, Days after onset: 0
Location:Oklahoma  Entered:2007-10-18
Life Threatening? No
Died? Yes
   Date died: 2007-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: PMH: COPD on home O2. ASCVD, s/p CABG. Recent hx of hemoptysis & URI
Diagnostic Lab Data: CXR right pneumothorax.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS789959IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arteriosclerosis, Asthenia, Cardiac failure congestive, Chest X-ray abnormal, Chest tube insertion, Chronic obstructive pulmonary disease, Death, Intubation, Pneumothorax, Respiratory depression
SMQs:, Cardiac failure (narrow), Angioedema (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (narrow)
Write-up: Client presented to drive through flu exercise for influenza vaccination. Gave history of having had flu shots in past without incident. No contraindications to vaccinations identified. Client was vaccinated and returned home. At some time after returning home client went to Hospital emergency room where he coded and expired. 10/23/07 Reviewed hospital medical records which reveal patient experienced weakness & decreased respirations upon arriving home s/p flu shot. Collapsed in seat of pickup truck. EMS intubated, started CPR & transported to hospital. CXR revealed right pneumothorax & chest tube placed. 1/8/08 Reviewed autopsy report which states COD as COPD with atherosclerotic cardiovascular disease & CHF as contributing factors.

VAERS ID:293597 (history)  Vaccinated:2007-10-18
Age:15.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-18, Days after onset: 0
Location:Florida  Entered:2007-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES0710USA03850
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.106241IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Musculoskeletal pain, Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: CHILD FAINTED AFTER RECEIVING HPV VACCINE AT FRONT COUNTER IN OFFICE. WHEN SHE CAME AROUND SHE EXPLAINED TO THE PHYSICIAN THAT SHE HAD PAIN AND NUMBNESS FROM HER SHOULDER TO HER ELBOW AFTER RECEIVING BOTH OF THE HPV VACCINES (THIS WAS HERE 2ND)

VAERS ID:293612 (history)  Vaccinated:2007-10-18
Age:58.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-18, Days after onset: 0
Location:Michigan  Entered:2007-10-18
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: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA294EA IMUN
Administered by: Other     Purchased by: Private
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Passed out after flu shot.

VAERS ID:293618 (history)  Vaccinated:2007-10-18
Age:12.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-18, Days after onset: 0
Location:Georgia  Entered:2007-10-18
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1106F3IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0522U1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1032U2SCLA
Administered by: Public     Purchased by: Public
Symptoms: Face injury, Fall, Hyperhidrosis, Loss of consciousness, Muscle rigidity, Muscle twitching
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient here for vaccines with family 2 other sisters received shots first. She received the shots listed below , sat in chair for few minutes got up and was walking around in lab and nurse was entering shots in computer. Patient had loss consciousness and fell into desk by nurse. Patient fall, sweating was lowered to floor, became rigid and twitching. Elevated feet and became responsive, talking saying Im alright, had her rest on floor, (gave water, yogurt and slice of toast in sitting position - Stated she had not eat breakfast. BP 110/65 Felt Pulse 76. Let her stay in clinic for 30-40 minutes and left with mother and sisters around 11:10 Am with All recommended to mother to see MD for evaluation for injury. Stated nose hurt, no bleeding or deviation nasal - Scropeal left arm

VAERS ID:293725 (history)  Vaccinated:2007-10-18
Age:56.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:Michigan  Entered:2007-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: serum sickness~Influenza (no brand name)~UN~44~In Patient
Other Medications: Premarin, Zocor, Lisinopril qd and Benadryl & Zyrtec PRN.
Current Illness:
Preexisting Conditions: Allergies: Zithromax, Sulfa, Cats & Nickel.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2446AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Nausea, Similar reaction on previous exposure to drug, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Vaccine given approx. 7:40am on 10-18-07. Approx. 5:30pm, nausea, vomiting and hives. Took Benadryl w/some relief. 10-19-07 8:00am, pt called office - feeling better, just weak. Called again at 9:00am stating hives are returning. Seen in office at 10:00am, dx: serum sickness. Pt now remembers having similar reaction last year to flu vaccine (never reported it).

VAERS ID:293790 (history)  Vaccinated:2007-10-18
Age:64.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2007-10-19, Days after onset: 0
Location:California  Entered:2007-10-19
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2512AA IMUN
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Itchy rash at injection site penny-size diameter swelling at injection site

VAERS ID:294702 (history)  Vaccinated:2007-10-18
Age:0.6  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2007-10-22, Days after onset: 3
Location:Wisconsin  Entered:2007-10-29, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: recent sinus infection. NKDA.
Diagnostic Lab Data: WBC 17.9; Neutro pH 11,340; rest of CBC = negative. Labs and Diagnostics: Upper GI with no evidence of malrotation. Mild delay in gastric emptying. Abd US WNL. CBC with WBCs 17.9.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2449AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Dehydration, Full blood count normal, Neutrophil count increased, Oral intake reduced, Ultrasound abdomen normal, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe vomiting, mild dehydration. Surgical consult, GI consult = neg findings. 11/19/2007 MR received for o/n observation 10/19-20/2007 with D/C DX: Emesis. Child presented to ER with 10-12 episodes of emesis over a 12 hour period. Decreased po intake. PE WNL. Surgery consult: surgical cause of emesis unlikely. No further emesis during admission.

VAERS ID:294713 (history)  Vaccinated:2007-10-18
Age:32.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:Kansas  Entered:2007-10-29, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA039AA UNRA
Administered by: Public     Purchased by: Private
Symptoms: Musculoskeletal pain, Neck pain, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt reports swelling and pain that hurts in neck and shoulder blade.

VAERS ID:294718 (history)  Vaccinated:2007-10-18
Age:26.0  Onset:2007-10-22, Days after vaccination: 4
Gender:Female  Submitted:2007-10-22, Days after onset: 0
Location:Oregon  Entered:2007-10-29, Days after submission: 7
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
TDAP: TDAP (ADACEL)SANOFI PASTEURC2825AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Very painful, swollen (L) upper arm. Covered approx 2/3 upper arm. Pt unable to work x 3 d.

VAERS ID:294741 (history)  Vaccinated:2007-10-18
Age:15.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-25, Days after onset: 7
Location:New York  Entered:2007-10-29, 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: Codeine - rash/hives
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0522U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2392BA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B016BA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Muscle twitching, Pruritus generalised, Pyrexia, Syncope, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Received imms at noon on 10/18/07. Immediately after Gardasil felt dizzy, used cool cloth. Received Boostrix and fainted with some twitching and then slumped over. Back to self within 1 min. Coherent afterward. Lungs were clear. At 7 PM that night she was itching all over and had hives were on (L) arm but present all over. Pt also had fever 103.4 that night. Responded well to Benadryl. Still has temp next AM.

VAERS ID:295067 (history)  Vaccinated:2007-10-18
Age:18.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New Hampshire  Entered:2007-10-31
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1263U0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Maculopapular rash over most of body, which began the evening of receiving dose #1 on her arms and then spread. Gradually resolving over 5-7 days with antihistamines.

VAERS ID:295095 (history)  Vaccinated:2007-10-18
Age:45.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Male  Submitted:2007-10-23, Days after onset: 4
Location:Washington  Entered:2007-10-31, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Similar~Influenza (no brand name)~1~0~In Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Hx of pneumonia, HTN, Hypercholesteremia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU444AA3UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0961U0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Injection site pain, Injection site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Temp of 103, vomiting, pain at injection site (L) arm, swelling at injection site in (L) arm.

VAERS ID:295320 (history)  Vaccinated:2007-10-18
Age:0.5  Onset:2007-10-30, Days after vaccination: 12
Gender:Male  Submitted:2007-11-02, Days after onset: 3
Location:Florida  Entered:2007-11-02
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: Mild hyperbilirubinemia at birth.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2765AA2IMLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2459PA0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB70143D2IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0973U2PO 
Administered by: Private     Purchased by: Private
Symptoms: Abnormal faeces, Diarrhoea, Nasal congestion
SMQs:, Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Fould smelling loose stools, associated with nasal congestion. No fever or vomiting noted.

VAERS ID:295323 (history)  Vaccinated:2007-10-18
Age:69.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-11-02, Days after onset: 15
Location:Wisconsin  Entered:2007-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~NULL~~In Patient
Other Medications: Loratine, Lipitor
Current Illness: none
Preexisting Conditions: NKDA
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2825AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: No adverse reaction, Wrong drug administered
SMQs:
Write-up: none. Adacel given instead of Td.

VAERS ID:295412 (history)  Vaccinated:2007-10-18
Age:  Onset:2007-10-18, Days after vaccination: 0
Gender:Male  Submitted:2007-11-02, Days after onset: 15
Location:Kansas  Entered:2007-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PLAVIX; ZETIA; ZOCAR; TROPNOLOL; baby aspirin - per client
Current Illness: No per client
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2490AA5UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0555U UNLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain, soreness, swelling left arm - redness - left upper arm extended to forearm. Persisted up to 5 - 7 days. No symptoms at present 10-18-07 onset within 1-2 hours after the vaccines.

VAERS ID:295549 (history)  Vaccinated:2007-10-18
Age:57.0  Onset:0000-00-00
Gender:Male  Submitted:2007-10-18
Location:Indiana  Entered:2007-11-05, Days after submission: 18
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Mild 1) one person vaccination, was writing with pen with gloves on after vaccination, then took off gloves, put on new ones, but picked up pen again before vaccination, patient 2) another person vaccinating - did not gloves off good for a while preparing another patient I reminded him to do so. My suspicion so thus he did not change his gloves before the vaccinations also he of gloves was on his side of the left only on the Flu other side.

VAERS ID:295562 (history)  Vaccinated:2007-10-18
Age:76.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Male  Submitted:2007-10-29, Days after onset: 11
Location:Washington  Entered:2007-11-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None 1/4/08-records received-Previously discharged with DX cellulitis LUE.
Preexisting Conditions: COPD, GERD, Arrhythmia, Peripheral Neuropathy 1/4/08-records received- Allergy to PCNs. PMH: DJD, moderte COPD, CAD, CHF, paroxysmal atrial fibrillation, GERD, HLP.
Diagnostic Lab Data: Cellulitis and Pneumonia diagnosed about 10-22-07. 1/4/08-records received-WBC 12.6. new RLL infiltrate on CXR.Elevated leukocytes. Blood and urine cultures no growth
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2488AA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0958F1UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Blood culture negative, Breath sounds abnormal, Cellulitis, Chest X-ray abnormal, Chills, Clostridium colitis, Confusional state, Culture urine negative, Diarrhoea, Pneumonia, Pyrexia, Somnolence, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Pseudomembranous colitis (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow)
Write-up: Cellulitis - Evening 10-18-07 hospitalized 1 day. Pneumonia - Evening 10-21-07 Hospitalized 8 days. 1/4/08-records received for DOS 10/25-11/2/07-DC DX: Pneumonia. C. diff. colitis. Presented to ED with 1 day HX rigors, disorientation. Temp 102, Diminshed sounds in RLL. No cellulitis.On day 4 became acutely drowsy and unable to stay awake. . Spiked fevers. Loose stools and history of c. diff.

VAERS ID:296251 (history)  Vaccinated:2007-10-18
Age:64.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2007-10-23, Days after onset: 4
Location:New York  Entered:2007-11-09, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10g, Glucotoral XL 5g, Atenolol 50g, Lipitor 2g,
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1405F8SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Musculoskeletal pain, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Vaccine given on 10 18 07 right Deltoid - 5 hour later patient woke up from sleep with pain from shoulder up to neck - Pt applied Heat and Tiger Balm Pain lessened and on 102007 pustule blisters on Shoulder Right in a group Pt said on 102207 scabs started on drying

VAERS ID:296515 (history)  Vaccinated:2007-10-18
Age:59.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2007-11-07, Days after onset: 19
Location:Nevada  Entered:2007-11-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2504AA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Pt. complains of soreness in arm daily ever since the shot was administered, about 2 weeks now. Patient had taken Lortab with no relief. And she is unable to take ASA or NSAIDs per patient. Told to follow up with MD

VAERS ID:296669 (history)  Vaccinated:2007-10-18
Age:45.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:Maryland  Entered:2007-11-14, Days after submission: 26
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
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLAD38AA5UNRA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Hyperhidrosis, Hypersomnia, Limb discomfort, Muscle tightness, Musculoskeletal discomfort, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad)
Write-up: ON MY WAY HOME FELT TIGHTNESS IN ARM AND NECK. PAIN IN RIGHT ARM LEADING TO RIGHT SIDE OF NECK - FELT LIKE PULLED MUSCLE. TOOK BENADRYL AND TYLENOL - WOKE UP WITH CHILLS THEN SWEAT - SLEPT 12 HOURS. (SOME ACHES TODAY - NECK AND ARM SORE)

VAERS ID:296796 (history)  Vaccinated:2007-10-18
Age:41.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2007-11-15, Days after onset: 27
Location:Florida  Entered:2007-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: CLIENT NOW STATES THAT COMPANY FOR WHICH SHE WORKS CHANGED LAUNDRY COMPANY USED TO CLEAN UNIFORMS AND THAT SHE AND OTHER STAFF ARE ALL COMPLAINING OF ITCHING.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2507AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: CLIENT CALLED 11/15/07 TO REPORT THAT ONE DAY AFTER INFLUENZA ADMINISTRATION (10/19/07) SHE BEGAN TO ITCH ON BOTH ARMS. SHE REPORTS THAT SHE HAD TO BUY A CREAM TO CONTROL THE ITCHING.

VAERS ID:296806 (history)  Vaccinated:2007-10-18
Age:68.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-11-15, Days after onset: 28
Location:California  Entered:2007-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none reported
Preexisting Conditions: Allergic to PCN
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA305AA0IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: After injected, patient made the comment that it felt like the shot went into her muscle. I assured her that that is where it is supposed to go. Patient states that later that evening her arm began to hurt at the injection site and she applied ice. She did not notice any inflammation, redness, or warmth. Patient does not experience pain at rest; pain is with movement only. She describes the pain at its worst to be 6-7 out of 10 pain scale. The pain level has remained the same over the past 4 weeks since immunization. She has not taken any medications for it and has not seen an MD, although she plans to at the beginning of December. Past history includes whiplash 5 years ago and prior arm muscular pain, but not related to any past vaccinations.

VAERS ID:296924 (history)  Vaccinated:2007-10-18
Age:62.0  Onset:2007-10-21, Days after vaccination: 3
Gender:Female  Submitted:2007-10-29, Days after onset: 8
Location:Wisconsin  Entered:2007-11-15, 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: HCTZ
Current Illness: No
Preexisting Conditions: Allergy: PCN, Med. conditions HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2437AA4IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pharyngitis bacterial, Viral pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow)
Write-up: Dx Bacterial and Viral Pharyngitis, onset 2 days after Influenza Vaccine

VAERS ID:296925 (history)  Vaccinated:2007-10-18
Age:70.0  Onset:2007-10-21, Days after vaccination: 3
Gender:Male  Submitted:2007-10-29, Days after onset: 8
Location:Wisconsin  Entered:2007-11-15, 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: Lisinopril, Metoprolol, Glipizide, Flomax, Prilosec, Plavix, Digoxin, Bumex, Advocan, Metformin, Allegra, Flonase NS
Current Illness: No
Preexisting Conditions: Allergic to Ampicillin; DM, HTN, CVA, hypercholesterolemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2437AA9IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pharyngitis bacterial, Sinusitis, Viral pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow)
Write-up: Bacterial and viral pharyngitis, sinusitis. Onset 2 days after receiving flu vaccine.

VAERS ID:296943 (history)  Vaccinated:2007-10-18
Age:8.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Male  Submitted:2007-10-26, Days after onset: 7
Location:Arizona  Entered:2007-11-15, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: See attached; Omeprazole; Kepra ; Gylcolax; Kepra; Metoclopran; Albuterol; Claritin; Motrin
Current Illness: none
Preexisting Conditions: Static encephalopathy with MR/Seizure d/o/Cerebral palsy
Diagnostic Lab Data: Chest X-ray positive LU infiltrate CBC-normal; blood cultures negative
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2490AA5UNLL
Administered by: Private     Purchased by: Public
Symptoms: Blood culture negative, Chest X-ray abnormal, Full blood count normal, Palpitations, Pneumonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Developed fever of up to 103 deg, racing heart rate over 6 days following vaccine. Seen at Medical Center and diagnosed with pneumonia. Antibiotic, Rocephin IV administered, rx of Zithromax given.

VAERS ID:299590 (history)  Vaccinated:2007-10-18
Age:  Onset:0000-00-00
Gender:Female  Submitted:2007-11-14
Location:Delaware  Entered:2007-11-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA03925
Vaccination
Manufacturer
Lot
Dose
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Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     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: Information has been received from a physician concerning a female patient who on approximately 18-OCT-2007 "this week", was vaccinated with a first 0.5ml dose of Gardasil. Subsequently, the patient fainted. Unspecified medical attention was sought. It was reported that the patient was monitored and recovered. No product quality complaint was involved. Additional information is not expected.

VAERS ID:297102 (history)  Vaccinated:2007-10-18
Age:  Onset:2007-10-19, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:West Virginia  Entered:2007-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1
Current Illness: None Known
Preexisting Conditions: HX Reflux
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2436AA UNRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0888U0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Back pain, Rash, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: lower right sided abdominal pains that moved to trunk area then back within 4 days of receiving vaccine. Then rash appeared on waist on 10-27-07 and back pain that would awaken patient from sleep.

VAERS ID:297108 (history)  Vaccinated:2007-10-18
Age:43.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-11-19, Days after onset: 32
Location:Texas  Entered:2007-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none PMH: chronic seasonal allergies, previous anaphylaxis reactions, IBS.
Diagnostic Lab Data: Patient saw 3 doctors, ER, PCP, and Neurologist. At ER had x-rays and blood work done. Started physical therapy at Rehab. Neurologist diagnosis: brachial plexitis or Parsonage-Turner syndrome. LABS: CXR WNL. EMG/NCS abnormal suggesting
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS800620IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Autoimmune disorder, Axillary pain, Blood test, Brachial plexopathy, Chest X-ray normal, Electromyogram abnormal, Hypoaesthesia, Hyporeflexia, Immunisation reaction, Injection site pain, Injection site swelling, Insomnia, Muscular weakness, Musculoskeletal pain, Musculoskeletal stiffness, Myalgia, Nerve conduction studies abnormal, Nerve injury, Neuralgic amyotrophy, No reaction on previous exposure to drug, Pain in extremity, Radiculitis brachial, Sensory loss, Skin discolouration, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Dr. used these terms: brachial plexitis or acute brachial neuritis and Parsonage-Turner Syndrome. Literature on both seem to totally match up with my experience. I got my shot on Thursday, October 18. In the next hours the pain spread down my arm, worsened, and then by 1am th next morning, was severe. I went to the ER - had x-rays, blood work, given pain pills. It was predicted to lessen in a week. However, the pain persisted and made me unable to sleep, even with the pain pills. Additionally, my right pointer finger went totally numb. So after a week, I saw my PCP. He said there was nerve damage, and he wanted me to totally rest my arm in a sling to let the nerves start to heal and assess in a week more. At the next week''s appointment, I was not better and he referred me to the neurologist, Dr., who I saw the next day (November 2.) He quickly diagnosed it. He said the brachial plexus was very inflamed, causing the pain and damage. He described it as a fairly rare "auto-immune" reaction to the flu shot that required an immediate high dose of steriods, physical therapy to maintain mobility and strength and monitoring. A "nerve mapping" is scheduled for November 28. He said that some of the damage may be permanent. He said the present goal was to work through the pain, avoiding further complications of guarding a painul area, a potential of something he called RSD. I started a course of physical therapy at Rehab yesterday, November 12. 11/30/07 Reviewed medical records from neurologist which reveal patient experienced pain & sensory change in RUE x approx 3 weeks. Initially injection site had a tender bump & then pain traveled downward to distal aspect of RUE & had intractable pain & sensory loss of right index finger since then. Difficulty sleeping due to pain. Had received previous flu shots w/o problems. Had been seen in ER on 10/21. CBC, chemistry & shoulder x-ray WNL. Exam revealed stiff tender c-spine musculature; tenderness of right axilla; abduction & extension of right shoulder caused pain; & entir

VAERS ID:297285 (history)  Vaccinated:2007-10-18
Age:72.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-10-18, Days after onset: 0
Location:Ohio  Entered:2007-11-19, Days after submission: 32
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2507AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Patient stated she was feeling well today. Received flu vac, shortly after she sat in waiting area saying she felt dizzy. We offered assistance and food. She went home, we called to make sure she was doing two hours later. Husband said she was resting

VAERS ID:299664 (history)  Vaccinated:2007-10-18
Age:24.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-12-12, Days after onset: 55
Location:New York  Entered:2007-12-13, 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: Nuva Ring
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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HPV4: HPV (GARDASIL)MERCK & CO. INC.1210U0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Nausea, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Patient called office on 12/10/07 to cancel 2nd Gardasil vaccine. Complained of nausea after 1st injection on 10/18/07, on 10/19/07 noted left side of face red and swollen. No other symptoms, resolved without any further symptoms.

VAERS ID:300448 (history)  Vaccinated:2007-10-18
Age:0.4  Onset:2007-11-15, Days after vaccination: 28
Gender:Female  Submitted:2007-12-13, Days after onset: 28
Location:Maine  Entered:2007-12-19, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC Split Type:
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DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2489AA1IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0072U1IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR2024021SCLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB08657F1IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1053U1PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Enema administration, Haematochezia, Intussusception, Irritability, Lethargy, Oral intake reduced, Ultrasound abdomen abnormal, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad)
Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

VAERS ID:301151 (history)  Vaccinated:2007-10-18
Age:67.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2007-12-28, Days after onset: 70
Location:Tennessee  Entered:2007-12-28
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: allergic to sulfur and sulfur derivatives, penicillin, shrimp
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Dry skin, Headache, Pain, Pruritus, Rash, Skin induration, Skin reaction
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: I had the flu vaccine and I had no soreness at the injection site, but the next day between the injection site and my elbow, I experienced a rash and extreme itching. It covered an area about 3 inches in diameter. It has continued to itch and sometimes sting in that area. The skin in that area is hard and dry. I also had a headache the next morning and have continued to have off and on for the past two months. I have not felt well since the injection. I have had the flu vaccine before with no adverse effects. I feel like it was a preservative or something that the vaccine was mixed in. I have allergies to sulfur and sulfur derivatives (even the additives to food) and penicillin. I am allergic to shrimp. They cause me to break out in hives.

VAERS ID:302252 (history)  Vaccinated:2007-10-18
Age:70.0  Onset:0000-00-00
Gender:Female  Submitted:2007-12-21
Location:Unknown  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ATENOLOL MSD, TRIAMTEREN COMP, IMODIUM, PRISOLEC
Current Illness: Drug hypersensitivity; Hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: complete blood cell
CDC Split Type: WAES0710USA05599
Vaccination
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VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0462U SCUN
Administered by: Other     Purchased by: Other
Symptoms: Full blood count, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a registered nurse concerning an approximate 70-year-old female with allergies to BENGAY and opsite topical dressing who on 18-OCT-2007 was vaccinates subcutaneous with a dose of ZOSTAVAX (lot # 657559/0462U). Concomitant therapy included IMODIUM, omeprazole (MSD), TRIAMTEREN COMP), atenolol (MSD) and influenza virus vaccine (unspecified) administered on 23-OCT-2997. On an unspecified date (after administration of vaccine) the patient experienced injection site erythema and swelling. The patient sought medical attention via a telephone call. On an unspecified date a hemogram diagnostic lab was performed. At the time of the report the patient''s status was unknown. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:302292 (history)  Vaccinated:2007-10-18
Age:60.0  Onset:2007-10-20, Days after vaccination: 2
Gender:Female  Submitted:2007-12-21, Days after onset: 62
Location:California  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Impaired fasting glucose. Hypertension; Gastroesophageal reflux disease; sulfonamide allergy
Preexisting Conditions: Hypertension; Gastroesophageal reflux disease; sulfonamide allergy
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA06144
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a female consumer who was vaccinated with a dose of ZOSTAVAX on an unspecified date. Subsequently, the patient experienced a hot, red bump at the injection site. No medical attention was sought. The outcome of this event was unspecified. No product quality complaint was involved. Additional information has been requested. This is in follow-up to report(s) previously submitted on 12/21/2007. Information has been received from a 60-year-old female consumer with hypertension, GERD and sulfa allergy who was vaccianted with a dose of ZOSTAVAX (Oka/Merck) on 18-OCT-2007. At the time of vaccination the patient had an imparied fasting glucose. Subsequently, "two days after vaccination" on 20-OCT-2007, the patient experienced a local injeciton site reaction characterized by redness, swelling, heat, and red bump at the injection site. No medical attention was sought at the office as it was reported that the patient was on vacation; therefore, no laboratory or diagnostic tests were performed. The outcome of this events was reported as recovered as of 28-OCT-2007. No product quality complaint was involved. Additional information is not expected.

VAERS ID:302302 (history)  Vaccinated:2007-10-18
Age:74.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Male  Submitted:2007-12-21, Days after onset: 64
Location:New York  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chickenpox; Penicillin allergy; Peanut allergy; Allergic reaction to antibiotics; Drug hypersensitivity
Preexisting Conditions: Penicillin allergy; Peanut allergy; Allergic reaction to antibiotics; Drug hypersensitivity
Diagnostic Lab Data: VZV strain, 11/10/07
CDC Split Type: WAES0710USA06529
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Burning sensation, Fatigue, Herpes zoster, Injection site rash, Pain, Rash, Scab, Virus serology test, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a consumer concerning a 74 year old husband with penicillin allergy, peanut allergy, and allergies to SEPTRA, ENTEX LA, PRILOSEC, and REGLAN and a history of chicken pox (age 8) who on 18-OCT-2007 was probably vaccinated in left arm with a dose of ZOSTAVAX (Oka/Merck) instead of a dose of influenza virus vaccine (unspecified). Concomitant therapy included primidone, propranolol HCl, PREVACID, finasteride (MSD), "baby" aspirin and vitamin B (unspecified). On 19-OCT-2007 or 20-OCT-2007, 1 to 2 days after vaccination the patient developed shingles. It was reported that the patient was there to receive the influenza shot which the office said they gave him but the reporter believed that the patient received ZOSTAVAX (MSD). It was reported that the office was administering both vaccines at the time of patient''s vaccination. Unspecified medical attention was sought. No diagnostic laboratory tests were undertaken. At the time of report the patient had not recovered. A product quality complaint was not involved. Additional information has been received from the consumer concerning her husband who stated that the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) instead of a dose of influenza virus vaccine (unspecified). She reported that he patient prior to her husband received a dose of ZOSTAVAX (Oka/Merck). The patient developed rash under his left arm that moved to his back and a little on his chest. The patient was seen by his physician and subsequently was diagnosed with shingles. The nurse practitioner stated that the patient was vaccinated with flu vaccine and "they don''t make mistakes". The patient currently had a few large scabs and was starting to have a lot of pain. Follow up information from a health care professional reported that 1-2 days after vaccination (Oct-19-2007), he developed symptoms of a rash at the injection site, a burning sensation under the arm accompanied by fatigue and pain (site not specified). On 10-NOV-2007, a specimen was obtained (unspecified source) and sent for varicella zoster identification (results not reported). It was reported that at the time of this report the patient had recovered. It was also reported that there was no recent exposure to chickenpox or shingles. Additional information has been requested.

VAERS ID:302453 (history)  Vaccinated:2007-10-18
Age:45.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2007-12-21, Days after onset: 64
Location:Washington  Entered:2007-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: General symptom
Preexisting Conditions: Shingles; Zollinger-Ellison syndrome; Surgery
Diagnostic Lab Data: None
CDC Split Type: WAES0711USA04443
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1085U0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a 45 year old female medical assistant with no pertinent medical history who on 18-OCT-2007 was vaccinated with a 0.65 ml dose of zoster vaccine live (Oka/Merck). There was no concomitant medication. On that same day, the patient developed injection site redness, warmth and swelling. The patient sought unspecified medical attention. No labs or diagnostic studies were performed. In November 2007, "about 1 month later" the patient recovered. There was no product quality complaint. Additional information has been requested. 03/26/2008 Follow-up information indicated that a 45 year old female certified medical assistant with a history of shingles who on 18-OCT-2007 at 16:00 was vaccinated IM with the first dose of ZOSTAVAX (Oka/Merck) (lot# 658209/1085U) in the right arm. On 18-Oct-2007 (also reported as 21-OCT-2007) the patient developed injection site redness, warmth and swelling lasting five weeks. The patient did not seek medical attention but was noted to have had a yearly physical. It was also noted that on approximately 21-OCT-2007 the patient broke out in shingles lasting 2 & 1/2 months. Additional follow-up information indicated that the 45 year old female certified medical assitant with several GI problems and a history of shingles, zollinger-ellison syndrome followed by an unspecified surgery who on 18-OCT-2007 was vaccinated with the first dose of ZOSTAVAX (lot# 658209/1085U). There was no illness at the time of vaccination. Concomitant drug therapy included TOPROL XL tablets and nonsteroidal anti-inflammatory drug (unspecified). On 18-OCT-2007 the patient experienced injection site redness that lasted 6 weeks (also reported as 5 weeks) and broke out in shingles 3 days after vaccination. Subsequently, the patient recovered. Additional information has been requested.

VAERS ID:301428 (history)  Vaccinated:2007-10-18
Age:0.2  Onset:2007-10-21, Days after vaccination: 3
Gender:Male  Submitted:2007-12-26, Days after onset: 66
Location:Oregon  Entered:2008-01-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Stools for C and S (neg)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B124DB0UNRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0260U0UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH89728380UNLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.066920PO 
Administered by: Private     Purchased by: Public
Symptoms: Culture stool negative, Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: 3 days after Rotateq given developed significant diarrhea with stools and for many white cells, no blood, neg cultures, OVP-no other explanation-took 6 hrs to totally resolve

VAERS ID:308620 (history)  Vaccinated:2007-10-18
Age:54.0  Onset:2007-12-01, Days after vaccination: 44
Gender:Male  Submitted:2008-03-27, Days after onset: 116
Location:Pennsylvania  Entered:2008-03-31, Days after submission: 4
Life Threatening? Yes
Died? Yes
   Date died: 2008-05-16
   Days after onset: 166
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 30 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data: CSF - 153 protein on 2/25/08
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFUA05288 IMUN
Administered by: Private     Purchased by: Other
Symptoms: Abasia, Asthenia, CSF protein increased, Chemotherapy, Death, Gastrointestinal tube insertion, Guillain-Barre syndrome, Hypoaesthesia, Lymphoma, Mechanical ventilation, Paraesthesia, Pharyngolaryngeal pain, Pulmonary embolism, Respiratory failure, Sepsis, Staphylococcal infection, Tonsillar disorder, Tracheostomy, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Malignant tumours (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Respiratory failure (narrow)
Write-up: Patient had influenza vaccine on 10-18-07. Complaints on 1/9/08 of numbness for 1-2 wks in arms/feet. 2/22/08 unable to ambulate. 3/2 Placed on vent. (1/21/08 had malignant lymphoma removed from tonsil). MD diagnosis Guillain barre, 2 lymphoma. 6/24/08 Death certificate states COD as respiratory failure with Guillain-Barre Syndrome & lymphoma. as underlying cause. 6/13/08 Reviewed hospital medical records for 2/23-5/16/2008. FINAL DX: diffuse large B cell lymphoma Records reveal patient experienced paresthesias of hands/feet, sore throat. Had lump on tonsils removed & found to have diffuse large B cell lymphoma. Weakness & paresthesias worsened & dx w/GBS. Had very prolonged extensive hospital course complicated by multiple issues: chronic ventilator dependent respiratory failure; tracheostomy; PEG feeding tube; multiple septic episodes; pulmonary embolism; chemotherapy. Condition worsened, developoed MRSA septicemia, became unresponsive. Family requested comfort measures only, patient was extubated & expired 5/16/2008. Patient had cancer and was undergoing chemo and radiation. This was cause of death.

VAERS ID:309970 (history)  Vaccinated:2007-10-18
Age:  Onset:2008-01-17, Days after vaccination: 91
Gender:Female  Submitted:2008-03-26, Days after onset: 68
Location:Unknown  Entered:2008-04-16, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0802USA02034
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster
SMQs:
Write-up: Information has been received from a female consumer concerning herself and her husband, both "in their sixties", who on 18-OCT-2007 were vaccinated with Zostavax (Oka/Merck). On 17-JAN-2008 the female consumer reported she developed symptoms of shingles. At the time of reporting the female consumer stated she was" taking VALTREX and pain medication, battling the virus". It was also noted that her husband showed no symptoms at the time of reporting. Additional information has been requested.

VAERS ID:310441 (history)  Vaccinated:2007-10-18
Age:12.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2008-04-14, Days after onset: 179
Location:Arizona  Entered:2008-04-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Drug hypersensitivity
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0803USA01615
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a physician concerning a 13 year old female with an allergy to Amoxil, who was vaccinated intramuscularly in the right arm on 18-Oct-2007 with Gardasil (lot# 658556/1060U). Concomitant medication included the influenza virus vaccine (unspecified) which was administered in her left arm on 18-Oct-2007 (lot Number U2443AA). Subsequently the patient experienced numbness in her arm for one to three months post vaccination. The patient sought unspecified medical attention. Follow up information revealed the pain is still lingering at the time of second dose, which is 2 months later. Additional information has been requested.

VAERS ID:310635 (history)  Vaccinated:2007-10-18
Age:17.0  Onset:2008-03-10, Days after vaccination: 144
Gender:Female  Submitted:2008-04-14, Days after onset: 35
Location:Illinois  Entered:2008-04-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Pap test posit, 03/10/08
CDC Split Type: WAES0803USA03499
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0387U1IMUN
Administered by: Public     Purchased by: Public
Symptoms: Smear cervix abnormal
SMQs:
Write-up: Information has been received from a registered nurse concerning a 18 year old female who on 03-AUG-2007 was vaccinated 0.5mL, IM with a 1st dose of GARDASIL (lot# 655165/1425F). On 18-Oct-2007 the patient was vaccinated 0.5mL, IM with a 2nd dose of GARDASIL (lot# 657621/0387U). There was no concomitant medication. Subsequently the patient had a positive panpanicolaou test on 10-MAR-2008. The patient sought unspecified medical attention in her physician''s office. It was reported that the patient had not been sexually active since previous papanicolaou test one year ago. Additional information has bee requested. No further information is expected.

VAERS ID:316331 (history)  Vaccinated:2007-10-18
Age:44.0  Onset:2007-10-22, Days after vaccination: 4
Gender:Female  Submitted:2008-06-16, Days after onset: 238
Location:South Carolina  Entered:2008-06-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cipro 500mg bid prescribe on that day
Current Illness: had stepped on a nail
Preexisting Conditions: suprax allergy otherwise healthy
Diagnostic Lab Data: Patient does have weakness on left arm versus right per examination.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)SANOFI PASTEURC2771AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Muscular weakness, Neck pain, Pain in extremity, Physical examination abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt describes neck pain starting 3 days after injection which radiates to Left arm and has cause weakness. Has done massage therapy and seen nurtritionist for event and has not helped. Injection was given 10/18/07 in the right deltoid.Did not report fever or any other symptoms.

VAERS ID:317482 (history)  Vaccinated:2007-10-18
Age:1.0  Onset:2007-10-24, Days after vaccination: 6
Gender:Male  Submitted:2008-05-30, Days after onset: 219
Location:California  Entered:2008-06-18, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Food allergy; Egg allergy; Atopy
Preexisting Conditions:
Diagnostic Lab Data: body temp 10/24/07 103 degrees
CDC Split Type: WAES0710USA06876
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0424U0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Pyrexia, Rash generalised
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician assistant concerning a 12-month-old male with food, egg and atopic allergies who on 18-OCT-2007 was vaccinated intramuscularly in the thigh with a 0.4 milliliter dose and a 0.1 milliliter dose (for a total of 0.5 milliliters) of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (lot# 657248/0424U). The patient received 2 separate doses because of an egg allergy. There was no concomitant medication. On 27-OCT-2007, the patient developed a fever for about 3 days with no other symptoms. After the fever resolved, the patient developed a rash that was not itchy and with no vesicles. On an unspecified date, the patient''s guardian contacted the office. No laboratory tests or studies were performed. On an unspecified date, the patient recovered. No product quality complaint was involved. The physician''s assistant requested a lot check. She wanted to know if the vaccine was more potent than usual. Follow-up information received indicates that the patient is a male who was vaccinated at 11:30 AM, subcutaneously (previously reported as intramuscularly) in the right thigh with a first dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). There was no illness at the time of vaccination. "Seven days post vaccination, on 24-Oct-2007" (previously reported as 27-Oct-2007), the patient developed a high fever of 103 degrees Fahrenheit. The fever lasted for 3 days and then he developed a rash all over the body. No other symptoms were reported. The records of testing prior to release of the lot in question have been rechecked and found to be satisfactory. The lot met the requirements of the Center for Biologics Evaluation and Research and was released by the regulatory agency. This is one of several reports from the same reporter. Additional information has been requested.

VAERS ID:317947 (history)  Vaccinated:2007-10-18
Age:5.0  Onset:2008-06-22, Days after vaccination: 248
Gender:Female  Submitted:2008-06-30, Days after onset: 8
Location:Arkansas  Entered:2008-06-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056AA IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB124BA IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURX1031 IMLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0985U IMRL
Administered by: Private     Purchased by: Public
Symptoms: Varicella post vaccine
SMQs:
Write-up: Varicella Outbreak

VAERS ID:318156 (history)  Vaccinated:2007-10-18
Age:65.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2008-07-02, Days after onset: 258
Location:California  Entered:2008-07-02
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) (FLUZONE)SANOFI PASTEUR02489AA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient complains of pain at injection site since injection. Now pain radiates down all the way to elbow. She can not lift her arm still without pain.

VAERS ID:319327 (history)  Vaccinated:2007-10-18
Age:77.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2008-06-24, Days after onset: 250
Location:Colorado  Entered:2008-07-11, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: methotrexate
Current Illness: Rheumatoid arthritis
Preexisting Conditions:
Diagnostic Lab Data: temperature measurement - no fever;
CDC Split Type: WAES0803USA02931
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1085U UNUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature, Injection site bruising, Injection site haematoma, Injection site swelling, Injection site ulcer
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning a 78 year old female with rheumatoid arthritis and no known allergies who on 18-OCT-2007 was vaccinated once with 0.65 mL zoster vaccine live (Oka/Merck) (lot # 658209/1085U). Concomitant therapy included methotrexate. Initially, on 18-OCT-2007 the patient had bruising and swelling which turned into a hematoma over the injection site. Medical attention was sought, there were no lab studies performed. The physician saw the patient on 17-MAR-2008, the patient developed ulceration on the injection site. She had a 1 centimeter by 1 centimeter ulcer on the arm. However, she had no systemic symptoms including fever. At the time of the report the patient had not recovered. There was no product quality complaint involved. Additional information has been requested.

VAERS ID:328023 (history)  Vaccinated:2007-10-18
Age:24.0  Onset:2008-01-21, Days after vaccination: 95
Gender:Female  Submitted:2008-10-09, Days after onset: 261
Location:New Jersey  Entered:2008-10-10, 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: Unknown
Current Illness: Pregnancy NOS (LMP = Unknown)
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0712USA07879
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abortion induced, Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: Information has been received through the Merck Pregnancy Registry through a physician concerning a female who was intramuscularly vaccinated with her first dose of GARDASIL and found out she was pregnant. No adverse events were reported. Follow up information was received from the physician who reported that the 24 year old female with a history of two previous pregnancies (1 spontaneous abortion and 1 elective termination) who on 18-OCT-2008 was vaccinated with a first dose of GARDASIL. On 21-JAN-2008 the patient underwent elective termination. Upon internal review, elective termination was determined to be an other important medical event. Additional information is not expected.

VAERS ID:335192 (history)  Vaccinated:2007-10-18
Age:39.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-08, Days after onset: 294
Location:Wisconsin  Entered:2008-11-13, Days after submission: 97
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: The patient had no concurrent illnesses, pre-existing medical conditions, or use of other medications at the time of the vaccination with FLUZONE SV 2007-2008 on 18 October 2007.
Diagnostic Lab Data:
CDC Split Type: 200800094
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2464A UNUN
Administered by: Other     Purchased by: Private
Symptoms: Staphylococcal infection
SMQs:
Write-up: Initial report received on 10 January 2008 from a health care professional. A 39-year-old male patient, who had no concurrent illness, pre-existing medical conditions, or use of other medications had received a dose of FLUZONE SV 2007-2008 (lot number U2464AA) on 18 October 2007. The route and site of administration was not provided. The following day, after receiving the FLUZONE vaccine. the patient experienced a "staph infection." No relevant diagnostic tests, or laboratory data were performed to confirm the diagnosis of "staph infection". At the time of this report, the patient had recovered. No other relevant medically significant information was provided. Follow-up information was received 08 August 2008 from a health care professional. The reporter reviewed the case information and had no new relevant medically significant information to provide at the time of the report. The reporter for this case is the same for case 2007-03565, which is a case for a 55-year-old female who developed a "staph infection" after administration of the FLUZONE SV2007-2008 on 16 October 2007.

VAERS ID:336111 (history)  Vaccinated:2007-10-18
Age:55.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-10, Days after onset: 296
Location:Wisconsin  Entered:2008-11-13, Days after submission: 95
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: The patient had no concurrent illnesses, pre-existing medical conditions, or use of other medications at the time of the vaccination with FLUZONE SV 2007-2008 on 18 October 2007.
Diagnostic Lab Data: None
CDC Split Type: 200703565
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2484AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Staphylococcal infection
SMQs:
Write-up: A cluster of 2 unidentifiable patients, who received on an unspecified date FLUZONE (lot # U2484AA) and experienced "staph infection". Initial report received on 22-October 2007 from a health care professional. 2 unidentifiable patients received on an unspecified date FLUZONE (lot # 00464AA) and experienced "staph infection". There were no proven cultures. No other information was provided. Follow-up information received on 10 January 2008 from the original reporting health care professional. The two patients have been identified, and this case will now serve as the case for the 55 year-old female patient. Who had no concurrent illness, pre-existing medical conditions, or use of other medications at the time of administration was not provided. The following day, after receiving the FLUZONE vaccine, the patient experienced the "staph infection." No relevant diagnostic tests, or laboratory date were performed to confirm the diagnosis of "staph infection." At the time of this report, the patient had recovered. No other relevant radically significant information was provided. Follow-up information was received 21 July 2008 from a health care provider. The reporter reviewed the case information and had no new relevant medically significant information to provide at this time. Follow-up information was received on 11 August 2008 from a health care provider. The patient received an injection of FLUZONE in the left deltoid. The patient''s staph infection occurred at the injection site. The reporter for this case is the same as for case 2008-00094, which is the case for the other identified patients, who was a 39-year-old male patient who developed a "staph infection" after administration of the FLUZONE SV 2007-2008 on 18 October 2007.

VAERS ID:339498 (history)  Vaccinated:2007-10-18
Age:0.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Male  Submitted:2009-02-12, Days after onset: 483
Location:Texas  Entered:2009-02-12
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 0UNUN
Administered by: Public     Purchased by: Private
Symptoms: Lethargy, Screaming
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Extreme lethargy after Hepatitis B vaccination that was administered at approximately 24 hours after delivery of child. When performing metabolic tests afterward where heel was pierced to draw blood there was no reaction to the needle at all nor to the strong pressure that had to be put on his heel to extract the blood. There was no motion of his body, limbs or facial muscles during this whole process. For days following the vaccination he was lethargic with bouts of screaming fits. His first 24 hours of life he was very responsive to even light touch.

VAERS ID:343638 (history)  Vaccinated:2007-10-18
Age:12.0  Onset:2007-10-18, Days after vaccination: 0
Gender:Female  Submitted:2009-04-02, Days after onset: 532
Location:Pennsylvania  Entered:2009-04-07, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU1956CA0 LA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0524U0 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncopal event.

VAERS ID:423373 (history)  Vaccinated:2007-10-18
Age:17.0  Onset:2010-07-08, Days after vaccination: 994
Gender:Female  Submitted:2011-05-12, Days after onset: 308
Location:Unknown  Entered:2011-05-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: House dust allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1007USA01766
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1257U1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Skin lesion, Varicella post vaccine
SMQs:
Write-up: Information has been received from a nurse concerning a 20 year old female with no routine medications and slight allergy to dust otherwise no know allergies who on 12-MAR-1996 was vaccinated with the first dose of VARIVAX (Merck) (Lot# 608586/0413B, therapy dose, route and site unknown) and on 18-OCT-2007 received the second dose of VARIVAX (Merck) (Lot# 658572/1257U, therapy dose, route and site unknown). On approximately 08-JUL-2010 the patient experienced break through chicken pox. She had similar lesions a few days after her sister. She was not seen by the doctor. No treatment required. At the time of this report, the patient was doing better. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:423434 (history)  Vaccinated:2007-10-18
Age:15.0  Onset:2010-07-06, Days after vaccination: 992
Gender:Female  Submitted:2011-05-12, Days after onset: 310
Location:Unknown  Entered:2011-05-18, Days after submission: 6
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: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1007USA01437
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1257U1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Oropharyngeal pain, Skin lesion, Varicella post vaccine
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Information has been received from a nurse concerning a 17 year old female with no routine medications, no medical history and no known allergies who on 12-MAR-1996 was vaccinated with the first dose of VARIVAX (Merck) (Lot# 608586/0413B, therapy dose, route and site unknown) and on 18-OCT-2007 received the second dose of VARIVAX (Merck) (Lot# 658572/1257U, therapy dose, route and site unknown). On 10-JUL-2010 the patient was seen in the office with chicken box with dried lesions and a sore throat which had started on 06-JUL-2010. The patient was treated with acetaminophen. At the time of this report, the patient was doing better. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:424407 (history)  Vaccinated:2007-10-18
Age:1.4  Onset:2007-10-18, Days after vaccination: 0
Gender:Male  Submitted:2011-05-26, Days after onset: 1316
Location:New Jersey  Entered:2011-06-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES1103USA01125
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Lethargy, Speech disorder, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician concerning a 16 month old male patient with no known drug allergies and no pertinent medical history who on 18-OCT-2007 was vaccinated with a first dose of MMR II (Dose, route and Lot# not reported). There was no concomitant medication. The physician stated that on 18-OCT-2007 the patient became lethargic and nonreactive for 2 weeks after MMR II was administered. The physician also stated that the patient did not speak or walk for 2 weeks. There were no laboratories diagnostics performed. There was no treatment given for the events. The patient sought unspecified medical attention. At the time of the report the patient had recovered. Additional information has been requested.

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