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Found 557344 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:288380 (history)  Vaccinated:2007-08-17
Age:21.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-17, Days after onset: 0
Location:Connecticut  Entered:2007-08-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness/well visit
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.O93001IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Chest discomfort, Dyspnoea, Injection site pain, Neck pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Within minutes - neck pain/injection site pain 1 hr dyspnea/chest tightness. Sent to ED for monitoring

VAERS ID:288395 (history)  Vaccinated:2007-08-17
Age:48.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-17, Days after onset: 0
Location:Pennsylvania  Entered:2007-08-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol 50 mg.
Current Illness: None
Preexisting Conditions: Allergic to sulfa, iodine, codeine, and bee stings. Has hypertension.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1169F0SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2688AA0IMLL
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. received Tdap and MMR and within 10 min. began to have red spots on neck, chest and back with itching. Pt. took Bensdryl 25 mg. Remained in office for 15 min.

VAERS ID:288501 (history)  Vaccinated:2007-08-17
Age:4.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Male  Submitted:2007-08-20, Days after onset: 2
Location:New Mexico  Entered:2007-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B046AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08723SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1026F1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0595U1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Localized redness and swelling to left deltoid. Progressively getting better.

VAERS ID:288513 (history)  Vaccinated:2007-08-17
Age:37.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Male  Submitted:2007-08-20, Days after onset: 2
Location:Texas  Entered:2007-08-20
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
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1101SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Local reaction at site of injection. Erythema and warmth measuring 120mm X 200mm. No other effects, no systemic effects.

VAERS ID:288514 (history)  Vaccinated:2007-08-17
Age:10.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-20, Days after onset: 3
Location:Illinois  Entered:2007-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI diagnosed at the same visit.
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Fatigue, Headache, Pain in extremity, Pruritus, Skin necrosis, Skin warm, Swelling
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: My daughter developed a large (2 1/2 inch) area of swelling that was itcy and painful and was very warm to the touch. The area was also hard. She also has headaches and fatigue. The site of the mass of swelling was approximately 2 inches below and to the right of the injection site which was in the top center of her left arm. We took her to the acute care center after the dr told us it was a AE. We thought she may have been bit by a spider becuase the reaction was not at teh injection site. The fact that the Chicken Pox vaccine causes secondary bacterial cellulitis was not disclosed to us a the dr''s appointment.

VAERS ID:288553 (history)  Vaccinated:2007-08-17
Age:12.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Male  Submitted:2007-08-21, Days after onset: 3
Location:Washington  Entered:2007-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR02358AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Approximately 5 inches of swelling, redness, and warmth to arm site - covering circumference of arm.

VAERS ID:288663 (history)  Vaccinated:2007-08-17
Age:18.0  Onset:2007-08-21, Days after vaccination: 4
Gender:Female  Submitted:2007-08-22, Days after onset: 1
Location:Iowa  Entered:2007-08-22
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2771AA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injected limb mobility decreased, 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: ADACEL 8-17-07. Symptoms started on 8-21-07, pain left arm, no redness, swelling noted entire arm. Pain in arm with movement.

VAERS ID:288678 (history)  Vaccinated:2007-08-17
Age:0.4  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-22, Days after onset: 5
Location:Ohio  Entered:2007-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B097AB0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUFO88AA0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB08692B0IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, High-pitched crying, Injection site swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Two hours after vaccines administered infant with high pitched non stop crying for 24 hours. Fever 103, swollen site, and diff breathing for 24 hours. Treated at home with Tylenol every four hours. Contacted the ER by phone per family and instructed to continue with Tyl and if breathing worsened to go to ER. Mom up all night with infant and evaluated per Dr on 08/18/07. Symptoms subsided after 24 hours and Dr. instructed family to not give Pertussis in the vaccine. 3 maternal Uncles had mod -severe reactions to Pertussis. One Uncle passed away at 4 mos of age from the pertussis vaccine. Other two Uncles had mod reactions. One with seizures and other with same symptoms as patient.

VAERS ID:288800 (history)  Vaccinated:2007-08-17
Age:0.2  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-08-22, Days after onset: 5
Location:California  Entered:2007-08-23, 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: None
Current Illness: None
Preexisting Conditions: Reflux
Diagnostic Lab Data: F/U 24 hours, doing ok; no tachypnea
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2650AA0UNRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0627U1UNLL
HIBV: HIB (ACTHIB)SANOFI PASTEURVF160AA0UNLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0875U0PO 
Administered by: Private     Purchased by: Private
Symptoms: Choking, Pallor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Pt received oral dose of Rotavirus. Mother said he had a choking spell turned pale. No cyanosis, no apnea.

VAERS ID:288810 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-17, Days after onset: 0
Location:North Carolina  Entered:2007-08-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2059BA4IMUN
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05473SCUN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0429U0SCUN
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:288811 (history)  Vaccinated:2007-08-17
Age:11.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-08-17, Days after onset: 0
Location:Georgia  Entered:2007-08-23, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNRA
Administered by: Public     Purchased by: Other
Symptoms: Diplopia, Dizziness, Muscular weakness, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)
Write-up: Above patient was given his 2nd Varicella vaccine at the health dept this AM in (R) arm. About 30 minutes after vaccine was given, patient complained of dizziness, double vision, leg weakness and wheezing started about 45 minutes after vaccine was administered. Mom brought child to my office for evaluation.

VAERS ID:288835 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Male  Submitted:2007-08-23, Days after onset: 5
Location:Kansas  Entered:2007-08-23
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURAC14B0564IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ1009-23IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1470F1IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1004U1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Gait disturbance, Joint swelling
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Pt received DTap and varicella vaccine in right thigh, had acute large amount of swelling, knee joint swelling, difficulty walking

VAERS ID:288846 (history)  Vaccinated:2007-08-17
Age:1.3  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-08-23, Days after onset: 6
Location:New York  Entered:2007-08-23
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
RAB: RABIES (IMOVAX)SANOFI PASTEURA02084UNLL
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hive on trunk - 6-8 hrs after immunization.

VAERS ID:288935 (history)  Vaccinated:2007-08-17
Age:1.1  Onset:2007-08-21, Days after vaccination: 4
Gender:Female  Submitted:2007-08-21, Days after onset: 0
Location:Pennsylvania  Entered:2007-08-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVBIL3AB0IMLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0650U0SCLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB26510H3IMRL
Administered by: Private     Purchased by: Private
Symptoms: Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fine red raised papules rash torso, legs arms $g 50 lesions

VAERS ID:288945 (history)  Vaccinated:2007-08-17
Age:4.0  Onset:2007-08-20, Days after vaccination: 3
Gender:Female  Submitted:2007-08-24, Days after onset: 4
Location:Illinois  Entered:2007-08-24
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2569AA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ1069-23IMRL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0789U0SCRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8/20/2007 Patient presented in office with hive type rash to lt anterior lateral thigh, warm to touch. Mother reports that it is spreeding. Refered to PCP who gave Depomedrol 40 mg IM to follow with Benadryl. Mother presented in office 8/23/2007 reports that patient is better.

VAERS ID:288979 (history)  Vaccinated:2007-08-17
Age:  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:2007-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol, Lasix, Pleuk, Aspirin, Zantac, Zoloft, Ambien, Lantus insulin, Humalog, Calcium
Current Illness: Flu like symptoms, headache, cough
Preexisting Conditions: Diabetes, arthritis, allergies: Codeine, Sulfa, Penicillin, Epinephrine, Morphine, Myacin, Dymaril, Levaquin, Prednisone, Ultracet, Atrovent
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0 LA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Influenza like illness, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Prescribed 3 day Azithromycin due to flu-like symptoms arm began to ache, by 2am pain increased and had fever also. Pain increased on 8/18 took Tylenol and Benadryl, arm was also red. On 8/19 arm was swollen, red, hot, are affected extended from shoulder to elbow sensitive underneath arm pit. On 8/20 seen by nurse problems started to resolve by then.

VAERS ID:289047 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2007-08-27
Location:Pennsylvania  Entered:2007-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0329U SCUN
Administered by: Private     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Pt ordered to receive 4-6 yo Varivax (routine booster) but received Zostavax by staff in error. Pt was doing fine when reached for f/u 3d later (given on Friday PM, reached Monday AM).

VAERS ID:289063 (history)  Vaccinated:2007-08-17
Age:18.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-20, Days after onset: 3
Location:Michigan  Entered:2007-08-27, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0929U IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2366AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Musculoskeletal stiffness, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, Rt arm pain, neck stiffness, severe headache

VAERS ID:289071 (history)  Vaccinated:2007-08-17
Age:20.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-20, Days after onset: 3
Location:Ohio  Entered:2007-08-27, 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: Singulair 10 mg QD
Current Illness: None
Preexisting Conditions: Seasonal allergies; Allergic to Doryx; Mono 6/05.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0515U1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pain, Pharyngeal oedema, Pyrexia, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rec''d 2nd Gardasil vaccine 8/17/07 at approximately 815 AM. Client noticed swollen throat and tongue at approx 3 PM the same day along with overall body aches and low-grade fever. Client did not seek treatment. Mother of client notified H.D. 8/20/07 at 1140 AM. Symptoms still persist but client went to classes.

VAERS ID:289072 (history)  Vaccinated:2007-08-17
Age:13.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-21, Days after onset: 4
Location:Pennsylvania  Entered:2007-08-27, 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: Albuterol inhaler
Current Illness: None
Preexisting Conditions: Asthma, Scoliosis, NKDA
Diagnostic Lab Data: CBC done in ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2393BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Full blood count, Photophobia, Pyrexia, Rash, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever (103), shaking, chills, rash, photophobia. All resolved with Motrin in 24 hours.

VAERS ID:289132 (history)  Vaccinated:2007-08-17
Age:13.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Female  Submitted:2007-08-21, Days after onset: 3
Location:North Carolina  Entered:2007-08-27, 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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0798U0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0778U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Seen in office 8/20/07 with area of swelling and erythema at site of Varicella injection. Redness measured 13 x 14cm and indurated area in center measured 3 x 3.5 cm. Patient diagnosed with likely cellulitis and treated with Cephalexin 500mg TID x 10 days.

VAERS ID:289171 (history)  Vaccinated:2007-08-17
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2007-08-20
Location:Washington  Entered:2007-08-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0800U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR42382BA0IMRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.046161SCLA
Administered by: Private     Purchased by: Private
Symptoms: No adverse effect, Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: No reaction

VAERS ID:289193 (history)  Vaccinated:2007-08-17
Age:1.2  Onset:2007-08-24, Days after vaccination: 7
Gender:Female  Submitted:2007-08-24, Days after onset: 0
Location:Massachusetts  Entered:2007-08-28, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB149AA0UNLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0915U0UNLL
Administered by: Private     Purchased by: Public
Symptoms: Body temperature increased, Postictal state, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 7 days post Proquad - temp 104 in ER. Had episode of shaking x 6 mins. Postictal x 6 min. Exam not focal.

VAERS ID:289205 (history)  Vaccinated:2007-08-17
Age:18.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-17, Days after onset: 0
Location:New Hampshire  Entered:2007-08-28, Days after submission: 11
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: H/O LOC x2 as a child.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0929U1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dyskinesia, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Approximately 30 seconds after immunization pt had LOC with jerking motion rt and rt leg, lasted for 45 seconds. Witnessed by MA with tongue biting, no tongue biting, no loss of bladder or bowel function. Pt recovered fully with normal vital signs. Was sent to ER for eval.

VAERS ID:289253 (history)  Vaccinated:2007-08-17
Age:1.1  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-22, Days after onset: 5
Location:Illinois  Entered:2007-08-28, 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: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0807F0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.085560SCRL
Administered by: Private     Purchased by: Public
Symptoms: Decreased appetite, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever x 5 days, decrease appetite. Motrin altered with Tylenol as directed. Irritable

VAERS ID:289260 (history)  Vaccinated:2007-08-17
Age:0.8  Onset:2007-08-20, Days after vaccination: 3
Gender:Male  Submitted:2007-08-21, Days after onset: 1
Location:Georgia  Entered:2007-08-28, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B090BA2IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB26510C2IMRL
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives to face, arms, neck and legs per mother, no fever.

VAERS ID:289557 (history)  Vaccinated:2007-08-17
Age:18.0  Onset:2007-08-22, Days after vaccination: 5
Gender:Female  Submitted:2007-08-23, Days after onset: 1
Location:New York  Entered:2007-08-31, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: See attached 11/19/07-records received- Gram stain positive for diplococci. Hypokalemia. White count mildly elevated. CT head negative. EEG abnormal III, spikes focal left central, intermittent slow generalized. background slow. CSF protein 657, RBC 233, WBC 16,625 with 100% polys. AST 108, ALT 159, eGFR $g60.0, CK-total 1312, C-reactive protein 28.1. Blood cultures no growth.Labs and Diagnostics: CSF culture (+) for few Gram (-) Diplococci. Appended report shows (+) for Neisseria meningitidis group C by PCR. Blood cultures (-).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2339AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Agitation, Alanine aminotransferase increased, Aspartate aminotransferase increased, Back pain, Blood creatine phosphokinase increased, Blood culture negative, C-reactive protein increased, CSF protein increased, CSF white blood cell count increased, Computerised tomogram normal, Convulsion, Diarrhoea, Electroencephalogram abnormal, Electroencephalogram normal, Glomerular filtration rate increased, Gram stain positive, Headache, Hypokalaemia, Lasegue's test positive, Lumbar puncture abnormal, Malaise, Meningitis, Meningitis meningococcal, Mental status changes, Nausea, Neck pain, Partial seizures, Petechiae, Purpura, Red blood cells CSF positive, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Patient reported headache, nausea, vomiting, diarrhea starting Tuesday, 8/22/07 in the afternoon. Wednesday, 8/23/07 awoke w/ petechial rash on palms, arms, soles of feet and legs and increasing severe headache. Seen in our office at 8:40am. Referred to hospital for admission and evaluation w/ diagnosis of probable meningitis. Lumbar Puncture done - spinal fluid showed gram negative diplococci on gram stain. At 12:00pm started Rocephin 2grams IV. Decreased mental status throughout the am. Last coherent verbal communication from patient was at 12:00pm. Due to worsening status pt. was admitted to ICU after LP. As of today pt. is still non-verbal. EEG was WNL. Continues w/ IV antibiotic therapy. Currently prognosis is guarded. 11/19/07-records received for DOS 8/22-9/4/07-DC DX: Acute meningococcal meningitis. Seizures. Headaches. Debility. Encephalopathy. Elevated liver function tests. Presented with acute febrile illness associated with rash, nuasea, vomiting, diarrhea, fever and was not feeling well. Recent travel. PE: Skin warm dry with flat pinpoint petechial and purpuric rash on palms of hands. Agitated. Focal seizures. Opted not to talk to anyone in the middle of her hospitalization. Positive pain sensation with any neck motion. Back Pain. Positive straight leg raising test. Per 60 day follow up: See attached note from neurologist.

VAERS ID:289581 (history)  Vaccinated:2007-08-17
Age:45.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-08-17, Days after onset: 0
Location:Missouri  Entered:2007-08-31, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known - states had similar episode years ago - ? etiology
Diagnostic Lab Data: Took Benadryl PO = "better" after.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB183AA0IMRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1950BA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA02210IMLA
Administered by: Other     Purchased by: Private
Symptoms: Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt called several hours after receiving vaccines c/o "swollen lips". No c/o SOB, throat problems, etc. Advised to contact MD - go to ER if symptoms worsen.

VAERS ID:289628 (history)  Vaccinated:2007-08-17
Age:14.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-08-31, Days after onset: 14
Location:Illinois  Entered:2007-08-31
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: unk
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.42331AA1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR087240IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Hypoventilation, Loss of consciousness, Respiratory rate decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)
Write-up: Vaccine given at a health fair at the community school large multi-purpose room. After rec''d immunization nurse reports "slight seizure activity,breathing shallow and decreased." In and out of consciousness for ? minutes. Fire Department paramedics called. Mother of child states child revived in ambulance.

VAERS ID:289686 (history)  Vaccinated:2007-08-17
Age:4.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Male  Submitted:2007-08-28, Days after onset: 10
Location:Connecticut  Entered:2007-09-04, 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:
Current Illness:
Preexisting Conditions: The patient had no illness at the time of vaccination and no pre-existing medical conditions. He had received no other vaccinations with for weeks of the 17 August 2007 vaccinations.
Diagnostic Lab Data: The patient had no illness at the time of vaccination and no pre-existing medical conditions. He had received no other vaccinations within four weeks of the 17 August 2007 vaccinations.
CDC Split Type: 200702892
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657A IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ0873 IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1015U IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Rash macular, Rash papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report received on 24 August 2007 from a health care professional. A four-year-old male patient, with no illness at the time of vaccination, had received a left deltoid, intramuscular injection of Daptacel, lot number C2657AA; a left deltoid, intramuscular injection of IPOL, lot number Z0873 (not a valid Sanofi Pasteur lot number); a left forearm administration of Tubersol 5 TU, lot number C2670AA; and a right deltoid, intramuscular injection of Varivax, manufacturer Merck, lot number 1015U; on 17 August 2007. The following day, the patient developed cellulitis from his left wrist to mid chest with macules and papules. He was examined by a physician two days later. Diagnostic testing was none. Treatment included Benadryl, Tylenol and Motrin as needed. Ice packs were applied intermittently. Recovery status was reported as unknown.

VAERS ID:289751 (history)  Vaccinated:2007-08-17
Age:40.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-08-29, Days after onset: 12
Location:Unknown  Entered:2007-09-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1094SCLA
Administered by: Other     Purchased by: Military
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient received his 5th Anthrax vaccine am of 17AUG07 when 15 minutes later he felt nauseated, then vomited once. He felt a bit better but still a little queasy. Without treatment, he finally felt well after one hour.

VAERS ID:289753 (history)  Vaccinated:2007-08-17
Age:15.0  Onset:2007-08-29, Days after vaccination: 12
Gender:Female  Submitted:2007-09-04, Days after onset: 6
Location:Massachusetts  Entered:2007-09-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data: Patient does NOT have Lyme disease. The Lyme disease test was negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0928U1 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysgeusia, Eye movement disorder, Facial palsy
SMQs:, Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Ocular motility disorders (narrow)
Write-up: Patient developed Bell''s Palsy 12 days after the vaccine was administered. 9/7/07 Received vax record which provided dose & Lot #. VAERS database updated w/same. 9/28/07 Reviewed hospital medical records which reveal patient experienced left eye twitching & abnormal taste x 2 days. Noted crooked smile & difficulty closing left eye. Seen in ER on 8/31/07. Had returned from summer camp 1 week prior. Peds neuro consult done. Tx w/prednisone & antivirals. FINAL DX: Bell''s Palsy.

VAERS ID:289986 (history)  Vaccinated:2007-08-17
Age:4.0  Onset:2007-08-23, Days after vaccination: 6
Gender:Female  Submitted:2007-08-29, Days after onset: 6
Location:West Virginia  Entered:2007-09-06, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURU1813BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03064IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0430U1IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Body temperature increased, Irritability, Scab, Varicella
SMQs:, Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Child received DTaP, IPV, MMRV on 8/17/07 - on 8/23/07 began breaking out with what looked like varicella. Broke out on 8/23/07; 8/24/07 was very irritable, temp 101 - starting to scab. On 8/24/07, is recovering. Pt had generalized varicella like event; chicken pox too numerous to count.

VAERS ID:290337 (history)  Vaccinated:2007-08-17
Age:27.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-08-27, Days after onset: 10
Location:Pennsylvania  Entered:2007-09-12, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2182AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC688AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Nausea, Pain, Pyrexia, Tenderness
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 6-8 hours after vaccination, pain, chills, nausea, localized tenderness (L) arm, fever 104 which lasted approx. 24 hrs - other symptoms lasted 72 hours. Did not seek medical attention. Pt fully recovered within 72 hours.

VAERS ID:290348 (history)  Vaccinated:2007-08-17
Age:11.0  Onset:2007-08-30, Days after vaccination: 13
Gender:Female  Submitted:2007-09-03, Days after onset: 4
Location:Pennsylvania  Entered:2007-09-12, 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
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB186BD0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0389U0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site abscess
SMQs:
Write-up: Abscess formation at injection site on (R) deltoid muscle

VAERS ID:290534 (history)  Vaccinated:2007-08-17
Age:14.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-09-13, Days after onset: 27
Location:Indiana  Entered:2007-09-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: CT HEAD NEGATIVE, CBC/CMP ESSENTIALLY NORMAL IN EMERGENCY DEPARTMENT
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0389U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2226AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Computerised tomogram normal, Confusional state, Fall, Full blood count normal, Head injury, Metabolic function test normal, Tonic clonic movements
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Shortly after receiving vaccines, patient walked out to front desk of office. While standing at front desk, patient fell to floor, hitting head on counter & floor. Witnesses noted brief (10-15 seconds) of tonic/clonic activity of right arm & leg. Patient became responsive but was confused for 10-15 minutes afterward.

VAERS ID:290935 (history)  Vaccinated:2007-08-17
Age:0.2  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-09-19, Days after onset: 33
Location:California  Entered:2007-09-20, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Premature baby
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA02286
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Apnoea, Respiratory syncytial virus infection
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)
Write-up: Information has been received from a physician concerning a 2 month old male with a history of being 27 week premature baby on 17-AUG-2007 was vaccinated with a dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHib and Pediarix. In August 2007, the patient experienced apnea and respiratory syncytial virus and was hospitalized. The reporter felt that apnea was related to therapy with Rotateq. The physician considered Apnea and respiratory syncytial virus serious due to hospitalization and were considered to be immediately life-threatening. Additional information has been requested.

VAERS ID:290967 (history)  Vaccinated:2007-08-17
Age:17.0  Onset:0000-00-00
Gender:Male  Submitted:2007-08-27
Location:Washington  Entered:2007-09-20, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0186F1IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0247U1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05271SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0652U1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2358AA0IMLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1923GA1IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: a 17 yo was inadvertently given ProQuad, a combination MMR/Varicella vaccine, instead of Separate MMR & Varicella. ProQuad is licensed through 12 years of age.

VAERS ID:290968 (history)  Vaccinated:2007-08-17
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Washington  Entered:2007-09-20
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: None Reported
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0186F0IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0495U0IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05270SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0652U0SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2358AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B013AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: A 15 yo was inadvertently given ProQuad, a combination MMR/Varicella vaccine, instead of separate MMR + Varicella. ProQuad is licensed through 12 years of age.

VAERS ID:290973 (history)  Vaccinated:2007-08-17
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2007-09-20
Location:North Carolina  Entered:2007-09-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acne Cream
Current Illness: None
Preexisting Conditions: Acne
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2290AA5IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2384BA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: None aware of.

VAERS ID:292847 (history)  Vaccinated:2007-08-17
Age:21.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 31
Location:Unknown  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Pregnancy NOS (LMP = 7/27/2007)
Preexisting Conditions:
Diagnostic Lab Data: Pap test, 08/17/07, results unspecified; beta-human chorionic, 08/17/07, positive
CDC Split Type: WAES0708USA05584
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Injection site pain, Pregnancy test positive, Smear cervix, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received for the Pregnancy Registry for Gardasil from a 21 year old female licensed visiting nurse with no pertinent medical history or drug reactions/allergies who on 17-AUG-2007 was vaccinated with a first dose of Gardasil (lot# unknown). No concomitant medication was used. On 17-AUG-2007 the patient discovered she was pregnant. The patient''s date of last menstrual period was 27-JUL-2007. Medical attention was sought. On 17-Aug-2007 a Papanicolaou test was performed and the results were unspecified. A beta-human chorionic gonadotropin test (unspecified) was performed and was positive. The patient also reported soreness at the injection site. As of 29-AUG-2007 the arm is still tender. The estimated date of delivery was 02-MAY-2007. Additional information has been requested.

VAERS ID:293222 (history)  Vaccinated:2007-08-17
Age:17.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 31
Location:California  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0708USA03386
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
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), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 17 year old female who on 17-AUG-2007 was vaccinated with a 0.5 ml third dose of Gardasil. Suspect vaccination on 17-AUG-2007 included varicella virus vaccine live (MSD). Other concomitant vaccination included a dose of MENACTRA. On 17-AUG-2007 the patient fainted. Unspecified medical attention was sought. On 17-AUG-2007 the patient recovered. Additional information has been requested.

VAERS ID:295435 (history)  Vaccinated:2007-08-17
Age:1.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Unknown  Submitted:2007-09-24, Days after onset: 38
Location:Minnesota  Entered:2007-09-27, Days after submission: 3
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: WAES0708USA03332
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Information has been received from a registered nurse concerning a 12 month old patient who on 17-AUG-2007 was vaccinated with a dose of Zostavax (Oka/Merck) instead of Varivax (Oka/Merck) (MSD). She did not know if it was product confusion but felt it was human error only. Unspecified medical attention was sought. No further information was provided. There was no product quality complaint involved. Additional information has been requested. 12/21/07 This is in follow-up to report(s) previously submitted on 9/24/2007. Initial and follow up information has been received from a registered nurse concerning a 12 month old patient who on 17-AUG-2007 was vaccinated with a dose of ZOSTAVAX (Oka/Merck) instead of VARIVAX (Oka/Merck) (MSD). The nurse learned of the event second hand from a co worker, and did not know the physician''s name, the lot number or have any patient information. The nurse reported that the event was "just human error" that the patient received ZOSTAVAX (Oka/Merck), since the packaging was not similar. The patient did not experience any adverse event following the vaccination. Unspecified medical attention was sought. No further information was provided. There was no product quality complaint involved. Additional information is not expected.

VAERS ID:295448 (history)  Vaccinated:2007-08-17
Age:65.0  Onset:2007-08-19, Days after vaccination: 2
Gender:Female  Submitted:2007-09-24, Days after onset: 36
Location:Unknown  Entered:2007-09-27, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0708USA03682
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0740U SCUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a 65 year old female with a penicillin allergy who on 17-AUG-2007 was vaccinated with Zostavax (Oka/Merck). Concomitant therapy included lisinopril (manufacturer not provided) and lovastatin (manufacturer not provided). On 17-AUG-2007 the patient developed local redness and itching at the injection site. In 2007, the patient recovered from the local redness and itching at the injection site. Additional information is not expected.

VAERS ID:291862 (history)  Vaccinated:2007-08-17
Age:15.0  Onset:2007-09-19, Days after vaccination: 33
Gender:Male  Submitted:2007-10-02, Days after onset: 13
Location:Texas  Entered:2007-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 10/3/07-records received- PMH: chronic bilateral otitis media requiring tubes. Gangrene of right hand. Vertiginous headaches. Ichthyosis vulgaris. Varicella with exanthem. Influenza syndrome. Pubertal gynecomastia.
Diagnostic Lab Data: MRI w & w/o contrast, CBC, ESR, CMP (normal with slightly low potassium of 3.4), UA (normal), EBV Panel pending, blood culture pending 10/3/07-records received-MRI brain diffuse mucosal thickening in paranasal sinuses which is new compared to prior examination. No abnormal enhancement. Unremarkable MRI. Alk Phos 177. WBC 1.48, platelets 101, monos 18.4,neutrophils 41.9. Peripheral blood smear:normocytic, normochromic smear, mild thrombocytopenia, mild absolute lymphopenia and neutropenia.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2323AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Blood culture, Blood potassium decreased, Epstein-Barr virus test, Headache, Laboratory test normal, Leukopenia, Lymphocyte count decreased, Malaise, Neutropenia, Nuclear magnetic resonance imaging normal, Oliguria, Platelet count decreased, Pyrexia, Red blood cell sedimentation rate normal, Sinusitis, Streptococcus identification test negative, Thrombocytopenia, Urine analysis normal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Was seen on 9/25/07 with a 6 day history of occipital pounding headache, anorexia, malaise, and fever. Fundi were normal. No neck stiffness. Rapid Strep negative. Advised to give Tylenol alternating with Motrin and rest. Seen again on 9/26/07 with persistent headache now generalized. Associated fever 102.9, malaise, oliguria, & anorexia. A monospot was negative. He was admitted to the hospital. MRI was unremarkable except he does have diffuse mucosal thickening of the paranasal sinuses suggestive of a sinusitis. CBC w/diff & platelets showed a WBC count of 1,460 with 51 segs, 8 bands, 27 lymphocytes, 12 monocytes, 1 eosinophil, and 1 basophil. His ESR was 20. He was discharged on 9/28/07 and is scheduled to follow up in the office on 10/2/07. 10/3/07-hospital records received for DOS 9/26-9/27/07-DC summary not included. Admitting DX: headache, fever, anorexia, extreme malaise, marginal oliguria, query secondary to Menactra vaccination. Temp 102.9, no sore throat, no visual symptoms, no diarrhea, no vomiting, no rash.11/01/07-DC Summary received for DOS 9/26-9/28/07-DC DX: Headache, fever, anorexia, malaise, query secondary to Menactra vaccination. Associated leukopenia with thrombocytopenia query cause.

VAERS ID:292234 (history)  Vaccinated:2007-08-17
Age:4.0  Onset:2007-08-20, Days after vaccination: 3
Gender:Male  Submitted:2007-09-19, Days after onset: 30
Location:Texas  Entered:2007-10-04, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: TX0786
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1014U0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Herpes zoster
SMQs:
Write-up: Patient developed herpes zoster (shingles) on right lateral thigh 2 days after vaccination with Varicella. He recovered well on Acyclovir treatment for 1 week.

VAERS ID:292483 (history)  Vaccinated:2007-08-17
Age:16.0  Onset:2007-09-28, Days after vaccination: 42
Gender:Female  Submitted:2007-10-08, Days after onset: 10
Location:Wisconsin  Entered:2007-10-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.024640UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR62331AA0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.084741UNLA
Administered by: Private     Purchased by: Private
Symptoms: Affective disorder, Attention deficit/hyperactivity disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Self-injurious ideation, Suicide attempt, Vaccine positive rechallenge
SMQs:, Dyslipidaemia (narrow), Suicide/self-injury (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Drug abuse and dependence (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow), Lipodystrophy (broad), Medication errors (broad)
Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.

VAERS ID:292496 (history)  Vaccinated:2007-08-17
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-07
Location:Missouri  Entered:2007-10-09, 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: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2391BA0SCRA
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:292501 (history)  Vaccinated:2007-08-17
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-07
Location:Missouri  Entered:2007-10-09, Days after submission: 32
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB115CA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2391BA0SCRA
Administered by: Other     Purchased by: Other
Symptoms: Incorrect route of drug administration
SMQs:, Medication errors (narrow)
Write-up: No adverse events. The immunization was given subq. instead of IM.

VAERS ID:297473 (history)  Vaccinated:2007-08-17
Age:14.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-10-06, Days after onset: 50
Location:California  Entered:2007-10-12, 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: WAES0708USA03727
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Information has been received from a registered nurse concerning her 14 year old son who on 17-AUG-2007 was vaccinated with a dose of ProQuad (Merck) instead of a dose of VARIVAX (Merck) (MSD). It was reported that the office did not had Varivax (Merck) (MSD) vaccine on 17-AUG-2007. It was reported that the patient had a dose of VARIVAX (Merck) (MSD) in 1995. The reporter stated that the this was patient''s third dose of MMR (MSD). Unspecified medical attention was sought. A product quality complaint was not involved. Additional information has been requested. Thi is in follow-up to report (s) previously submitted on 10/6/2007. Additional information has been received from the physician who stated that the patient was vaccinated in a health clinic in other city. It was reported that no adverse reaction was noted. No further information is expected.

VAERS ID:297475 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:2007-08-26, Days after vaccination: 9
Gender:Female  Submitted:2007-10-06, Days after onset: 41
Location:New Hampshire  Entered:2007-10-12, 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: None
Diagnostic Lab Data: Body temp, 08/27/07, afebrile
CDC Split Type: WAES0708USA05021
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0914U SCUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature decreased, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 5 year old female with no allergies or pertinent medical history who on 17-AUG-2007 was vaccinated SC with a 0.5 ml dose of PROQUAD (Lot#656891/0914U). There was no concomitant therapy. On 26-AUG-2007 the patient developed a rash described as 12 papules. Unspecified medical attention was sought over the phone by the patient''s mother. No lab studies were performed. The nurse was not interested in VZV analysis by PCR. The patient has no other symptoms. At the time of this report the patient had not recovered. It was noted that the patient''s vaccination history included VARIVAX given 15-JUL-2003. No further information was provided. There was no product quality complaint involved. Additional information has been requested. This is in follow-up to report(s) previously submitted on 10/6/2007. Information has been received from a licensed practicall nurse concerning a 5 year old 42 lb. 42 1/2 in. female who was 9 lb. 12 oz. at birth with no allergies or pertinent medical history who on 13-AUG-2007 was vaccinated SC with a 0.5 dose of PROQUAD (Lot#656891/0914U). There was no reported illness at the time of vaccination and no adverse events following prior vaccination. There was no concomitant therapy. On 26-AUG-2007 the patient developed a rash described as 12 papules and was itchy. Unspecified medical attention was sought over the phone by the patient''s mother. No lab studies were performed. The nurse was not interested in VZV analysis by PCR. The patient had no other symptoms. At the time of the initial report the patient had not recovered. It was noted that the patient''s vaccination history included VARIVAX (Merck) given 15-JUL-2003. No further information was provided. There was no product quality complaint involved. Follow-up information from a licensed practical nurse indicated that the patient had recovered. Additional information has been requested.

VAERS ID:295828 (history)  Vaccinated:2007-08-17
Age:6.0  Onset:2007-10-26, Days after vaccination: 70
Gender:Female  Submitted:2007-11-02, Days after onset: 7
Location:Pennsylvania  Entered:2007-11-06, 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: ZYRTEC
Current Illness: None
Preexisting Conditions: G.E.R.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1003U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash pustular, Skin lesion, Varicella
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varicella vaccine breakthrough. Had Varivax on 6-7-02 and 8-17-07. Diagnosed 10-31-07 with Varicella. Had 10 lesions, some with pustules. No fever.

VAERS ID:296610 (history)  Vaccinated:2007-08-17
Age:1.1  Onset:2007-08-22, Days after vaccination: 5
Gender:Male  Submitted:2007-11-01, Days after onset: 71
Location:Nebraska  Entered:2007-11-13, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none~ ()~~0~In Patient|none~ ()~~0~In Sibling
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0495U0IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0065U2IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0413U0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0846U0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Injection site urticaria, No reaction on previous exposure to drug, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 11/1/07 mother of above said child seen thru clinic. Verb. last vaccines given child had few areas on L thigh, on 5th day after. By 6th day full blown hives, no resp. problems, no fever. Hives cleared with Benadryl. Hives lasting 5 days. F/u with physician with stated possible from MMR. No previous comp/problems with any prior vaccines. Vaccines on this date of 8/17/07 given were MMR, VZV, Hep A & Hib.

VAERS ID:297160 (history)  Vaccinated:2007-08-17
Age:8.0  Onset:2007-11-02, Days after vaccination: 77
Gender:Male  Submitted:2007-11-09, Days after onset: 7
Location:Pennsylvania  Entered:2007-11-16, 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: Singular
Current Illness: no
Preexisting Conditions: allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1003U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Varicella
SMQs:
Write-up: Varicella vaccine breakthrough. Had vaccine 6-2-00 and 8-17-07. Diagnosed with varicella 11-7-07

VAERS ID:297597 (history)  Vaccinated:2007-08-17
Age:0.4  Onset:2007-08-25, Days after vaccination: 8
Gender:Male  Submitted:2007-11-12, Days after onset: 79
Location:Oregon  Entered:2007-11-23, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2651AA1UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR205481UNRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB70145E1UNLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0503U0PO 
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Sinus congestion, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: 8/17/07 started w/sinus cold, 2 days later vomiting. After feeding, then diarrhea x 7 days. 9/28/07 started w/sinus cold, then diarrhea x 4 days

VAERS ID:300725 (history)  Vaccinated:2007-08-17
Age:12.0  Onset:2007-08-19, Days after vaccination: 2
Gender:Female  Submitted:2007-12-14, Days after onset: 117
Location:Florida  Entered:2007-12-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Perennial allergic rhinitis; Ashtma
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0711USA02905
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0927U0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2657AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0837U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a 12 year old female who on 17-AUG-2007 was vaccinated intramuscularly with the first 0.5 mL dose of Gardasil (lot # 65822/0927U). Concomitant vaccination included Menactra. On approximately 19-AUG-2007 "two days after vaccination" the patient developed a rash. The patient presented with little crusty lesions on her knees and buttocks. The rash was localized to the lower area of the body. The patient went back to the doctor''s office a few weeks ago and she still had some lesions. The patient''s status was reported as recovering. There was no product quality complaint. Additional information has been requested. Follow-up received 04/16/2008. Follow up information obtained on 11-DEC-2007. The physician reported that the 12 year old female patient with asthma and a chronic allergic rhinitis weighed 131 pounds and height of 64 inches. It was reported that there were no asthma symptoms at the time of vaccination and that the allergic rhinitis is better with immunotherapy. It was reported that on 17-AUG-2007, the patient was vaccinated intramuscularly in the right deltoid with the first dose of GARDASIL (lot # 558222/0927U), intramuscularly in the left deltoid with the first dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (lot # C2657AA) and the subcutaneously in the left deltoid with the second dose of varicella virus vaccine (lot # 658058/0837U). On 19-AUG-2007, the patient developed molluscum contagious/multiple lesions in different sites. The patient''s dermatologist was consulted and gave "unspecified" topical treatment. It was reported that the patient status improved after treatment. Additional information has been requested.

VAERS ID:301665 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2007-12-21, Days after onset: 126
Location:Pennsylvania  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: WAES0708USA04767
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Information has been received from a physician concerning a 5 year old female who on 17-AUG-2007 was vaccinated with zoster vaccine live (Oka/Merck). There was no adverse event reported. In follow-up, the physician noted that the patient was in for a routine varicella virus vaccine live (Oka/Merck) booster. The employee who gave the vaccine was not permanent staff but medical assistant from OB/GYN who was helping out. The administering health professional stated that the vaccines were both in the freezer in their own boxes. She stated that they both stated zoster and the boxes did not state adult or pediatric use. The box in front was zoster vaccine live (Oka/Merck) and she pulled that one out and administered it. The physician noted that the patient did not experience any untoward effect. No further information is expected.

VAERS ID:301666 (history)  Vaccinated:2007-08-17
Age:71.0  Onset:2007-08-24, Days after vaccination: 7
Gender:Male  Submitted:2007-12-21, Days after onset: 119
Location:South Carolina  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: None
Diagnostic Lab Data: VZV strain 08/28/07 - VZV WILD TYPE STRAIN
CDC Split Type: WAES0708USA04950
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1477F0UNUN
Administered by: Other     Purchased by: Private
Symptoms: Herpes zoster, Hypoaesthesia, Pain in extremity, Scab, Varicella zoster virus serology positive
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a pharmacist concerning a 71 year old retired white male with no known allergies or pertinent medical history who on 17-AUG-2007 was vaccinated in the left deltoid with a first dose of Zostavax (Lot# 656413/01477F). There was no illness at the time of vaccination. Subsequently on 24-AUG-07, the patient developed a couple lesions at the injection site after the vaccination. The pharmacist received a call from the patient''s physician who had diagnosed the lesions as shingles. The patient''s shingles persisted as of 27-AUG-2007. The patient was enrolled in the VZVIP program: the Varicella Zoster Virus Identification Program enables biological samples to be analyzed by PCR to identify if VZV is present and if it is present to identify if it is associated with the wild-type strain or with the vaccine VZV strain. The sample of the lesion was collected on 28-AUG-2007. The sample was taken from a vesicle on the patient''s left arm. PCR results were provided: the isolated virus was wild type VZV strain. An office visit on 29-AUG-07 indicated that the left arm shingles had more crusting and some pain. The physician prescribed 7 days of LYRICA. Follow up information from the physician indicated on 04-SEP-07 the patient had finished treatment with VALTREX and LYRICA. There was some pain and numbness. Additional information from the physician indicated that the lesions were pretty well healed. Some still crusted on the left arm, and pain if he hit his elbow on a hard surface, and some numbness. The patient declined more LYRICA. According to the reporter the patient recovered on 18-SEP-07. No further information was provided. On the initial office visit on 27-AUG-2007 there was on the left arm a rash consistent with shingles. Manufacturer and I.D. recommended treatment with VALTREX 1 gm three times a day by mouth for 7 days. On 29-AUG-2007 in the office it was noted the left arm shingles more crusting some pain. The treatment of 7 days of LYRICA was added. On 04-SEP-2007 after finishing treatme

VAERS ID:302594 (history)  Vaccinated:2007-08-17
Age:0.2  Onset:2007-08-17, Days after vaccination: 0
Gender:Male  Submitted:2007-12-17, Days after onset: 122
Location:California  Entered:2008-01-09, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0677110A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS 0UNUN
Administered by: Private     Purchased by: Other
Symptoms: Crying, Fatigue, Screaming, Sleep disorder
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: This case was reported by a sales representative via a physician and described the occurrence of screaming in a 2-month-old male subject who was vaccinated with Pediarix for prophylaxis. On 17 August 2007 the subject received 1st dose of Pediarix (.5 ml, unknown). On 17 August 2007, less than one day after vaccination with Pediarix, the subject experienced screaming to the point of exhaustion, crying and sleep interruption. At the time of reporting the events were unresolved. The physician considered the events were probably related to vaccination with Pediarix.

VAERS ID:303443 (history)  Vaccinated:2007-08-17
Age:15.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2008-01-07, Days after onset: 143
Location:Unknown  Entered:2008-01-16, 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: Thyroid disorder
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0712USA01405
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Disturbance in attention
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a consumer concerning a 15 year old female with thyroid condition and no drug reactions/allergies who on 17-AUG-2007 was vaccinated with her first dose of GARDASIL and her second dose of GARDASIL on 17-OCT-2007. Concomitant therapy included propranolol HCl. The patient had been very anxious and had trouble focusing since she was given both doses of GARDSASIL. As of 04-DEC-2007, the patient had not recovered. Additional information has been requested.

VAERS ID:306696 (history)  Vaccinated:2007-08-17
Age:15.0  Onset:2007-10-20, Days after vaccination: 64
Gender:Female  Submitted:2008-02-07, Days after onset: 110
Location:New Jersey  Entered:2008-03-07, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~HPV (Gardasil)~1~15~In Patient|~HPV (Gardasil)~2~15~In Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Neurology; Cardiology ENT referred EKG, MRI head, EEG. Labs and Diagnostics: 9/19/07: CBC WNL. EKG WNL. 1/16/08: CBC with WBCs 13.4. EKG WNL. Drug screen (-). Chemistry with CO2 31 and Ca 10.7 otherwise WNL. UA with Large amt blood, 11-20
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1425F1UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0639U1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Aphasia, Bacteria urine, Blood calcium increased, Blood urine present, Carbon dioxide abnormal, Computerised tomogram normal, Dizziness, Drug screen negative, Dysarthria, Dysphemia, Electrocardiogram normal, Fall, Feeling cold, Full blood count normal, Headache, Neurological examination, Pallor, Presyncope, Red blood cells urine positive, Syncope vasovagal, Tremor, White blood cell count increased, White blood cells urine positive
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Gardasil (#1: 08/17/07) (#2 10-20-07) Dizziness (1) 09/17/07 Coldness (2) 01/17/08 Slurred speech with Headache. 04/07/2008 MR received from PCP beginning with WCC 5/2/2007 and including vax record and 2 ER records with DX: Vasovagal Syncope (9/19/2007) and Vasovagal episode, r/o seizure (1/16/2008). On 9//19/2007 pt presented to ER after near syncopal episode while running. Pt felt dizzy and almost passed out. Transported by EMS to ER. PE WNL. Seen again 1/16/08 after a fall/shaking episode. Pt reported feeling cold and being unable to speak. Suttering upon arrival to ED. PE WNL. D/C home to f/u as outpt. Seen by PCP 2/7/08 with c/o dizziness and pallor on 2/5/08. Under work-up

VAERS ID:314946 (history)  Vaccinated:2007-08-17
Age:13.0  Onset:2007-08-21, Days after vaccination: 4
Gender:Female  Submitted:2008-05-16, Days after onset: 269
Location:Unknown  Entered:2008-05-23, 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: None
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0709USA01830
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0851U1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Varicella
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a licensed practical nurse concerning a 13-year-old female who on 17-AUG-2007 was vaccinated with her second dose of varicella virus vaccine live (Oka/Merck) (Lot # 657941/0851U). There was no concomitant medication. On 21-AUG-2007, the patient experienced a red, itchy rash at the injection site four days after vaccination. It was reported one chickenpox lesion was located directly over the injection site. The patient sought unspecified medical attention. No diagnostic labs were performed. No more lesions developed and at an unknown date the patient recovered from all adverse events. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:319181 (history)  Vaccinated:2007-08-17
Age:4.0  Onset:2008-03-24, Days after vaccination: 220
Gender:Female  Submitted:2008-07-03, Days after onset: 101
Location:New York  Entered:2008-07-11, 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: Unknown
Current Illness:
Preexisting Conditions: Dry skin
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0804USA02503
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0616U1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Pruritus, Skin lesion, Varicella
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 5 year old female who on 08-SEP-2003 was vaccinated subcutaneously in the left arm with a first dose of varicella virus vaccine live (Oka/Merck) (lot # 644974/0196N). It was noted that on 17 AUG 2007 the patient was vaccinated subcutaneously into the left arm with a second dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (+) varicella virus vaccine live (Oka/Merck upgrade process) (lot # 657749/0616U). On 24 MAR 2008 the mother reported that she had noticed a little lesion on the patient''s inner thigh. She reported that she did not think much of it at the time because the patient has had problems with dry skin. On the evening of 25 MAR 2008, the mother reported she noticed that the lesions were starting to spread. The patient complained of a little bit of itching. The patient had not had a temperature. Upon examination the physician noted that patient to be alert and cooperative. The patient presented with scattered small erythematous papular lesions. Some of the lesions had a little whitish dot in the center. The original lesion that she had was actually scabbed ever. In the opinion of the physician this was highly suspicious for atypical varicella. Treatment included BENADRYL and TYLENOL, as long as the patient does not run a temperature, a review of routine care with the mother, and abstinence from school for one day. At the time of reporting the patient had recovered, on an unspecified date. Additional information is not expected.

VAERS ID:320205 (history)  Vaccinated:2007-08-17
Age:24.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2008-07-22, Days after onset: 340
Location:Ohio  Entered:2008-07-23, 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: Unknown
Current Illness: Pregnancy NOS (LMP = 8/1/2007)
Preexisting Conditions:
Diagnostic Lab Data: Beta-human chorionic, 08/17/07, positive
CDC Split Type: WAES0708USA03534
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0913F UNUN
Administered by: Private     Purchased by: Private
Symptoms: Drug exposure during pregnancy, Intra-uterine death, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received through the Merck Pregnancy Registry from a physician concerning a 24 year old female who on 17-AUG-2007 (also reported as 07-AUG-2007) was vaccinated with VARIVAX (Oka/Merck) (LOT # 654030/0913F), MMR II and DTaP (manufacturer not reported). The physician reported that the patient learned that she was pregnant after receiving the vaccination with the VARIVAX. Her last menstrual period was 01-AUG-2007. The estimated due date is 07-MAY-2008. Both the vaccination with and pregnancy test were done on 17-AUG-2007. The physician reported that there was no maternal adverse event. The patient contacted the physician. Follow up information has been received from the same physician. The infant was liveborn (weeks gestation not reported). The infant was diagnosed with Triploidy 69 KY (male). It died at 5-6 gestation weeks. Per the physician''s discussion with OB there was no evidence it was vaccine related. Additional information has been requested.

VAERS ID:325601 (history)  Vaccinated:2007-08-17
Age:16.0  Onset:2007-08-18, Days after vaccination: 1
Gender:Female  Submitted:2008-09-12, Days after onset: 391
Location:Washington  Entered:2008-09-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prozac
Current Illness: None
Preexisting Conditions: PMH: depression, anxiety
Diagnostic Lab Data: Every test came back negative, (i.e. meningitis, West Nile, mono, etc.). Labs and Diagnostics: CSF cx (-). Blood cx (-). Head CT (-). Sinus X-ray (-). CRP 15.3. ESR 9-13. SGOT 92. SGTP 104. Total protein 5.0Albumin 2.6. Ca++ 6.4 wi
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0171U0UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B015AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Alanine aminotransferase increased, Arthralgia, Aspartate aminotransferase increased, Bacterial culture negative, Blood albumin decreased, Blood bicarbonate decreased, Blood calcium decreased, Blood culture negative, Blood sodium decreased, Blood urea decreased, C-reactive protein increased, CSF culture negative, Computerised tomogram normal, Electrolyte imbalance, Face and mouth X-ray normal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Headache, Hypoaesthesia, Liver function test abnormal, Myalgia, Neck pain, Pain, Pancytopenia, Platelet count decreased, Protein total decreased, Pyrexia, Red blood cell count decreased, Red blood cell sedimentation rate normal, Screaming, Tremor, Viral infection, Viral test negative, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)
Write-up: Severe neck pain, headache so bad she held her head screaming in pain, drop in white blood cell count to 1000, very high fever, uncontrollable shaking, hurting from head to toe, numbness in arms. 10/6/2008 MR received for DOS 8/21-26/2007 with D/C DX: Viral Syndrome. Pt presented with onset of severe headache, myalgias, arthralgias, and fever beginning on 8/18/07. Seen in local ER for meningitis w/u which was (-). Found to be pancytopenic so admitted for further w/u. Severe H/A tx with IV and po pain meds. Fevers up to 103 with ID w/u all (-), so abx d/c after cx (-). Pancytopenia improving. Had some electrolyte imbalances to be f/u as outpt. LFTs abnormal to f/u as outpt.

VAERS ID:335354 (history)  Vaccinated:2007-08-17
Age:36.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2008-12-15, Days after onset: 486
Location:Georgia  Entered:2008-12-15
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: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB403AA1IMLA
Administered by: Military     Purchased by: Military
Symptoms: Keloid scar
SMQs:
Write-up: Keloid formation devoloped at site of smallpox vaccination given on 17 Aug 2007.

VAERS ID:394307 (history)  Vaccinated:2007-08-17
Age:49.0  Onset:2007-08-22, Days after vaccination: 5
Gender:Male  Submitted:2010-08-04, Days after onset: 1078
Location:New Jersey  Entered:2010-08-04
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: high blood pressure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Private
Symptoms: Arthralgia, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain in top of hands and pain in ankles. Taking Enbrel, still in pain. My work consists of heavy wrenching.

VAERS ID:399370 (history)  Vaccinated:2007-08-17
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Florida  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Palpitations; supraventricular tachycardia; learning disability; flat feet; back pain
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0911USA03601
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.0802U0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Aggression, Anxiety, Crying, Depression, Obsessive-compulsive disorder
SMQs:, Dementia (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a mother reported her daughter who was vaccinated with a first 0.5ml dose of GARDASIL, and "within a week of getting vaccinated, the patient became depressed and showed a sign of obsessive compulsive disorder." The patient sought unspecified medical attention. At the time of the report, the patient''s status was unknown. Follow up information was received from the physician concerning the 14 year old female student with 2 siblings, flat feet and back pain who on 17-AUG-2007 was vaccinated in the left deltoid with her first dose of GARDASIL (lot #: 658490/0802U). Concomitant therapy included a dose of HAVRIX and MENACTRA. The patient had learning difficulty and palpitations later diagnosed with supraventricular tachycardia at the time of vaccination. Subsequently the patient experienced anxiety, increased crying, depression and unusual aggressive behavior. The patient suspended from school and was evaluated by psychiatrist. The outcome was unknown. Additional information has been requested.

VAERS ID:288423 (history)  Vaccinated:2007-08-18
Age:39.0  Onset:2007-08-18, Days after vaccination: 0
Gender:Female  Submitted:2007-08-18, Days after onset: 0
Location:Texas  Entered:2007-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE AS STATED BY PATIENT
Preexisting Conditions: NONE AS STATED BY PATIENT
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0508F1IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2731AA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURZ0572 IMRA
Administered by: Military     Purchased by: Military
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: After recieving vaccinations, pt stated she "feel like passing out". She sat down and moments later had a syncope episode with returning to consiousness apprx 1-2 min later. Oxygen was given, she was positioned supine with legs elevated, cool towels were applied and she was evaluated by the physician.

VAERS ID:288590 (history)  Vaccinated:2007-08-18
Age:18.0  Onset:2007-08-18, Days after vaccination: 0
Gender:Female  Submitted:2007-08-21, Days after onset: 3
Location:California  Entered:2007-08-21
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
DTAPH: DTAP + HIB (NO BRAND NAME)UNKNOWN MANUFACTURERU1965AB5IMUN
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB175AA2IMUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.0012U0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2049AA2IMUN
Administered by: Public     Purchased by: Public
Symptoms: Hyperhidrosis, Hypokinesia, Immediate post-injection reaction, Inappropriate schedule of drug administration, Nausea, Pallor, Wrong drug administered
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Medication errors (narrow), Hypoglycaemia (broad)
Write-up: Patient immediately became pale, nauseated, and diaphoretic. She was momentarily non responsive. Remained nauseated for the remainder of the day.

VAERS ID:288592 (history)  Vaccinated:2007-08-18
Age:  Onset:2007-08-18, Days after vaccination: 0
Gender:Female  Submitted:2007-08-21, Days after onset: 3
Location:California  Entered:2007-08-21
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0012U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2049AA1IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU1965AB1IMLL
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Local reaction, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 12 hours after receiving injections patient developed localized reaction 4 inches of redness, swelling, and itching

VAERS ID:288797 (history)  Vaccinated:2007-08-18
Age:16.0  Onset:2007-08-19, Days after vaccination: 1
Gender:Female  Submitted:2007-08-22, Days after onset: 3
Location:New York  Entered:2007-08-23, 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: PPD
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0802U0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: hives occurring on legs, arms and trunk 24 hr. past immune

VAERS ID:288844 (history)  Vaccinated:2007-08-18
Age:26.0  Onset:2007-08-18, Days after vaccination: 0
Gender:Female  Submitted:2007-08-23, Days after onset: 5
Location:Kentucky  Entered:2007-08-23
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: NKDA; had tonsillectomy, no other PM Hx.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS419011A0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Dizziness, Feeling abnormal, Hyperhidrosis, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Donor began to c/o feeling "strange" just after immunization was given. Donor was monitored for required 15 min and stated that she felt ok upon leaving center. Donor states that on her way home from center, she began to feel dizzy and light-headed, c/o chills and warmth, also diaphoresis. Donor made appt. with her MD, but felt better by the next day so she did not go. Donor did not notify center of reaction until 8/23/07. Donor states that she is feeling normal today, had no further problems.

VAERS ID:289008 (history)  Vaccinated:2007-08-18
Age:10.0  Onset:2007-08-19, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Michigan  Entered:2007-08-24
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB148AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0845U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varivax and Hep A given on 8/18/07 right upper arm laterally for Varivax. Itching locally followed by erythema, induration 1" diameter. Redness 4 1/2" x 3 7/8" slightly tender on palpitation. Full range of movement for the arm. Seen on 8/20/07. Advised cold compress and Benadryl PO.

VAERS ID:290226 (history)  Vaccinated:2007-08-18
Age:4.0  Onset:2007-08-18, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Wisconsin  Entered:2007-09-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: allergic to peanuts
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEUR    
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Unknown
Symptoms: Nasopharyngitis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On Wednesday August 15th at 11:00 my son went in for his five year round of immunizations. Please see attached documentation of shots received. On Thursday he began showing symptoms of what appeared to be a cold. On Friday he woke up with hives all over his body. We administered Benadryl and hives went away but cold symptoms remained. Saturday again he appeared to have a cold and then broke out in hives again. We once again administered Benadryl and the hives went away. On Sunday we had the same experience he appeared to have a minor cold but midmorning he broke out in hives. We administered Benadryl. Monday everything was normal. On Monday I noticed he had hives at one of the areas where he was given the shots. I would like it documented that my son had an adverse reaction to the immunizations he received. Please call me if you have any further questions.

VAERS ID:290842 (history)  Vaccinated:2007-08-18
Age:37.0  Onset:2007-08-19, Days after vaccination: 1
Gender:Female  Submitted:2007-09-18, Days after onset: 30
Location:Indiana  Entered:2007-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mobic insulin
Current Illness:
Preexisting Conditions: Diabetes-type 1
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site discolouration, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 1 day after pneumonia vaccine-my arm turned very red and was tender-the next day, redness had spread in lines away from injection site. 2 days later it was blue/black and extremely painful went to ER, received antibiotic injection and oral antibiotics

VAERS ID:296749 (history)  Vaccinated:2007-08-18
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-08
Location:Ohio  Entered:2007-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0709USA00707
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0211U1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)
Write-up: Information has been received from a medical assistant concerning a 14 year old female with no drug reactions or allergies who on 11-JUN-2007 was vaccinated intramuscularly with the first 0.5 mL dose of GARDASIL. There was no concomitant medication. On 18-AUG-2007, the patient was vaccinated intramuscularly with the second dose of 0.5 mL dose of GARDASIL, (Lot # 0211U). It was reported that the patient called the office on 05-SEP-2007, and reported that she had not had her menses since she received her second dose of GARDASIL on 18-AUG-2007. The medical assistant was unable to provide the date of the patient''s last menstrual period. The patient was scheduled for a pregnancy test in the office on 06-SEP-2007. No further information was available. Additional information has been requested.

VAERS ID:297335 (history)  Vaccinated:2007-08-18
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2007-11-07
Location:Washington  Entered:2007-11-19, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2552AA0UNLL
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)
Write-up: None Known ( We gave DTAP instead of Tdap)

VAERS ID:310620 (history)  Vaccinated:2007-08-18
Age:16.0  Onset:2007-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-04-14, Days after onset: 240
Location:Connecticut  Entered:2008-04-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: iron (unspecified); NOVO-PAROXETINE
Current Illness: Obsessive-complusive disorder; Panic attack; Anaemia; Scoliosis; Allergic to cats; Pollen allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0803USA03626
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0688F0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Chest pain, Dizziness, Dysphonia, Pain in extremity, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 16 year old female with obsessive-complusive disorder, panic attacks, anaemia, scoliosis with fusion (2005), and allergies to cat dander, pollen and grass who on 18-AUG-2007 was vaccinated with her first dose of 0.5 ml GARDASIL (Lot #653735/0688F) intramuscularly in the left arm. Concomitant therapy included NOVO-PAROXETINE and iron tablets (unspecified). These symptoms were reported to the physician during an appointment on 21-FEB-2008. The patient reported to the physician that after her first dose on 18-AUG-2007 she developed wheezing, a hoarse voice, and chest pain in the car after her vaccination. The patient said the chest pain traveled from her arm to her chest, and stopped near her neck. She also reported to the physician being anxious and feeling lightheaded. All symptoms resolved within two minutes. The patient had come to the physician''s office on 21-FEB-2008 for a second dose GARDASIL. Due to the symptoms on the first dose, the patient was not given a second dose. Also, the patient had reported that she had a yeast allergy. She stated that she experienced swelling after eating a pizza. On 21-MAR-2008 the patient reported that she was joking about her yeast allergy. She is requesting the second dose of GARDASIL. There was no further information available. Additional information has been requested.

VAERS ID:311175 (history)  Vaccinated:2007-08-18
Age:1.2  Onset:2007-08-27, Days after vaccination: 9
Gender:Male  Submitted:2008-04-28, Days after onset: 245
Location:Unknown  Entered:2008-04-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Ear infection
Diagnostic Lab Data: pulse oximetry 08/30/07 98%; stool analysis 08/29/07 - normal; blood culture 08/29/07 - normal; body temp 08/30/07 99.1 F; neutrophil count 08/30/07 14%; band neutrophil count 08/30/07 - none; serum blood urea 08/30/07 7; serum sodium 08/30
CDC Split Type: WAES0709USA00172
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Band neutrophil count decreased, Blood chloride normal, Blood creatinine normal, Blood culture negative, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Body temperature, Dehydration, Diarrhoea, Faeces discoloured, Gastroenteritis, Heart rate normal, Lip dry, Respiratory rate, Respiratory tract congestion, Stool analysis normal, Urine analysis normal, White blood cell count normal
SMQs:, Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Information has been received from an investigator concerning a 14 month old male who entered a study. On 18-AUG-2007 the patient was vaccinated with VAQTA inactivated. The patient received MMR II and PREVNAR on 07-JUL-2007. On 24-AUG-2007 the patient began experiencing diarrhea. The patient was subsequently hospitalized. Treatment medications included PEDIALYTE 20 oz, IV D5 1/4NS (40 cc/hr), IMODIUM 5 ml. All medication were for diarrhea. ON 29-AUG-2007 a stool analysis was performed with normal results. The patient recovered from diarrhea. Follow-up information was received on 18-APR-2008. The SAE was changed to gastroenteritis with dehydration. The patient was also treated with acetaminophen on 30-AUG-2007. The patient''s medical history was significant for frequent ear infections. He had no known drug allergies. On 30-AUG-2007 the patient was seen in the emergency room and had been experiencing bouts of diarrhea every day since 27-AUG-2007. The diarrhea was loose and watery with green discoloration. There was no mucous or blood and he had no associated vomiting or fever. Vital signs were: temperature 99.1 F, pulse 124, respirations 24 and pulse oximetry 98%. Oropharyngeal examination showed mild congestion and his lips appeared dry. Labs were: WBC 16.8, neutrophil 14%, no bands, glucose 95, BUN 7, creatinine 0.3, sodium 138, potassium 4.1, chloride 104. Urine was clear and negative for microscopic exam. Blood culture collected on 30-AUG-2007 showed no growth at 5 days. The patient was subsequently admitted to the hospital. The patient recovered from gastroenteritis with dehydration. The investigator considered the gastroenteritis with dehydration to be related to study medication.

VAERS ID:320800 (history)  Vaccinated:2007-08-18
Age:5.0  Onset:2008-07-23, Days after vaccination: 340
Gender:Male  Submitted:2008-07-23, Days after onset: 0
Location:Massachusetts  Entered:2008-07-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; Pulmicort
Current Illness: None
Preexisting Conditions: Augmentin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0915U1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Blister, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mom called 7/23/08: patient had multiple papules; some with pustules; few vesicles scattered throughout body on extremities; trunk and back (diagnosed today).

VAERS ID:336853 (history)  Vaccinated:2007-08-18
Age:15.0  Onset:2007-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-01-07, Days after onset: 508
Location:Colorado  Entered:2009-01-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Vulval ulceration; West Nile viral infection
Preexisting Conditions: Mouth ulceration; Canker sores oral; Viral infection PMH: PCOS, ? DMII on oral meds. Allergy: sulfa.
Diagnostic Lab Data: Diagnostic laboratory, STD testing LABS: pathergy test neg. ESR 32(H), CRP 10.5(H). CBC, chemistry, LFTs WNL. HSV/PCR neg. HSV I (+), HSV II(-). Biopsy vulvar lesion.
CDC Split Type: WAES0812USA02633
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Private     Purchased by: Other
Symptoms: Acne, Aphthous stomatitis, Behcet's syndrome, Biopsy skin, Blindness transient, C-reactive protein increased, Catheter placement, Cellulitis, Depression, Dysuria, Flushing, Full blood count normal, Herpes simplex serology negative, Hirsutism, Hypoaesthesia, Inflammation, Influenza like illness, Laboratory test normal, Liver function test normal, Lymphadenopathy, Oropharyngeal pain, Pain, Paraesthesia, Polymerase chain reaction, Pyrexia, Rash erythematous, Rash pruritic, Red blood cell sedimentation rate increased, Suicidal ideation, Vulval ulceration, West Nile viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Suicide/self-injury (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Depression (excl suicide and self injury) (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Information has been received from a physician concerning a female patient with a history of mouth ulcers who on an unknown date was vaccinated with a dose of GARDASIL, lot # unspecified. The patient came back to the physician''s office 4 hours after getting GARDASIL with "vulvar ulcers" diagnosed as "bipolar aphthosis". The physician stated that the patient had gotten the shot when she was experiencing symptoms of West Nile virus; however it was not diagnosed after she had been given GARDASIL. The patient became sexually active "shortly before" she got GARDASIL. At the time of reporting, the outcome of the event was unknown. Follow-up information was received from the physician who reported that the patient had a history of canker sores. The physician also reported that the patient had a viral illness (not specified) prior to receiving the third dose of GARDASIL. The physician stated that the patient had experienced bipolar aphthosis every month for over one year. Follow-up information was received from the physician, who reported that the patient was vaccinated with the third dose of GARDASIL IM, on 18-AUG-2007. The physician reported that within 4 hours of vaccination, the patient had the first outcome of nonherpetic vulvar ulcers. Major work up negative. Presumed to be bipolar aphthosis. At the time of reporting, the patient had not recovered. The patient had numerous cultures and laboratories (unspecified) and a presumptive positive West Nile virus test. The physician considered the event to be disabling. This is one of two reports from the same source. No further information is available. 2/17/09 Received Immunology Clinic records of 7/15-9/26/2008. FINAL DX: Bechet''s disease Records reveal patient did not have symptoms when initially evaluated. Valtrex d/c. Had bout of depression w/suicidal ideation. Being seen by counselor & tx w/meds. Developed oral canker sores that waxed & waned & by 9/18 had over 40+ vulvar ulcers w/exudate & bilateral lymph node adenopathy. Depression aggravated by eruption, fever 100.5, flu like s/s of aches/pain all over. Developed fine erythematous rash over face & skin next day that waxed & waned. Continues to self cath. Tx w/steroid burst & antibiotics. Improved w/steroids 2/18/09 Received ID clinic records of 4/12-5/21/2008 which revealed no new information. 1/20/09 Received PCP office records 4/8-12/3/2008. FINAL DX: suspect bipolar aphthosis Records reveal patient had cleaned out pond 8/2007. Dx w/WNV & had recurring symptoms since then of: 7-14 day menses, facial warmth, painful oral & vaginal lesions, dysuria requiring self catheterization. Lesions are blisters that ooz yellow fluid & also red bumpy itchy rash on trunk & arms. Skin painful during these episodes. Fevers up to 101,(+) inguinal nodes, axillary nodes. Not sexually active. Tx w/antivirals, pain meds & antigout med. Referred to ID 2/5/09 Received GYN medical records of 8/28/2007-11/25/2008. FINAL DX: Bechet''s syndrome records reveal patient seen 8/28/07 in f/u on vulvar operations that were felt to be response to viral illness. Patient was feeling better, lesions were resolving w/o pain. RTC 10/15/07 w/vaginal lesions; numbness & tingling of LEs; intermittent recurrent vision loss; and mouth lesions x 3 days. Referred to Neuro. RTC 12/10/07 & record states pt w/known West Nile virus x approx 5 mo. RTC 2/28/08 w/hirsutism & acne. Added yaz to glucophage & valtrex already on. Labs ordered. RTC 3/17/08 w/recurrent vaginal lesions x 2 days & sore throat x 2 weeks. Records state HSV IgM (+) 12/2007. Patient had self d/c valtrex due to increased depression. Dx w/HSV outbreak w/superimposed cellulitis. RTC 7/08 & referred to university specialist. RTC 10/29 & given trial of colchicine as recommended by specialist. RTC 11/25/08 w/recurrent outbreak of vulvar ulcers most c/w Bechets. Tx w/meds.

VAERS ID:380615 (history)  Vaccinated:2007-08-18
Age:22.0  Onset:0000-00-00
Gender:Female  Submitted:2010-02-08
Location:Pennsylvania  Entered:2010-02-17, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Crohn''s - Stable on REMICADE
Preexisting Conditions: Crohn''s
Diagnostic Lab Data: Will be sent.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0929U2UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Endoscopy abnormal, Oesophagitis ulcerative, Pelvic pain
SMQs:, Gastrointestinal ulceration (narrow), Gastrointestinal nonspecific inflammation (broad)
Write-up: Patient has Crohn''s Disease. 2-3 weeks after each inj. she developed ulcerative esophogitis. 3 endoscopies proved it not to be viral etc. but could not prove Crohns. Before the last bout was over she developed pelvic pain - was ill thru 11/05.

VAERS ID:296193 (history)  Vaccinated:2007-08-18
Age:0.5  Onset:2007-09-03, Days after vaccination: 16
Gender:Female  Submitted:2007-11-09, Days after onset: 67
Location:Foreign  Entered:2007-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: X-ray showed croup compatible and laboratory data was negative.
CDC Split Type: B0494150A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Cough, Croup infectious, Laboratory test normal, Sleep disorder, Viral infection, X-ray abnormal
SMQs:, Anaphylactic reaction (broad)
Write-up: This female subject was enrolled in the post marketing surveillance open study. On 18 August 2007, she received the 3rd dose of Infanrix, IM. On 03 September 2007, 16 days after the 3rd dose of Infanrix, this seven-month-old subject developed croup. The subject was hospitalised. The subject was treated with hydration therapy, medication and nebulizer treatment. The event resolved on 11 September 2007. The investigator considered that there was no reasonable possibility that the croup may have been caused by Infanrix and that the event was possibly due to viral infection. Relevant risk factors: Attend the child day care center. Investigator comments: The subject experienced a cough and sleep disturbance.

VAERS ID:290756 (history)  Vaccinated:2007-08-19
Age:45.0  Onset:2007-08-21, Days after vaccination: 2
Gender:Male  Submitted:2007-08-27, Days after onset: 6
Location:Unknown  Entered:2007-09-17, Days after submission: 21
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
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Injected limb mobility decreased, Oedema, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient received Anthrax on 19 Aug 07 and 3 days later developed a large erythematous, edematous and warm patch to post LUE extremity past elbow joint to mid foreman. Decrease ROM and increase. No joint effusion.

VAERS ID:305063 (history)  Vaccinated:2007-08-19
Age:32.0  Onset:2007-08-19, Days after vaccination: 0
Gender:Female  Submitted:2008-02-18, Days after onset: 183
Location:Minnesota  Entered:2008-02-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cut on bottom of right foot from stepping on a rough nail.
Preexisting Conditions: Sulfa medications
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2770AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Erythema, Eye pain, Headache, Injection site pain, Muscle swelling, Myalgia, Nausea, Oedema peripheral, Pain in extremity, Pyrexia, Retching
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 08/19/2007 Had severe pain in left arm above, below and at site of injection with in an hour. Took 3 reg ADVIL, used heat on arm and went to bed. On 08/20/2007, awoke with severe pain in left arm from top of shoulder to elbow then into fingertips, intolerable headache, dizziness, fever 100.5, nausea, gagging, very weak and eye pain. Went to urgent care to report reaction with physicians office. Suggested rest, ice and Benadryl. 08/23/2007 Arm becoming more swollen and redness expanding further into the arm. Visited doctor at clinic on 08/23/2007 with reaction measured sizes of 10x10 cm swelling, 4x6 cm redness. Reported this reaction to both clinic and to my regular clinic. Physician advised to continue resting, use ice and drink plenty fluids. Two weeks after Tdap shot regained most of my physical strength with continued pain and weakness in left arm. Pain in left arm muscle continued for another month after doctors visit on 08/23/2007, but eventually subsided as all the swelling in the muscle dissipated.

VAERS ID:288560 (history)  Vaccinated:2007-08-20
Age:0.5  Onset:2007-08-20, Days after vaccination: 0
Gender:Male  Submitted:2007-08-20, Days after onset: 0
Location:Montana  Entered:2007-08-21, 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: None
Current Illness: None per mom
Preexisting Conditions: None per mom
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB163AB0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB08690D3IMRL
TDAP: TDAP (ADACEL)SANOFI PASTEURC2631AA0IMLL
Administered by: Public     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Tdap and Hep A given in error. Prevnar #3 given today. Will return 9/6/07 to receive (DTaP/IPV/Hep B) Pediarix and HIB #3. Last IZ given 7/6/07 - Pediarix, HIB and Prevnar. No adverse symptoms. 8/20/07 or 8/21/07.

VAERS ID:289077 (history)  Vaccinated:2007-08-20
Age:14.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-08-22, Days after onset: 2
Location:Iowa  Entered:2007-08-27, 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
HPV4: HPV (GARDASIL)MERCK & CO. INC.0181U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2342CA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B013AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pallor, Syncope, Visual disturbance
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: After injections, client pale - then reports "things are going black". Eyes remained open but not alert. Observed for 30-40 minutes. BP range 92/60 - 80/60, P. 62-80 - thready. Becomes more alert, responsive - taking sips of H20 and juice. Report no breakfast or fluids this AM and swam for 2 hours. Client becomes faint again - recommend ambulance - parent refuses. At 1515 - color returning, responsive - no further occurrence of fainting events. Parents have arranged appt at doctor. 8/21/07 - PC to parents - no further problems - did not see doctor - as were advised by doctor office to keep client cool and hydrate.

VAERS ID:289196 (history)  Vaccinated:2007-08-20
Age:11.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-08-23, Days after onset: 3
Location:Oregon  Entered:2007-08-28, 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: Depo Provera; Motrin/Tylenol
Current Illness: None
Preexisting Conditions: Hx VU reflux, encopresis. Allergic to Augmentin, Cefzil
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0001U1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1427F2IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood pressure decreased, Hyperhidrosis, Oxygen saturation normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt. received 3 injections: HPV #3 (Gardasil), Hep A #2 and Depo Provera. Pt. fainted in hallway of clinic approx 5-10 min. after injections. Sweaty. BP 98/60. HR 70 O2 sat 98; 15 min. later (after lying down) felt better, BP 110.70, HR 82, O2 sat 99; to home to rest.

VAERS ID:289203 (history)  Vaccinated:2007-08-20
Age:18.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Female  Submitted:2007-08-22, Days after onset: 1
Location:New Jersey  Entered:2007-08-28, 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: None
Preexisting Conditions: PCN, Acidemenophine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0928U0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives on hand (1), hip (1), back (1); total of 3 hives. Advised Benadryl PO q 4 hrs x 24 hrs.

VAERS ID:290001 (history)  Vaccinated:2007-08-20
Age:64.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Female  Submitted:2007-08-29, Days after onset: 8
Location:North Carolina  Entered:2007-09-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NL
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.076U IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Local reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe local reaction after 24 hrs. Urticarial rash after 2-3 days.

VAERS ID:290009 (history)  Vaccinated:2007-08-20
Age:20.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Female  Submitted:2007-09-06, Days after onset: 16
Location:Wisconsin  Entered:2007-09-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Klonopin, Effexor
Current Illness: None
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2758AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe right shoulder pain and riht arm pain. Patient denies any reddness or severe swelling just pain.

VAERS ID:290446 (history)  Vaccinated:2007-08-20
Age:81.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Female  Submitted:2007-09-12, Days after onset: 22
Location:Iowa  Entered:2007-09-12
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
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1137F0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Erythema approx 6cm x 8cm and itching, tx with Prednisone and Benadryl.

VAERS ID:290493 (history)  Vaccinated:2007-08-20
Age:21.0  Onset:2007-09-01, Days after vaccination: 12
Gender:Female  Submitted:2007-09-13, Days after onset: 12
Location:Georgia  Entered:2007-09-13
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: Per ER- possible Nickel allergy
Diagnostic Lab Data: CDC, Basic Chem WNL at ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH   LA
Administered by: Military     Purchased by: Unknown
Symptoms: Erythema, Full blood count normal, Injection site vesicles, Laboratory test normal, Rash pustular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received smallpox vaccine Aug 20 (part of basic training?); approx 10 days later developed vescicles at site of imm on L arm; in next few days got pustules on both distal lower extremities. All evolved into pustules and subsequent ulcerations...presented to Med Ctr ER on Sept 8 because leg ulcers not healing. Approx 10 1-3 mm ulcers on distal L lower leg with 15 mm surrounding erythema, about 5-10 on R LE. ER called Department of Community Health, call referred to me (MD)- pt discharged with instructions and antibiotics...needs to not use lotions/ointments, and not to allow drainage from sites to contact others; after discussion with DOD, likely auto-inoculation....as no new lesions in last week prior to arrival to ER.

VAERS ID:292831 (history)  Vaccinated:2007-08-20
Age:16.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 28
Location:Ohio  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ACCUTANE, mg
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: electrocardiogram, 08/20/07, normal; computed axial, 08/20/07, see narr.
CDC Split Type: WAES0708USA05340
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U0IMUN
Administered by: Private     Purchased by: Other
Symptoms: Computerised tomogram abnormal, Contusion, Electrocardiogram normal, Haematoma, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a registered nurse concerning a 16 year old female (126 lbs., 62in.) student with no known drug allergies, who on 20-AUG-2007 was vaccinated with the first dose of Gardasil. Concomitant therapy included MENACTRA, ADACEL and ACCUTANE. There was no illness at the time of vaccination. Approximately 10 minutes after vaccination, the patient fainted for approximately 1-2 minutes in the office parking lot, struck her head on the pavement and was taken by EMS to the emergency room of a hospital. The patient experienced hematoma on the scalp of the right back side of the head and contusion due to the syncope from getting "3 shots". The patient''s ECG was "normal" and a CT scan of the head without contrast revealed soft tissue swelling in the right parietal occipital region suggestive of recent trauma and no evidence of intracranial hemorrhage or parenchymal contusion. On the same day, 20-AUG-2007, the patient was discharged from the emergency room as "improved". Additional information is not expected.

VAERS ID:296031 (history)  Vaccinated:2007-08-20
Age:6.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-09-24, Days after onset: 35
Location:Idaho  Entered:2007-09-27, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0708USA04612
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0800U1IMUN
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0357U SCUN
Administered by: Private     Purchased by: Private
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Information has been received concerning a 6 year old female with no reported medical history or allergies who on 20-AUG-2007 was vaccinated with ZOSTAVAX (lot # 656859/0357U) instead of VARIVAX. Concomitant therapy included VAQTA (lot # 658172/0800U) and measles-mumps-rubella vaccine (MSD) (lot # 656038/0204U). No adverse event was reported. Unspecified medical attention was sought. It was also reported that the patient''s sister also received a dose of ZOSTAVAX instead of VARIVAX (WAES # 0708USA03966). Additional information has been requested.

VAERS ID:291749 (history)  Vaccinated:2007-08-20
Age:13.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-09-24, Days after onset: 35
Location:Colorado  Entered:2007-10-01, 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: Proventil; Albuterol
Current Illness: N/A
Preexisting Conditions: Fraternal twin with controlled asthma/NKDA
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1426F0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Muscle spasms, Nausea, Syncope, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Immediate reaction to injection: dizzy, lightheaded, syncope, neck spasm lasted a few seconds. Improved quickly, appropriately. Headaches, nausea, dizziness persisted x 15 days. Pt lost 5 lbs.

VAERS ID:291856 (history)  Vaccinated:2007-08-20
Age:  Onset:2007-08-21, Days after vaccination: 1
Gender:Female  Submitted:2007-10-02, Days after onset: 42
Location:Virginia  Entered:2007-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV1055UNLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHABVB294AA2UNRA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURERC2769AA0UNRA
Administered by: Military     Purchased by: Military
Symptoms: Axillary pain, Fatigue, Headache, Pain in extremity, Similar reaction on previous exposure to drug
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Pt had anthrax #6 in left arm on 8/20/07. on 8/21 had pain in left arm and left axilla. Also c/o of headache and fatigue. States she had a similiar reaction with AVA 1-5. All sx resolved on 8/28/07

VAERS ID:300291 (history)  Vaccinated:2007-08-20
Age:12.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-11-30, Days after onset: 102
Location:Pennsylvania  Entered:2007-12-18, Days after submission: 18
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: Persistent hyperplastic primary vitreous right eye
Diagnostic Lab Data: Cat scan positive for pseudo tumor.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2775AA IMUN
Administered by: Private     Purchased by: Private
Symptoms: Brain neoplasm, Computerised tomogram abnormal, Headache, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tumours of unspecified malignancy (narrow), Hypoglycaemia (broad)
Write-up: 8/20/07 - very lethargic this continues even now. 9/13/07 - headaches treated with Motrin. 9/23/07 - ER visit, got steroids for pseudo tumor behind right eye, pain was so severe that Motrin couldn''t control them. At this point she was incapacitated.

VAERS ID:314678 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Male  Submitted:2008-05-16, Days after onset: 270
Location:Colorado  Entered:2008-05-23, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0708USA04206
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dysphagia, Dyspnoea, Pruritus
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a nurse concerning a 5 year old male who on 04-AUG-2003 was vaccinated with a first dose of varicella virus vaccine live (Oka/Merck). On 20-AUG-2007, the patient received a second 0.5mL dose of varicella virus vaccine live (Oka/Merck) (Lot # 658054/10100). On 20-Aug-2007, the patient developed difficulty breathing and swallowing, and was itchy all over his body. The physician advised the nurse to take the patient to the local emergency room. The patient was advised to take Benadryl and was given an epinephrine pen. The physician suggested that the patient see an allergist. No laboratory or diagnostic tests were performed. No additional information was provided. No product quality complaint was involved. Additional information has been requested.

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