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Case Details (Sorted by Vaccination Date)

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VAERS ID: 267184 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Male  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-20
   Days after onset:0
Entered: 2006-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0700F / 2 RA / SC
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR Z0664 / 2 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Dyspnoea, Swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SWELLING, HIVES, SHORTNESS OF BREATH OVER A 1.5 HRS TIME SPAN.


VAERS ID: 267406 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Colorado  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-20
   Days after onset:0
Entered: 2006-11-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR - / UNK RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient accidentally given adult Td in right arm IM. Patient with no adverse reactions currently. Patient had last DTAP on 5/31/2002.


VAERS ID: 267540 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Male  
Location: New York  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-20
   Days after onset:0
Entered: 2006-11-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2243AA / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Coma, Disorientation, Dizziness, Nausea, Respiratory rate increased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ, Ambien
Current Illness: Kidney stones
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG normal
CDC Split Type:

Write-up: 3 1/2 hours after receiving vaccine, spouse found pt slouched and unresponsive. After arousing him, he was disoriented, nausea, dizzy,chilly, rapidly breathing x 30 minutes.


VAERS ID: 267609 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Male  
Location: Unknown  
Vaccinated:2006-11-20
Onset:0000-00-00
Submitted: 2006-11-22
Entered: 2006-11-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 30725 / 2 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Medication error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: No adverse event: PPD inadvertently substituted for flu vaccince. 0.5ml of PPD given deep IM in deltoid. No adverse events. No local reaction. Patient recently PPD negative prior to this event.


VAERS ID: 267623 (history)  
Form: Version 1.0  
Age: 36.0  
Gender: Male  
Location: Georgia  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-11-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UE638AA / 2 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Dyspnoea, Eye inflammation, Inflammation, Injection site erythema, Injection site oedema, Lacrimation increased, Speech disorder, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD, Augmentin
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Localized erythema, edematous reaction at vaccination site. Pt c/o difficulty speaking, throat constriction, slight breathing problem, watering eyes, inflammation behind eyes, glottal inflammation. 500 NS 2 c 03mm Epinephrine 25 mg.


VAERS ID: 267655 (history)  
Form: Version 1.0  
Age: 62.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-11-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2239AA / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal discomfort, Cold sweat, Hyperhidrosis, Hypoaesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Evista, Lexopro, ASA, vitamin
Current Illness: none
Preexisting Conditions: Sulfa and codine allergy (sulfa-hives) (codine-makes ill).
Allergies:
Diagnostic Lab Data: EKG, Chest xRay (normal) taken 11/20/06 about 2:30 PM
CDC Split Type: KY2006033

Write-up: 11:15am burning in stomach, clammy/sweaty, vomiting x3, numbness on arms and hands (all within 20 minutes).


VAERS ID: 267664 (history)  
Form: Version 1.0  
Age: 49.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-22
   Days after onset:2
Entered: 2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0088F / 3 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Cellulitis, Injection site pain, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol,Singulair,Lasix,lorazepam,estradiol,buproprion,nexium, atenolol, loratidine
Current Illness: none
Preexisting Conditions: Asthma, Edema,Hypertension, GERD
Allergies:
Diagnostic Lab Data: A CBC and Sedimentation rate drawn on 11/21/2006 were normal.
CDC Split Type:

Write-up: Later in the evening after receiving her third pneumovax, she developed severe pain, swelling, and warmth at the injection site. She also developed diffuse arthralgias and fever. She was initially treated by another physican for possible cellulitis but when I saw her the next day I treated for inflammation and arthralgias with prednisone.


VAERS ID: 267712 (history)  
Form: Version 1.0  
Age: 70.0  
Gender: Female  
Location: Hawaii  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-11-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Cellulitis, Erythema, Joint stiffness, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen, Aspirin, Simvastatin, Tolbutamide
Current Illness: sinusitis-treated with amoxicillin
Preexisting Conditions: (+) TB, DM II, Hyperlipidemia, allergies: albuterol, codeine, ace inhibitors
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of left upper arm/shoulder pain and stiffness last night after shot was administered. Redness, swelling to the left upper arm above elbow. TYLENOL taken with relief of pain. Patient in our clinic today for assessment. Seen by doctor mentioned. Diagnose: Cellulitis, KEFLEX treated.


VAERS ID: 267865 (history)  
Form: Version 1.0  
Age: 0.33  
Gender: Male  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-11-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1985AB / 3 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0401F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0421 / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666E / 3 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Has a fever of 100.2 -100.4 started last night. Lethargic, given Tylenol.


VAERS ID: 267949 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-22
   Days after onset:1
Entered: 2006-11-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965AB / UNK RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2168DA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 4 RL / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1139R / 2 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Skin burning sensation
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom stated that around 3:00pm on Tues afternoon she noticed that his left thigh was swollen size of baseball warm to touch, mom called nurse for advice at night they told her stay of legs and cold compress mom did, Wed am he woke up swelling decreased but still red to area and warm, leg is same size as other, no raise noted on left thigh, right thigh looked good, no adverse reactions noted, child doing good, playing well, happy, says leg is hot/burning. Mom will C/B if any other SX appear.


VAERS ID: 267954 (history)  
Form: Version 1.0  
Age: 0.93  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-11-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2286AA / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day of vaccine fever to 104.6, brief 30 sec seizure. No treatment for this. DX febrile seizure.


VAERS ID: 267966 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Texas  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-11-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2250AA / 4 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1921AA / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma; Allergic rhinitis; Overactive bladder; Antiphospholipid syndrome; Sjogren''s syndrome.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother states patient developed hives and whelps at approximately 1930 on 11/20/2006. Denies difficulty breathing or any respiratory distress.


VAERS ID: 267970 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Michigan  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-11-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 2 RL / -

Administered by: Private       Purchased by: Other
Symptoms: Hypokinesia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 105.2 right. Leg pain - would not move leg. Presented 24 hours after immunization.


VAERS ID: 267976 (history)  
Form: Version 1.0  
Age: 1.58  
Gender: Male  
Location: Missouri  
Vaccinated:2006-11-20
Onset:2006-11-22
   Days after vaccination:2
Submitted: 2006-11-22
   Days after onset:0
Entered: 2006-11-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B035AA / 4 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0741F / 1 RA / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0889R / 3 LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 4 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/22/06 mother phoned report of big welts at injection sites. Immunizations on 11/20/06.


VAERS ID: 267977 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Male  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-11-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0352F / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Erythema, Respiratory rate decreased, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLOMAX; LOVASTATIN
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen reddened arm and joint pain. Patient complained of respiratory distress and discomfort.


VAERS ID: 268039 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Texas  
Vaccinated:2006-11-20
Onset:2006-11-24
   Days after vaccination:4
Submitted: 2006-11-30
   Days after onset:6
Entered: 2006-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500431P / UNK NS / IN

Administered by: Military       Purchased by: Military
Symptoms: Dysphonia, Nasal congestion, Pharyngolaryngeal pain
SMQs:, Parkinson-like events (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccinated on Monday. Nasal congestion 24 hrs post vaccination, then within 96 hrs (on Firday)had voice hoarsness that worsened to complete voice loss on Sunday with gradual return on Monday. 10 days post vaccination voice remains hoarse but improving. No fever, no sore throat, no throat reddness or pustules, no fatigue or change in appetite, no enlarged nodes. Did not have cough, just slight irritation in throat area.


VAERS ID: 268170 (history)  
Form: Version 1.0  
Age: 90.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-27
   Days after onset:7
Entered: 2006-12-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2283AA / 7+ LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0881F / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Exam only
CDC Split Type:

Write-up: Entire right arm site of pneumovax was edematous/erythematous, no other rashes ore edema (had flu vaccine in left arm). Resolved when seen 1 week later.


VAERS ID: 268176 (history)  
Form: Version 1.0  
Age: 1.73  
Gender: Male  
Location: Virginia  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-12-04
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC143027AA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2187AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0278F / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649E / 4 RL / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin, Debrox ear drops.
Current Illness: Otitis media on treatment
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Induration over vaccine site, (site of Dtap and Prevnar on right thigh.


VAERS ID: 268331 (history)  
Form: Version 1.0  
Age: 1.34  
Gender: Female  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-22
   Days after onset:2
Entered: 2006-12-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2515AA / 4 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2175CA / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. VE950AA / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666 / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pectus excavatum
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever to 103-104 degrees within 12 hours of vaccine


VAERS ID: 268332 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Michigan  
Vaccinated:2006-11-20
Onset:2006-11-22
   Days after vaccination:2
Submitted: 2006-11-21
   Days after onset:1
Entered: 2006-12-05
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR PMC02402BA / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR PMCY1030Z / 4 RA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Cerebrovascular accident, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: no fever
Preexisting Conditions: Wheelchair bound. History per gm cognitively impaired. Severe CP since birth
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Grandmother calls HD states above client had 2 seizures or "possible stroke" today prior to call to HD at 11:55 am. Has not taken client in for care. Encouraged to call client''s doctor for treatment at time of immunization gm (custodian) denied allergies or any problems with immunizations today client question may have had a problem with pertussis immunization. GM states this did not reveal at immunization time 11/20/06. GM states client recovered.


VAERS ID: 268333 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-22
   Days after onset:1
Entered: 2006-12-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 72005C / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Feeling hot, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left upper arm hot, erythematous swollen (22 cm right arm) 24.5 cm swelling 7x8cm erythema


VAERS ID: 268461 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Texas  
Vaccinated:2006-11-20
Onset:2006-11-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074DA / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08682C / 3 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, CSF test abnormal, Encephalitis, Encephalopathy, Laboratory test abnormal, Myelitis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt had brief episode of severe vomiting on 11/21/06
Allergies:
Diagnostic Lab Data: MRI consistent with transverse myelitis and demylinating encephalitis (ADEM). Cultures of CSF, throat and rectal swab, negative. CSF: protein 55 Enterovirus negative. Aldolase 11.3.
CDC Split Type:

Write-up: Sudden onset of global weakness. Pt hospitalized and diagnosed with ADEM. Specialist believes the condition may have been caused by vaccines. 01/08/07-records received and reviewed. DOS 11/29-12/9/06- DC DX: acute disseminating encephalopathy. Began with weakness not moving all 4 limbs, PE little movement in lower limbs, hypotonic, 2+reflexes, without clonus, poor head control. Two weeks prior had respiratory illness. Treatment included Solu Medrol. Residual neurological symptoms - weakness of extremities, mild developmental delay (motor), and vesico-uretral reflux (possibly due to urinary retention).


VAERS ID: 268608 (history)  
Form: Version 1.0  
Age: 55.0  
Gender: Female  
Location: California  
Vaccinated:2006-11-20
Onset:0000-00-00
Submitted: 2006-12-07
Entered: 2006-12-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2255AA / 1 LA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0391F / 1 RA / -
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR U1907BA / UNK RA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Lumbar DJD, knee pain, depression.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt states pain both arms after flu vax, TD, Pneumovax.


VAERS ID: 268618 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-27
   Days after onset:6
Entered: 2006-12-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB0610AA / 2 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Dermatitis contact, Erythema, Oedema peripheral, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, HCTZ, Fossimax.
Current Illness:
Preexisting Conditions: PCN, high blood pressure, facial tick, environmental allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 2nd Twinrix 11/20/06, 11/21/06 in PM developed itchy, red, generalized rash, middle finger right hand swollen, took Benadryl 11/22 still itchy, by PM hands swelling and itchy took Benadryl, 11/23 continued Benadryl rash remained hands and wrist swollen. 11/24 Hospital ER, DX contact dermatitis VS vaccine reaction, RX with steroids and antihistamines. TC to ACHD 11/27 to discuss above, TC 12/08/06 responded to RX okay.


VAERS ID: 268591 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-12-11
   Days after onset:21
Entered: 2006-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / ID
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Decreased appetite, Hypoaesthesia, Influenza like illness, Injection site warmth, Pain, Pyrexia, Skin discolouration, Skin hypertrophy, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax XR, Xananx, synthroid, remeron,flexeril, morphine, tramadol,more taken as needed.
Current Illness: Chronic Fatigue Syndrome, Fibromyalgia, Irritable Bowel Syndrome, Endometriosis, Bone spurs in Cervical spine
Preexisting Conditions: Chronic Fatigue syndrome, Fibromyalgia, Endometriosis, Irritable Bowel Syndrome, Bone spurs in Cervical spine, Panic disorder
Allergies:
Diagnostic Lab Data: Had WBC that registered 6.6, within normal limits approximately 2 weeks after the shot was administered. At the same time a temp of 99.6 was detected.
CDC Split Type:

Write-up: Arm pain, gradually increasing from day the shot was given. One day after shot, a lump formed under skin that gradually got larger as days passed. Larget is was was 3/4 size of ping pong ball. Area was black, blue, green and very sensitive to touch almost immediately. Also caused flu like symptoms approximately 12 hours after shot was administered. Infection grew worse over next few days and sought out medical treatment 7 days after shot was given. Was given Diclocil antibiotics. By this time the arm was very sore to move, hot to the touch and getting worse by the hour. It also caused slow and increasing swelling of my entire body from day one of the shot. At one point, The area was so bad, it looked as if someone had taken a mellon ball scooper and scooped out all the tissue around the sizeable lump right down to the bone. By this time, the rest of my arm had begun to swell to the point of making my fingers numb and I thought I was in danger of serious blood infection or arm amputation. I sought medical attention 7 days after the shot was given, I was overseas and had to go to hospital there. I was advised that this was a very serious infection and I was not to leave the Bangkok area for at least 12 days to make sure the infection was under control. During the time after the shot was given, sweats and chills were prominent, and fever up to 101.3 were detected, with other fevers hovering at 100.00. The swelling of my whole body progressed with time. After I started the antibiotics, the swelling subsided about 20% and the lump gradually diminished to about 1/3 the largest size it had been. After 7 days of anti-biotics, the infection came back rapidly, within 12 hours of the last pill, and developed rapidly. Over the course of 3 hours the arm had swollen significantly and the lump tripled in size and the discoloration began to return. Two days after ending the first round of antibiotics, I saw urgent care at home. I was advised to take augmentin for 10 days and if it did not improve within the first three days of treatment, to go to the ER to have it drained and get stronger drugs. So far, the augmentin has made the swelling go down, the lump has diminished but is not gone, and the over all sick feeling has subsided to some degree. The color is improving but you can still see the marks from the worst it had been. This has been a very scary infection for me. It does not want to seem to go away. I am resting and drinking fluids and eating easily digestible foods, although my appetite is zero.


VAERS ID: 268601 (history)  
Form: Version 1.0  
Age: 59.0  
Gender: Female  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-12-06
   Days after onset:16
Entered: 2006-12-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1036P / 1 LA / -

Administered by: Other       Purchased by: Private
Symptoms: Erythema, Pain, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE known
Current Illness: NONE
Preexisting Conditions: Morphine allergy
Allergies:
Diagnostic Lab Data: NONE known
CDC Split Type:

Write-up: Patient received vaccine on 11/20/06 and developed reaction that night. Came back to pharmacy next day with symptoms of redness, pain and swelling from the left shoulder to elbow. Went to ER next day.


VAERS ID: 268625 (history)  
Form: Version 1.0  
Age: 60.0  
Gender: Male  
Location: Illinois  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-12-06
   Days after onset:16
Entered: 2006-12-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0888F / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0611USA07063

Write-up: Information has been receive from a licensed practical nurse concerning a 60-70 yea old male who was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (lot 654977/088F). Subsequently, last week the pt developed redness, swelling and pain in the injection are. The pt was treated with Benadryl. It was reported that the adverse event lasted 2-3 days. The reporter considered redness, swelling and pain in the injection arm to be disabling. Additional information has been requested.


VAERS ID: 268637 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-27
   Days after onset:7
Entered: 2006-12-11
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1213R / 1 RA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1009F / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2491AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TN0631

Write-up: Parent reported child had 102 fever and general aches beginning 12 hours after vaccines. Fever lasted about 24 hours.


VAERS ID: 268693 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Colorado  
Vaccinated:2006-11-20
Onset:2006-12-08
   Days after vaccination:18
Submitted: 2006-12-11
   Days after onset:3
Entered: 2006-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2248AA / 2 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0496-2 / UNK LA / SC
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2609AA / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR Z0572 / 1 RA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UE913AA / 1 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dysphagia, Eye disorder, Headache, Musculoskeletal stiffness, Myalgia, Pruritus, Rash, Rash pruritic, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CIPROFLOXACIN MALARONE
Current Illness: HEALTHY
Preexisting Conditions: ALLERGIES: ANESTHETIC, TEGRETOL, AMOXICILLIN W/CLAVULANATE, DESPIRAMINE, ADHESIVE TAPE, IODINE AND IODINE CONTAINING PRODUCTS AND HYDROXYZINE PMH: ANXIETY, GANGLIONEUROMA OF MEDIASTINUM, BENIGN, DORSALGIA, STRESS DISORDER, CHRONIC PAIN SYNDROME, ACHWANNOMA SPINAL CORD
Allergies:
Diagnostic Lab Data: 12/8: ALL LABS WNL HEPATIC FUNCTION PANEL CBC W/DIFF SR CREATINE URINALYSIS WBC W/DIFF
CDC Split Type:

Write-up: 11/20: PT DEVELOPED HA AND VOMITING ABOUT 1 HR AFTER SHOTS THEN GOT SORE MUSCLES 12/6: FIRST SPOT NOTED 12/8: PT HAVING DIFFICULTY USING HANDS DUE TO PAINFUL STIFFNESS. PT C/O NIGHT SWEATS, SORE MUSCLES, NOW BREAKING OUT W/SPOTS, ITCHY AND PAINFUL. TROUBLE SWALLOWING 2ND TO PAIN. NO DIARRHEA. URINE NL. EYES ITCHY AND BLURRY. COUGH FOR SEVERAL MONTHS - HURTS TO COUGH. USING APAP AND IBUPROFEN AT HOME - MOSTLY APAP AT NL DOSES. RANITIDINE 150 MG BID FOR GERD AND IBUPROFEN 800 MG TID FOR PAIN/INFLAMMATION STARTED 12/11 (11:15 AM): PT STATES HA WORSENED AND BUMPY RASH ALL OVER BODY LABS NORMAL


VAERS ID: 268754 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Ohio  
Vaccinated:2006-11-20
Onset:2006-11-28
   Days after vaccination:8
Submitted: 2006-12-12
   Days after onset:14
Entered: 2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA242AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site nodule, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin for pain once sx began. Vitamins
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine on 11/20/06 and experienced mild pain on 11/20-11/21 which went away. On 11/28/06 patient started having severe pain at injection site. The pain was severe enough to wake her up at night. Also a nodule was noted at the injection site. She reported this to her Safety Officer at the company where she works. (The flu shots had been administered at the company through the health department) The Safety Officer contacted a health center who recommended heat and exercise. At the time of interview with the patient on 12/11/06 she reports sx have significantly improved to where she only has a slight ache when moving in certain positions.


VAERS ID: 268975 (history)  
Form: Version 1.0  
Age: 1.28  
Gender: Male  
Location: Florida  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-12-08
   Days after onset:17
Entered: 2006-12-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B033AA / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1054F / UNK - / -

Administered by: Military       Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Gave him Benadryl because he had welts on his back, belly, legs. No other symptoms though. (Could breathe fine and no fever).


VAERS ID: 269052 (history)  
Form: Version 1.0  
Age: 1.45  
Gender: Male  
Location: Alaska  
Vaccinated:2006-11-20
Onset:2006-12-03
   Days after vaccination:13
Submitted: 2006-12-07
   Days after onset:4
Entered: 2006-12-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B032AA / 5 LL / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2175GA / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0889R / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0424R / 2 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Petechiae, Rash maculo-papular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AK200665

Write-up: PA-C who was seen child today stating child has maculopapular rash interior, posterior trunk extended to neck and upper extremities. No fever. Petechiae in oropharynx.


VAERS ID: 269063 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-12-13
   Days after onset:22
Entered: 2006-12-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42166JA / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Difficulty in walking, Fatigue, Headache, Inflammation, Joint stiffness, Swelling, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Denied
Preexisting Conditions: Denied
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/21 and 11/22-headache, stiff neck, low grade fever; 11/23 felt fatigued, neck and back pain; 11/24 "night sweats"-joints ached, felt warm and knees became swollen. Temp 101.5; 11/26 difficulty walking-went to emergency room. Treated with IV fluid and anti- flammatory med. Discharged with Doxyclyine and Naprocyn; 11/28 went to primary care physician-had urinary tract infection, given Cipro and cortisone shot; 12/1 inflammation decreased and saw a rheumatologist. Blood work drawn.


VAERS ID: 269315 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-12-18
   Days after onset:28
Entered: 2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA239BA / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Povider ordered the flu vaccinne 0.5cc. Gave the child a flu vaccinne for 18yrs and older. So I immediately notified the Clinc Director.Fluarix lot # AFLUA239BA Exp 06/30/2007


VAERS ID: 269671 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: Michigan  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-11-27
   Days after onset:6
Entered: 2006-12-27
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHHABB050AA / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 032F / 1 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U195BA / UNK RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Body temperature increased, Cellulitis, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, cardiac medications
Current Illness:
Preexisting Conditions: Diabetes insulin., coronary artery disease. Stent 2005 PMX: Appenectomy. Hypertension. Hypothyroidism. Hyperlipidemia
Allergies:
Diagnostic Lab Data: BC pending. WBC 17.3.
CDC Split Type:

Write-up: Vaccines were given Monday 11/20/06 in the evening. Tuesday afternoon 11/21/06 client C/O left arm being sore, red and hot to touch. Client also C/O feeling feverish. Tuesday evening after work her symptoms continued to worsen. She had a temperature 101.5 degrees F and took some Tylenol for relief. Client began to feel weak and tired and went to bed early. She woke up in the night and her left arm was swollen and tender. Her temperature was 100 degrees F. Client stayed home from work Wednesday. She C/O feeling feverish and weak and her arm hurt a lot. By Thursday a.m. she felt she was getting very sick so she went to Hospital Emergency department. Client states she was given antibiotics by I.V., arm marked to indicate progression of swelling and she was sent home with an oral antibiotic, Augmentin to take. Friday she returned to emergency room and was admitted. She was diagnosed as having cellulitis. Client was given I.V. antibiotics and stayed 2 days. She was again discharged and put on oral antibiotics, Augmentin. Today, Monday 11/27/06 client states she is feeling better. her left arm is still red, swollen and tender to touch but not as bad as it was. She will follow up with02/16/07-her own doctor.for 2/16/07-Records reviewed DOS 11/23-11/25/06 DC DX: Cellulitis ADmitted with fever of 101, increased redness over left arm. PE: WNL except for left arm erythema with mild induration at the site of the prior vaccination, no abscesses or crepitus. Local increased warmth, mild lymphadenitis in the axillary area.


VAERS ID: 269706 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: Kansas  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2006-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2202AA / 4 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2609AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Headache, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Focalin XR, Allergy Shot.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC
CDC Split Type:

Write-up: Severe headache began 3am 11/21/06 and abdominal pain began 8am 11/21/06. Had Abd pain off and on throughout the day. Also ran fever 101.2 that day. Was fine by am 11/22/06.


VAERS ID: 270145 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: New York  
Vaccinated:2006-11-20
Onset:2006-11-22
   Days after vaccination:2
Submitted: 2006-12-18
   Days after onset:26
Entered: 2007-01-08
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2240A / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2159A / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Erythema, Flushing, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nevacor, Birth control pills, Celexa, Clontin
Current Illness:
Preexisting Conditions: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2006034630

Write-up: Initial report received from a health care professional in the USA on 12 December 2006. A 18 year old, female patient (with a medical history of no known allergies) developed a flushed, red and itchy face, 2 days after she received Fluzone (lot number U2240AA) intramuscularly in the left deltoid, Menactra (lot number U2159AA) intramuscularly in the right deltoid and Gardasil (lot number unknown) on 20 November 2006. On 24 November 2006, the patient called to reports red spots on hands. The patient did not have any illness at the time of the vaccination. She was treated with Benadryl. She was not seen at the doctor''s office and has moved. It was reported that she recovered.


VAERS ID: 270302 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: New York  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-01-08
   Days after onset:49
Entered: 2007-01-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abortion, Unintended pregnancy
SMQs:, Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Miscarriage, Abortion spontaneous.
Allergies:
Diagnostic Lab Data: 12/04/06 blood work positive for pregnancy, 11/20/06 negative for pregnancy, 11/20/06 fluid in pelvis no IUP seen, Urine beta human positive.
CDC Split Type: WAES0612USA01040

Write-up: Initial and follow up information has been received from a licensed practical nurse through the manufacturer pregnancy registry concerning a 24 year old female with a history of two miscarriages in the past and not planning on being pregnant, a spontaneous abortion (March 2006) and no known allergies reported. On 20 Nov 2006, the patient was vaccinated intramuscularly in the left deltoid with the first 0.5ml dose of HPV vaccine (lot #653978/0955F). On 20 Nov 2006, the patient had a pelvic ultrasound performed due to pelvic pain. The pelvic ultrasound revealed fluid in pelvis and no intrauterine pregnancy was seen (previously reported as was negative for pregnancy). On an unspecified date, post vaccination, the patient presented to the office stating that she took a urine home pregnancy test and it was positive. On 04 Dec 2006, the patient had blood work drawn which revealed positive for pregnancy. The patient was approximately 6 weeks gestation with last menstrual period noted as approximately 21 Oct 2006. The patient was scheduled for a follow up blood test on 07 Dec 2006 and an ultrasound and blood lab was scheduled on 11 Dec 2006. On 17 Dec 2006 the patient experienced spontaneous abortion. The patient sought unspecified medical attention. At the time of this report, the outcome of the event was unknown. Upon internal review, the spontaneous abortion was considered to be an other important medical event (OMIC).


VAERS ID: 270464 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Georgia  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-27
   Days after onset:7
Entered: 2007-01-12
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0105F / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Loss of consciousness, Nervousness, Rash, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA06063

Write-up: 18 year old received #1 Hepatitis B shot, was very nervous and had not eaten anything prior to immunization. After receiving injection walked with mom to desk to pay and fainted. Vomited small amount of emesis. Hit back of head on floor. Mom reports next day had rash on both side of neck which faded away.


VAERS ID: 270472 (history)  
Form: Version 1.0  
Age: 1.01  
Gender: Female  
Location: Oklahoma  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-01-12
   Days after onset:53
Entered: 2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (DITANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B033A / 4 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0602F / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 3 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1120F / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649E / 3 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dyskinesia, Eye movement disorder
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Just mom was asked to follow up with other specialists, per our conversation today, but mom is reluctant to take child for further assessments , because the child has not had any further problems since the week in November.
CDC Split Type:

Write-up: Mom of child phoned health dept. today stating that the day the child received her 12 mo old shots , she startingto have head jerking and eyes rolling around in her head-- this went on for a week , mom noticing this movement. Mom states she took child to see her Dr and it is not clear whether Dr thought the problem was related to the immunizations. Mom states after the week she has not noticed any further problems. Mom has also video taped the childs head movement.


VAERS ID: 270576 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Male  
Location: Alabama  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2007-01-16
   Days after onset:56
Entered: 2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2258AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Purpura, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Omeprazole 40 mg BID 2. Atrovent inh 2 puffs QID 3. Guaifenesin syrup (has not taken yet) 4. Felodipine 10 mg QD 5. Enalapril 20 mg BID 6. Diclofenac 100 mg BID with food 7. Quetiapine 50 mg BID plus 200 mg QHS 8. Mirtazapine 90
Current Illness: None other than chronic conditions
Preexisting Conditions: 1. COPD and asthma--PFTs 2/01 FVC 2.97, FEV1 2.19. 5 inpatient admits to BVAMC since 1/02 for COPD exacerbation (last 1/04) 2. Sleep apnea on CPAP 12 3. Hypertension 4. PTSD 5. History of alcohol abuse 6. History of migraines 7. Depression 8. Abnormal sestamibi in 10/02 with mild scar in RCA, mild stress and resting left ventricular dysfunction and dilation. Rest EF was 47%. 9. Erectile d/o 10. Septoplasty and turbinoplasty, 9/05 11. Restless leg syndrome 12. HLD--lipid panel 7/06: TC 167, TG 80, HDL 56, LDL 95 13. Allergic rhinits, sinusitis ALL: 1. Codeine--n/v 2. Morphine--HA
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 47 YO developed erythematous, pruritic rash on eyelids and face after receiving flu vaccine on 11/21/06. He had received flu vaccination previously without complications or reaction. The rash was treated with PO diphenhydramine.


VAERS ID: 271244 (history)  
Form: Version 1.0  
Age: 80.0  
Gender: Female  
Location: Colorado  
Vaccinated:2006-11-20
Onset:2006-12-04
   Days after vaccination:14
Submitted: 2007-01-16
   Days after onset:43
Entered: 2007-01-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Therapy unspecified
Current Illness:
Preexisting Conditions: Type II diabetes mellitus, glaucoma, hypertension, neuropathy peripheral, irritable bowel syndrome, osteoporosis
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0612USA00633

Write-up: Information has been received from a health professional concerning an 80 year old female with type II diabetes mellitus, g glaucoma, hypertension, peripheral neuropathy, irritable bowel syndrome, and osteoporosis who on 20 Nov 2006 was vaccinated SC with a 0.65 mL dose of Zostavax. Concomitant therapy included 11 unspecified medications. On 04 Dec 2006, the patient called her physician''s office to report that she had experienced a sudden loss of hearing in both ears. Unspecified medical attention was sought. A product quality complaint was not involved. Additional information has been requested.


VAERS ID: 272174 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Female  
Location: California  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2007-01-29
   Days after onset:69
Entered: 2007-02-13
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroxine
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Reported first on 1/3/07. Then seen in EHS 1/4/07. Left upper arm around deltoid with indentation/depression. States day after she received injection her left arm was sore within one week had redness, swelling, warm, raised area, no drainage.


VAERS ID: 272242 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Female  
Location: Wyoming  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-02-09
   Days after onset:81
Entered: 2007-02-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Blood test, Erythema, Liver function test abnormal, Pruritus, Rash, Rash morbilliform, Skin haemorrhage, Urticaria
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1957~Influenza (Seasonal) (no brand name)~~0.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood tests and nutritional review showed liver stress
CDC Split Type:

Write-up: On way home from shot my arm turned bright red-then hives all over my body. Administered Atarax-Cephlin to counteract reaction-given by my doctor. Could not tolerate this medications after going off this my body broke out like measles all over and a rash on top of that and extemity itchy and then bled an awful situation.


VAERS ID: 272302 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Michigan  
Vaccinated:2006-11-20
Onset:2006-11-22
   Days after vaccination:2
Submitted: 2007-02-14
   Days after onset:84
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Acne
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0701USA00894

Write-up: Initial information has been received from a physician via a company representative and follow-up information has been received from the physician concerning a 14 year old female student who, on 20-NOV-2006, was vaccinated with a 0.5 ml dose of Gardasil (yeast) (lot# not reported). There was no concomitant medication. Subsequently, on approximately 22-NOV-2006 or 23-NOV-2006, the patient developed a bad acne breakout. The physician reported that the patient developed "giant pimples" the likes of which she''d not experienced previously. The patient was reported to have been using over the counter acne wash which had been working well up to this point. The patient was put on oral antibiotics and given a topical wash for the breakout, which occurred on her face, chest and back. The patient''s acne breakout was continuing at the time of the report. Additional information has been requested.


VAERS ID: 272864 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Maine  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:1
Entered: 2007-02-21
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0504R / 3 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaphylactic reaction, Angioneurotic oedema, Blood glucose normal, Blood pressure, Dizziness, Full blood count normal, Lip swelling, Pharyngeal oedema, Throat irritation, Urine analysis normal, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meds: none.
Current Illness:
Preexisting Conditions: PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: UA nl, CBC, glucose were nl. Labs and Diagnostics: CBC normal, Chemistry normal, UA (-), UCG (-), Tox screen (-).
CDC Split Type:

Write-up: On 11/20/06 this well 13 YO male had Hep BW3 and 1-1 1/2 hours after Hep B # IM the patient felt dizzy, lightheaded and had a tickle in her throat. Her school nurse did BP 100/80 P 98. Her mother took her at me request to urgent care where she had angioedema (throat swollen and lips swollen) and hives. She was treated for anaphylaxis with IV fluids, Epinephrine and Benadryl and IV steroids and released to home care. 04/02/2007 MR received for an ER visit for c/o feeling dizzy with a tickle in her throat 1 hour after 3rd Hep B vax. While in the ER a rash developed on her back. PMH: none. Allergies: none. Meds: none. PE: Slight eyelid edema, initially erythema at the site which resoved with Benadryl. Clinical Impression: Allergic reaction to hep B shot.


VAERS ID: 273024 (history)  
Form: Version 1.0  
Age: 73.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-02-23
   Days after onset:95
Entered: 2007-02-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1012F / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster, Incorrect dose administered, Lymphadenectomy, Oedema, Skin lesion, Varicella zoster virus serology positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Breast cancer; Lymphadenectomy
Allergies:
Diagnostic Lab Data: diagnostic laboratory - positive VZ 1GG
CDC Split Type: WAES0702USA01797

Write-up: Information has been received from a physician concerning a 73 year old female with a history of breast cancer and lymphadenectomy who on 20-NOV-2006 was vaccinated SC with a 0.5ml dose of Zostavax (lot #652946/1012F). On 25-JAN-2007 the patient developed shingles. The patient has symptoms of herpes zoster 5-7 days prior to being seen. The patient also developed some edema near the lesions. The patient was seen by the physician and was treated with Valcyclovir. It was reported that the patient has had the herpes zoster in the dermatone of the lymphadenectomy and had a prolonged recovery. As of 13-FEB-2007 she may still have active lesions and was recovering. There was no product quality complaint involved. The patient''s shingles and edema were considered to be disabling. Additional information has been requested.


VAERS ID: 273463 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Female  
Location: Connecticut  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2007-03-05
   Days after onset:104
Entered: 2007-03-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Body temperature increased, Diarrhoea, Haematochezia, Irritability, Pyrexia, Similar reaction on previous exposure to drug, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Protein allergy, Milk allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: body temperature 11/21/06 100.6 F
CDC Split Type: WAES0702USA04076

Write-up: Information has been received from a physician concerning a 9 week old female with a protein allergy and a milk allergy who was vaccinated with a first and second dose of Rotateq on 20-NOV-2006 and 18-JAN-2007, respectively. On 21-NOV-2006 the patient developed vomiting, irritability, and diarrhea. The patient was taken to the emergency room and had a fever of 100.6. The patient was sent home from the emergency room that day. On 19-JAN-2007, one day after the second dose, the patient developed a low grade fever, blood in stool and diarrhea. These symptoms resolved with a few days. On 18-FEB-2007 the patient went to the emergency room with projectile vomiting with some oral bile discharge. The physician reported on 20-FEB-2007 that the vomiting had resolved, but reported that the patient had periodic diarrhea after both vaccinations had occurred (date and time unspecified). There was no product quality complaint involved. Upon internal review the patient''s blood in stool was considered to be an other important medical event. Additional information has been requested.


VAERS ID: 273475 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Maryland  
Vaccinated:2006-11-20
Onset:2006-12-01
   Days after vaccination:11
Submitted: 2007-01-29
   Days after onset:59
Entered: 2007-03-06
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states she missed her menses the month after administration of her first Gardasil injection. Another nurse says she heard another patient say the same thing happened to her, but she couldn''t remember the second patient''s name in order to fill another report.


VAERS ID: 274917 (history)  
Form: Version 1.0  
Age: 0.59  
Gender: Unknown  
Location: Florida  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:113
Entered: 2007-03-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse effect
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA01419

Write-up: Information has been received from a registered nurse concerning a 30 week old infant who was vaccinated 20-NOV-2006 with an oral dose of Rotateq. No problems were reported. It was not reported if medical attention was sought. There was no product quality involved. Additional information is not expected.


VAERS ID: 275347 (history)  
Form: Version 1.0  
Age: 0.09  
Gender: Female  
Location: Ohio  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2007-03-07
   Days after onset:106
Entered: 2007-03-26
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0039F / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0611USA07280

Write-up: Information has been received from a licensed practical nurse (L.P.N.) concerning a 35-day-old female with no medical history or allergies, who on 20-NOV-2006 was vaccinated intramuscularly with a second dose of Recombivax HB. There was no concomitant medication. On 21-NOV-2006 the baby broke out in a rash. Unspecified medical attention was sought and no laboratory or diagnostic test were performed. Subsequently, the patient recovered. No product quality complaints were involved. Additional information has been requested.


VAERS ID: 275880 (history)  
Form: Version 1.0  
Age: 1.28  
Gender: Male  
Location: Connecticut  
Vaccinated:2006-11-20
Onset:2006-12-26
   Days after vaccination:36
Submitted: 2007-04-04
   Days after onset:98
Entered: 2007-04-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0829F / 1 LG / SC

Administered by: Private       Purchased by: Other
Symptoms: Pruritus generalised, Rash vesicular, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0701USA04508

Write-up: Information has been received form a physician''s assistant concerning a 15 month old male who in the "end of November 2006", was vaccinated with 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). At the "end of December 2006", four weeks after receiving the vaccine, the patient developed chickenpox; over 100 lesions. The patient had a doctor''s visit on 26, Dec 2006. The lesions cleared up within ten days. The patient was considered recovered at the time of the report. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 4/4/2007. Information has been received from a physician''s assistant concerning a 15 month old male, with no pre-existing allergies, birth defects, medical conditions or illness at the time of vaccination. On 20-NOV-2006, the patient was vaccinated subcutaneously into the thigh, with his first dose, 0.5ml, of PROQUAD (Oka/Merck upgrade process) (Lot # 655000/0829F). On 26-DEC-2006, four weeks after receiving the vaccine, the patient developed an generalized itchy, vesicular rash, with greater than 200 lesions over his entire body, determined to be chickenpox. The patient had a doctor''s visit on 26-DEC-2006. The lesions cleared up within ten days. The patient recovered on 05-JAN-2007. Unspecified medical attention was sought. There was no product quality complaint. There were no lab diagnostic studies performed. No specimen collected. No further information is expected.


VAERS ID: 276108 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:136
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Drug exposure during pregnancy, Foetal heart rate, Nausea, Pregnancy, Pregnancy test urine positive, Ultrasound scan
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARITIN; NASONEX
Current Illness: Pregnancy NOS (LMP = 10/05//2006); Food allergy
Preexisting Conditions: Migraine; Streptococcal infection; Pharyngitis;
Allergies:
Diagnostic Lab Data: Ultrasound, 12/11/2006, CRL 10.4 mm, positive fetal heartbeat, 7 1/2 weeks pregnant; urine beta-human , 12/05/2006 posit
CDC Split Type: WAES0701USA04121

Write-up: Information has been received as part of a pregnancy registry from a nurse practitioner concerning a 15 year old caucasion female with food allergies to coconut and mushrooms and a of history migraines, streptococcal infection and pharyngitis who on 20, Nov 2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast), 0.5 mL by intramuscular injection, first dose (lot# 6539381/0954F). Concomitant medication included (CLARITIN) and (NASONEX). On 20, Nov 2006, the patient indicated that her last period was one week ago (13, Nov 2006). On 05, Dec 2006, the patient was seen in an clinic with complaints of nausea and dizziness and had a positive urine pregnancy test at that time. On 11, Dec 2006, the patient underwent and ultrasound which revealed that she was 7 1/2 weeks pregnant. CRL 10.4 mm, positive fetal heartbeat. Additional information is not expected. This is in follow-up to report(s) previously submitted on 4/6/2007. On 08-JAN-2007, the patient was placed on therapy with PHENERGAN, 25mg, one every 4 to 6 hours for the treatment of nausea and vomiting. Follow-up information was received from a certified medical assistant. On 30-JUL-2007, the patient delivered a liveform female infant (8 pounds, 2 ounces). The infant was normal and there were no congenital anomalies. No further information is expected.


VAERS ID: 483628 (history)  
Form: Version 1.0  
Age: 66.0  
Gender: Female  
Location: Unknown  
Vaccinated:2006-11-20
Onset:0000-00-00
Submitted: 2013-02-06
Entered: 2013-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0622F / 1 RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA001205

Write-up: Information has been received from the VAERS database via a journalist. This spontaneous report as received from a other refers to a patient of unknown age. The patient was vaccinated with lot # (652965/0622F) ZOSTAVAX on 20-NOV-2006. No other co-suspects were reported. No concomitant medications were reported. On an unknown date the patient experienced herpes zoster. No treatment information was reported. The outcome of herpes zoster is unknown. The relatedness for herpes zoster is unknown for ZOSTAVAX. Additional information is not expected.


VAERS ID: 579439 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-11-20
Onset:2006-11-24
   Days after vaccination:4
Submitted: 2015-05-27
   Days after onset:3105
Entered: 2015-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 2F601411 / UNK LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Blood test, Computerised tomogram, Dehydration, Ear infection, Lethargy, Nausea, Nuclear magnetic resonance imaging, Pyrexia, Vertigo, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Bloodwork, CT scans, MRI, to rule out Multiple Sclerosis.
CDC Split Type:

Write-up: Ear infection, vertigo, nausea, vomiting, fever, lethargy, weight loss, severe dehydration. Over the course of three weeks, symptoms increased in intensity and frequency. After several trips to the doctor, several prescriptions to ease the symptoms, and the ER, I was admitted to the hospital for a four day stay on December 20th, 2007.


VAERS ID: 268010 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Foreign  
Vaccinated:2006-11-20
Onset:0000-00-00
Submitted: 2006-11-28
Entered: 2006-11-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (NO BRAND NAME) / UNKNOWN MANUFACTURER KV5190V1 / UNK MO / PO
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER A0255 / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blister, Dysgeusia, Face oedema, Tenderness, Tongue disorder, Tongue oedema
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Taste and smell disorders (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200603228

Write-up: Initial report received from a health care professional on 23 November 2006. A 26 year old female patient (with a medical history of no known allergies) developed a swollen tongue, after she took her first vial of Dukoral (lot number KV5190V1) on 20 November 2006 (reporter was "unsure" of the date). The patient also received a 0.5 ml, intramuscular injection of Avaxim (lot number A0255-2, site of administration not reported) and a 0.5 ml, intramuscular injection of Typhim VI (lot number Z1149-2, site of administration not reported) on the same day. The previous day she received a flu vaccine and Td vaccine (the manufacturer name, lot number, route and site of administration were not reported). It was unknown if the patient was on any concomitant medications or had any illness at the time of vaccination. The patient''s tongue is quite tender on the outside when in contact with her teeth. Her taste buds are "quite off" and her lips are swollen and blistered. She had no shortness of breath. The patient did not seek medical attention and at the time of the report, the swelling had decreased. (OMIC)


VAERS ID: 268100 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Unknown  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-21
   Days after vaccination:1
Submitted: 2006-12-01
   Days after onset:10
Entered: 2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS A20CA270B / UNK LA / -
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS A20CA270B / UNK LA / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A20CA270B / UNK LA / -

Administered by: Other       Purchased by: Other
Symptoms: 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: B0447980A

Write-up: This case was reported by a regulatory authority and described the occurrence of sudden death in a 1 year old subject of unspecified gender who was vaccinated with combined Infanrix-Polio-Hib, for prophylaxis. The child was previously healthy. Previous and or concurrent vaccination included pneumococcal vaccine, unspecified, unk, given on an unspecified date. On 11/20/06 subject received unspecified dose of Infanrix-Polio-Hib (unk). Shortly after, the child received also a dose of Prevnar. Within hours following vaccination with Infanrix Polio Hib, the subject was sub febrile and developed marked irritability. Eighteen hours after vaccination, the child died during his sleep. The regulatory authority reported that the events were possibly related to vaccination with Infanrix Polio Hib. The subject died on 11/21/06, cause of death was not reported. A autopsy was performed. The autopsy did not reveal any obvious cause of death such as bronchoaspiration or bacterial meningitis. Macroscopic examination results are pending.


VAERS ID: 268247 (history)  
Form: Version 1.0  
Age: 62.0  
Gender: Female  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-24
   Days after vaccination:4
Submitted: 2006-12-04
   Days after onset:10
Entered: 2006-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Eye disorder, Facial palsy, Nausea, Nervous system disorder
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: A0630051A

Write-up: This case was reported by a pharmacist and described the occurrence if possible Bell''s palsy in a 62-year-old female subject who was vaccinated with Influenza virus vaccine trivalent (Fluviral) for prophylaxis. On 20 November 2006 the subject received unspecified dose of Fluviral. On 24 November 2006, 4 days after vaccination with Fluviral, the subject experienced neurological symptoms, dizziness, nausea, droopy eyelids, and facial palsy. The subject was seen at a physician''s office and was hospitalized. On 29 November 2006, the pharmacist reported that the subject "possibly has Bell''s palsy, but we do not have a definite diagnosis yet". The outcome of the events was not reported.


VAERS ID: 268772 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Foreign  
Vaccinated:2006-11-20
Onset:0000-00-00
Submitted: 2006-12-12
Entered: 2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS A20CA273A / UNK UN / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS A20CA273A / UNK UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A20CA273A / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 23613 / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Gastroenteritis, Hypotonia, Pyrexia, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Body temp 11/2006 38.2 deg C.
CDC Split Type: D0051722A

Write-up: This case was reported by a regulatory authority and described the occurrence of hypotonic hyporesponsive episode in a 3 month old male subject who was vaccinated with Infanrix-IPV-Hib for prophylaxis. Co suspect vaccine included Prevnar. There were no concurrent medications. Former vaccinations were well tolerated. On 11/20/06 the subject received 1st dose of Infanrix-IPV-Hib IM, unk thigh, together with 1st dose of Prevnar IM unk thigh. In Nov 2006, 9 hours after vaccination with Infanrix IPV Hib and Prevnar, the subject experienced hypotonic hyporesponsive episode, resolving after 10 to 15 seconds. twelve hours after vaccination the subject developed fever up to 38.2 deg C. Additionally the subject had diarrhea once. The subject was hospitalised. Examinations including EEG, Echocardiogram, ECG, neurological examination, infection values, electrolytes, ammonia, pH were normal. Monitoring was without further findings. In Nov 2006, the events resolved after ambulatory and stationary treatment. The reporter stated that a differential diagnosis of beginning gastroenteritis could not be excluded. no further information will be available.


VAERS ID: 268890 (history)  
Form: Version 1.0  
Age: 54.0  
Gender: Male  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-23
   Days after vaccination:3
Submitted: 2006-12-14
   Days after onset:21
Entered: 2006-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Gamma-glutamyltransferase increased, Headache, Hepatic enzyme increased, Hypersensitivity, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Gamma Glutamyl transpeptidase increase, Steatosis Hepatitis.
Allergies:
Diagnostic Lab Data: Alanine aminotransferase 23NOV2006 163 26NOV2006 152, Aspartate aminotransferase 23NOV2006 158 26NOV2006 81, Basophil 23NOV2006 1.7, Blood pressure 23NOV2006 130/80 mmHg, Body temperature 23NOV2006, Eosinophils 23NOV2006 3.8, Gamma glutamyl transpeptidase 23NOV2006 263 26NOV2006 244, Lymphocytes 23NOV2006 16.0, Monocytes 23NOV2006 10.7, Neutrophils 23NOV2006 64.4, Platelet count 23NOV2006 193000
CDC Split Type: D0051718A

Write-up: This Case was reported by a physician and described the occurrence of hepatic enzymes increased in a 54 year old male subject who was vaccinated with Twinrix adult for prophylaxis. concurrent medical conditions included increased gamma glutamyl transpeptidase and steatosis hepatitis. On 11/20/06 the subject received 1st dose of Twinrix adult (intramuscular, left deltoid). On 23 November 2006, 3 days after vaccination with Twinrix adult, the subject experienced aspartate aminotransferase increased, alanine aminotransferase increased, fever with body temperature up to 39 Dec C, bad general condition, myalgia and headache. Meningism was excluded as well as Hepatitis A and B. Examination of heart and lung were percussory and auscultatory normal. This case was assessed as medically serious by manufacturer (OMIC). Without any medications the bad general condition improved two days after starting. Three days after starting aspartate aminotransferase, alanine aminotransferase and Gamma Glutamyl transpeptidase, showed slight decreased. At the time of reporting the outcome of fever, melalgia and headache was unknown. At the time of reporting the outcome of bad general condition further improved and aspartate aminotransferase, alanine aminotransferase and gamma glutamyl transpeptidase was normal. The physician considered the events were related to vaccination with Twinrix adult. The physician suspected a hyperallergic reaction (possible allergic reaction). Follow up information has been requested.


VAERS ID: 269662 (history)  
Form: Version 1.0  
Age: 72.0  
Gender: Male  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2006-12-22
   Days after onset:32
Entered: 2006-12-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR VE934AA / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Hyperthermia, Lung disorder, Obstructive airways disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Accidents and injuries (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SYMBICORT 400 (budesonide and formoterol), VENTOLINE (salbutamol), BECLONE (beclomstasone dipropionate)
Current Illness:
Preexisting Conditions: History of chronic obstructive lung disease due to tobacco.
Allergies:
Diagnostic Lab Data:
CDC Split Type: E200606876

Write-up: Initial report on 18 Dec 06. It was reported that a 72 year old male patient with a history of chronic obstructive lung disease due to tobacco received a dose of Menomune, batch number VE934AA via subcutaneous route in an unspecified site on 20 Nov 06. In the evening after vaccination, the patient developed hyperthermia. On the following day, hyperthermia persisted and was associated to cough. Evolution was not favorable in the following days, and on 23 Nov 06 the patient was hospitalised for decompensation of chronic obstructive lung disease. Chest X ray suggested bilateral pneumopathy. He was given Atrovent and Spiramycin (Rovamycine) as corrective treatment. The patient recovered on an unspecified date.


VAERS ID: 273145 (history)  
Form: Version 1.0  
Age: 0.25  
Gender: Female  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-20
   Days after vaccination:0
Submitted: 2007-02-27
   Days after onset:99
Entered: 2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS A20CA253A / UNK LA / -
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS A20CA253A / UNK LA / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A20CA253A / UNK LA / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 20658 / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cognitive disorder, Crying, Cyanosis, Discomfort, Dyspnoea, Malaise, Pallor, Skin discolouration, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0459366A

Write-up: This case was reported by a regulatory authority and described the occurrence of not responsive in a 3-month-old female subject who was vaccinated with Infanrix-IPV/Hib, Prevnar for prophylaxis. On 20 November 2006 at 10:00 subject received 1st dose of Infanrix-IPV/Hib (unknown), 1st dose of Prevnar (unknown). On 20 November 2006, at approximately 14 hours, the child was unwell, showed discomfort and cried several times. She was afebrile and ate well. At approximately 20:50 hours, she was pale, vomited, presented a gray skin and was blue over the mouth, she breathed infrequently, gasped a lot and gave no response. It lasted 5 to 10 minutes. The ambulance arrived after 3 minutes, the baby was still pale and cyanotic. She subject was hospitalized for 1 day but was unconspicious during hospitalisation and the tests were normal. The hospital stated that the attack was caused by initial vomiting with obstructive apnea. On 20 November 2006, the events were resolved. The subject was discharged on 21 November 2006 without agreement about further control at hospital. The regulatory authority reported that the fact that the subject was unwell was almost certainly related to vaccination with Infanrix-IPV/Hib and Prevnar, but that the obstructive apnea and associated symptoms was caused by vomiting and was not a reaction to the vaccines.


VAERS ID: 273518 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-12-05
   Days after vaccination:15
Submitted: 2007-03-06
   Days after onset:91
Entered: 2007-03-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Angina pectoris, C-reactive protein increased, C-reactive protein normal, Capillary fragility test, Echocardiogram normal, General physical health deterioration, Kawasaki's disease, Local swelling, Lymphadenopathy, Measles, Otitis media, Petechiae, Pharyngeal erythema, Platelet count normal, Pyrexia, Rash generalised, Tonsillar hypertrophy, Vasculitis, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Other ischaemic heart disease (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: MALTOFER
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Echocardiography 11Dec06 no coronary findings, body temp fever 05Dec06 39.5C, body temp 08Dec06 38.1C, WBC count 11Dec06 normal range 3-9.6, Platelet count 11Dec06 238 g/l normal range 143-400, serum C reactive protein 11Dec06 normal range 0.3 mg/l
CDC Split Type: WAES0703USA00120

Write-up: Information has been received from a health authority concerning a 12 month old male with no medical history or allergies who on 20-NOV-2006 was vaccinated a 0.5 ml SC dose of MMR II. Two weeks later the patient developed otitis media which was treated with ESCAMOX. On 05-DEC-2006 the patient presented with a fever with a maximum temperature of 39.5 degrees Celsius and an exanthema beginning on the face and spreading all over the body. On 06-DEC-2006 the patient was presented at the hospital due to an increase of the exanthema. The doctors indicated a strong suspicion of measles due to vaccination. On 08-DEC-2007 the patient showed a good general condition but still had intermittent fever which was treated with ACETALGIN. Over course of time the patient''s neck and tonsils surged. On 09-DEC-2006 an angina was diagnosed and treated with ZITHROMAX 3ml over a period of 5 days. After impairment of the general condition the patient was hospitalized (date of hospitalization was not reported) and showed the following symptoms: fever of 38.1C, no signs of meningitis, red throat, no signs of involvement of ear drums, micro circulation 1-2 seconds, enlarged cervical lymph nodes, generalized exanthema (all over the body). Laboratory results included the following Leukocytes 601 g/l, CRP 24 mg/L, platelets 238 g/l and Strep A negative. Therapy with immunoglobulins, oral steroids, and aspirin was started with a suspicion of a Kawasaki syndrome. The subsequent echocardiogram showed no coronary findings. Over the course of time the exanthema showed with petechial bleedings, a typical Rumpel-Leeder phenomenon but with normal thrombocytes. Due to the findings vasculitis was diagnosed. Other business partner numbers included E2007-01271 and 2007-00382. Additional information has been requested.


VAERS ID: 278374 (history)  
Form: Version 1.0  
Age: 73.0  
Gender: Male  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-23
   Days after vaccination:3
Submitted: 2007-05-11
   Days after onset:168
Entered: 2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Biopsy muscle abnormal, Biopsy peripheral nerve, Burning sensation, C-reactive protein increased, CSF test normal, Cardiac fibrillation, Computerised tomogram normal, Coordination abnormal, Cryoglobulinaemia, Cryoglobulins present, Electromyogram abnormal, Gait disturbance, Motor dysfunction, Muscle disorder, Myalgia, Nerve conduction studies abnormal, Neuralgia, Neuropathy, Neuropathy peripheral, Nuclear magnetic resonance imaging normal, Paraesthesia, Polyneuropathy, Purpura, Red blood cell sedimentation rate increased, Sensorimotor disorder, Serology test, Tumour marker test
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Vasculitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Paroxetine hydrochloride, Pravastatin sodium, Clopidogrel bisulphate
Current Illness: Unknown
Preexisting Conditions: CORONAROPATHY, LUNG CANCER, STENT IMPLANT
Allergies:
Diagnostic Lab Data: Biopsy muscle Dec2006 Abnormal, C-reactive protein Dec2006 20, Cryoglobulins Dec2006 Present, Electromyogram Dec2006 Abnormal, Erythrocyte sedimentation rate Dec2006 28/62, Sural nerve biopsy Dec2006 Abnormal, Tumor marker test Dec2006 negative. In December 2006 : - Ct scan and medullar MRI : non contributive - Cerebrospinal fluid : normal - Autoimmun check up : negative - Anti neuron antibodies : negative - Lyme''s and Q fever serologies : negative - Thoraco-abdomino-pelvic scan : normal - electromyogram : absence of sensitive and motor potential of lower limbs, decrease of the amplitude of the right sensitive cubital. Nerve conduction velocity was normal on upper limbs except a mild slowdown at elbow level without conduction block Distal motor latency and latency of wave F were normal at upper limb levels. In detection, the spontaneous activity revealed tracing mild accelerated and impoverished. No voluntary activity was noted on the right anterior tibial and right quadriceps. A mild fibrillation was observed on the muscles of upper limbs. - the biopsy on the right fibula muscle showed lesions of denervation, spread to a subacute mode. - the right sural nerve biopsy revealed a severe acute axonal neuropathy which progressed speedily with associated regeneration. Several inflammatory elements were found in the interstitial sector, without sign of real vasculitis. - the salivary gland biopsy was normal with a mild lymphocytic infiltrate (grade I of Chisholm).
CDC Split Type: B0469372A

Write-up: This case was reported by the regulatory authority (AFSSaPS, MA0700563) and described the occurrence of sensorimotor polyneuropathy in a 73-year-old male subject who was vaccinated with Fluarix for prophylaxis. The subject''s medical history included lung cancer operated in 2002 (without chemotherapy) and stent implant under coronaropathy in 2004. Concurrent medications included Deroxat, Elisor and Plavix. On 20 November 2006, the subject received a dose of Fluarix (batch number not available, subcutaneous). On 23 November 2006, three days after vaccination, suddenly, the subject presented with motor deficit of right lower limb with neuropathic pain type burning and electrical discharge which spread to a deficit of the left dorsiflexion. No sphincteral trouble was noted. As well, he developed lower limb purpura, which spontaneously resolved. No improvement was observed. Thus, on 05 December 2006, the subject went to the emergency unit. Initially, diagnosis of slipped disc was made. But, the check up did not conformed. CT scan and medullar MRI were non contributive and cerebrospinal fluid was normal. Due to the severe and fast aggravation of the symptomatology, the subject was hospitalized on 22 December 2006. on the top of the previous events, he presented with ataxia, walking difficulty and intense myalgia. A diagnosis of distal polyneuropathy of lower limbs with symmetric installation was evoked. During this hospitalisation, several check up were performed. C-reactive proteine was at 20, erythrocyte sedimentation rate at 28/62. Autoimmun check up, anti neuron antibodies and tumor marker test were negative. Lyme''s and Q fever serologies were negative. A mild type 2 cryoglobulinemia was noted. Thoraco-abdomino-pelvic scan was normal. Electromyogram showed an absence of sensitive and motor potentials of lower limbs and a decrease of the amplitude of the right sensitive cubital. Nerve conduction velocity was normal on upper limbs except a mild slowdown at elbow level without conduction block. Distal motor latency and latency of wave F were normal at upper limb levels. At detection, the spontaneous activity revealed tracing mild accelerated and impoverished. No voluntary activity was noted on the right anterior tibial and right quadriceps. A mild fibrillation was observed on the muscles of upper limbs. The biopsy on the right fibula muscle showed lesions of denervation, spread to a subacute mode. The right sural nerve biopsy revealed a severe acute axonal neuropathy which progressed speedily with associated regeneration. Several inflammatory factors were found in the interstitial sector, without sign of real vasculitis. The salivary gland biopsy was normal with a mild lymphocytic inflitrate (grade I of Chisholm). Thus, no etiology, as vasculitis, was found. The subject was treated with Neurontin and Laroxyl with wearing of orthesis. The conclusion was that the subject had developed a bilateral sensorimotor polyneuropathy with a sudden and asymmetric beginning. At the time of reporting, the events were unresolved. The regulatory authority reported that the events were disabling and dubiously related to the vaccination with Fluarix. No more information will be available. This case has been closed.


VAERS ID: 318551 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Female  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2006-11-25
   Days after vaccination:5
Submitted: 2008-07-08
   Days after onset:590
Entered: 2008-07-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Balance disorder, Computerised tomogram normal, Electroencephalogram normal, Inner ear disorder, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: computed axial tomography, no abnormalities; electroencephalography, no abnormalities
CDC Split Type: WAES0807USA00179

Write-up: Information has been received from an health authority (HA ref. DK-DKMA-20072362) concerning a 16 month old girl who on 20-NOV-2006 was vaccinated with MMR II S.C. (batch number and site of administration not reported). On 25-NOV-2006 the patient developed balance disorder. The symptoms were intermittent. It was interpreted to be labyrinthine dysfunction that occurred in connection with fever. The patient was hospitalized on an unspecified date for an unspecified period. The patient had been monitored for 1 year at the pediatric department of the hospital. CT and EEG revealed no abnormalities. Later, the patient''s GP suspected a connection with the vaccination. The patient had not recovered. Additional information is requested. Other business partner numbers included E2008-06042.


VAERS ID: 386147 (history)  
Form: Version 1.0  
Age: 1.75  
Gender: Male  
Location: Foreign  
Vaccinated:2006-11-20
Onset:2007-02-16
   Days after vaccination:88
Submitted: 2010-04-27
   Days after onset:1165
Entered: 2010-04-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 4 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autism spectrum disorder, Blood count, Blood test, Disability, Hair metal test abnormal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: diagnostic laboratory test, 1.1, test performed in a hair sample (mercury level)
CDC Split Type: WAES1004USA03660

Write-up: Information has been received concerning a male patient who received three doses of RECOMBIVAX HB on 11-MAY-2005, 11-JUL-2005 and 09-NOV-2005. The patient received four doses of DTaP + Hib + Hep + IPV (manufacturer unknown, batch number, route and site of administration not reported) on 11-JUL-2005, 09-SEP-2005, 09-NOV-2005 and 20-NOV-2006. The patient received three doses of Meningococcal C polysaccharide vaccine (manufacturer unknown, batch number, route and site of administration not reported) on 11-JUL-2005, 09-SEP-2005 and 09-NOV-2005. The patient received four doses of PREVNAR (batch number, route and site of administration not reported) on 11-AUG-2005, 11-OCT-2005, 12-DEC-2005 and 20-NOV-2006. The patient received one dose of MMR (manufacturer unknown, batch number, route and site of administration not reported) on 11-AUG-2006. The patient received one dose of VARILRIX (batch number, route and site of administration not reported) on 11-SEP-2006. According to the report, the patient was diagnosed with autism on 16-FEB-2007, and had a disability grade of 35% which was evaluated on 16-JUL-2007. Autism spectrum disorder was reported on 11-MAR-2008 and 05-MAY-2008. A test performed in a hair sample (dates not reported) showed that the patient had a mercury level of 1.1; normal range was below 0.40 (units not reported). According to the form received from the claimant, the following statements were included: hair test, blood count, blood test. In the form received from the claimant it was written "medical report: yes", but the company had not received it yet. This is one of several reports received from the same source. This case was related to a general claim related to all products containing thimerosal. Some of the cases were poorly documented. The original reporting source was not provided. Other business partner numbers include E2010-01909. No further information is available.


VAERS ID: 267608 (history)  
Form: Version 1.0  
Age: 0.69  
Gender: Male  
Location: New Jersey  
Vaccinated:2006-11-21
Onset:0000-00-00
Submitted: 2006-11-21
Entered: 2006-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1397BA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2201BA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0018 / 4 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1123F / 1 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: upper respiratory infection
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: no adverse events as of yet. 8 month old received immunizations scheduled for a 4 year old.


VAERS ID: 267652 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Ohio  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-22
   Days after onset:1
Entered: 2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2280AA / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Feeling hot, Headache, Hyperhidrosis, Throat tightness, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant 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), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 90 minutes after vaccine given, Reported headache, feeling hot, diaphoretic, denied difficulty breathing, skin appeared sl red, denied itching, Patient reports took 50 mg benadryl, 10 minutes later "jaw felt tight, tongue swelling, and throat started to swell". Went to ER.


VAERS ID: 267661 (history)  
Form: Version 1.0  
Age: 60.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-22
   Days after onset:1
Entered: 2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2254AA / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Ocular hyperaemia, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pravicol, dioxin, singular
Current Illness: none
Preexisting Conditions: HTN, asthma, chol,
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Shaking chills, fever up to 101F, blood shot eyes, arm capillaries seemed to be raised on bilteral arms only. Took benadryl 50 mg at 5:30, Symptoms reduced by 11:30 pm, resolved by 11/22 AM.


VAERS ID: 267682 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-24
   Days after onset:3
Entered: 2006-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR U1030 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0832R / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1057F / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Injection site warmth, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of deltoid area on same day that vaccine administered, swelling warmth abd pain continued til 11/24/2006, has not progressed ansd is a little better.


VAERS ID: 267690 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2006-11-26
   Days after onset:4
Entered: 2006-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / 1 NS / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain upper, Dysphonia, Dyspnoea, Rhinorrhoea, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 36 to 48 hours of nasal FluMist vaccine, my son started complaining of stomach pain and runny nose. This progressed to Upper Respiratory Congestion, Hoarseness, Loss of Voice, and some difficulty breathing within 48 more hours.


VAERS ID: 267704 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: California  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-22
   Days after onset:1
Entered: 2006-11-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 05176EA / 1 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1008F / 2 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bactrim
Current Illness: Urinary tract infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 101.8 several hours after vaccination.


VAERS ID: 267816 (history)  
Form: Version 1.0  
Age: 72.0  
Gender: Female  
Location: Maine  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-27
   Days after onset:6
Entered: 2006-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -

Administered by: Other       Purchased by: Public
Symptoms: Blister, Face oedema, Herpes simplex, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, and minerals, cozaar
Current Illness:
Preexisting Conditions: High blood pressure, thyroid conditions.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lips and legs were swollen, even got fever blister swelling went down on 11/25. Rash on shin bone on 11/22, lasted for 3 days. Doctor visit today problems have subsided, only fever blister on lip remains.


VAERS ID: 267812 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-28
   Days after onset:7
Entered: 2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Pyrexia, Rash, Sleep disorder, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gave tylenol for fever
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child was given vacc. on 11/21/06....ran a fever started on 11/21/06 until 11/25/06. Noticed small red bumps on neck 11/22/06, red bumps on face 11/24/06 started to spread to upper body noticed 11/25/06. spreading to vagina/anal area 11/26/06. spreading to lower body fast. vomiting, loss of appetite, sleep disturbance.


VAERS ID: 267883 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Female  
Location: South Dakota  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-28
   Days after onset:7
Entered: 2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U21675A / 5 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0749F / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil, Albuterol Nebs
Current Illness: None
Preexisting Conditions: chronic obstructive pulmonary disease, osteoporosis, Left upper lung lobectomy, increased cholesterol, history sinus tachycardia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cellulitis by that evening. In office next day for treatment. Rocephin 1gm IM given. Patient started on Keflex 500 mg every day for 10 days. Went to acute care 11/28 received another shot of Rocephin.


VAERS ID: 267896 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-11-21
Onset:2006-11-27
   Days after vaccination:6
Submitted: 2006-11-28
   Days after onset:1
Entered: 2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2559AA / 1 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM AHBVB360CA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0489R / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site reaction, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Demerol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presents to HS c/o tenderness, swelling and itching LUA where Tdap had been given 11/21/06. States she hasn''t noticed any redness or swelling LUA until yesterday afternoon, but has experienced localized tenderness at site since injection. States she was sitting out in the sun yesterday afternoon at the time she noticed it. States she took Benadryl. Site examined. Slight induration and erythema measuring 11 cm long and 8 cm across at or near injection site. Warm to touch.


VAERS ID: 267973 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Ohio  
Vaccinated:2006-11-21
Onset:2006-11-23
   Days after vaccination:2
Submitted: 2006-11-24
   Days after onset:1
Entered: 2006-11-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1813CA / 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 41068 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0538F / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1050F / 2 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, Erythema, Feeling hot, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Vaccine site reaction
CDC Split Type:

Write-up: Patient here for well-check 11/21/06. Had vaccinations. Parent noticed left thigh swollen area, slightly red and warm to touch. Stated swelling about size of baseball, per mom. Came to office 11/24/06 for evaluation, swelling 11cmX7cm area at visit. Treated for cellulitis - Amoxicillin 400/5ml script given.


VAERS ID: 268020 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-11-30
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2258AA / 3 - / -

Administered by: Other       Purchased by: Private
Symptoms: Oedema peripheral, Swelling, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: sulfa allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Puffy and swelling fingers and tongue. Reported puffiness of hands/fingers and swelling tongue. Complain of mild tightness in throat. BENADRYL 25 mg given times 2, 1 hour apart. Returned to work.


VAERS ID: 268022 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-11-30
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500434P / 1 NS / IN

Administered by: Public       Purchased by: Public
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold/URI symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flumist given at 10:30 am (1 spray each nostril). Patient mother returned with a bloody nose. 1/2 to 1 cup blood overall. Bloody nose began "15-20 minutes after".


VAERS ID: 268031 (history)  
Form: Version 1.0  
Age: 0.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-27
   Days after onset:6
Entered: 2006-11-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blindness, Bradycardia, Dizziness, Impaired healing, Pallor, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 1 minute after receiving influenza vaccine, the patient states she lost her vision and hearing and felt dizzy. She sat on the floor, was pale, tachypneic and bradycardic. Patient gradually felt better and refused treatment after EMS was called.


VAERS ID: 268209 (history)  
Form: Version 1.0  
Age: 1.01  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-11-21
Onset:0000-00-00
Submitted: 2006-11-28
Entered: 2006-12-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0527R / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1068 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1053R / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666C / 4 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Decreased appetite, Erythema, Irritability, Pyrexia, Rash macular, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CDP-normal
CDC Split Type:

Write-up: Erythematous, raised, macules (rash); low grade fever; fussy; slightly decreased appetite; not sleep well. Treatment- Ibuprofen and Prelone syrup 1/2 tsp every day for 6 days.


VAERS ID: 268346 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Male  
Location: Unknown  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-12-05
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV102 / 2 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness:
Preexisting Conditions: Environmental allergies-on antihistamine and epi pen
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Generalized rash on shoulder and chest/face.


VAERS ID: 268382 (history)  
Form: Version 1.0  
Age: 0.53  
Gender: Female  
Location: Mississippi  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2006-11-29
   Days after onset:7
Entered: 2006-12-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2174HA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0086F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Medication error, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Only RSV Shots
Current Illness: None
Preexisting Conditions: Premi
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS06018

Write-up: Grandmother called HD and said Dr. said 6 month old shouldn''t get flu vaccine That it made baby very sick and they were taking baby to Dr. the next day. Regular immunizations and flu were given 11/21/2006. Baby was taken to doctor 6 days later 11/28/2006. Upon talking to baby''s mother on 11/29/2006, she stated the baby ran temp 100.4 on the day after the shots. States doctor gave cough and cold medication.


VAERS ID: 268443 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Unknown  
Vaccinated:2006-11-21
Onset:2006-11-28
   Days after vaccination:7
Submitted: 2006-12-06
   Days after onset:8
Entered: 2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coma, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 65 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Spiralactone
Current Illness:
Preexisting Conditions: Drug abuse history, Long history of bulemia
Allergies:
Diagnostic Lab Data: MRI:periventricular white matter changes which have been stable, appear somewhat consistent with ADEM. LP in ER protein 31, glucose 58, one WBC and no RBC, differential was 68% lymphocytes and 33% monocytes. Multiplanar images of T spine showed a small right paracentral T9-10 protrusion without central canal or foraminal compromise, cholelithiasis without cholecystitis and no evidence for abnormal cord fosaa arachnoid cyst versus a giant cisterna magna and otherwise unremarkable MRI and no evidence for abnormal cervical spine. WBC 6.8 with 48% neutrophils and 39% lymphocytes.
CDC Split Type:

Write-up: Admitted via ER on 11/28/06 with paresthesias in both legs. Illness worsened and she now is in a coma in the neuro ICU with unknown diagnosis. On admit to ER, stated had received a flu vaccine one week earlier. Date of vaccination is estimated and not exact date. 02/01/07 records received and reviewed for DOS 11/26/06-01/23/07 DC DX: Acute disseminated encephalomyelitis Remote history of bulimina nervosa Spasticity secondary to acute dissseminated encephalomyelitis Diarrhea, chronic Respiratory failure with permanent tracheostomy, status post prolonged respiratory failure on vent previously. Methicillin resistant Staphylococcus aureus colonization, status post Baclofen pump placement for spasticity. Protein calorie malnutrition on feeds via percutaneous endoscopic gastrostomy tube. DC to long term care facility PE: positive for total paresthesia and now complete paralysis of arms and legs. No respiratory distress or chest pain. Pain in all 4 extremities. Developed respiratory distress and insufficiency, extensor posturing to deep painful stimuli, clonus and positive Babinski. Treatment included plasmapheresis and Solu-Medrol. Developed bulbous type rash of buttocks and posterior thigh, suspect may be autoimmune. WBC:range from 6.3-22.8, sed rate 47, ionized Ca 5.36-5.70, CRP 0.7-11.2, measles AB IGG positive ISR, mumps AB IGG positive ISR, blood culture enterococcus faecalis, pseudomonas mendocina, urine culture postive E.coli and candida albicans and pseduomonas aeruginosa, sputum culutre positive staph aureus MSRA and stenotrophomonas maltophilia, cath tip culture pseudomonas aeruginosa, herpes simplex PCR negative, Epstein Barr virus positive, CMV AB IGG 10.60, lymphocyte subset panel ABS CD4 177, CD8 998, CD3 1191, CD8 0.18, viral culture of brain negative.HIV1 negative, histoplasma antigen AG negative. Brain biopsy:intact myelin staining seems to make multiple sclerosis less likely. Vasculitis is not appreciated. A microinfarct may bet he cause although axonal staining is intact in the majority of the tissue. Macrophage infiltrates and reactive gliosis


VAERS ID: 268476 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-21
   Days after onset:0
Entered: 2006-12-06
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0964F / 2 LL / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Hives and itching, erythema of skin all over body.


VAERS ID: 268717 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-12-01
   Days after onset:10
Entered: 2006-12-12
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 71646 / 2 LA / -

Administered by: Public       Purchased by: Private
Symptoms: Chest pain, Dizziness, Dyspnoea, Hypersensitivity, Laryngeal oedema, Throat tightness, Thrombophlebitis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Allergy to PCN, sulfa only.
Allergies:
Diagnostic Lab Data: CT showed some laryngeal and pharyngeal edema without obvious tongue, lip or papular edema.
CDC Split Type:

Write-up: 1:46pm at first dizziness, had client sit with nurse took BP, relax techniques. 2:00 came back throat closing tight. given Benadryl 1.25 fast melt no results. Getting worse Epi 1/1000 0.3cc SQ at 2:05pm then again 2.15pm called 911 DIT worse, SOB, throat closing now chest pain. 911 to Hospital. 12/21/06-records received. DX: Allergic reaction. received epinephrine injection in ER, CT showed some laryngeal and pharyngeal edema without obvious tongue, lip or papular edema. Allergic to penicillin and sulfa. Impression: angioedema of oral pharynx Some thrombophlebitis of left arm from IV therapy.


VAERS ID: 268788 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-12-11
   Days after onset:20
Entered: 2006-12-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / AVENTIS PASTEUR - / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives within secondary of vaccine. No SOB. Hives resolved with Benadryl PO-prn.


VAERS ID: 268856 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Missouri  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2006-12-13
   Days after onset:21
Entered: 2006-12-14
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 70240 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1025P / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5x4cm to left deltoid reddened area prescribed Benadryl.


VAERS ID: 268878 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: Maryland  
Vaccinated:2006-11-21
Onset:2006-11-26
   Days after vaccination:5
Submitted: 2006-12-12
   Days after onset:16
Entered: 2006-12-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS FLUA221 / UNK - / IM
JEV: JAPANESE ENCEPHALITIS (JE-VAX) / SANOFI PASTEUR EBN223C / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Pruritus, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OCP, MVI
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: On 11-26 7 days after JE vaccine patient stood began to feel like this was really bad used handrail for support. Then had 10 seconds shaking both extremities. Patient awake/aware but unable to stop. Post itch state. No treatment given.


VAERS ID: 269007 (history)  
Form: Version 1.0  
Age: 73.0  
Gender: Male  
Location: Unknown  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-12-11
   Days after onset:20
Entered: 2006-12-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0391F / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Hypokinesia, Shoulder pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: aspirin, DDAVP, digoxin, ZOCOR, triamterene
Current Illness:
Preexisting Conditions: Coronary artery disease, Cardiac pacemaker insertion, hiatus hernia, Nephrectomy, renal cancer, Dyslipidaemia.
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0611USA07029

Write-up: Information has been received from a nurse practitioner concerning a 73 year old male with dyslipidaemia and a history of coronary artery disease, cardiac pacemaker insertion, hiatus hernia, right nephrectomy and renal cancer who on 21-Nov-2006 was vaccinated with pneumococcal 23v polysaccharide vaccine (lot#651357/0391F), IM. Concomitant therapy included simvastatin, aspirin, digoxin, triamterene and desmopressin (DDAVF). On 21-Nov-2006, the patient developed pain in his right shoulder which radiated down his arm about 1-2 hours after vaccination with pneumococcal 23v polysaccharide vaccine. The pain progressed resulting in an inability to move his shoulder. The patient went to the emergency room (ER) ON 26-Nov-2006 and was admitted to the hospital the same day. The patient had orthoscopic surgery on his right shoulder to clean mucopurlent drainage from the shoulder joint. The patient received IV Vancomycin while in the hospital. The patient was discharged on 24-Nov-2006. The patient received daily antibiotics for one month. Pain in his right shoulder which radiated down his arm and inability to move shoulder were considered to be disabling, other important medical event and life threatening (OMIC). Additional information has been requested.


VAERS ID: 269338 (history)  
Form: Version 1.0  
Age: 53.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2006-12-19
   Days after onset:27
Entered: 2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2213AA / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Arthralgia, Asthenia, Diarrhoea, Dyspnoea, Fatigue, Feeling abnormal, Feeling hot, Insomnia, Lethargy, Malaise, Migraine, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (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 (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE Meds: Prilosec, HCTZ, Lisinopril, Doxepin, clonazapam.
Current Illness:
Preexisting Conditions: PMH: Hypertension, GERD, Insomnia, Anxiety.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: CBC unremarkable, CMP with glucose of 120 and low sodium and chloride, Lyme IGG/IGM (-), H. pylori (-), stool for occult blood (-). Abd. CT showed fatty liver, distended stomach without obstruction, ? bibasilar infiltrates of lungs.
CDC Split Type:

Write-up: 11/21/2006 Fluzone vaccine, lot U2213AA expiration date 6/30/06 administered 2:10 pm intramuscularly in left deltoid, 11/22/06 11AM (less than 24 hours after flu vaccination) stated he felt unusually tired and very drained. 11/23/06 stated increased tiredness, overall did not feel good, feeling weird, unable to be more specific. 11/24/06 described self as sick, states lethargic, very painful achy muscles and joints, stated difficulty transferring from bed to chair (< 2 feet away), stated warm, had fever (did not check temperature), migraine headache, labored breathing, unable to sleep 11/24/06 (Friday night). 11/25/06 went to hospital, states developed vomiting and diarrhea while in hospital, admitted to hospital for 3 days (11/25/06, 11/26/06, 11/27/06, states IV fluids were given, CAT scan was done (pt stated he did not know results). 12/18/2006 received telephone call from company and spoke with human resource personnel who stated pt said others were ill, but indicated no one else had come forward. Human resource personnel indicated that pt had reported to manufacturer. Spoke with a representative who gave pt my name and number. 12/19/06 telephone call received from pt and VAERS form completed per protocol. Pt indicated that he heard second hand that others were ill with similar, but milder signs and symptoms and a similar time course. Pt was unable to give names of employees who were ill. Requested that pt have other employees who became ill call me. Hospital MR received for 2 night hospital stay for c/o fatigue, abdominal pain, nausea, vomiting, black diarrhea, increased heartburn, arthralgias, myalgias, and fever. HPI: Pt. reports above symptoms started 1 day s/p flu shot. Weakness and lethargy increased for several days resulting in ER admit. Pt. showed much improvement after 2 days and was d/c home. Assessment: Likely viral syndrome-improved.


VAERS ID: 269423 (history)  
Form: Version 1.0  
Age: 0.71  
Gender: Male  
Location: Florida  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2006-12-19
   Days after onset:27
Entered: 2006-12-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Vasculitis
SMQs:, Vasculitis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEWYE866318DEC06

Write-up: Information regarding Prevnar was received from a healthcare professional via a regulatory authority regarding an 8 month old male patient who experienced vasculitis. The patient received the first dose on 21 Nov 2006. The patient experienced vasculitis starting 22 Nov 2006. he was hospitalized. On 29 Nov 2006 the event was abating.


VAERS ID: 269835 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Female  
Location: Alabama  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2006-11-27
   Days after onset:6
Entered: 2006-12-28
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1008F / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Chills, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, Vomiting, Chills occurred about 30 minutes after vaccine.


VAERS ID: 270073 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Female  
Location: Michigan  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2007-01-04
   Days after onset:43
Entered: 2007-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2247AA / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Denies
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Arm became sore after receiving flu immunization to the point unable to sleep on it and if reaching (full extension) needs to support arm to carry out task. Denies redness, fever swelling, rash.


VAERS ID: 270259 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Florida  
Vaccinated:2006-11-21
Onset:2006-12-05
   Days after vaccination:14
Submitted: 2007-01-05
   Days after onset:31
Entered: 2007-01-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0868F / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Anogenital warts, Smear cervix abnormal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho Tri-Cyclen Lo
Current Illness:
Preexisting Conditions: papanicolaou smear abnormal, genital wart
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0612USA00964

Write-up: Information has been received from a Certified Medical Assistant concerning a 22 year old female patient with genital warts and history of abnormal Pap smears who on 21 Nov 2006 was vaccinated IM in the left deltoid with her first dose of Gardasil (yeast), lot #653736/0868F. Concomitant therapy included Ortho Tri-Cyclen Lo. The patient called to report that prior to the vaccination she had 2 undiagnosed "bumps" in the vulva area. Two weeks after the vaccination, on 05 Dec 2006, the patient had an increase in amount of genital warts (3 more "bumps" appeared in the surrounding area). Medical attention was sought. The patient had undergone a Pap smear and cervical biopsy on 21 Nov 2006 (results were not reported). At the time of the report the patient had not recovered. Additional information has been requested. Follow-up information has been received concerning the female student with genital warts who on 21-NOV-2006 at 2:00 p.m. had received her first dose of GRDASIL, lot # 653736/0868F. The patient stated she had a history of bumps in vaginal area, and was never diagnosed with any disease. On 05-DEC-2006 the bumps increased in size and number. The patient was positive for HPV 6. On 15-JAN-2007 at 3:00 p.m. she was vaccinated IM in left deltoid with her second dose of GRDASIL, lot # 655617/1447F. Her outcome was unknown. Additional information is not expected.


VAERS ID: 270305 (history)  
Form: Version 1.0  
Age: 63.0  
Gender: Female  
Location: California  
Vaccinated:2006-11-21
Onset:2006-11-29
   Days after vaccination:8
Submitted: 2007-01-09
   Days after onset:41
Entered: 2007-01-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0621F / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: RASHES
Preexisting Conditions: depression
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: After over a month post vaccine developed small papular rashes, varicella-like rashes over ears, chest, back, trunk with some pruritus.


VAERS ID: 270369 (history)  
Form: Version 1.0  
Age: 60.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2006-11-21
Onset:2006-11-22
   Days after vaccination:1
Submitted: 2007-01-01
   Days after onset:40
Entered: 2007-01-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Private
Symptoms: Pruritus, Skin burning sensation, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lotrel, Zocor, Esterdiol
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received flu shot arm bled 11/21/06; woke up itching, burning, tongue, mouth swelling 11/22/06; took Benadryl called doc on call told to take Benadryl twice and Pepcid 11/25/06; Went to doctor given Cortisone and Prednisone; back to doctor given shot again and Dexpak; back to doctor told to take Zyrtec and prescribed Triamcinclone cream; Still going to doctor still itching and burning.


VAERS ID: 272140 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2007-02-12
   Days after onset:83
Entered: 2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 5 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 200/8-2 / 4 RA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Cough, Hypersensitivity, Pulmonary congestion, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Food Allergies - Milk, Egg, Sesame, Tree Nuts, Peanuts, Cashew
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started to put my son in the car in the parking lot of the drs. office approximately 10 minutes after his 11/21/06 ~10A.M. 4 year wellness visit and receiving the DTap5 vaccination and the IPV4 vaccination. I realized he started to suddenly be congested. When he tried to speak he would cough and I heard a wheeze. I brought him back into the dr.''s office, told her I suspected an allergic reaction and wanted to watch him there. I watched him there for approximately another 10 minutes. The coughing and wheezing continued. The doctor then examined him and said that indeed she heard a wheeze that she had not noticed during his earlier examination. We gave him benadryl and she then gave him a breathing treatment of albuteral and then pulmicort with a nebulizer. We watched him for at least another half an hour. The wheezing seemed to subside. The doctor recommended I continue with treatments of pulmicort once daily for the next two days and albuteral every four for the next three days. On the last day of treatment, he did have a recurrence of the wheezing after running around.


VAERS ID: 274120 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: Illinois  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:112
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Fatigue, Influenza, Insomnia
SMQs:, Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Inderal
Current Illness: Syncope
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0702USA00593

Write-up: This is in follow-up to report(s) previously submitted on 3/14/2007. Information has been received from a Certified Medical Assistant concerning a 24 year old female patient with neurocardiogenic syncope who on 21-NOV-2006 was vaccinated IM with her first dose of Gardasil, lot #653938/0954F. Concomitant therapy included INDERAL. On 21-NOV-2006 the patient experienced insomnia for one month following the administration of Gardasil. She later had the flu from being run down and lack of sleep. The patient desired a prescription for sleep after her next injection. Unspecified medical attention was sought. The patient was reported as recovered. Additional information is not expected.


VAERS ID: 276566 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-11-21
Onset:2006-11-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE948AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO5691F / 3 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Pyrexia, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Negative. Labs and Diagnostics: UA (+) for trace protein and Large blood. CRP high at 22.0. CBC unremarkable. Chemistry remarkable for AST of 79. Blood Culture (-). UC (-). RSV and Flu (-). CXR normal.
CDC Split Type:

Write-up: Pt had a high fever early in the afternoon. After her nap the fever dropped to about 100. After about an hour of normal activity, she slumped over in her chair and started convulsing. and stopped breathing. After mouth to mouth was given she began breathing on her own. The paramedic took her to the hospital. 05/01/2007 MR received for ER visit of 11/25/2006 for c/o fever and seizure activity x1. Infant became stiff, turned blue and was not breathing x 30 sec. per parents. PE: (+) for rhinorrhea, pharyngeal erythema, and tonsillar exudate. Temp in ER was 104''F rectally. Otherwise WNL. DX: Febrile Seizure. Viral Syndrome. 05/17/2007 Vax record received. Vax for 11/21/2006 Prevnar- Wyeth-BO8691F Hib-Aventis-UE054AA Flu-unknown. Info updated in VAERS database and submitted for scanning.


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