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Found 557322 cases where Symptom is Immune system disorder or Immunodeficiency or Immunoglobulins decreased or Lymphadenopathy

Case Details (Sorted by Age)

This is page 304 out of 558

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VAERS ID:237078 (history)  Vaccinated:2005-04-04
Age:15.0  Onset:2005-04-16, Days after vaccination: 12
Gender:Female  Submitted:0000-00-00
Location:Ohio  Entered:2005-05-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0958P0  
Administered by: Private     Purchased by: Unknown
Symptoms: Dehydration, Fatigue, Pharyngolaryngeal pain, Pyrexia, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Infectious mononucleosis and hepatitis 12 days after vaccine (fever, vomiting, dehydration, sore throat, tiredness) Fever lasted 10 days) ER visit for dehydration. IV administered.

VAERS ID:237465 (history)  Vaccinated:2005-05-10
Age:15.0  Onset:2005-05-11, Days after vaccination: 1
Gender:Male  Submitted:2005-05-11, Days after onset: 0
Location:Pennsylvania  Entered:2005-05-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin OTC, Flonase
Current Illness: Seasonal allergies
Preexisting Conditions: Allergy to Motrin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1221DA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt experienced hives beginning on left arm site to neck, trunk, and face with nausea and vomiting.

VAERS ID:237497 (history)  Vaccinated:2005-05-16
Age:15.0  Onset:2005-05-17, Days after vaccination: 1
Gender:Female  Submitted:2005-05-17, Days after onset: 0
Location:Texas  Entered:2005-05-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy med? Birth control pills?
Current Illness:
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0404P1 RA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1202AA0 LA
Administered by: Public     Purchased by: Public
Symptoms: Skin nodule, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5/16/05 client received vaccinations at 4PM. On 5/17/05 she presents in clinic reporting she noticed bumps on her left arm and left leg upon awakening at 7AM. 2hrs later bumps developed on right leg. Denies fever, n/v or difficulty breathing. Bumps are sparse and hive-like in appearance.

VAERS ID:237570 (history)  Vaccinated:2004-06-11
Age:15.0  Onset:2004-06-12, Days after vaccination: 1
Gender:Female  Submitted:2004-12-29, Days after onset: 200
Location:Kansas  Entered:2005-05-19, Days after submission: 140
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Brain samples from the puppy were sent in for testing, but whether the puppy died from distemper or rabies could not be definitively determined. Further testing will be done, but it is not known if these tests will be reliable. Follow up re
CDC Split Type: 200402243
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)AVENTIS PASTEUR 2 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Chest pain, Fatigue, Hypoaesthesia, Injection site pain, Laboratory test abnormal, Muscle twitching, Myalgia, Pyrexia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: From initial information received on 6/23/04 from the patient''s parent regarding an adverse event occurring in the USA, it was reported that a 15 year old female patient received a first dose of IMOVAX RABIES, lot number not reported, administered in the right deltoid, and a first dose of IMMUNOGLOBULIN HUMAN ANTIRABIES , lot number not reported, administered in the gluteal area and left deltoid on 6/11/04 as part of a post-exposure series. Reportedly, the patient had been exposed to a possibly rabid puppy. Within 24 hours of vaccination, on 6/12/04, the patient experienced a sore right arm and generalized muscle aches. On 6/14/04 and 6/18/04, the patient received her second and third doses of IMOVAX RABIES, lot numbers not reported, in the right deltoid. After both of these doses, she experienced soreness in her entire right arm. Brain samples of the puppy were sent in for testing, but whether the puppy died from distemper or rabies could not be definitively determined. Further testing will be done, but it is not known if these tests will be reliable. The recovery status of the patient was not reported. From additional information received on 7/22/04 from the patient''s mother, it was reported that the lot number for the second and third doses of IMOVAX RABIES was W0046. The lot number for the first dose of IMOVAX RABIES is still unknown. Per the mother, the patient''s doctor feels that the patient is experiencing an immune complex like reaction, which is an autoimmune reaction to the vaccine or RIG product. The patient''s condition has improved. She had experienced numbness in her hands and feet, but these symptoms have subsided. She also had joint pain in her legs and feet and these symptoms are subsiding. Per the patient''s mother, she is still experiencing tiredness. From additional information received on 8/27/04 from the patient''s parent, it was reported that the patient has experienced periodic episodes of chest pain and tightness, sometimes felt on her back below her shoulder. One episode of muscle twitching

VAERS ID:237821 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-05-16
Location:New Jersey  Entered:2005-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0404USA00782
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash, Skin ulcer, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a certified medical assistant concerning a 15 year old female with no pertinent medical history who was vaccinated with a dose of varicella virus vaccine live. There was no concomitant medication. Subsequently, the patient developed 39-45 chicken pox lesions 21 days later. She was treated with diphenhydramine hydrochloride and calamine lotion. The patient recovered. Unspecified medical attention was sought. There was no product quality complaint. There were no laboratory diagnostic studies performed. Additional information has been requested.

VAERS ID:237883 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-05-16
Location:Unknown  Entered:2005-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0404USA01970
Vaccination
Manufacturer
Lot
Dose
Route
Site
BCG: BCG (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Loss of consciousness, Sluggishness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a health professional concerning a 15 year old female who was vaccinated with a dose of varicella virus vaccine live (Oka/Merck). Concomitant therapy included a dose of BCG vaccine and a dose of Hepatitis B vaccine, recomb (manufacturer unknown). Subsequently, the patient felt faint and passed out for under a minute. The patient woke up and felt a little sluggish, but is now recovered. Unspecified medical attention was sought. No product quality complaint was involved. No additional information was provided. Additional information has been requested.

VAERS ID:238046 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-05-16
Location:Unknown  Entered:2005-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Colitis Ulcerative
Diagnostic Lab Data: UNK
CDC Split Type: WAES0404USA02160
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician assistant concerning a 15 year old female with a history of ulcerative colitis who was vaccinated with a dose of varicella virus vaccine live. The reporter indicated that the patient was vaccinated and a year or so later, had a severe case of chicken pox. She had been on steroid treatment when exposed to wild type chicken pox. Subsequently, the patient was hospitalized for three days. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:239651 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2005-03-02
Gender:Male  Submitted:2005-05-27, Days after onset: 85
Location:Unknown  Entered:2005-06-03, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: immunizations.
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0503USA00511
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician through a company representative concerning a 15 year old male patient with a history of vaccination subcutaneously with 2 doses, 0.5ml, of measles virus vaccine live, mumps virus vaccine live, rubella virus vaccine live, as a child. On 03/02/2005 the patient came into the office with a case of the mumps. Concomitant is unknown. The patient outcome is unknown. There was no product quality complaint involved. Additional information has bee requested.

VAERS ID:239357 (history)  Vaccinated:2005-06-03
Age:15.0  Onset:2005-06-06, Days after vaccination: 3
Gender:Female  Submitted:2005-06-07, Days after onset: 1
Location:Texas  Entered:2005-06-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: NONE
Preexisting Conditions: Seasonal Allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD30008021PO 
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain upper, Asthenia, Nausea, Retching
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Complained of nausea, dry heaves, severe stomach pains, generalized weakness after taking second dose of Typhoid capsule. Improved after taking maalox. Made aware that this is one of the possible side affects: advised not to continue taking if cannot tolerate.

VAERS ID:239698 (history)  Vaccinated:2005-05-17
Age:15.0  Onset:2005-05-18, Days after vaccination: 1
Gender:Male  Submitted:2005-06-09, Days after onset: 22
Location:New Hampshire  Entered:2005-06-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol back in 2004
Current Illness:
Preexisting Conditions: Strep throat, seizures at birth and through first year of life. No antiseizure medications since.
Diagnostic Lab Data: Initial evaluation was notable for temp of 101.3, blood pressure of 116/65, respirations 16 and O2 Stat 95% on room air. Further eval included a WBC of 19.2 with an ANC of 17.2. A comprehensive metabolic profile was notable for normal rena
CDC Split Type: NH0506
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURTD1245IMRA
Administered by: Private     Purchased by: Public
Symptoms: Alanine aminotransferase increased, Candidiasis, Chest pain, Cough, Diarrhoea, Dyspepsia, Folliculitis, Glossodynia, Hypertension, Laboratory test abnormal, Nausea, Pharyngolaryngeal pain, Platelet disorder, Pyrexia, Rash, Rash maculo-papular, Tenderness, Vomiting, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Dt booster 5/17/05, chest pain 5/18/05, red raised rash, sore throat 5/19/05, fever 5/20/05, vomiting 5/22-5/24, Increased WBC 191200. There are an additional 4 pages of report of consultation. 15 year old was in good health until 5/17/05 when he received a tetanus vaccine. Within one hour he developed some mild chest pain. While he went to school the following day, the original chest pain was worrisome and he went to his PCP office on 5/18 for evaluation. I do not believe that any clear diagnosis was made. By the following day 5/19, the pt developed some palmar tenderness and within several hours he recalls having bumps under the skin of his hands and some associated hand pain. During the course of the day, the exanthem spread to involve his forearms and then his chest and abdomen. He was seen in the emergency dept on 5/19 where he was found to have a temperature of 98.9, blood pressure of 117/70 and O2 sat 99% on room air. His palms are noted to be slightly erythematous and mildly tender to palpation and he had an erythematous papular rash involving the forearms and abdomen, this was felt to involve primarily the hair follicles and a ? of folliculitis was raised. A rapid strep test was negative. Benadryl and Pepcid were prescribed as the pt was complaining of some mild dyspepsia at the time. By 5/20, the pt began having fevers and loose stools three or more each day and described as watery. The exanthem became more confluent. On that day, he saw his PCP office again and was thought to have a possible viral process. Over the ensuing two days, the pt developed some nausea and vomiting and had continued watery diarrhea. He noted that he had no significant headache at that point, he did have some burning of his tongue and he developed dry cough. He did not recall any skin tenderness nor any arthralgias or arthropathy, no difficulty with urination and no abdominal pain. With his complaints of rash and fevers, he presented to the emergency dept on 5/24. Initial evaluation was notable for temp of 101.3, blood pressure

VAERS ID:239956 (history)  Vaccinated:2005-06-13
Age:15.0  Onset:2005-06-15, Days after vaccination: 2
Gender:Male  Submitted:2005-06-16, Days after onset: 1
Location:Unknown  Entered:2005-06-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEUR613708AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Dollar size erythema at injection site, tender node to left axilla.

VAERS ID:239992 (history)  Vaccinated:2004-10-05
Age:15.0  Onset:2004-10-05, Days after vaccination: 0
Gender:Male  Submitted:2004-10-11, Days after onset: 6
Location:Louisiana  Entered:2005-06-16, Days after submission: 248
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: Sinus allergies only
Diagnostic Lab Data: Blood sugar - normal
CDC Split Type: LA050602
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1240N1IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1185AA5IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Diplopia, Dizziness, Hyperhidrosis, Nausea, Skin discolouration
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Weak, dizzy, sweaty, pale, double vision, nausea.

VAERS ID:240440 (history)  Vaccinated:2005-06-17
Age:15.0  Onset:2005-06-20, Days after vaccination: 3
Gender:Female  Submitted:2005-06-24, Days after onset: 4
Location:Indiana  Entered:2005-06-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1659AA  LA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Pharyngitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pharyngitis, fever, headache, vomiting with 72 hours post vaccine.

VAERS ID:240880 (history)  Vaccinated:2005-05-23
Age:15.0  Onset:2005-05-23, Days after vaccination: 0
Gender:Male  Submitted:2005-06-27, Days after onset: 35
Location:New Jersey  Entered:2005-06-30, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NJ200504
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0831P0 RA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site oedema, Injection site reaction, 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)
Write-up: According to pt, had edema, redness and itching at the site of vaccination.

VAERS ID:241176 (history)  Vaccinated:2005-06-22
Age:15.0  Onset:2005-06-23, Days after vaccination: 1
Gender:Female  Submitted:2005-06-24, Days after onset: 1
Location:Michigan  Entered:2005-07-11, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Mother states allergic to one (unknown) antibiotic.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0678P IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEUR41356AA IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives (itchy) developed on both arms (upper arms) overnight following vaccination. Given Benadryl orally. Resolved with additional problems.

VAERS ID:241263 (history)  Vaccinated:2005-07-01
Age:15.0  Onset:2005-07-03, Days after vaccination: 2
Gender:Female  Submitted:2005-07-12, Days after onset: 9
Location:Washington  Entered:2005-07-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1250AA5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site mass, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large local reaction, golf ball sized induration, red and painful area. Pt travelled right after injection given and swelling has since gone down quite dramatically.

VAERS ID:241431 (history)  Vaccinated:2005-07-12
Age:15.0  Onset:2005-07-13, Days after vaccination: 1
Gender:Female  Submitted:2005-07-13, Days after onset: 0
Location:California  Entered:2005-07-18, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: PPD- 07/12/2005
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1641AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Red, swelling, pain, itch at the menactra site.

VAERS ID:241585 (history)  Vaccinated:2005-07-08
Age:15.0  Onset:2005-07-09, Days after vaccination: 1
Gender:Male  Submitted:2005-07-15, Days after onset: 6
Location:Indiana  Entered:2005-07-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog
Current Illness:
Preexisting Conditions: Diabetic type I, seizure last 1999, no treatment since 2002.
Diagnostic Lab Data: Seen by neurologist in ER, EEG normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1659AA0IMRA
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURERU1563BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Seizure on 7/9/05 transported to ER, seen by neurologist, EEG done.

VAERS ID:241672 (history)  Vaccinated:2005-07-21
Age:15.0  Onset:2005-07-21, Days after vaccination: 0
Gender:Female  Submitted:2005-07-22, Days after onset: 1
Location:Indiana  Entered:2005-07-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1659AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B003AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Difficulty in walking, Headache, Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)
Write-up: Around 2-3 hours after vaccines were given, pt developed sudden onset of leg pain and headache while sitting down. The pt was given ibuprofen. The pain progressed and she developed arm pain. She had difficulty walking secondary to the pain and a feeling of numbness in her legs. ("walked like a duck" per mom). She had no fever, no rash, no difficulty breathing. She was evaluated in the ER. After another 2 hours, pain was slightly improved where she could walk with less pain. Evaluated again ~24hours after vaccine in my office. Still c/o of pain, slight decreased strength in lower extremities, normal gait, no arm pain, no headache.

VAERS ID:242445 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2005-08-08
Location:Unknown  Entered:2005-08-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: Visual field tests 20/400.
CDC Split Type: B0389465A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Infection, Optic neuritis, Rheumatoid arthritis, Visual disturbance
SMQs:, Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Ocular infections (broad), Arthritis (narrow), Hypoglycaemia (broad)
Write-up: This case was reported in a literature article and described the occurrence of optic neuritis in a 15 year old male subject who was vaccinated with hepatitis B vaccine for prophylaxis. In one family branch a grandparent, initially thought (from butterfly rash) to have lupus, and a second cousin have Crohn''s disease. On an unspecified date the subject received second dose of Hepatitis B vaccine. At an unspecified time after vaccination with Hepatitis B vaccine, the subject experienced a compound adverse event, acute optic neuritis (vision degradation to 20/400) and rheumatoid arthritis that had resolved with prompt treatment. Three years later, an idiopathic similar episode occurred, possibly from an asymptomatic infection, again it had resolved. The sequence suggested that a particular persisting memory based immune response mode would have been established by the abbreviated vaccination scheduled. This case was assessed as medically serious (OMIC). The author considered the events were almost certainly related to vaccination with Hepatitis B vaccine.

VAERS ID:242793 (history)  Vaccinated:2005-06-10
Age:15.0  Onset:2005-06-17, Days after vaccination: 7
Gender:Female  Submitted:2005-07-27, Days after onset: 40
Location:California  Entered:2005-08-08, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200501382
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1641AA0SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Headache, Medication error
SMQs:, Arthritis (broad), Medication errors (narrow)
Write-up: An initial report was received in the USA from a health care professional on 7/15/05. A 16 year old female patient complained of headache and joint pain of knees and elbows seven days after she had received SC injection of Menactra, lot number U1641AA, in the left arm. The vaccine was admnistered SC in stead of IM. She was treated with Motrin and her symptoms resolved. Follow-up information received on 30-August-2005. The patient received the vaccine on 10-June-2005 at 10:00 and the adverse events started 7 days later at 13:00. The patient also received MOTRIN concomitantly.

VAERS ID:242795 (history)  Vaccinated:2005-05-04
Age:15.0  Onset:2005-06-12, Days after vaccination: 39
Gender:Female  Submitted:2005-07-19, Days after onset: 37
Location:Ohio  Entered:2005-08-08, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness:
Preexisting Conditions: The patient has a history of seasonal allergies and back pain for one year.
Diagnostic Lab Data: A home urine pregnancy test on 7/2/05 was reported as negative.
CDC Split Type: 200501115
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR  IM 
TDAP: TDAP (ADACEL)AVENTIS PASTEUR  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: It was reported through a clinical trial in the USA that a 15 year old female subject was pregnant. Last menstrual period: 4/25/05, expected delivery date not provided. She has no previous obstetric history. Maternal drug exposure includes OrthoEvra Patch (5/8/05 - 5/30/05), Tylenol (5/6/05), Flonase (Mid March 2005 - present), Diazepam (6/1/05), Tylenol Arthritis(date not provided, Cyclobenzaprine HCl (6/1/05) and Flurbiprofen (5/31/05). The subject received her first dose of the study vaccine on 5/4/05, she did not experience any adverse event. The Adacel IND number 9266, has been added to this case. From additional information received on 7/8/05, it was reported that the subject had an elective abortion performed on 6/12/05. A home urine pregnancy test on 7/2/05 was reported as negative.

VAERS ID:242662 (history)  Vaccinated:2005-07-25
Age:15.0  Onset:2005-07-27, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:New Jersey  Entered:2005-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The pt has no known allergies or medical conditions. She had no illnesses at the time of vaccination.
Diagnostic Lab Data: 29Jul05: WBC 2.4x10^3/uL (4.0-12.5); Platelets 75x10^3/uL (140-440); Neutrophils 32% (38-63); Lymphs 53% (27-47; Monocytes 14% (4-13); Neutrophils 0.8 x10^3/uL (1.5-7.8); Lymphs 1.3x10^3/uL (1.1-5.9); Monocytes 0.3x10^3/uL (0.2-1.6). The pt
CDC Split Type: 200501513
Vaccination
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Lot
Dose
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Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1492AB0IM 
Administered by: Private     Purchased by: Private
Symptoms: Laboratory test abnormal, Leukopenia, Monocytosis, Platelet disorder, Pyrexia, Thrombocytopenia, White blood cell disorder
SMQs:, Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial information received on 8/5/05 and 8/8/05. A 15 year old female patient had received an IM injection of Menactra, lot number U1492AB, on 7/25/05. Two days later, the patient developed a fever. Three days later, her blood work displayed leukopenia, neutropenia, and thrombocytopenia. The patient was seen by a physician and is currently being tested for Epstein Barr virus. At the time of this report she had not recovered from these events. (OMIC)

VAERS ID:242668 (history)  Vaccinated:2005-07-26
Age:15.0  Onset:2005-07-27, Days after vaccination: 1
Gender:Male  Submitted:2005-07-29, Days after onset: 2
Location:Florida  Entered:2005-08-10, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1677AA0IM 
Administered by: Private     Purchased by: Private
Symptoms: Eczema
SMQs:, Hypersensitivity (narrow)
Write-up: Eczema flair, face, 2.5% hytone lotion, Cetaphil.

VAERS ID:242707 (history)  Vaccinated:2005-08-10
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-08-10
Location:New Mexico  Entered:2005-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14A006BA5IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1572AC0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Patient recieved DTaP. She was to receive td.

VAERS ID:242719 (history)  Vaccinated:2005-06-30
Age:15.0  Onset:2005-07-07, Days after vaccination: 7
Gender:Female  Submitted:2005-07-25, Days after onset: 18
Location:Georgia  Entered:2005-08-10, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Left eye was red, itchy, and hurting
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1213AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Fluid retention, Injection site mass, Injection site oedema, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Drained much green discharge prior to coming this day, left arm with area of induration, dimpled. Symptoms initially were warm, tender area, enlarged 1 wk after Td immunization. It decreased to knot then increased in size again.

VAERS ID:242845 (history)  Vaccinated:2005-08-10
Age:15.0  Onset:2005-08-10, Days after vaccination: 0
Gender:Female  Submitted:2005-08-10, Days after onset: 0
Location:Missouri  Entered:2005-08-12, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1293IMLA
Administered by: Public     Purchased by: Public
Symptoms: Eye movement disorder, Feeling hot, Lacrimation increased, Loss of consciousness, Musculoskeletal stiffness, Salivary hypersecretion, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Lacrimal disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Child brought in by mother for TD. Child also accompanied by sister. Administered TD in lt deltoid IM. After giving TD. Child stood and walked beside her mother. Mother states child passing out. CHN was standing right beside child. Noted child''s eyes rolling back, CHN put arms under child''s axilla and laid her on the floor without injury. child''s body became rigid and extremities shook. Noted salvia at mouth and tears in eyes. Child came out of activity without noted injury. Child was frightened when she became alert. Child calmed and reassured by CHN. 8:40 am pulse 68 reg. BP 110/76. RR16. Ice pack placed behind child''s neck and she remained on the floor. Ambulance called for transport to ER. Child states she did not eat this am. 8:50 am BP 120/80 pulse 68 neg RR 16. Skin warm pink calmy. Child A&ox3. ER staff arrived they took BS results 101. 8:55 am Child taken to R on wheeled cart by ER staff. Child''s mother and sister Followed. 08/10/2005 TC to Dr ,PCP reported incident to Nurse. 08/10/2005 TC to ER states client was treated and released this AM. Message left requesting DR. call CHN. 08/10/2005 RTC from Medical Director, Informed Dr of incident. Dr said it was a Vasovagal response. VAERS form completed and mailed.

VAERS ID:242915 (history)  Vaccinated:2005-08-02
Age:15.0  Onset:2005-08-03, Days after vaccination: 1
Gender:Male  Submitted:2005-08-15, Days after onset: 12
Location:Texas  Entered:2005-08-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1208BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever 99, full body rash beginning on head spreading to trunk and then arms and leg, hands, bright red, no itching.

VAERS ID:243053 (history)  Vaccinated:2005-07-27
Age:15.0  Onset:2005-07-30, Days after vaccination: 3
Gender:Male  Submitted:2005-08-07, Days after onset: 8
Location:Ohio  Entered:2005-08-17, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1675AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site oedema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Received Menactra in our office 7/27/05, saw his allergist 7/30/05 and had to receive a breathing treatment, MD questioned if related to Menactra. 50 cent size raised warm area around injection site.

VAERS ID:243106 (history)  Vaccinated:2005-08-12
Age:15.0  Onset:2005-08-12, Days after vaccination: 0
Gender:Male  Submitted:2005-08-12, Days after onset: 0
Location:Missouri  Entered:2005-08-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1315IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hyperhidrosis, Hypoglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Hypoglycaemia (narrow)
Write-up: Gave TD at 2:30pm. Client was asked to wait 15 min before leaving clinic waiting area. At 2:41 pm RN was asked to waiting area to check on client, Client was sitting, diaphoretic, alert and oriented to PPTS stated felt ok. Bp 90/50 p62 resp WNL no signs of resp distress. Asked client to rest in exam room; stated only had drank water today ok, not eaten any food, Gave sucker, checked FS BS 71. Rechecked BP at 2:55 94/58. No swelling or redness or rash at inj site.

VAERS ID:243150 (history)  Vaccinated:2005-08-01
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Kansas  Entered:2005-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Dose
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS01AA0IM 
Administered by: Public     Purchased by: Public
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Adult dose Hep B 20mcg given instead of adolescent dose. No reaction.

VAERS ID:243304 (history)  Vaccinated:2005-08-19
Age:15.0  Onset:2005-08-20, Days after vaccination: 1
Gender:Male  Submitted:2005-08-22, Days after onset: 2
Location:North Carolina  Entered:2005-08-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NC05070
Vaccination
Manufacturer
Lot
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Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU13700A IMLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Feeling hot, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm upper deltoid area, quarter size swelling with hint erythema and warmth, slight tender to palpate. Warm compress, Benadryl.

VAERS ID:243363 (history)  Vaccinated:2005-08-16
Age:15.0  Onset:2005-08-16, Days after vaccination: 0
Gender:Male  Submitted:2005-08-24, Days after onset: 8
Location:Rhode Island  Entered:2005-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Lactose intolerance, Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1675AA0 RA
Administered by: Public     Purchased by: Unknown
Symptoms: Hyperhidrosis, Nausea, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: About 5 minutes after receiving vaccine pt became nauseated and sweaty. He than broke out in hives, All symptoms resolved after about one hour.

VAERS ID:243367 (history)  Vaccinated:2005-08-04
Age:15.0  Onset:2005-08-04, Days after vaccination: 0
Gender:Female  Submitted:2005-08-24, Days after onset: 20
Location:Michigan  Entered:2005-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Deaf, Allergic to beestings.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0113P  LA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient is receiving vaccines in preparation for cochlear surgery. After vaccination muscle soreness that afternoon. On 08/05/ at 01:30 began to mow lawn but had to stop and rest because experiencing breathing problems got well after resting. On 08/06 no problems noted. On 08/07 also had breathing problems but might have been due to menstrual period was starting. Mom usually experiences similar problems. On 08/10 patient again had breathing problems when just started to Mow lawn. Patient has been performing this type of activity all summer with no problems, only difference this instance is the vaccine. On 08/10 had an adjustment with the chiropractor. On 08/17 had another adjustment and complained of breathing problems after appointment, at 11PM had hard time breathing, Benadryl given. On 08/18 had adjustment session for opening airways before leaving for camp, adjusted front of chest. On 08/12, 08/17, 08/18 chiropractor mentioned that during the adjustment he found that the joints on left side were tight (same as vax received). On 08/19 left for camp. Today 08/24 patient is feeling much better but complains of some breathing discomfort still.

VAERS ID:243422 (history)  Vaccinated:2005-08-24
Age:15.0  Onset:2005-08-24, Days after vaccination: 0
Gender:Female  Submitted:2005-08-25, Days after onset: 1
Location:Alaska  Entered:2005-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none, had just recovered/completed antibiotics for strep pharyngitis
Preexisting Conditions: none known
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURTD122 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: MACULOPAULAR RASH, HIVES DEVELOPED WITHIN 6 HOURS OF Td BOOSTER.

VAERS ID:243504 (history)  Vaccinated:2005-08-25
Age:15.0  Onset:2005-08-25, Days after vaccination: 0
Gender:Male  Submitted:2005-08-25, Days after onset: 0
Location:Georgia  Entered:2005-08-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LAB1361IMLA
HEP: HEP B (FOREIGN)MERCK & CO. INC.0956P0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURYN32420SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0612P0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1113P0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Patient received 5 vaccines then felt warm according to him and fainted, got patient to sofa took vital signs 100/60, 62, 20, regained consciousness within 30 seconds. Vital signs retaken 15 minutes later 94/50, 60, 20. Stayed in clinic 20 more minutes. Left after oriented with mother

VAERS ID:243545 (history)  Vaccinated:2005-08-08
Age:15.0  Onset:2005-08-08, Days after vaccination: 0
Gender:Male  Submitted:2005-08-11, Days after onset: 3
Location:Tennessee  Entered:2005-08-29, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: WBC, electrolytes
CDC Split Type: TN05037
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1215DA  RA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Injection site oedema, Injection site pain, Malaise, Pyrexia, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3-6 hrs right arm red, warm, swollen and limp. 24 hrs headaches, malaise, throbbing pain right arm. 8/22/05 had increased temp for 72. So much improved. Site continues to be "tender".

VAERS ID:243551 (history)  Vaccinated:2005-08-10
Age:15.0  Onset:2005-08-10, Days after vaccination: 0
Gender:Male  Submitted:2005-08-29, Days after onset: 19
Location:South Carolina  Entered:2005-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE noted.
Diagnostic Lab Data: CBC, CT, EKG, urine screen, urinalysis, metabolic panel
CDC Split Type: SC0514
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB168BA0IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURY02980IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0484R0SCRA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1200IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Loss of consciousness, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (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), Hypoglycaemia (broad)
Write-up: Mother states she and patient were in car and less than 1 mile from Health Department when patient slumped in seat. When she attempted to awaken patient, patient started to "shake" all over. When shaking stopped, patient vomited, then blacked out with shaking again. Mom turned car around and went to ER. Mom states tests were done including "halo" x-ray and ER doctors do not believe immunizations caused seizures. Patient recently moved to area and had no immunization records. Has appointment for 8/30/05 for physical exam. Follow up - Name of Td vaccine manufacturer provided.

VAERS ID:243609 (history)  Vaccinated:2005-08-23
Age:15.0  Onset:2005-08-23, Days after vaccination: 0
Gender:Female  Submitted:2005-08-30, Days after onset: 7
Location:Utah  Entered:2005-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1767AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Neck pain, Pallor, Posturing, Stupor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Slumped over while sitting about 2 hours after receiving injection. Difficult to rouse, complained of head and neck pain. Became very pale and shaky. Was feeling somewhat better by evening.

VAERS ID:243624 (history)  Vaccinated:2005-08-15
Age:15.0  Onset:2005-08-16, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Illinois  Entered:2005-08-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1723AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash (maculo/papular) on right shoulder and upper arm area also high fever 101.2.

VAERS ID:243773 (history)  Vaccinated:2005-08-26
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-09-01
Location:Michigan  Entered:2005-09-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1741AB  LA
Administered by: Private     Purchased by: Unknown
Symptoms: Headache, Musculoskeletal stiffness, Pyrexia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, onset 08/30/2005, vomiting, headache, stiff neck onset 08/30/2005. Hives the size of mosquito bites behind each knee, onset 09/01/2005.

VAERS ID:243793 (history)  Vaccinated:2005-08-30
Age:15.0  Onset:2005-09-01, Days after vaccination: 2
Gender:Male  Submitted:2005-09-01, Days after onset: 0
Location:Michigan  Entered:2005-09-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1750AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Fatigue, Pain, Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccine given 08/30/2005, Dad described today at 02:00PM 09/01/2005, patient fatigued, just woke up, achy and splotchy looking, ash on face. Yesterday complained of allergy symptoms. Treated with Claritin towards evening.

VAERS ID:243809 (history)  Vaccinated:2005-08-18
Age:15.0  Onset:2005-08-18, Days after vaccination: 0
Gender:Female  Submitted:2005-08-29, Days after onset: 11
Location:California  Entered:2005-09-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Runny nose, cough
Preexisting Conditions: NONE
Diagnostic Lab Data: PPD, 08/18/2005 , left arm.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1589AA  LA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen, red arm when MCV 4 given, area on left deltoid area per Mom. Complained of pain with injection, next day swelling about 1/2 dollar size. Complained of severe pain.

VAERS ID:244021 (history)  Vaccinated:2005-08-17
Age:15.0  Onset:2005-08-17, Days after vaccination: 0
Gender:Male  Submitted:2005-09-09, Days after onset: 23
Location:Virginia  Entered:2005-09-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS0632B20  
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0334P0  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1143N0  
Administered by: Other     Purchased by: Other
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Vaccine administration not in accordance with VFC recommended childhood and adolescent immunization schedule 2005, Administration of vaccine not licensed for adolescents.

VAERS ID:244099 (history)  Vaccinated:2005-06-17
Age:15.0  Onset:2005-06-20, Days after vaccination: 3
Gender:Female  Submitted:2005-06-30, Days after onset: 10
Location:Indiana  Entered:2005-09-13, Days after submission: 75
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200501231
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURUNK0 UN
Administered by: Private     Purchased by: Private
Symptoms: Headache, Pharyngolaryngeal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: From initial information received on June 23 2005 from a health care professional regarding an adverse event, it was reported that a 15 year old female received a dose of Menactra, lot number not reported, on June 17 2005. The route and site of administration were not reported. Three days later, on June 20 2005, the patient developed a headache. On June 23 2005, she developed a fever, vomiting and sore throat, At the time of this report, the patient had not recovered from these events.

VAERS ID:244117 (history)  Vaccinated:2005-06-28
Age:15.0  Onset:2005-06-28, Days after vaccination: 0
Gender:Female  Submitted:2005-07-15, Days after onset: 17
Location:New York  Entered:2005-09-13, Days after submission: 60
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient has a history of gastroesophageal reflux and allergic to Augmentin and Septra, which makes her itchy.
Diagnostic Lab Data: A mono test was drawn, but the results were not provided.
CDC Split Type: 200501307
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1657AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B003AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eye oedema, Lymphadenopathy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Initial report received from the patients parent on July 05 2005. A 15 year old female patient with a medical history of gastrointestinal reflux and allergies to Augmentin and Septra developed a fever of 99.2 degrees F, swollen eyes and swollen glands in her neck hours after she had received an intramuscular injection in the right arm of Menactra, lot number U1657AA and an intramuscular injection in the left arm of Boostrix, lot number AC52B003AA. She was examined by a physician and blood work was drawn, including a mono test. At the time of this report, the patient had not recovered from these events.

VAERS ID:244147 (history)  Vaccinated:2005-06-09
Age:15.0  Onset:2005-08-17, Days after vaccination: 69
Gender:Female  Submitted:2005-09-13, Days after onset: 27
Location:New York  Entered:2005-09-15, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline
Current Illness:
Preexisting Conditions: The patient denies any illness at the time of vaccination. The patient has allergies to Cefzil.
Diagnostic Lab Data:
CDC Split Type: 200501602
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1575AA IM 
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1370BA IM 
Administered by: Private     Purchased by: Private
Symptoms: Intracranial pressure increased, Papilloedema
SMQs:, Guillain-Barre syndrome (broad), Optic nerve disorders (narrow)
Write-up: Initial report received from a nurse in the USA on 8/18/05. A 14 year old female patient was diagnosed with papilledema 69 days after receiving the IM injection of Menactra, lot number U1575AA on 6/9/05. Site of administration not reported. The patient received in concomitant the IM injection of Td, lot number U1370BA. Site of administration not reported. On 8/17/05 the patient was seen by her optometrist for a routine visit and was found to have papilledema of unknown origin. The patient is asymptomatic. The patient denies any illness at the time of vaccination and was on no medication. Follow up information received on 9/6/05 from a physician. The patient was referred to a neurologist on 8/31/05 for papilledema one month''s duration. It was noted that the patient had been taking minocycline since March 2005. Upon examination, it was noted the patients'' visual acuity was 20/20 in the left eye and 20/25 in the right eye. The neurologist''s impression was pseudotumor cerebri, possible secondary to menicycline. The minocycline was discontinued. It was not reported whether the patient has recovered from these events. Based upon the new medical information provided, this case has been upgraded to serious. (OMIC)

VAERS ID:244165 (history)  Vaccinated:2005-08-22
Age:15.0  Onset:2005-09-07, Days after vaccination: 16
Gender:Male  Submitted:2005-09-09, Days after onset: 2
Location:Virgin Islands  Entered:2005-09-15, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0004R0IMRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1370DA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0069R SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site reaction, Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Inflammatory lesion in site of vaccination noticed 2 days ago, no fever, lesions are spreading.

VAERS ID:244179 (history)  Vaccinated:2005-09-06
Age:15.0  Onset:2005-09-06, Days after vaccination: 0
Gender:Male  Submitted:2005-09-15, Days after onset: 9
Location:Missouri  Entered:2005-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: hypoglycemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1294IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Hyperhidrosis, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: About 1 min after TD injection, pt complained of dizziness, follow by diaphoresis, vomiting, syncope in rapid succession. Pt recovered with in 10 minutes and left under parental supervision.

VAERS ID:244362 (history)  Vaccinated:2005-08-23
Age:15.0  Onset:2005-08-24, Days after vaccination: 1
Gender:Male  Submitted:2005-09-20, Days after onset: 27
Location:New York  Entered:2005-09-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: high fever, rash, went to ER;Measles Mumps Rubella (Priorix);;0;In Patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: Tourette Syndrome
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD130   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed rash in neck area the day after the vaccine. Also his tics from Tourette Syndrome worsened so much that he has an appt. with dr tommorrow to do blood work etc.

VAERS ID:244689 (history)  Vaccinated:2005-08-23
Age:15.0  Onset:2005-08-24, Days after vaccination: 1
Gender:Female  Submitted:2005-08-27, Days after onset: 3
Location:California  Entered:2005-09-28, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA050063
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1210DA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythematous area of about 12cm in diameter on left deltoid.

VAERS ID:244875 (history)  Vaccinated:2005-09-20
Age:15.0  Onset:2005-09-20, Days after vaccination: 0
Gender:Male  Submitted:2005-09-22, Days after onset: 2
Location:Unknown  Entered:2005-10-04, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trileptal, Seroquel
Current Illness:
Preexisting Conditions: Has seizure and behavior disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1750AA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad)
Write-up: Developed diptonia in neck and back several hours after getting Menactra vaccine. He has given IV Benadryl in ER and reaction stopped. He is also taking Seroquel and Trileptal.

VAERS ID:245212 (history)  Vaccinated:2005-10-10
Age:15.0  Onset:2005-10-10, Days after vaccination: 0
Gender:Female  Submitted:2005-10-11, Days after onset: 1
Location:Hawaii  Entered:2005-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1575AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Headache, Hypoaesthesia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: PATIENT RECEIVED MENACTRA ON 10/10/2005. THAT EVENING SHE HAD FEVER, HEADACHE, DIZZINESS AND A SUBJECTIVE FEELING OF DIFFICULTY BREATHING. SHE ALSO FELT LIKE HER ENTIRE BODY FELT NUMB FOR ABOUT 5 MINUTES. HOWEVER WHEN SHE RETURNED THE NEXT DAY FOR CHECK MOST OF THESE SYMPTOMS HAD RESOLVED AND SHE HAD A NORMAL NEUROLOGIC EXAM.

VAERS ID:245253 (history)  Vaccinated:2005-09-16
Age:15.0  Onset:2005-09-26, Days after vaccination: 10
Gender:Female  Submitted:2005-10-11, Days after onset: 15
Location:California  Entered:2005-10-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1780AA  RA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1563AA  LA
Administered by: Private     Purchased by: Other
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: This is 14 y/o female who received Menactra on 9/16/05 and two wk later had numbness of arm for 1 wk and now has resolved. The twin sister also had shot but no complaints.

VAERS ID:245347 (history)  Vaccinated:2005-08-23
Age:15.0  Onset:2005-08-23, Days after vaccination: 0
Gender:Male  Submitted:2005-08-24, Days after onset: 1
Location:Texas  Entered:2005-10-13, Days after submission: 50
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: 2 yrs ago completed Tx for pollen allergies as per mom (8/24/05)
Diagnostic Lab Data: ER: x-rays done, no Fx. as per mother report 8/24/05/
CDC Split Type: TX05084
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0476P2 RA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1091P0 RA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1563AA  LA
Administered by: Public     Purchased by: Public
Symptoms: Cyanosis, Dyskinesia, Loss of consciousness, Musculoskeletal stiffness, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: 14 yr old passed out after Td administered. Fell to floor face forward, landed on abd and face, turned slightly cyanotic, had slight jerking once, rigid, responded after 1-2 mins. O2 at 6 later, feet slanted, pt taken to ER for evaluation accompanied by mom and brother and 2 ambulance personnel. Pt stated after rec''d TD felt tingle sensation to left arm.

VAERS ID:245348 (history)  Vaccinated:2005-09-15
Age:15.0  Onset:2005-09-16, Days after vaccination: 1
Gender:Male  Submitted:2005-09-16, Days after onset: 0
Location:Texas  Entered:2005-10-13, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: CBC WBC 7.6, RBC 4.52, HGB 13.2, HCT 39.0, RDW 17.4, MPV 6.3, Lymp%9.0, Lym#0.6, MID 0.5, GRN 6.5: normal.
CDC Split Type: TX05083
Vaccination
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Lot
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1563AA5IMLA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Headache, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Onset of headache, malaise, weakness in legs and fever (103.3) x 12 hrs, no local reaction noted now at injection site, told to take ibuprofen and Tylenol for fever, go to ER if condition worsens, call Dr if questions.

VAERS ID:245584 (history)  Vaccinated:2005-10-04
Age:15.0  Onset:2005-10-04, Days after vaccination: 0
Gender:Female  Submitted:2005-10-05, Days after onset: 1
Location:New Mexico  Entered:2005-10-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergies
Diagnostic Lab Data:
CDC Split Type: NM102005
Vaccination
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1616AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Oedema, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Student came in today right upper arm swollen and tender to touch, warm pack applied T 98.1, Motrin 200mg 10/05/2005.

VAERS ID:245585 (history)  Vaccinated:2005-10-04
Age:15.0  Onset:2005-10-05, Days after vaccination: 1
Gender:Female  Submitted:2005-10-05, Days after onset: 0
Location:New Mexico  Entered:2005-10-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1616AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Left lower mil arm slight swollen, went swimming same day. Warm pack temp 97.6, Motrin 200mg 10/05/2005

VAERS ID:245682 (history)  Vaccinated:2005-09-26
Age:15.0  Onset:2005-09-27, Days after vaccination: 1
Gender:Male  Submitted:2005-10-10, Days after onset: 13
Location:Arizona  Entered:2005-10-19, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA0 LA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Joint pain and rash on forearms.

VAERS ID:246031 (history)  Vaccinated:2005-10-21
Age:15.0  Onset:2005-10-22, Days after vaccination: 1
Gender:Female  Submitted:2005-10-25, Days after onset: 3
Location:Mississippi  Entered:2005-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient presented 10/21/05 with nasal congestion and c/o myalgia on right side of neck and temperature of 99.3. Moderate erythe
Preexisting Conditions: none
Diagnostic Lab Data: Rapid strep test negative 10/21/05 and 10/24/05 in office.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1755AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On the day following vaccination, patient developed confluent pruritic maculopapular rash on elbows and knees which spread to buttocks and upper arms and ear pinnae over the next two days.

VAERS ID:246154 (history)  Vaccinated:2005-10-25
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-10-26
Location:Iowa  Entered:2005-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA123AC0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: UNKNOWN

VAERS ID:246194 (history)  Vaccinated:2005-10-14
Age:15.0  Onset:2005-10-22, Days after vaccination: 8
Gender:Male  Submitted:2005-10-26, Days after onset: 4
Location:Connecticut  Entered:2005-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0031R1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0323R1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Herpes zoster, Viral infection
SMQs:
Write-up: Herpes zoster (Shingles) left back area Acyclovir 800mg TID x 7D ordered.

VAERS ID:246278 (history)  Vaccinated:2005-10-22
Age:15.0  Onset:2005-10-22, Days after vaccination: 0
Gender:Female  Submitted:2005-10-23, Days after onset: 1
Location:Pennsylvania  Entered:2005-10-28, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy: dust, pollen. ADD. Questionable Marfans Syndrome
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1804AA1IMRA
Administered by: Other     Purchased by: Public
Symptoms: Vaccination failure
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Blank

VAERS ID:246319 (history)  Vaccinated:2005-10-19
Age:15.0  Onset:2005-10-20, Days after vaccination: 1
Gender:Male  Submitted:2005-10-28, Days after onset: 8
Location:Maryland  Entered:2005-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500391P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pruritic rash- individual bumps described as like "bug bites" all over his body.

VAERS ID:246357 (history)  Vaccinated:2005-10-16
Age:15.0  Onset:2005-10-27, Days after vaccination: 11
Gender:Female  Submitted:2005-10-28, Days after onset: 1
Location:Washington  Entered:2005-10-31, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)AVENTIS PASTEURC2341AA5 LA
Administered by: Private     Purchased by: Public
Symptoms: Contusion, Feeling hot, Injection site hypersensitivity, Injection site induration, Injection site pain, Injection site vesicles
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 5mm bruise at injection site, one inch below injection site one cm lump, red increasing warmth with blister and pain.

VAERS ID:246692 (history)  Vaccinated:2005-10-26
Age:15.0  Onset:2005-10-27, Days after vaccination: 1
Gender:Female  Submitted:2005-10-27, Days after onset: 0
Location:Michigan  Entered:2005-11-03, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Thyroid condition, Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1750AA0IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1215CA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Diarrhoea, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Phone call from client''s Mom R arm muscle sore, has nausea and vomiting X 1 some diarrhea, fever 99.9 f, chills, some illness in family and friends. Back to school today 10/28/05.

VAERS ID:246697 (history)  Vaccinated:2005-09-09
Age:15.0  Onset:2005-09-10, Days after vaccination: 1
Gender:Male  Submitted:2005-09-29, Days after onset: 19
Location:Georgia  Entered:2005-11-03, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NONE GIVEN
Diagnostic Lab Data: NA
CDC Split Type: GA0503410/03/2005
Vaccination
Manufacturer
Lot
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Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0475P1IMLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site reaction
SMQs:
Write-up: Client states he developed bumps that itch the day after vaccination given. Showed his mother on Monday 9/12/05. She brought him in on 9/13/05 bumps noted where vaccine administered and band aid applied. No soreness, lump, redness or pain at site.

VAERS ID:247038 (history)  Vaccinated:2005-11-01
Age:15.0  Onset:2005-11-02, Days after vaccination: 1
Gender:Female  Submitted:2005-11-03, Days after onset: 1
Location:Michigan  Entered:2005-11-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Recovering from mono;iron deficiency anemia
Diagnostic Lab Data: NONE
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1821AA0IM 
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Pruritus, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling and itching of the left upper arm. Swelling 6" x 3" warm to touch. No erythema. Tender 6/10. No red streaks. Benadryl 25 mg TLD and cold compress. To flu if symptoms increase.

VAERS ID:247099 (history)  Vaccinated:2005-11-02
Age:15.0  Onset:2005-11-02, Days after vaccination: 0
Gender:Female  Submitted:2005-11-04, Days after onset: 2
Location:California  Entered:2005-11-08, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl;Claritin
Current Illness: NONE
Preexisting Conditions: Allergies to several things; trees, grass, dust, fish.
Diagnostic Lab Data:
CDC Split Type:
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VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Swelling, Vulval disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Her vulva swollen up. It happened about 2-3 hours after getting vaccine. Her grandmother on fathers side was in emergency when we got there and had swelling in arm from vaccine. Swelling still exits - 2nd day.

VAERS ID:247225 (history)  Vaccinated:2005-08-09
Age:15.0  Onset:2005-08-10, Days after vaccination: 1
Gender:Female  Submitted:2005-08-11, Days after onset: 1
Location:Arizona  Entered:2005-11-10, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seizures, nephrotic syndrome
Diagnostic Lab Data:
CDC Split Type: AZ0513
Vaccination
Manufacturer
Lot
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0945P0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1677AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Eye movement disorder, Grand mal convulsion, Salivary hypersecretion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: @ 4:00p on 8/10/05 father found client on the floor "frothing at the mouth with eyes rolled back" x 15 min. At bedtime, client in bed with Mom, had x 1 gran mal seizure. Client has history of seizures since 2001 but hasn''t had any seizures for the past 2 years. No additional terms found in records rec''d 12/22/2005/sr

VAERS ID:247729 (history)  Vaccinated:2005-10-03
Age:15.0  Onset:2005-10-04, Days after vaccination: 1
Gender:Male  Submitted:2005-11-17, Days after onset: 44
Location:New York  Entered:2005-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT 50MG QHS ZYRTEC 10MG QD PIROXICAM 20MG QD PRN KNEE PAIN
Current Illness:
Preexisting Conditions: OBCESSIVE COMPULSIVE DISORDER TURRET''S SYNDROME DEPRESSION PERENNIAL ALLERGIES OSGOOD-SCLATTER DISEASE EXERCISE INDUCED ASTHMA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1794AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1640AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Musculoskeletal stiffness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 16 TO 17 HRS AFTER VACCINES GIVEN PATIENT DEVELOPED FEVERS, MYALGIS, STIFF NECK, & HEADACHE. PATIENT TREATED SYMPTOMATICALLY AND SYMPTOMS RESOLVED IN 48 HRS.

VAERS ID:247739 (history)  Vaccinated:2005-10-03
Age:15.0  Onset:2005-10-09, Days after vaccination: 6
Gender:Female  Submitted:2005-11-17, Days after onset: 39
Location:New York  Entered:2005-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBV13156AA0IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURY03250SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0601R0SCLA
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURERTD-1340IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0562R0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 6 days after receiving immunizations, patient developed a rash on both arms, one leg and her back. There was no fever or itching. Patient was seen by 2 MD''s who told the Mother that this was "mosquito bites", not a reaction to vaccine. One month later the rash persists.

VAERS ID:247749 (history)  Vaccinated:2005-11-12
Age:15.0  Onset:2005-11-12, Days after vaccination: 0
Gender:Female  Submitted:2005-11-17, Days after onset: 5
Location:California  Entered:2005-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EMG C/W Guillain Barre, LP CSF nl protein/glucose, 2 WBC Discharge summary statres abnormal lab results.
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1871BA UNUN
Administered by: Other     Purchased by: Unknown
Symptoms: CSF test normal, Dizziness, Electromyogram abnormal, Guillain-Barre syndrome, Headache, Laboratory test abnormal, Muscular weakness, Nausea, Paraesthesia, Sensation of heaviness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Vestibular disorders (broad)
Write-up: Heaviness in foot, both lower extremities weakness and tingling,ataxia. Dx''D mild Guillain Barre Discharge summary states headache. Medical record states dizziness, nausea

VAERS ID:247986 (history)  Vaccinated:2005-11-11
Age:15.0  Onset:2005-11-11, Days after vaccination: 0
Gender:Male  Submitted:2005-11-11, Days after onset: 0
Location:California  Entered:2005-11-21, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: 5 minutes after receiving flu vaccine he felt dizzy, pale. Pt fell to the floor, possible loss of consciousness for about 30 seconds then came around. Observed in the office for about one hour felt ok. Sent home will lie down re-elevated.

VAERS ID:248086 (history)  Vaccinated:2005-11-02
Age:15.0  Onset:2005-11-02, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2005-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1861AA IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0705R0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Immediate acute swelling of right deltoid area. Tender but non erythematous. Advised ice compress and Motrin. Vaccines received: Hep A and Meningococcal.

VAERS ID:248095 (history)  Vaccinated:2005-10-24
Age:15.0  Onset:2005-10-26, Days after vaccination: 2
Gender:Male  Submitted:2005-11-07, Days after onset: 12
Location:Colorado  Entered:2005-11-22, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: singulair 5 mg, elavil 10 mg
Current Illness:
Preexisting Conditions: sulfa allergy, chronic fatigue syndrome, asthma, depression
Diagnostic Lab Data: WBC''s , treated as cellulitis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1755AA IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0513P0SC 
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA0IM 
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site pain, White blood cell disorder
SMQs:, Haematopoietic leukopenia (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: 2 days post vaccine developed redness & pain at site - went to ER, differential diagnosis was vaccine reaction VS cellulitis ; tests included blood cultures and CBC ; had consult with infectious disease specialist and was treated with keflex X 14 days

VAERS ID:248109 (history)  Vaccinated:2005-08-26
Age:15.0  Onset:2005-08-27, Days after vaccination: 1
Gender:Female  Submitted:2005-11-15, Days after onset: 80
Location:California  Entered:2005-11-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: The subjects medical history, concurrent conditions, and concurrent medication were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0572430A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS   UN
Administered by: Other     Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a physician to a sales representative and described the occurrence of hives in a 14 year old female subject who was vaccinated with tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine absorbed (Boostrix) for prophylaxis. On Aug 26 2005 the subject received a dose of Boostrix. On Aug 27 2005, 1 day after vaccination with Boostrix, the subject experienced hives and rash all around the body. The subject was seen at a physicians office and was treated with diphenhydramine hydrochloride (Benadryl). On Aug 30 2005, the events were resolved. the physician considered the events to probably be related to vaccination with Boostrix.

VAERS ID:248205 (history)  Vaccinated:2005-09-01
Age:15.0  Onset:2005-09-01, Days after vaccination: 0
Gender:Female  Submitted:2005-11-22, Days after onset: 82
Location:Virginia  Entered:2005-11-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Pregnancy LMP 9/15/2005
Diagnostic Lab Data: beta-human chorionic 9/2005 positive
CDC Split Type: WAES0509USA02063
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Medication error, Unintended pregnancy
SMQs:, Normal pregnancy conditions and outcomes (narrow), Medication errors (narrow)
Write-up: Information has been received through the manufacturer pregnancy registry from a physician concerning a 15 year old healthy female (who has had regular menstrual periods in the past) who was vaccinated SC with a 0.5 mL dose of Varivax. The pt had indicated that her LMP was on approximately 15-SEP-2005. The same day of vaccination, in September 2005, the physician did a pregnancy test, which came back positive. The physician noted that it was too soon to tell how far along in the gestation the pt was, or even what the pt will do about the pregnancy. Unspecified medical attention was sought. No further information was available. There was no product quality complaint. Follow up information indicated that the pt had an elective termination in October 2005, one month after finding out she was pregnant. The elective termination was considered to be an other important medical event (OMIC). No additional information is expected.

VAERS ID:248541 (history)  Vaccinated:2005-10-18
Age:15.0  Onset:2005-10-19, Days after vaccination: 1
Gender:Female  Submitted:2005-11-29, Days after onset: 41
Location:Pennsylvania  Entered:2005-12-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no illnesses at the time of the vaccination. Her medical history reveals that she was born with mild weakness on her right side. The patient has had no other vaccinations with in four weeks prior to the date of this vaccination.
Diagnostic Lab Data:
CDC Split Type: 200502567
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1782AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Complex regional pain syndrome, Contusion, Muscle twitching, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dyskinesia (broad), Dystonia (broad), Accidents and injuries (narrow)
Write-up: Initial report received on Nov 23 2005 from a health care professional. A 15 year old female patient who was born with weakness on her right side had received an intra muscular injection of Menactra, lot number U1782AA, expiration date 2/11/2007, in the right deltoid on Oct 18 2005. The next day she had a deep aching bruise sensation in her right arm, third, fourth and fifth fingers on her right hand. She was seen by a neurologist and was treated with prednisone for five days. Her diagnosis was complex regional pain syndrome with reflex sympathetic dystrophy. At the time of this report the patient had not recovered.

VAERS ID:248547 (history)  Vaccinated:2005-11-08
Age:15.0  Onset:2005-11-08, Days after vaccination: 0
Gender:Female  Submitted:2005-11-10, Days after onset: 2
Location:Maryland  Entered:2005-12-02, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Acute, Chronic, Psoriasis, Hypothyroid (hashimotos)
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU1911AA IJLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0815P0IJLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 11/08/2005 received flu shot and pneumo vaccine in left deltoid and PPD left forearm. Pain in left deltoid within 1/2 hour of recd shot. Swelling started by that evening and grew larger within 24 hours. Approx 4-5 inches from injection site dime size, non blanching erythema that was tender to palp started 24 hours later. By 48 hours erythema increased to about 4x3.

VAERS ID:249101 (history)  Vaccinated:2005-12-02
Age:15.0  Onset:2005-12-03, Days after vaccination: 1
Gender:Female  Submitted:2005-12-05, Days after onset: 2
Location:California  Entered:2005-12-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0607P1 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0149R1 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0068R1 RA
Administered by: Public     Purchased by: Other
Symptoms: Myalgia, Oedema, Pharyngeal oedema
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received MMR, V2V and 2nd Hep B shot on 12/2/05 presented to ER on 12/3/05 with swollen left arm, severe soreness and throat swelling.

VAERS ID:249218 (history)  Vaccinated:2005-12-12
Age:15.0  Onset:2005-12-12, Days after vaccination: 0
Gender:Male  Submitted:2005-12-13, Days after onset: 1
Location:Texas  Entered:2005-12-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: BP=110/70, PR=88, RR=24
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1871BA1IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Fainted within 15 minutes of administration of fluzone (Aventis). Regained conscious within one minutes but continue dizziness for 30-45 minutes after that. Uncertained of vasovagal response or adverse reaction to Fluzone. Previous flu vaccine vaccination without any problems.

VAERS ID:249556 (history)  Vaccinated:2005-08-12
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2005-12-13
Location:Texas  Entered:2005-12-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1577AA  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Vaccination failure
SMQs:, Lack of efficacy/effect (narrow)
Write-up: None stated

VAERS ID:249596 (history)  Vaccinated:2005-12-14
Age:15.0  Onset:2005-12-15, Days after vaccination: 1
Gender:Female  Submitted:2005-12-20, Days after onset: 5
Location:Massachusetts  Entered:2005-12-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none noted.
Current Illness: no illness at the time of vaccination.
Preexisting Conditions: none noted.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX CONNAUGHTY0496 SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0302R SCRA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1370IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt returned to clinic 48 hrs post Td vaccination c/o redness, swelling,pain at injection site (L deltoid) beginning 12/15/2005. Denied lymphadenopathy, fever, or chills. Pt''s mother was instructed to ice area, take tylenol prn for pain control, and call/return to clinic if symptom worsens or does not resolve.

VAERS ID:249723 (history)  Vaccinated:2005-09-27
Age:15.0  Onset:2005-10-21, Days after vaccination: 24
Gender:Female  Submitted:2005-12-21, Days after onset: 61
Location:New Jersey  Entered:2005-12-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200502242
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1808AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Amnesia, Confusional state, Encephalitis, Fatigue
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Seriousness Criteria other medically significant (OMIC). Initial case received from a health care professional on 10/31/2005. A fifteen year old female patient with no pre existing medical conditions received an intramuscular left deltoid injection of Menactra, lot number U1808AA on Sept 27 2005.Twenty four days later, she experienced confusion, memory loss and was very tired. Per the reporter, the patient had been an A student and was not failing test and could not remember the number of days in a year. The patient was examined by a physician and found to have no weakness and her neurologic exam was within normal limits. A CT scan was also normal. She was scheduled for an EEG and an MRI. At the time of this report, the recovery status was not reported. Follow up information received on 12/19/2005 from the responsible physician. Based upon the new information provided, this case is being upgraded to serious. It was reported that the patient was diagnosed with meningoencephalitis. A spinal tap and MRI was completed, but no results were provided. At the time of this report the patient had not recovered from the events.

VAERS ID:249793 (history)  Vaccinated:2005-09-15
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2005-12-13
Location:Texas  Entered:2005-12-27, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1577AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None Stated

VAERS ID:249796 (history)  Vaccinated:2005-08-10
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2005-12-13
Location:Texas  Entered:2005-12-27, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1577AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None Stated

VAERS ID:249797 (history)  Vaccinated:2005-11-27
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2005-12-13
Location:Texas  Entered:2005-12-27, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1577AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None Stated

VAERS ID:249816 (history)  Vaccinated:2005-12-27
Age:15.0  Onset:2005-12-27, Days after vaccination: 0
Gender:Male  Submitted:2005-12-27, Days after onset: 0
Location:Missouri  Entered:2005-12-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: No
Preexisting Conditions: Unknown. Patient stated no known allergies.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0133R0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Mother called to say her son was complaining of numbness from his elbow to his hand on the left side where the immunization was given. No other complaint.

VAERS ID:250172 (history)  Vaccinated:2005-09-02
Age:15.0  Onset:2005-09-02, Days after vaccination: 0
Gender:Female  Submitted:2005-10-07, Days after onset: 35
Location:Virginia  Entered:2006-01-09, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no preexisting medical conditions or illness at the time of vaccination
Diagnostic Lab Data:
CDC Split Type: 200501974
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1750AA  RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Complex regional pain syndrome, Flushing, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Complex regional pain syndrome-tingling of extremity, pain; hives, flushing. Initial report received from health care professional on 04/10/2005. A 14 year old female with no pre existing medical conditions received in the right deltoid an injection of Meanactra on 9/2/2005. The route of administration was not reported. She immediately experienced flushing, hives, tingling in her upper arms and a gradual intensity in pain over one week. Physician diagnosed "reflex pain syndrome" and stated that the patient refused to use her arm. No paralysis was involved. After one week, there was a gradual decrease in pain. The right arm was the affected arm. As per the reporter, it is unknown whether the patient recovered from these events. Follow-up information received on 07/Dec/2005 from a health care professional. Per the reporter, the physician reviewed the case and reports that the patient did recover from these events. No other information is available. No further information is expected.

VAERS ID:250175 (history)  Vaccinated:2005-06-24
Age:15.0  Onset:2005-08-30, Days after vaccination: 67
Gender:Female  Submitted:2005-12-30, Days after onset: 122
Location:New Jersey  Entered:2006-01-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to pollen, nickel, sports induced asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR    
Administered by: Private     Purchased by: Private
Symptoms: Pain
SMQs:
Write-up: Patient started complaining of legs being tired and aching. Patient is involved in sports never had problems running. After vaccine symptoms occurred.

VAERS ID:250354 (history)  Vaccinated:2006-01-09
Age:15.0  Onset:2006-01-09, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Minnesota  Entered:2006-01-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tegretol, 400mg.
Current Illness: History of seizures
Preexisting Conditions: History of seizures.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSVB141AA2IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURY045922IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0786R1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Patient did not take seizure medication this am but failed to tell me that until after shots were administered. Patient experienced a seizure activity 5 minutes after shots were administered. Fully recovery after seizure.

VAERS ID:250372 (history)  Vaccinated:2005-12-22
Age:15.0  Onset:2005-12-29, Days after vaccination: 7
Gender:Female  Submitted:2005-12-29, Days after onset: 0
Location:Pennsylvania  Entered:2006-01-13, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0558R0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient was given Varicella-SQ on 12/22/05. Patient has no known allergies of any kind. 12/29/05 mother called to report the patient woke this morning 12/29/05 at 10:30 with swollen lips. Only symptom patient has. Patient admitted to consuming salmon prior to going to sleep 12/28/05. Patient''s mother also states that patient has a history of eczema. Mother states that child had flare up of eczema located on her scalp starting earlier in the week of 12/29/05.

VAERS ID:250447 (history)  Vaccinated:2005-12-21
Age:15.0  Onset:2005-12-22, Days after vaccination: 1
Gender:Male  Submitted:2006-01-09, Days after onset: 18
Location:Ohio  Entered:2006-01-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.M0419R1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Erythema, Injection site mass, Nasal congestion, Pharyngolaryngeal pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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)
Write-up: Patient''s mom called to report child had #2 Varicella vaccine and started to hurt right away, site become swollen with "deformed lump" on 12/22/05. Red in color, warm to touch, low grade fever and chills. Patient became congested with sore throat while arm better 12/23. Patient used ice and Advil reported to family doctor.

VAERS ID:250737 (history)  Vaccinated:2005-12-28
Age:15.0  Onset:2005-12-29, Days after vaccination: 1
Gender:Female  Submitted:2005-12-30, Days after onset: 1
Location:New Mexico  Entered:2006-01-23, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular;Zyrtec 10mg;Albuterol MPI;Asmanox
Current Illness: Cough;Ear ache
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1864AA IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1784AA0IMRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIESB08643A SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: PCV7 0.5 ml sub-q right arm given on 12/2//05. 12/30/05 at 16:00 received call fro mom. Inj. site red with 3 1/2" - 4" diameter. Temp 99.8. Advised ice pack and ibuprofen. Call on call physician if necessary.

VAERS ID:250825 (history)  Vaccinated:2006-01-04
Age:15.0  Onset:2006-01-05, Days after vaccination: 1
Gender:Male  Submitted:2006-01-06, Days after onset: 1
Location:Virginia  Entered:2006-01-24, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: VA06001
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY03432 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0381R1 LA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1576BA2 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Blister, Injection site reaction
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Sore fluid filled blister approx 1 cm.

VAERS ID:251058 (history)  Vaccinated:2006-01-26
Age:15.0  Onset:2006-01-26, Days after vaccination: 0
Gender:Female  Submitted:2006-01-30, Days after onset: 4
Location:Missouri  Entered:2006-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic to Amoxicillin.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEUR   LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chills, Dizziness, Ear pain, Headache, Hypokinesia, Malaise, Pain, Pharyngolaryngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Intense pain in the upper arm within two hours radiating into the shoulder causing immobility of the arm. Within 12 hours she complained of chills, weakness, general malaise, dizziness, low grade fever, headache, ear ache, and a sore throat. This lasted 24 - 48 hours. The sore arm still persists four days later to the point that she cannot raise it horizontal to the ground. Vaccine was Tdap but I do NOT know the manufacturer as listed below.

VAERS ID:251109 (history)  Vaccinated:2006-01-27
Age:15.0  Onset:2006-01-28, Days after vaccination: 1
Gender:Male  Submitted:2006-01-31, Days after onset: 3
Location:Georgia  Entered:2006-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 20,Clarinex
Current Illness:
Preexisting Conditions: Allergic to milk, wheat, pollen Pt has ADHD.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB156AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Dysphonia, Pallor
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Paleness, Weakness, Dizziness, Hoarseness.

VAERS ID:251332 (history)  Vaccinated:2006-02-03
Age:15.0  Onset:2006-02-03, Days after vaccination: 0
Gender:Male  Submitted:2006-02-08, Days after onset: 5
Location:North Carolina  Entered:2006-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: imatrex
Current Illness:
Preexisting Conditions: osgood schlatters disease L knee
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC2384AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling, Lymphadenopathy, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother reported swelling and soreness at injection site, he was seen on 2/6/06, had swollen lymph node under R arm no erythema or warmth noted. Had 6 inch tender area on anterior and posterior shoulder. Treated with Motrin 800 mg for pain. Mother reported on 2/7/06 he felt worse and he was seen again. Still no erythema or warmth but TTP in R axilla pain 6/10 given Lortab 5/500 for pain and Prednisone taper.

VAERS ID:251351 (history)  Vaccinated:2006-01-23
Age:15.0  Onset:2006-01-24, Days after vaccination: 1
Gender:Female  Submitted:2006-02-04, Days after onset: 11
Location:New Hampshire  Entered:2006-02-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI the proceeding 1-2 week
Preexisting Conditions: NONE
Diagnostic Lab Data: 01/25/2006 SGOT 174, SGPT 180, BILI 1.9, 01/29/2006 SGOT 29 SGPT 55, BILI 0.4
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB180AB0IMLL
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B002AB0IMLL
Administered by: Private     Purchased by: Public
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin increased, Headache, Liver function test abnormal, Pyrexia, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Biliary system related investigations, signs and symptoms (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever and headache within about 24 hours, vasovagal syncope about 40 hours after vaccine seen in ER and got IV. Labs there showed elevated LFT''s. days later LFT''s were back to normal.

VAERS ID:251507 (history)  Vaccinated:2006-02-13
Age:15.0  Onset:2006-02-13, Days after vaccination: 0
Gender:Female  Submitted:2006-02-14, Days after onset: 1
Location:Missouri  Entered:2006-02-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Well-child checkup. She needed a current health form at school to try out for soccer.
Preexisting Conditions: Auditory processing disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.94134060IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR52890IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Eye movement disorder, Fall, Headache, Lethargy, Staring, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad)
Write-up: I was at the front desk setting up a follow-up date for my daughter''s second shot for Hepatitis A vaccine when I turned my head toward her and it seemed she was coming toward me. I noticed that there was no recognition in her eyes (a vacant stare) and as I went to grab her because she kept coming towards me (she was falling)she fell to the floor. Her arms and legs immediately extended straight and her hands were shaking. Her eyes rolled back in their sockets. As I screamed for someone to help me, the doctor came and requested oxygen. Doctor asked if my daughter was allergic to latex, which I informed him that I did not know. She then came to and the doctor and myself moved her back into a room. Doctor checked her pulse and gave me a bag of ice for the bump on her head. After about 20-30 minutes, the doctor and nurse came in and checked on my daughter again. We sat her up at which time my daughter stated she felt pressure on her chest as she was breathing. Doctor checked her heartbeat and had the nurse give my daughter Benadryl. About 30 minutes later, they checked on her and we left. I stayed home to monitor my daughter (returned home around 2:30 p.m. - her appointment was at 11:00 a.m.)and she slept for about 3 hours. This morning (2/14/06) her head is sore and she stated she felt that she was moving in slow motion or that her body was lethargic.

VAERS ID:251537 (history)  Vaccinated:2006-02-03
Age:15.0  Onset:2006-02-05, Days after vaccination: 2
Gender:Male  Submitted:2006-02-15, Days after onset: 10
Location:Texas  Entered:2006-02-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMAHBVB134AA1IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0400R1IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0233R1SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1596DA1IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: REDNESS, SWELLING TO SITE. LYMPH NODES SWOLLEN.

VAERS ID:251634 (history)  Vaccinated:2005-07-05
Age:15.0  Onset:2005-08-09, Days after vaccination: 35
Gender:Male  Submitted:2006-02-14, Days after onset: 189
Location:California  Entered:2006-02-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: See outpatient consult transcript-Neurology Consult-Patient 15 year old male evaluation of episodes of tingling and numbness sensation on both feet. Assessment- tingling sensation in both feet was most likely secondary to parainfectious pol
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: Diagnosed with "mild" GBS not hospitalized, no weakness.

VAERS ID:251644 (history)  Vaccinated:2006-02-12
Age:15.0  Onset:2006-02-16, Days after vaccination: 4
Gender:Female  Submitted:2006-02-17, Days after onset: 1
Location:Louisiana  Entered:2006-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness: Sore throat
Preexisting Conditions: allergic to grass, ADD
Diagnostic Lab Data: Blood work in ER x 2, MRI head 02/16/2006 blood cultures 02/16/2006.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUE484AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Aphasia, Back pain, Dyskinesia, Dystonia, Eye movement disorder, Headache, Lethargy, Nausea, Pain, Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Information obtained form Mom 02/12/2006, vaccine given at 1:30pm, later that afternoon had terrible headache, nausea that evening, patient admits to her mom that she did have a sore throat before she received the vaccine. 02/13/2006 went to school that morning, saw DR that after noon, fever 99, aches and pains in her back and spine, negative influenza test, ordered Levaquin and Lortab, patient is lethargic, sleepy, 02/14/2006 7pm went to hospital ER for itchy rash on neck and face, given Toradol and Compazine, rash resolved during ER visit. 02/15/2006 sleepy all day, at 8pm, eyes cross, tongue sticking out and she can''t talk, called 911 and taken to Medical center, given Benadryl and jaw loosened. MD told mom it was dystonia or locked jaw. MD stopped Levaquin and Lortab and ordered Amoxicillin and Tylenol. 02/16/2006 had MRI of head and thinks blood cultures done, will be seeing DR for follow up, nausea comes and goes, headache is continuous ranges from a 5 to a 8, very sleepy doesn''t wake up unless someone wakes her, MD instructed MOM to wake her up every 2 hours.

VAERS ID:251807 (history)  Vaccinated:2006-02-14
Age:15.0  Onset:2006-02-15, Days after vaccination: 1
Gender:Female  Submitted:2006-02-17, Days after onset: 2
Location:Virginia  Entered:2006-02-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Parkdale 00274P L forearm, NONE
Current Illness: NONE
Preexisting Conditions: Cardiac Dm drops, allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAMVHA844B20 RA
Administered by: Private     Purchased by: Public
Symptoms: Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash that started on abdomen and spread outward over entire body. Used Benadryl cream at home without relief and at that time went to ER where she was given Epinephrine SC. Diagnosed with allergic reaction and sent home with instruction for Benadryl 25mg PO.

VAERS ID:252205 (history)  Vaccinated:2006-02-21
Age:15.0  Onset:2006-02-22, Days after vaccination: 1
Gender:Male  Submitted:2006-02-24, Days after onset: 2
Location:Connecticut  Entered:2006-03-01, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD30009350PO 
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Sharp stomach pains for approximately 24 hours after taking the 1st Typhoid pill.

VAERS ID:252216 (history)  Vaccinated:2006-01-10
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-03-01
Location:Pennsylvania  Entered:2006-03-01
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR01877AA0 RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Dyskinesia, Stress, Tic
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Within 1 to 2 weeks of Boostrix and Menactra, patient developed uncontrollable mouth opening and closing, especially with stress. Difficulty keeping food in her mouth. 60 Day Follow-up Information 18-MAY-2006: The Tics which developed were most likely secondary to the stress of receiving 2 vaccines

VAERS ID:252348 (history)  Vaccinated:2006-02-13
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2006-02-28
Location:Nebraska  Entered:2006-03-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB229AA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURY03251IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0301R1SCRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B004AB1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: Tdap given as a second dose per recommended immunization scheduled for children adolescents who start late or are more than 1 month behind. Given as per catch up schedule which says, Tdap may be substituted for any dose in a primary catch up series oar as a booster if age appropriate for Tdap. No adverse event. No treatment.

VAERS ID:252440 (history)  Vaccinated:2006-02-16
Age:15.0  Onset:2006-02-16, Days after vaccination: 0
Gender:Female  Submitted:2006-02-16, Days after onset: 0
Location:Texas  Entered:2006-03-08, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: PEARLS- neuro signs
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0304R IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURY042423SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0233R1SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1619AA5IMLA
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Dizziness, Loss of consciousness, Musculoskeletal stiffness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)
Write-up: 2 minutes after the shot was administered, patient looked dizzy. She was helped to sit down on a couch. Then she stiffened into seizure. All extremities stiff and loss of consciousness for 15 seconds. When she cam to she was confused then sleepy. She rested, and vital signs were checked. She was observed for an hour and then sent to the clinic.

VAERS ID:252577 (history)  Vaccinated:2005-04-05
Age:15.0  Onset:2005-04-06, Days after vaccination: 1
Gender:Female  Submitted:2006-03-07, Days after onset: 335
Location:Unknown  Entered:2006-03-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Depression, acne, premenstrual syndrome, headache, asthma exercised induced, sulfonamide allergy.
Diagnostic Lab Data: Body temperature - 04/06/2005 - 1 degree higher than normal.
CDC Split Type: WAES0504USA00850
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.6455710334P IM 
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 14 year old white female with exercised induced asthma and a bactrim allergy and a history of depression, acne, premenstrual syndrome, and headaches, who presented to the office on 04/05/2005 for a well child visit and was vaccinated intramuscularly in the left arm at 15:00 with a first dose of Hepatitis B virus vaccine. There was no concomitant medication. However, the report indicates the patient has taken fluoxetine hydrochloride in the past. On 04/06/2005 the patient experienced vomiting, 3 to 4 times, bad headache, lightheadedness and slight fever. The patient is reported as recovered. Unspecified medical attention was sought. No product quality complaint was involved. No additional information is expected.

VAERS ID:252621 (history)  Vaccinated:2005-06-07
Age:15.0  Onset:2005-06-07, Days after vaccination: 0
Gender:Female  Submitted:2006-03-02, Days after onset: 268
Location:Maryland  Entered:2006-03-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: The pt has no known drug allergies. The pt''s medical history and concurrent conditions were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0563292A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS031BB1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Medication error
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)
Write-up: This case was reported by a healthcare professional and described a 14 yr old female subject who was vaccinated with hep A vaccine inactivated (Havrix) for prophylaxis. There were no concurrent medications. On 07Jun05 the subject inadvertently received the adult dose of Havrix (lot AHAVA031BB) for the 2nd dose in the immunization series. At an unspecified time after the administration of Havrix, the subject experienced soreness at the injection which resolved in one day. The adult dose of Havrix is recommended for immunizing individuals older than 18 yrs of age. In the reporters opinion, the event were unrelated to vaccination with Havrix.

VAERS ID:252812 (history)  Vaccinated:2005-10-25
Age:15.0  Onset:2005-10-26, Days after vaccination: 1
Gender:Male  Submitted:2006-01-17, Days after onset: 83
Location:Utah  Entered:2006-03-10, Days after submission: 52
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline, Blecmycin
Current Illness:
Preexisting Conditions: Per the reporter, the pt had a current illness of a wart removed the same day of the vaccination and was treated with an injection of Blecmycin. The pt had no known allergies at the time of the vaccination and had a pre-existing condition of acne and a wart. The pt was currently taking Doxycycline at the time of the vaccination.
Diagnostic Lab Data: The pt had no relevant diagnostic tests or lab data.
CDC Split Type: 200502358
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1821AA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Back pain, Malaise, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)
Write-up: A 15 year old male pt had received an IM injection of Menactra, lot number U1821AA, in the right arm on 25Oct05. 12 hrs after Menactra was administered the pt complained of general malaise, generalized shaking, weakness in the legs and back pain. The pt was seen in the physician''s office the next day and received supportive care. Per the reporter, the pt recovered from these events on 28Oct05. Follow up information received on 19Dec05 from a health care provider. Per the reporter, Blecmycin given injection to wart on 25Oct05. Further information is not expected. A corrective version was created to amend co-manifestations to manifestations. Adverse events have been re ranked in this correction version (2).

VAERS ID:252664 (history)  Vaccinated:2006-03-08
Age:15.0  Onset:2006-03-08, Days after vaccination: 0
Gender:Female  Submitted:2006-03-10, Days after onset: 2
Location:California  Entered:2006-03-13, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic abdominal pain
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0570R   
Administered by: Private     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness/pain and swelling, warm to touch on left deltoid region.

VAERS ID:252749 (history)  Vaccinated:2006-02-16
Age:15.0  Onset:2006-02-17, Days after vaccination: 1
Gender:Male  Submitted:2006-02-17, Days after onset: 0
Location:California  Entered:2006-03-14, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)CHIRON CORPORATION62758   
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA03AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1822AA0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2340AA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0431R1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Chills, Dizziness, Eye swelling, Headache, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2/16 11:30 a.m. shots received. 2/17 2 a.m. fever, chills, vomiting. Today with both eye swelling, HA, dizziness, decrease po. Pt arrived from out of the country 2 days ago. Pt temp 100.9, B/P 107/76, Pulse 127 done by MD.

VAERS ID:252851 (history)  Vaccinated:2006-02-06
Age:15.0  Onset:2006-02-08, Days after vaccination: 2
Gender:Male  Submitted:2006-03-15, Days after onset: 35
Location:California  Entered:2006-03-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1370DA0 LA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling and redness to L arm.

VAERS ID:252978 (history)  Vaccinated:2006-01-13
Age:15.0  Onset:2006-02-04, Days after vaccination: 22
Gender:Male  Submitted:2006-02-06, Days after onset: 2
Location:Florida  Entered:2006-03-20, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB156AA1IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0301R1SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1576BA1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dry mouth, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever (low), swollen gland, dry mouth, blood taste, painful chewing.

VAERS ID:253109 (history)  Vaccinated:2006-03-21
Age:15.0  Onset:2006-03-21, Days after vaccination: 0
Gender:Male  Submitted:2006-03-22, Days after onset: 1
Location:Texas  Entered:2006-03-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: vital signs were taken. See above statement
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0561P0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA031AA0IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURY03260SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0033K0SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cold sweat, Loss of consciousness, Musculoskeletal stiffness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (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), Arthritis (broad), Hypoglycaemia (broad)
Write-up: As I was administering the last immunization of 4 immunizations, the client closed his eyes and lowered his head and slumped in the chair. His body stiffened and he straightened in the chair and started sliding to the floor. His mother and I helped him gently to the floor in a sitting postion holding him upright as he had lost consciousness. His mother and I told him to breathe deeply, and I was lightly tapping his cheeks to stimulate him to wake up. He started to regain consciousness and we helped him back into the chair. He started to breath deeply as instructed, and said he felt better and started to get up to walk away. He was told to sit in the chair and I got his blood pressure and checked his pulse. His pulse was weak and irreglar at 45. Skin was cold and clammy and his face lost color and was pale. His BP=85/45 at 09:45. I asked his mother if she would like me to call EMS and she said no she would take him to hiw own doctor to be checked. The client stated that he "lost it", "everything went black" and he didn''t remember anything. At present he just felt nauseated. The client stated feeling bad when he got the third shot which was the polio shot. He said he felt allright until the 3rd shot. The client said it never happened to him before and his mother said he never had this reaction before. At 0950 his BP=89/75 and pulse=62. At 10:00 his BP=92/62 and pulse=62. He told me he was feeling much better. Client was answering questions appropriately and acting appropriately. He denied being nauseated. I encouraged fluids and asked the mother again if she would like me to call EMS and have him transported to the hospital. The mother told me she was going to take him to his doctor to have him checked out. He got up and was walking normally and color returned to his face and he left the clinic without any problems or complaints.

VAERS ID:253292 (history)  Vaccinated:2006-03-14
Age:15.0  Onset:2006-03-14, Days after vaccination: 0
Gender:Female  Submitted:2006-03-21, Days after onset: 7
Location:California  Entered:2006-03-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: migraine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC23884AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Joint range of motion decreased, Swelling, Torticollis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dystonia (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Ocular motility disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt received an injection in one right deltoid on 3/14/06. That night her arm swelled to one point where she could not move it. She took advil and returned to one office and received (on 3/17) and received Benadryl 2.5 and Prednisone 50 mg. Came to office on 3/21 with tarchcollis. Rx flexeril 10 mg Ibuprofen. Still under Rx.

VAERS ID:253342 (history)  Vaccinated:2006-03-22
Age:15.0  Onset:2006-03-24, Days after vaccination: 2
Gender:Female  Submitted:2006-03-27, Days after onset: 3
Location:Michigan  Entered:2006-03-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Lumbar puncture, MRI of the thoracic and lumbar spine, EMG, Nerve conduction study, Oligoclonal Antibody.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB256AA2  
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1494AB0  
TDAP: TDAP (ADACEL)SANOFI PASTEURC2151AC4  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Muscular weakness, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow)
Write-up: Initial Left leg weakness followed by weakness bilaterally in hip flexion. Loss of two point discrimination of the lower extremities below the knees with urinary retention. MRI showed mild enhancement throughout the nerve roots in the lumbar spinal canal involving the cauda equina and surface of the conus medullaris. Started IVIG and treated as Guillain Barre.

VAERS ID:253442 (history)  Vaccinated:2006-02-27
Age:15.0  Onset:2006-03-09, Days after vaccination: 10
Gender:Male  Submitted:2006-03-29, Days after onset: 20
Location:New York  Entered:2006-03-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1852AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2124AA6IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fatigue, Guillain-Barre syndrome, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: MOM HAD A CONVERSATION ON 3/23/2006 WITH A FRIEND THAT HE HAD COMPLAINED IN THE LAST 2 WEEKS OF BODY ACHINESS, FATIGUE, NUMBNESS, TINGLING IN HAND, LEG ON THE SAME SIDE.

VAERS ID:253717 (history)  Vaccinated:2006-02-24
Age:15.0  Onset:2006-03-05, Days after vaccination: 9
Gender:Female  Submitted:2006-03-13, Days after onset: 8
Location:California  Entered:2006-04-05, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSVA031AA  RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS52B002AA  RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0942R  LA
Administered by: Public     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Patient developed mild case chicken pox.

VAERS ID:254026 (history)  Vaccinated:2006-04-05
Age:15.0  Onset:2006-04-08, Days after vaccination: 3
Gender:Female  Submitted:2006-04-12, Days after onset: 4
Location:Wisconsin  Entered:2006-04-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BEING TREATED WITH TOPICAL OINMENT FOR PRIOR RASH, RX UNKNOWN
Current Illness: HEALTHY WITH UNDIAGNOSED C/O OF SKIN RASH
Preexisting Conditions: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1723AA0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2151AC0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: CLIENT DESCRIBES RAISED RASH AND ITCHING OVER HER BODY ABOUT 72 HOURS POST VACCINE. STATES SHE ALSO HAD FEVER. CLIENT WAS SEEN ON 4/11/06. sHE HAD HX OF SKIN RASHES UNDER TREATMENT, NEW RAISED "HIVE LIKE" AREAS WERE NOTED ON ABDOMEN AND LEGS, AS WELL AS SCALP, ASSOCIATED WITH ITCHING, SHE WAS KEPT AWAKE AT NIGHT AND STAYED HOME FROM SCHOOL FOR 3 DAYS

VAERS ID:254078 (history)  Vaccinated:2006-04-11
Age:15.0  Onset:2006-04-11, Days after vaccination: 0
Gender:Male  Submitted:2006-04-13, Days after onset: 2
Location:Arizona  Entered:2006-04-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B002AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Influenza like illness, Injection site inflammation, Pharyngolaryngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mild flu like reacton, local inflammation to Tdap. Febrile, stomach ache, sore throat since Tdap administered (4-11-06).

VAERS ID:254154 (history)  Vaccinated:2006-03-27
Age:15.0  Onset:2006-03-29, Days after vaccination: 2
Gender:Female  Submitted:2006-03-29, Days after onset: 0
Location:Idaho  Entered:2006-04-17, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ID06013
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0504R1IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB099AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0827R1SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1766AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hot flush, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patients mother states client woke up on morning of 3/29/06 with a rash on her face. Clients mother states rash looks like hives, and patient has c/o itching and hotness on face. Rash appears only on patients face. No other symptoms. Instructed to take Benadryl.

VAERS ID:254321 (history)  Vaccinated:2006-04-18
Age:15.0  Onset:2006-04-19, Days after vaccination: 1
Gender:Male  Submitted:2006-04-19, Days after onset: 0
Location:California  Entered:2006-04-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1526AC0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2340AA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, 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)
Write-up: Pt presented back to us at 17:40 with 5" X 4" red, hot, itchy, swollen and indurated area of R deltoid. The rash induration, etc was also on L cheek, under chin, L arm and R thigh of variable sizes. No involvement in mouth, throat, tongue. At 17:43, 5mg Benadryl IM L arm was administered. Approx. 5 minutes later, redness was beginning to subside; alter 30 minutes much improvement was seen. No breathing difficulty. Adjusted Benadryl 4-6 hrs prn and if breathing, throat, or tongue swelling occurs call 911.

VAERS ID:254479 (history)  Vaccinated:2006-03-17
Age:15.0  Onset:2006-03-23, Days after vaccination: 6
Gender:Female  Submitted:2006-03-24, Days after onset: 1
Location:Tennessee  Entered:2006-04-24, Days after submission: 30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data:
CDC Split Type: TN06008
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0910R1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received varicella vaccine 3/17/2006 on 3/23/2006 had red streak marks on right side with severe pain PCP told mother having reaction to vaccine.

VAERS ID:254491 (history)  Vaccinated:2006-04-20
Age:15.0  Onset:2006-04-20, Days after vaccination: 0
Gender:Female  Submitted:2006-04-24, Days after onset: 4
Location:Pennsylvania  Entered:2006-04-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0936R0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1893AA0IMLA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC245AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Pt c/o fingers and toes were tingling and arms felt numb. Approx 1-2 hours after injection pt came back to Dr office walked into room alert. Neuro exam neg. Called pts home 4/31/06 pt doing fine.

VAERS ID:254514 (history)  Vaccinated:2006-03-21
Age:15.0  Onset:2006-03-21, Days after vaccination: 0
Gender:Male  Submitted:2006-03-21, Days after onset: 0
Location:Puerto Rico  Entered:2006-04-24, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PR0602
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B005AA IMUN
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Dyskinesia, Eye movement disorder, Lethargy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 8:20am we administered a Tdap in the right arm a minute later the patient fainted. The nurse observed that the kid started to make involuntary movements with the head and rolled the eyes like if it was a seizure. Then he was lethargic for 5 minutes and then he came back.

VAERS ID:254712 (history)  Vaccinated:2006-04-18
Age:15.0  Onset:2006-04-18, Days after vaccination: 0
Gender:Male  Submitted:2006-04-21, Days after onset: 3
Location:New York  Entered:2006-04-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1997AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Chills, Fatigue, Headache, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On the way home from receiving vaccine felt ill developed aches, chills, low grade fever and headache 2 hours after vaccine legs aches and back pain across the lower back,48 hours of headaches and fatigue, resolved by the next evening and well the 3rd day.

VAERS ID:254788 (history)  Vaccinated:2006-04-10
Age:15.0  Onset:2006-04-21, Days after vaccination: 11
Gender:Male  Submitted:2006-04-26, Days after onset: 5
Location:Kentucky  Entered:2006-04-28, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Strattera, Concerta, Albuterol, Prednisone inhaler.
Current Illness: Rash and hives
Preexisting Conditions: Asthma, ADD
Diagnostic Lab Data: ECG irregular rhythm
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0672R0 LA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1783AA0 RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B005AA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1035R0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Electrocardiogram abnormal, Erythema, Pruritus, Rash, Stomach discomfort, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: S/S began 4/21 c/o pruritus, then rash, red, then hives. DR prescribed Prednisone 20mg and Hydrocortisone 1% cream. Today 4/26 stomach upset.

VAERS ID:254848 (history)  Vaccinated:2005-07-05
Age:15.0  Onset:2005-07-06, Days after vaccination: 1
Gender:Female  Submitted:2006-04-26, Days after onset: 294
Location:Unknown  Entered:2006-05-01, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1658AA  UN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Chills, Diarrhoea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Chills and abd pain, diarrhea after receiving vaccine. Treated in Emergency only. No additional symptoms per mother.

VAERS ID:254900 (history)  Vaccinated:2006-04-21
Age:15.0  Onset:2006-04-27, Days after vaccination: 6
Gender:Female  Submitted:2006-05-01, Days after onset: 4
Location:New York  Entered:2006-05-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1492AB0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eyelid disorder, Facial palsy, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Periorbital and eyelid disorders (narrow)
Write-up: The patient received the Menactra vaccine on 4//06. She developed right sided Bells Palsy on 4/27/06. She was evaluated in the ER and was sent home on Prednisone and Acyclovir. She was admitted 4/29/06 for emesis and inability to tolerate p.o. She was discharged after 24 hours. She continues to have Bell''s Palsy and is being evaluated by a neurologist today. 60 day Follow-up Information 01-AUG-2006: Acc. to reporter, the patient continues to have diff. closing R eye lid. She is being referred back to Neurology.

VAERS ID:255378 (history)  Vaccinated:2006-05-05
Age:15.0  Onset:2006-05-05, Days after vaccination: 0
Gender:Female  Submitted:2006-05-08, Days after onset: 3
Location:Mississippi  Entered:2006-05-11, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: N/A
Diagnostic Lab Data: Negative head ct without contrast per ER report
CDC Split Type: MS06007
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURU1619AA0IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0678P1IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Administered Hep B and Td in separate deltoid without incident. After asking pt if ok and taling with him approx 1 minute, pt walked approx 12 feet down hall; stood in place aprox one min then collasped and hit his head on teh floor; pt started to seizure for approx 2 minutes, then stopped and pt became alert. EMS ambulance staff transported pt out of the building at 5:00 p.m. TETANUS AND DIPTHERIA TOXIOD ADMIN WAS DECAVAC

VAERS ID:255420 (history)  Vaccinated:2006-04-10
Age:15.0  Onset:2006-04-10, Days after vaccination: 0
Gender:Female  Submitted:2006-04-14, Days after onset: 4
Location:Missouri  Entered:2006-05-12, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MO200606
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD-147 IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: MOTHER STATED, "PT HAD 2 SEIZURES THE NIGHT SHE RECEIVED TD SHOT."

VAERS ID:255694 (history)  Vaccinated:2000-05-16
Age:15.0  Onset:2005-04-04, Days after vaccination: 1784
Gender:Male  Submitted:2006-05-12, Days after onset: 403
Location:Unknown  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0504USA00904
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.   UN
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Drug ineffective, Skin ulcer, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a school nurse concerning a 15 year old male who on 5/16/2000 was vaccinated with a dose of varicella virus vaccine live. On 4/4/2005 the patient experienced chickenpox and developed impetigo in his lesions. Unspecified medical attention was sought. It was noted that the chickenpox stemmed from the one wild type case. There was no outcome reported. No product quality complaint was involved. Additional information has been requested.

VAERS ID:256403 (history)  Vaccinated:1990-01-01
Age:15.0  Onset:2005-06-08, Days after vaccination: 5637
Gender:Female  Submitted:2006-05-12, Days after onset: 338
Location:Missouri  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0507USA03557
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Malaise, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a RN concerning a 15 yr old female who was vaccinated with a dose of varicella virus vaccine live. On 08Jun05 the pt was seen at the health dept with various red spots (approx 25) behind the knees, along the waist at her back, few on her face. Initially the spots appeared as fluid filled papules then began to scab. The nurse practitioner said the spots looked "more like chiggers and the location on the body were along skin folds and underwear lines. However, it was reported that the pt was in bed all day not feeling well the day before. The parent was advised that the rash could represent varicella disease but cannot rule out other etiology such as insect bites and to consider the child contagious for at least 4-5 days until all of the area are scabbed over. The nurse also reported adverse events experienced by the child''s siblings after receiving varicella virus vaccine live (WAES0507USA0715, 0507USA03558, and 0507USA03559). Additional information has been requested.

VAERS ID:256404 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2005-06-08
Gender:Female  Submitted:2006-05-12, Days after onset: 338
Location:Missouri  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0507USA03558
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Rash vesicular, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a RN concerning an approx 15 yr old female foster child who was vaccinated with a dose of varicella virus vaccine live. On approx 08Jun05 the pt developed a few pinpoint red spots scattered on her arms, face, and legs. The parent was advised that the symptoms could represent varicella disease but other etiologies can not be ruled out, therefore, to consider the pt contagious for 4-5 days, until all of the areas are scabbed over. No further information was available at the time of this report. The nurse also reported three siblings with adverse experiences after receiving a dose of varicella virus vaccine live (WAES0507USA03557, 0507USA03559, and 0507USA01715). Additional information has been requested.

VAERS ID:256501 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2005-04-06
Gender:Male  Submitted:2006-05-12, Days after onset: 401
Location:Pennsylvania  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Attention deficit/hyperactivity disorder.
Diagnostic Lab Data: NONE
CDC Split Type: WAES0508USA01857
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health professional concerning a 15 yr old white male with attention deficit/hyperactivity disorder who was vaccinated with a dose of varicella virus vaccine live. There was no illness at the time of vaccination. On 06Apr05 the pt developed an itchy rash. On 07Apr05 the pt was seen in the office and diagnosed with post Varicella. Supportive care was ordered. No diagnostic tests were performed. Neither the pt or his siblings experienced adverse events following prior vaccination. There was no product quality complaint involved. Additional information has been requested.

VAERS ID:256652 (history)  Vaccinated:2005-08-22
Age:15.0  Onset:2005-09-03, Days after vaccination: 12
Gender:Female  Submitted:2006-05-12, Days after onset: 251
Location:Minnesota  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Ureteric reflux, Hydronephrosis, Pyelonephritis chronic, and Ureteric re-implantation
Diagnostic Lab Data: None
CDC Split Type: WAES0509USA03047
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0216R0  
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Viral infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician and a registered nurse concerning a 15-year-old white female, with no drug allergies and a history of ureteric vesicle reflux, hydronephrosis, chronic pyelonephritis, and ureteric re-implantation who on 22-AUG-2005 was in the left arm vaccinated with the first dose of varicella virus vaccine live (Lot # 648082/0216R). There was no concomitant therapy. The physician reported that on 01-SEP-2005, the patient developed 20-24 chickenpox with fever. On 15-SEP-2005, the patient presented to the physician''s office with many lesions and was reported to be uncomfortable. Treatment was unknown and no laboratory/diagnostic tests were performed. subsequently, the patient''s chickenpox resolved. Additional information is not expected.

VAERS ID:256693 (history)  Vaccinated:2005-09-15
Age:15.0  Onset:2005-09-22, Days after vaccination: 7
Gender:Male  Submitted:2006-05-12, Days after onset: 232
Location:Virginia  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0510USA00613
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 15-year-old male with no pertinent medical history who on approximately 15-SEP-2005 was vaccinated with a dose of varicella virus vaccine live. On approximately 22-SEP-2005, 7 days post vaccination, the patient developed a varicella-like rash on his arms and legs. The lesions were vesicular in nature and no fever was present. It was reported that the patient recovered. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested.

VAERS ID:256799 (history)  Vaccinated:1999-05-01
Age:15.0  Onset:2005-09-25, Days after vaccination: 2339
Gender:Male  Submitted:2006-05-12, Days after onset: 229
Location:Unknown  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0510USA07523
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.   UN
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a consumer concerning her 15 year old son with no medical history or allergies who in May of 1999 was vaccinated subcutaneously with a 0.5 ml dose of varicella virus vaccine live. There was no concomitant medication. On 9/25/2005 the patient experienced a breakthrough case of chickenpox. Unspecified medical attention was sought and no diagnostic or laboratory test were performed. The patients breakthrough case of chickenpox persisted. No product quality complaint was involved. No further information was provided. Additional information is not expected.

VAERS ID:257044 (history)  Vaccinated:2005-12-08
Age:15.0  Onset:2005-12-12, Days after vaccination: 4
Gender:Male  Submitted:2006-05-12, Days after onset: 150
Location:Maryland  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0512USA03599
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6465360550R SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 15-year-old with no pertinent medical history and no allergies, who on December 06,2005, was vaccinated subcutaneously with a 0.5 ml does of varicella virus vaccine live (Oka/Merck) (lot #646536/0550R). There was no concomitant medication. About 7-10 days later, on approximately December 12,2005, the patient developed general pox eruptions with more than 50 lesions with itching. Unspecified medical attention was sought. It was reported that he was treated with diphenhydramine hydrochloride (Benadryl). The patient''s status was unspecified by the reporter. No product quality complaint was involved. Additional information has been requested.

VAERS ID:257583 (history)  Vaccinated:2006-03-15
Age:15.0  Onset:2006-03-17, Days after vaccination: 2
Gender:Female  Submitted:2006-05-12, Days after onset: 55
Location:Unknown  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0603USA03084
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1017R0SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a health professional concerning a 15 year old female with no allergies and no medical history who on 15-MAR-2006 was vaccinated SC with a 0.5ml first dose of varicella virus vaccine love (lot# 652454/1017R). There was no concomitant medication. On 17-MAR-2006 the patient experienced a red area around injection site the size of a quarter. It was also reported that there was no redness, no warmth and no pain. Unspecified medical attention was sought, but no treatment was provided and no labs were done. At the time of reporting the patient had not recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 5/12/2006. Information has been received from a health professional concerning a 15 year old female with no allergies and no medical history who on 15-MAR-2006 was vaccinated SC in the left arm with a 0.5ml first dose of VARIVAX (Merck) (lot#652454/1017R). There was no concomitant medication and no illnesses at the time of vaccination. On 17-MAR-2006 the patient experienced a red area aroung injection site the size of a quarter. It was also reported that there was no redness, no warmth and no pain. Unspecified medical attention was sought, but no treatment was provided and no labs were done. At the time of reporting the patient had not recovered. Follow up information froma health professional indicated that the patient had erythema approximately the size of a quarter the the injectionsite that increased in size to a half dollar. there was no pain or fever. She saw her primary physicianon 19-MAR-2006 for evaluationand no intervention was ordered. The patient recovered on an unknown date. Additionally information is not expected.

VAERS ID:256009 (history)  Vaccinated:2006-05-11
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2006-05-21
Location:New York  Entered:2006-05-22, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC2000AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Given Daptacel instead of Adacel. Daptacel for ages <7 yrs. No reported fever, no unusual soreness at injection site. Pt had no adverse reactions per parents. Thought this was significant to report given vaccine not indicated for his age.

VAERS ID:256027 (history)  Vaccinated:2006-05-03
Age:15.0  Onset:2006-05-03, Days after vaccination: 0
Gender:Female  Submitted:2006-05-05, Days after onset: 2
Location:Kansas  Entered:2006-05-22, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: high fever~DTP (unknown mfr)~1~0~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2340AA0 LA
Administered by: Public     Purchased by: Private
Symptoms: Contusion, Injection site erythema, Injection site mass, Injection site oedema, Injection site pain, Musculoskeletal stiffness
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Mom called today, stated pt''s arm is very reddened and has a lump where inj was given. Arm is stiff and very sore and swollen. Bruised at inj site.

VAERS ID:256056 (history)  Vaccinated:2006-03-21
Age:15.0  Onset:2006-03-21, Days after vaccination: 0
Gender:Male  Submitted:2006-03-23, Days after onset: 2
Location:Texas  Entered:2006-05-22, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: TX06030
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1596DA IMRA
Administered by: Other     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24 hr low grade temp followed by 12-24 hrs of 102-103T.

VAERS ID:257716 (history)  Vaccinated:2005-06-14
Age:15.0  Onset:2005-06-14, Days after vaccination: 0
Gender:Male  Submitted:2006-05-18, Days after onset: 338
Location:Indiana  Entered:2006-05-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: The subject''s medical history, concurrent conditions and concurrent medications were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0563863A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS    
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Injection site reaction, Medication error
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)
Write-up: This case was reported by a physician and described the occurrence of injection site soreness in a 15 year old male subject who was inadvertently vaccinated with Infanrix for prophylaxis. On 6/14/05, the subject inadvertently received a dose of Infanrix in an unspecified arm (dose and lot number not provided) rather than the intended administration of TD. Infanrix is not recommended for immunizing individuals 7 years of age or older. On 6/14/05, the subject also received injections of Hep-B and MMRII in the "other arm". At an unspecified time following the administration of Infanrix, on 6/14/06, the subject experienced injection site soreness at the site of the Infanrix injection. The immunization series with Infanrix was discontinued. The injection site soreness was ongoing at the time of reporting, 6/15/05.

VAERS ID:256139 (history)  Vaccinated:2006-05-04
Age:15.0  Onset:2006-05-08, Days after vaccination: 4
Gender:Female  Submitted:2006-05-22, Days after onset: 14
Location:Kentucky  Entered:2006-05-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: n/a
CDC Split Type: KY2006019
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1747AB0SCLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B002AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Light reddish patchy rash on arms, legs face, c/o itching. Mother says she took her to Dr. who gave her Benadryl, Zantac, steroids, Itching/rash continued until 5/10/06.

VAERS ID:256341 (history)  Vaccinated:2005-11-07
Age:15.0  Onset:2006-02-01, Days after vaccination: 86
Gender:Male  Submitted:2006-05-16, Days after onset: 103
Location:Florida  Entered:2006-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Neuro consult X 2 concurring dx-Parsonage/Turner Syndrome AKA neurologic amyotrophy
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU1804AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction, Muscle atrophy, Nervous system disorder, Neuralgic amyotrophy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Pt twice developed neurologic amyotrophy after influenza vaccine. It occurred in the deltoid region in which he was injected. First episode. Resolved totally. Recovering from 2nd episode. 60 day Follow-up Information 15-AUG-2006: Still in P.T. - not complete strength.

VAERS ID:257834 (history)  Vaccinated:2006-01-22
Age:15.0  Onset:2006-02-16, Days after vaccination: 25
Gender:Female  Submitted:2006-05-26, Days after onset: 98
Location:Unknown  Entered:2006-05-30, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: 02/16/06: serum direct bilirubin 0.48mg/dL 0.00-0.30; hepatic function tests Eleva; serum alanine 72 IU/L 30-65; serum albumin 2.6g/dL 3.4-5.0; serum alkaline IU/L 50-136; serum aspartate 58IU/L 15-37; serum hep A IgM negative; serum hep A IgG react; stool Salmonella culture positive; total serum bilirubin 1.2 mg/dL 0.0-1.0.
CDC Split Type: WAES0602USA04612
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Bacterial infection, Blood albumin decreased, Blood bilirubin increased, Diarrhoea, Hepatic enzyme abnormal, Pyrexia, Sepsis, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a nurse practitioner concerning a 15 yr old female who on 22Jan06 was vaccinated with hep A virus vaccine inactivated, 0.5mL once. There was no concomitant medication. On 14Jan06 the pt experienced elevated liver enzymes after vaccination with hep A virus vaccine inactivated. She was vaccinated to go on a church mission trip. The nurse practitioner suspected the pt had a salmonella infection as well as hep A. The nurse practitioner also stated the pt was really sick. Medical attention was sought. The pt was reported as not recovered. Follow up was received from the nurse practitioner on 20Mar06 concerning this 16 yr white female who on 16Feb06 was evaluated for fever, vomiting, and diarrhea. On lab tests performed for these symptoms it was noted that the pt had slightly elevated liver functions (ALT 72 IU/L, AST 58 IU/L, bilirubin total 1.2 mg/dL, bilirubin direct 0.48mg/dL), negative hep A IgM, reactive hep A antibodies, and stool culture positive for salmonella. Follow up labs were not required. On an unspecified date, the pt recovered from the events. Additional information is not expected.

VAERS ID:257342 (history)  Vaccinated:2006-05-10
Age:15.0  Onset:2006-05-11, Days after vaccination: 1
Gender:Male  Submitted:2006-05-15, Days after onset: 4
Location:Indiana  Entered:2006-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS244CB2 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Cyanosis, Dizziness, Injection site pain, Pharyngolaryngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother called a couple of days after vaccine given states pt c/o sore arm with hand turning blue, fever, sore throat and dizziness. Symptoms lasted one day.

VAERS ID:257651 (history)  Vaccinated:2006-05-22
Age:15.0  Onset:2006-05-22, Days after vaccination: 0
Gender:Male  Submitted:2006-05-26, Days after onset: 4
Location:Delaware  Entered:2006-06-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 18mg
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU2050AA IMLA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2384AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Contusion, Headache, Injection site induration, Injection site swelling, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Bruising/swelling, indurated area approx. 1 1/2" (circular) R deltoid. C/0 headache X 4 days, fever 100.8 to 102 (oral) X 3 days.

VAERS ID:257703 (history)  Vaccinated:2006-05-26
Age:15.0  Onset:2006-05-26, Days after vaccination: 0
Gender:Male  Submitted:2006-06-02, Days after onset: 7
Location:Texas  Entered:2006-06-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Rabies Prevention
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION384011A3IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Pain, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Reported by the ER physician in generalized urticaria and sore shortness of breath.

VAERS ID:258079 (history)  Vaccinated:2006-06-01
Age:15.0  Onset:2006-06-01, Days after vaccination: 0
Gender:Female  Submitted:2006-06-01, Days after onset: 0
Location:New York  Entered:2006-06-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2481AA1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Muscle twitching, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Child fell back from sitting position on exam table and started to have twitching movements of eyes and face for approx. 10 sec. after which she woke up and said she remembered nothing. This occurred about 5-7 min. after vaccination with Adacel.

VAERS ID:258260 (history)  Vaccinated:2006-05-12
Age:15.0  Onset:2006-05-12, Days after vaccination: 0
Gender:Female  Submitted:2006-05-12, Days after onset: 0
Location:Alabama  Entered:2006-06-12, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin.
Diagnostic Lab Data: NONE
CDC Split Type: AL200615
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU1620AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: C/o swelling of face. Seen in ER, given Benadryl, returned to school.

VAERS ID:258360 (history)  Vaccinated:2005-07-08
Age:15.0  Onset:2005-07-08, Days after vaccination: 0
Gender:Female  Submitted:2006-03-31, Days after onset: 266
Location:California  Entered:2006-06-12, Days after submission: 72
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject has no pre-existing medical history.
Diagnostic Lab Data:
CDC Split Type: 200600714
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Hyperventilation, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Hyperventilation Shortness of breath Numbness Post-licensure Safety Surveillance Study of Routine Use of Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate vaccine (Menactra), trail Code MTA30 Subject #23300291 Initial report received on 20/Mar/2006 from an investigator participating in the above mentioned trail in the USA under the reference number MTA30. A 15 year old female subject developed hyperventilation the same day as she received a dose of Menactra. The lot number was not reported. The event was considered to be non-serious. No treatment or recover status information was provided. Follow-up information on 29/Mar/2006. Five minutes post-vaccination, the subject began complaining of a feeling of shortness of breath and as if her throat felt "heaving". She began to hyperventilate and experienced perioral and fingertip numbness. She remained alert with normal speech, and her lungs were clear bilaterally. The symptoms lasted approximately 30 minutes. The subject was diagnosed with hyperventilation and at the time of this report, the subject had recovered. According to the investigator the event was related to the study vaccine.

VAERS ID:258496 (history)  Vaccinated:2006-06-12
Age:15.0  Onset:2006-06-12, Days after vaccination: 0
Gender:Male  Submitted:2006-06-16, Days after onset: 4
Location:Arizona  Entered:2006-06-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUE470AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives all over body after Menomune injection that lasted intermittently over 2 days. No respiratory distress or localized reaction. Saw primary care manager 2 days after hives appeared and sxs resolved. No ER visit.

VAERS ID:258633 (history)  Vaccinated:2006-06-16
Age:15.0  Onset:2006-06-19, Days after vaccination: 3
Gender:Male  Submitted:2006-06-20, Days after onset: 1
Location:Illinois  Entered:2006-06-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0426P1IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Headache, Nausea, Visual disturbance
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Nausea, headache, dizziness and visual problems on 6-19-06 referred to hospital er.

VAERS ID:258689 (history)  Vaccinated:2005-02-11
Age:15.0  Onset:2005-02-13, Days after vaccination: 2
Gender:Female  Submitted:2005-02-23, Days after onset: 10
Location:Delaware  Entered:2006-06-22, Days after submission: 483
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1281AA  LA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days after TD, developed rash, multiple single round or oval papules, 0.25ml, 1 cm diameter, erythematous, mildly raised borders with scaly centers. Greatest cluster L axilla and medial upper arm. 2cm lesion noted left lateral thigh. Not itchy or painful. Given Claritin.

VAERS ID:258807 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2006-06-12
Gender:Male  Submitted:2006-06-20, Days after onset: 8
Location:California  Entered:2006-06-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER  PO 
Administered by: Public     Purchased by: Private
Symptoms: Pharyngolaryngeal pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After 2nd dose of oral typhoid vaccine, client developed rash - after 3rd dose, rash increased and fever to 102 as well as sore throat developed. Saw PMD who felt that oral typhoid had activated varicella virus (chickenpox at 3 years) causing rash.

VAERS ID:258880 (history)  Vaccinated:2006-04-10
Age:15.0  Onset:2006-04-11, Days after vaccination: 1
Gender:Female  Submitted:2006-06-21, Days after onset: 71
Location:West Virginia  Entered:2006-06-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Macrodantin
Current Illness:
Preexisting Conditions: Strep, glomerulonephritis
Diagnostic Lab Data: Increased WBC 15.7, 90% neutrophils
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1750AA IM 
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2341AA IM 
Administered by: Private     Purchased by: Public
Symptoms: Abnormal labour, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Nausea/vomiting persistent. Had UTI and was on macrodatntin at same time.

VAERS ID:258918 (history)  Vaccinated:2006-04-20
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2006-06-26
Location:Maine  Entered:2006-06-27, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Blood culture positive Alpha hemolytic streptococci 5/6/06. CXR revealed pneumonia. BC positive for alpha strep. CXR repeated nodular pneumonia identified. CT of chest and abdomen showed lung nodules, right pleural effusion and a large li
CDC Split Type:
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0505R UNRA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Abscess, Bacterial infection, Coagulation time prolonged, Constipation, Cough, Dyspnoea, Hepatocellular damage, Laboratory test abnormal, Pericardial effusion, Pleural effusion, Pneumonia, Sepsis, Thrombosis, Vomiting
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Alpha strep intermittent pneumonia, empyema, liver abscess, hepatic vein clot. 07/17/06-records received from Maine Med Ctr the receiving hospital for transfer of patient. DOS 5/11-5/19/06 DC Principal DX: Alpha strep intermedius pneumonia and bacteremia. DC Secondary DX: Empyema Liver abscess Hepatic vein clot Constipation Fact V Leiden heterogeneous deficiency Reason for Admission: Beginning symptoms present on 4/20/06 at time of hepatitis B vaccine. Three days later he developed fever, cough and vomiting and three days later PCP DX viral syndrome. Symptoms persisted included 7-10 pound weight loss and CXR revealed pneumonia. BC positive for alpha strep. Presented at ED for c/o persistent cough, abdominal pain and diarrhea. Admitted to ICU. Transferred to Maine Med Ctr. C/O SOB attributed to drainage of empyema. Hospital Course and Treatment: Ceftriaxone, gentamicin, heparin, enoxaparin . DC included IV home therapy, enoxaparin sc. krk

VAERS ID:258928 (history)  Vaccinated:2006-06-06
Age:15.0  Onset:2006-06-06, Days after vaccination: 0
Gender:Female  Submitted:2006-06-23, Days after onset: 17
Location:Illinois  Entered:2006-06-28, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200601528
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU2057AA IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2457AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Initial report received on 6/19/06 from a healthcare professional. A 14 year old female patient with no significant medical history had received an IM dose of Adacel, lot number C2457AA, in the left upper arm and an IM dose of Menactra, lot number U2057AA, in the right upper arm on 6/6/06. Approximately five minutes post immunization, the patient lost consciousness and fell off the exam table onto the floor. The patient was unconscious for one minute, and was subsequently evaluated by the physician. No treatment was provided and no diagnostic testing, or laboratory data were performed. Reportedly, the patient did not have any illnesses at the time of the vaccinations. At the time of this report, the patient had recovered from these events. The reporter for this case is the same as for cases 200601529 and 200601530. (OMIC)

VAERS ID:259053 (history)  Vaccinated:2006-06-20
Age:15.0  Onset:2006-06-21, Days after vaccination: 1
Gender:Female  Submitted:2006-06-30, Days after onset: 9
Location:Michigan  Entered:2006-06-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA D 1 DAILY MULTI VITAMIN 1 DAILY
Current Illness: NONE
Preexisting Conditions: SEASONAL ALLERGIES ALLERGIC TO CATS, DUST MITES ALLERGIC TO PENICILLIN, ZITHROMAX, CEFTIN.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2456AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: REDNESS AROUND INJECTION SITE OF 5CM WITH INDURATION OF APPROX. 3CM. RAISED INDURATION OF APPROX. 1CM. AREA WAS WARM TO TOUCH AND THE ARM WAS SORE FOR 3 DAYS. REACTION OCCURED ABOUT 12-16 HRS AFTER INJECTION (OVER NIGHT) AND LASTED APPROX. 3-4 DAYS. PT. WAS TREATED WITH IBUPROFEN AND COLD COMPRESSES.

VAERS ID:259056 (history)  Vaccinated:2006-06-26
Age:15.0  Onset:2006-06-27, Days after vaccination: 1
Gender:Female  Submitted:2006-06-30, Days after onset: 3
Location:Illinois  Entered:2006-06-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Blood work and urine done at ambulatory care facility.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1194R0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1878AA0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2341AA5IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure decreased, Heart rate increased, Malaise, Pyrexia, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccine adm pm of 6-26-06, Sx developed 4am 6-27-06 - Temp near 105 and general malaise - Mom stated MD said BP low and pulse high, white "sorta" high.

VAERS ID:259072 (history)  Vaccinated:2006-06-20
Age:15.0  Onset:2006-06-21, Days after vaccination: 1
Gender:Female  Submitted:2006-06-30, Days after onset: 9
Location:South Carolina  Entered:2006-06-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keflex; Albuterol
Current Illness: Laceration to right posterior thigh
Preexisting Conditions: Asthma; Albuterol; Allergies
Diagnostic Lab Data: peak flow 250/440, O2 98%, CBC 80%segs- Labs: WBC 13,000 with left shift, ABS segmented neutrophils 11.7; CSF negative for bacteria; BC and Urine Cultures negative; CT of sinuses showed mild sinusitis.
CDC Split Type:
Vaccination
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Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1707CA0 RA
Administered by: Private     Purchased by: Public
Symptoms: Asthma, Back pain, Dyspnoea, Feeling hot, Headache, Injection site erythema, Injection site inflammation, Injection site swelling, Nonspecific reaction, Pyrexia, Sinusitis, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received stitches 6/20/06 in ER where Td was given. Then 6/21/06 arm red, swollen, warm to touch, trouble breathing fever, headache, back hurts, and a yellow around mouth. Admitted to hospital on 6/21/06 for meningitis work up. 07/03/06-received records from Lexington Pediatric Practice to include ED report for DOS 6/20/06-treated for puncture wound in right thigh. Attempted to seek medical attention on 6/19/06 but declined to wait 6 hours in ED. Current medication Albuterol and Motrin. RX with sutures and tetanus immunization, Keflex 250mg 1 dose in ED. Returned to physician''s office on 6/21/06-with c/o SOB, headache, neck pain and some light sensitivity. Skin around mouth yellow in color. Injection site indurated for 1.5 inches around site. Pain when move head and chin to chest. Did not fill RX for Keflex. Follow-up visit to pediatrician''s office after hospitalization for suture removal from thigh. Afebrile, referred to allergist. Admitted to hospital to r/o bacterial meningitis. Waiting for records from hospital. 07/17/2006-records received from Lexington Med Ctr DC Summary: DC DX: fever, meningitis ruled out; systemic reaction to tetanus or tetanus diphtheria (Tb) booster; local reaction to a tetanus diphtheria toxoid (Tb) booster; sinusitis; chronic diagnosis of asthma, under control. C/O persistent HA and neck pain, febrile for 2 days. PE on day 2 revealed continued inflammation around the site of the tetanus booster. RX with Rocephin and Motrin. DC instructions; follow-up in office in 2 days, RX Motrin, Omnicef and Nasonex, loratadine and Albuterol.

VAERS ID:259256 (history)  Vaccinated:2006-06-26
Age:15.0  Onset:2006-06-27, Days after vaccination: 1
Gender:Female  Submitted:2006-07-06, Days after onset: 9
Location:Ohio  Entered:2006-07-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cellulitis right thigh due to insect bite.
Preexisting Conditions: UNK
Diagnostic Lab Data: CBC; BMP; Hepatic profile
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1876BA IDLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site hypersensitivity, Medication error
SMQs:, Hypersensitivity (narrow), Medication errors (narrow)
Write-up: Vaccine administered incorrectly via the ID route left inner forearm. Patient developed cellulitis to the area and received IV antibiotics as an outpatient for 5 consecutive days.

VAERS ID:259572 (history)  Vaccinated:2006-07-14
Age:15.0  Onset:2006-07-14, Days after vaccination: 0
Gender:Male  Submitted:2006-07-14, Days after onset: 0
Location:Missouri  Entered:2006-07-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 10 mg XR and 30 mg; Adderall 5 mg
Current Illness: NONE
Preexisting Conditions: ADHD
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0144F0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1750AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B001AB0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: 5-10 min after receiving vaccines, pt felt faint, dizziness. Pt sitting in hallway near office sweating. Pt escorted back to office. Vital signs stable. Pt was observed in office 30-45 min and released home with parent. Instructed to go to ER if symptoms return.

VAERS ID:259657 (history)  Vaccinated:2006-07-06
Age:15.0  Onset:2006-07-08, Days after vaccination: 2
Gender:Male  Submitted:2006-07-10, Days after onset: 2
Location:Nebraska  Entered:2006-07-18, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2456AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient has area that is red, hard to touch, warm to touch and raised.

VAERS ID:259935 (history)  Vaccinated:2004-12-27
Age:15.0  Onset:2004-12-27, Days after vaccination: 0
Gender:Female  Submitted:2004-12-27, Days after onset: 0
Location:Oklahoma  Entered:2006-07-24, Days after submission: 573
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: OK0435
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0183P2IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0739P1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Headache-TYLENOL, red, puffy left arm- ice to arm, nausea-PHERGAN administered by mom.

VAERS ID:260892 (history)  Vaccinated:2006-07-25
Age:15.0  Onset:2006-07-25, Days after vaccination: 0
Gender:Female  Submitted:2006-06-26, Days after onset: 29
Location:California  Entered:2006-07-31, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA060035
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0833R1IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA019BA1IMLA
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0301R1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Dysphagia, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash noted on all extreme tries and body trunk back and front. Also complain of mild chest pain and some difficulty swallowing was taken to the emergency room. Received a shot did not know what medication given. No other discharge instructions.

VAERS ID:260938 (history)  Vaccinated:2006-07-31
Age:15.0  Onset:2006-07-31, Days after vaccination: 0
Gender:Female  Submitted:2006-08-01, Days after onset: 1
Location:Pennsylvania  Entered:2006-08-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1996AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Skin nodule
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Large knot in arm, itchy, measured 9 cm by 7 cm.

VAERS ID:261012 (history)  Vaccinated:2006-07-31
Age:15.0  Onset:2006-07-31, Days after vaccination: 0
Gender:Female  Submitted:2006-08-02, Days after onset: 2
Location:Missouri  Entered:2006-08-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data: CT Negative Blood Work Negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B0TAA5IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyskinesia, Muscle rigidity, Urinary incontinence
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (narrow), Noninfectious encephalopathy/delirium (broad)
Write-up: Within 15 -20 minutes of receiving the vaccine, the patient and her mother left the builidng and while in their car, the patient began having muscle rigidity, clonic activity, urinary incontinence. Total episode lasted approximately 45 seconds. Mother immediately took patient to the ER of the closest hospital.

VAERS ID:261015 (history)  Vaccinated:2006-07-06
Age:15.0  Onset:2006-07-23, Days after vaccination: 17
Gender:Male  Submitted:2006-08-02, Days after onset: 10
Location:Florida  Entered:2006-08-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arthralgia~Meningococcal (Menactra)~~0~In Sibling
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1978AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient was healthy prior to administration of Menactra. Received vaccination on 7/6 and presented on 7/25 with urticaria. Urticaria lasted approx. 1 week and was treated with claritin during the day and benadryl at night.

VAERS ID:261055 (history)  Vaccinated:2006-07-20
Age:15.0  Onset:2006-07-20, Days after vaccination: 0
Gender:Male  Submitted:2006-08-03, Days after onset: 14
Location:Illinois  Entered:2006-08-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Keflex, Erythromycin
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2384AA5IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure decreased, Chest pain, Dyspnoea, Erythema, Injury, Pallor, Rash, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 15 minutes after injection, client collapsed and hit his head on the wall. He was placed in shock position on the floor. BP started to go down. c/o horrible chest pain, afraid he would die, very pale, red rash around eyes, short of breath. Epinephrine given and BP increased, rash relieved around eyes, chest pain relieved, and breathing returned to normal after he recieved epinephrine.

VAERS ID:261056 (history)  Vaccinated:2006-07-20
Age:15.0  Onset:2006-07-20, Days after vaccination: 0
Gender:Male  Submitted:2006-08-03, Days after onset: 14
Location:Illinois  Entered:2006-08-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Allergic to Keflex and Erythromycin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2384AA5IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: His brother had an adverse reaction to vaccine at the same time. He was standing and watching his brother and he became pale and c/o being lightheaded. No rash, chest pain or shortness of breath. He was placed on floor in shock position. BP normal.

VAERS ID:261068 (history)  Vaccinated:2006-08-01
Age:15.0  Onset:2006-08-02, Days after vaccination: 1
Gender:Male  Submitted:2006-08-03, Days after onset: 1
Location:Alabama  Entered:2006-08-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2556AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Slight swelling of right underarm lymph node.

VAERS ID:261151 (history)  Vaccinated:2006-07-26
Age:15.0  Onset:2006-07-27, Days after vaccination: 1
Gender:Unknown  Submitted:0000-00-00
Location:Illinois  Entered:2006-08-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURLC2456AA0  
Administered by: Private     Purchased by: Public
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)
Write-up: Past Friday 1, site red, swollen, hot painful. past Friday 2, area increased to 10 centimeters.

VAERS ID:261814 (history)  Vaccinated:2006-08-16
Age:15.0  Onset:2006-08-18, Days after vaccination: 2
Gender:Female  Submitted:2006-08-18, Days after onset: 0
Location:Utah  Entered:2006-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB261AA0IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB099CB0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2341AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Tongue black hairy, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client called to report that tongue color is black on 2nd day post immunizations. Denies pain and states no problem swallowing. States she thinks that taste buds are swollen slightly at back of tongue. Also c/o headache. Talked to MD et was referred to PHD.

VAERS ID:261974 (history)  Vaccinated:2006-05-09
Age:15.0  Onset:2006-07-09, Days after vaccination: 61
Gender:Female  Submitted:2006-08-20, Days after onset: 42
Location:New Jersey  Entered:2006-08-23, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Mild acne
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU2050AA IM 
Administered by: Private     Purchased by: Private
Symptoms: Alopecia, Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: the pt had her shot, 2 months later she experienced a small bump at her left hair margin, no real symptoms then her hair fell out within a week or two at site. The area is now a bonafide Alopecia area.

VAERS ID:262083 (history)  Vaccinated:2006-08-22
Age:15.0  Onset:2006-08-22, Days after vaccination: 0
Gender:Female  Submitted:2006-08-24, Days after onset: 2
Location:Colorado  Entered:2006-08-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0604F0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1852AA0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2340AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Diarrhoea, Dizziness, Dyspnoea, Feeling hot, Heart rate increased, Hypertension, Rash macular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Heart coming out of throat, BP 128/84, P98, dyspnea, R arm warm to touch, dizziness, skin blotchy, diarrhea.

VAERS ID:262174 (history)  Vaccinated:2006-08-15
Age:15.0  Onset:2006-08-18, Days after vaccination: 3
Gender:Male  Submitted:2006-08-18, Days after onset: 0
Location:California  Entered:2006-08-28, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURC2457AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU2082AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: Bell''s Palsy 24 hours after receiving Menactra, had been healthy prior to receiving vaccine.

VAERS ID:262233 (history)  Vaccinated:2006-07-24
Age:15.0  Onset:2006-07-25, Days after vaccination: 1
Gender:Female  Submitted:2006-08-28, Days after onset: 34
Location:Iowa  Entered:2006-08-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2556AA5IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 12 x 9 cm red, swollen area left deltoid.

VAERS ID:262257 (history)  Vaccinated:2006-05-25
Age:15.0  Onset:2006-05-25, Days after vaccination: 0
Gender:Female  Submitted:2006-07-27, Days after onset: 63
Location:Utah  Entered:2006-08-29, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS17042IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.18080IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR17740IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR1767 IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.9311507 17060780IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: Not noted 05/25/06. 7/27/06 Follow up phone to foster father. No side effects or reaction.

VAERS ID:262363 (history)  Vaccinated:2006-08-28
Age:15.0  Onset:2006-08-28, Days after vaccination: 0
Gender:Female  Submitted:2006-08-30, Days after onset: 2
Location:California  Entered:2006-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 5 previous Dtap and one Td 9/03
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0651F1IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2457AA6IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Face oedema, Tongue oedema, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1 hr post injection hives 2 hours swollen lips and tongue.

VAERS ID:262468 (history)  Vaccinated:2006-07-11
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-08-28
Location:Indiana  Entered:2006-09-01, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC2129AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Medication error
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)
Write-up: Soreness at injection site, and mild redness.

VAERS ID:262742 (history)  Vaccinated:2006-08-01
Age:15.0  Onset:2006-08-01, Days after vaccination: 0
Gender:Female  Submitted:2006-09-05, Days after onset: 35
Location:Virginia  Entered:2006-09-08, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0608USA06904
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.   UN
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IM 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEUR   UN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Injection site pain
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 15 year old female patient who in August 2006, was vaccinated IM with a dose of HPV rL1 6 11 16 18 VLP vaccine. Prior to administration, the patient received the following concomitant therapy: hepatitis A vaccine and meningococcal ACYW conjugate vaccine. The patient had a mild seizure after receiving HPV rL1 6 11 16 18 VLP vaccine injection. She also complained of a great deal of pain at injection site. Medical attention was sought. It was reported that the patient recovered 1 day after the event. Her mother called the physician at home 1 day after the injections to state that the patient was fine. Upon internal review, mild seizure was considered to be an other important medical event (OMIC). Additional information has been requested.

VAERS ID:262865 (history)  Vaccinated:2006-08-30
Age:15.0  Onset:2006-08-30, Days after vaccination: 0
Gender:Female  Submitted:2006-08-30, Days after onset: 0
Location:Georgia  Entered:2006-09-12, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: did not eat today
Preexisting Conditions: NONE
Diagnostic Lab Data: Fasting blood sugar 83- had not eaten all day-except bag of chips
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBXB180AB0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU1853BB0IMRA
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2556AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Patient passed out fell out of chair onto floor bumped head after receiving meningococcal and Hep B vaccines. Regained consciousness within 30 seconds

VAERS ID:263032 (history)  Vaccinated:2006-07-07
Age:15.0  Onset:2006-07-20, Days after vaccination: 13
Gender:Female  Submitted:2006-08-24, Days after onset: 35
Location:Illinois  Entered:2006-09-14, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness:
Preexisting Conditions: Attention deficit disorder.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0637F0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2069AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Dehydration, Difficulty in walking, Gait disturbance, Guillain-Barre syndrome, Laboratory test abnormal, Paraesthesia, Psychomotor hyperactivity
SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Akathisia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Demyelination (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Write-up: Guillain Barre. She was well on day of immunization but later said she was weak and several months this was not objectively noticed then, but shortly after the vaccine. 9/28/06 Received medical records from neurologists which reveal patient seen by PCP 7/31/06 with complaint of loss of strength over past 3 mos. Labs were done by PCP & showed mild dehydration & elevated neutrophils, eos were absent. Patient referred to neuro & initial eval on 8/3 reveals patient noted weakness beginning in June which had progressively worsened. Symptoms included tingling sensation at tip of fingers & significant weakness to the point she could not do her own hair. Birth history was WNL & only PMH is of ADD & has been on Adderall for about 1 year as well as BCP. Exam showed definite weakness of all extremities, esp upper extremities, & neck. Reflexes were absent in legs. Gait was normal but had difficulty taking steps w/o support & could not rise from sitting w/o help. Normal CPK made dx difficult & EMG/NCS was done on 8/4 which was strongly positive for GBS & copy of test included with records. Treated with IVIG x 2 days & placed in rehab facility on 8/5/06 for eval & therapy then received home PT. Seen by neuro next on 8/24 which showed improvement but still with weakness especially in the hands. Now able to rise from sitting on floor w/o support. Still no reflexes in legs. Complete but slow recovery was expected at that time/ss 9/28/06 Received medical records from hospital which reveal patient admitted 8/4/-8/6/06 for IVIG & PT./ss

VAERS ID:263068 (history)  Vaccinated:2006-09-09
Age:15.0  Onset:2006-09-10, Days after vaccination: 1
Gender:Female  Submitted:2006-09-10, Days after onset: 0
Location:Pennsylvania  Entered:2006-09-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B002AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Began on 9/10/06 with temp of 99.0. Tylenol given temp at 0630 103.4. Temp at 0800 102.5.

VAERS ID:263072 (history)  Vaccinated:2006-08-22
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2006-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy rash with Motrin use.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU2069AA  UN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt had a vasovagal episode after injection of the vaccine dose.

VAERS ID:263074 (history)  Vaccinated:2006-09-14
Age:15.0  Onset:2006-09-14, Days after vaccination: 0
Gender:Female  Submitted:2006-09-15, Days after onset: 1
Location:Texas  Entered:2006-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER   UN
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER   UN
Administered by: Public     Purchased by: Unknown
Symptoms: Medication error, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Broke out in hives

VAERS ID:263170 (history)  Vaccinated:2006-07-31
Age:15.0  Onset:2006-08-01, Days after vaccination: 1
Gender:Female  Submitted:2006-09-01, Days after onset: 31
Location:Maryland  Entered:2006-09-19, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair, Duricef, Differin.
Current Illness: NONE
Preexisting Conditions: Asthma, Acne
Diagnostic Lab Data: CBC increase eosinophils, also Increase CPK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURU2138AA0 RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B008AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Blood creatine phosphokinase increased, Eosinophilia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1 day after vaccine given developed bilat popliteal pain, now with bilateral anterior thigh pain and muscle tenderness, and bilat hip pain.

VAERS ID:263185 (history)  Vaccinated:2006-08-29
Age:15.0  Onset:2006-08-29, Days after vaccination: 0
Gender:Female  Submitted:2006-08-31, Days after onset: 2
Location:New York  Entered:2006-09-19, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Allegra, Flovent, Rhinocort
Current Illness:
Preexisting Conditions: Asthma, Penicillin allergy.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0688F0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dysphagia
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)
Write-up: 2 hours after Gardasil Administration pt developed inability to swallow. Advised to take Benadryl by covering physician and go to ER. In ER not given EPI but Solumedrol to take for 5 days.

VAERS ID:263216 (history)  Vaccinated:2006-08-17
Age:15.0  Onset:2006-08-17, Days after vaccination: 0
Gender:Female  Submitted:2006-09-14, Days after onset: 28
Location:California  Entered:2006-09-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0608USA04465
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0702F0IMAR
Administered by: Private     Purchased by: Private
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information has been received from a physician concerning a 15 year old female with no pertinent medical history or drug reactions/allergies, who on 17-AUG-2006 was vaccinated intramuscularly with HPV rLi 6 11 16 18 VLP vaccine (yeast) (0.5 ml) (lot#653650/0702F). There was no concomitant medication. On 17-aug-2006 the patient experienced nausea. Unspecified medical attention was sought. At the time of this report, the patient''s nausea persisted. Additional information has been requested. This is in follow-up to report(s) previously submitted on 9/14/2006. Information has been received from a physician concerning a 15 year old female with no pertinent medical history or drug reactions/allergies, who on 17-AUG-2006 at 3:00 PM was vaccinated intramuscularly in the deltoid with the first dose of GARDASIL (lot # 653650/0702F). There were no illnesses at time of vaccination. There was no concomitant medication. On 17-AUG-2006 at 6:00 PM the patient experienced severe nausea. The patient subsequently recovered from the nausea on 21-AUG-2006. No further information is expected.

VAERS ID:263225 (history)  Vaccinated:2006-07-19
Age:15.0  Onset:2006-07-19, Days after vaccination: 0
Gender:Female  Submitted:2006-09-14, Days after onset: 57
Location:Texas  Entered:2006-09-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0608USA06029
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0637F0 UN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site pain, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been receiving from a registered nurse concerning a 15 year old female with no medical history who on 19-JUL-2006 was vaccinated in the right deltoid with the first dose of HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653937/0637F). Subsequently, on approximately 19-JUL-2006, the patient experienced burning at the injection site that lasted approximately 60 to 90 seconds and her arm became red and painful enough to cause the patient to cry. The patient subsequently recovered from the pain in the extremity, erythema, and injection site irritation. Additional information has been requested. The registered nurse also reported that the patient''s sister experienced pain in the extremity, erythema, and injection site irritation following vaccination with HPV rLi 6 11 16 18 VLP vaccine (yeast) (LOT#653937/0637F).

VAERS ID:263613 (history)  Vaccinated:2006-09-11
Age:15.0  Onset:2006-09-12, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2006-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: CBC showed anemia
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME)UNKNOWN MANUFACTURER   UN
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER   UN
Administered by: Other     Purchased by: Unknown
Symptoms: Anaemia, Chills, Headache, Hypoaesthesia, Migraine, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received meningococcal and tetanus shots on 9/11 she developed itchiness after vaccines were given, Ha started on 9/13 had a temp of 100.9 and chills had numbness of feet since 9/13/2006. 02/20/2007-records received and reviewed for DOS 09/20-09/26/06.Complained of chills, nausea and numbness in feet no trouble ambulating, complained of headache and migraine headache. Continues to have numbness and feels weak but doing better as of 9/22/06. 9/23/06 numbness decreasing, less tired from the Atarax, 9/25/06 feeling better parent unable to bring patient in for labs. To see neurologist is no improvement.

VAERS ID:263650 (history)  Vaccinated:2006-08-21
Age:15.0  Onset:2006-08-21, Days after vaccination: 0
Gender:Female  Submitted:2006-09-27, Days after onset: 37
Location:Massachusetts  Entered:2006-09-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma, allergic rhinitis.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB077CC1 LA
Administered by: Private     Purchased by: Public
Symptoms: Incoherent, Loss of consciousness, Syncope, Vaccine positive rechallenge
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Fainted, incoherent x 1 minute or less Black out both times.

VAERS ID:263692 (history)  Vaccinated:2006-09-25
Age:15.0  Onset:2006-09-26, Days after vaccination: 1
Gender:Female  Submitted:2006-09-27, Days after onset: 1
Location:Virginia  Entered:2006-09-28, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)AVENTIS PASTEURV1675AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever X 1 day; nausea, headache X 1 day and body pain.

VAERS ID:263862 (history)  Vaccinated:2006-09-28
Age:15.0  Onset:2006-09-29, Days after vaccination: 1
Gender:Female  Submitted:2006-10-02, Days after onset: 3
Location:Illinois  Entered:2006-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0702F0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Back pain, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fatigue, Headache, Backaches, Temp 103, no appetite, x 3 days then was ok no treatment.

VAERS ID:263869 (history)  Vaccinated:2006-03-30
Age:15.0  Onset:0000-00-00
Gender:Male  Submitted:2006-09-28
Location:Oregon  Entered:2006-10-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL
Current Illness: NONE
Preexisting Conditions: ADHD
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB030AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: No adverse events we were instructed to report to VAERS because vaccine was given to a pt under 18 yrs old.

VAERS ID:263937 (history)  Vaccinated:2006-08-10
Age:15.0  Onset:2006-08-10, Days after vaccination: 0
Gender:Female  Submitted:2006-09-12, Days after onset: 33
Location:Puerto Rico  Entered:2006-10-03, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: PR0608
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)AVENTIS PASTEURC2492BA0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Blister, Oedema, Pain, Skin hyperpigmentation, Skin ulcer, Thermal burn
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Few hours after receiving the Tdap, she woke up with pain, swelling and hyperpigmented became and crops of vesicles, burn like lesion as reaction to Tdap.

VAERS ID:264058 (history)  Vaccinated:2006-09-11
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-10-05
Location:Kansas  Entered:2006-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB185AA0IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURY05750SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0466F0SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: No adverse reaction occured. However Proquad is not licensed for over the age of 12 years.

VAERS ID:264204 (history)  Vaccinated:2006-09-12
Age:15.0  Onset:2006-09-13, Days after vaccination: 1
Gender:Female  Submitted:2006-09-22, Days after onset: 9
Location:Massachusetts  Entered:2006-10-10, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium, Propanolol, Prozac, Seraguel, Clozapine, Ritalin, Aviane, Keflex.
Current Illness: NONE
Preexisting Conditions: Bipolar DS, ADHS, left hydronephrosis.
Diagnostic Lab Data: At ER 9/13/06 EKG sinus arrhythmia, chest X ray NL, CT head normal, CBC, U/A, Lytes and toxic screen neg NL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0688F0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Coma, Mental impairment, Sinus arrhythmia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Disorders of sinus node function (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 09/13/06 pt went to school where she developed hives at 10am. She was sent home, mom came home and found pt unresponsive and called 911. Pt seen at ER. Became responsive and talking well at ER. Exam WNL. DX''d changed mental status sent home.

VAERS ID:264431 (history)  Vaccinated:2006-09-27
Age:15.0  Onset:2006-09-27, Days after vaccination: 0
Gender:Male  Submitted:2006-09-29, Days after onset: 2
Location:Oregon  Entered:2006-10-12, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OR200621
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB156AA1IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHABV113AA1IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B005BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: TC per mom Tdap is only new vaccination client received on 9/27. By evening client had developed a fine rash on ant post torso described as prickly heat type of rash. By morning rash was more extensive over torso. No other s/s.

VAERS ID:264527 (history)  Vaccinated:2006-10-02
Age:15.0  Onset:2006-10-02, Days after vaccination: 0
Gender:Female  Submitted:2006-10-04, Days after onset: 2
Location:Unknown  Entered:2006-10-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0672R0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 hours after shot complain of headache-several hours later warm, complain of rash-arms and back feeling bad next day continue to complain of rash red, warm to touch, headache, temperature 98.6.

VAERS ID:264617 (history)  Vaccinated:2006-09-05
Age:15.0  Onset:2006-09-05, Days after vaccination: 0
Gender:Male  Submitted:2006-10-02, Days after onset: 27
Location:Texas  Entered:2006-10-16, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX06064
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0602F1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mom called 10/02/06 reporting child had soreness and pain with stinging sensation in his left deltoid that started about 10 minutes after the Hep A injection given on 9/5/06 (2nd Dose). No redness or swelling and denies numbness, decreased sensation or limits in movement. Requested VAERS be done in case others have had the same problems.

VAERS ID:264745 (history)  Vaccinated:2006-08-31
Age:15.0  Onset:2006-09-06, Days after vaccination: 6
Gender:Female  Submitted:2006-10-13, Days after onset: 37
Location:Maine  Entered:2006-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: Breast lump, Flu symptoms, Pregnancy NOS ( LMP = Unknown), Depression.
Preexisting Conditions:
Diagnostic Lab Data: Urine beta human 09/06/06 positive.
CDC Split Type: WAES0609USA02871
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0637F0IMUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Abdominal distension, Amniocentesis abnormal, Antibiotic resistant Staphylococcus test negative, Appendicectomy, Bacterial infection, Bilirubin conjugated increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood chloride increased, Blood culture positive, Blood pH decreased, Blood potassium increased, Caesarean section, Central venous catheterisation, Chest X-ray abnormal, Colonic stenosis, Culture negative, Drug screen positive, Fear of pregnancy, Foetal disorder, Foetal growth restriction, Gastroschisis, Haematocrit decreased, Haemoglobin decreased, Intestinal anastomosis, Intestinal resection, Maternal exposure during pregnancy, Mean cell haemoglobin concentration increased, Mean cell haemoglobin increased, Mean cell volume increased, Nitrite urine present, PCO2 increased, PO2 increased, Parenteral nutrition, Platelet count decreased, Protein total decreased, Red blood cell count decreased, Red cell distribution width increased, Total lung capacity decreased, Ultrasound antenatal screen abnormal, Umbilical cord abnormality, Unintended pregnancy, Urinary system X-ray, Urine colour abnormal, Urine leukocyte esterase positive, Viral infection, White blood cells urine positive, X-ray abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Drug abuse and dependence (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Normal pregnancy conditions and outcomes (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received through the pregnancy registry from a nurse practitioner concerning a 15 year old female with no known drug allergies, and with depression who on 8/31/06 at 3:00pm was vaccinated IM in the right deltoid with the first dose of GARDASIL (lot 653937/0637F). Illnesses at the time of vaccination included flu symptoms and a breast lump. Concomitant therapy included Zoloft. Other vaccinations given on 9/6/06 included Tdap. On 9/6/06 the pt was seen at her physician with a complaint of continued viral illness. It was reported that the pt was aware that she was pregnant but did not disclose this information to her health care provider until after vaccination. A urine pregnancy test was performed and found to be positive. The pt was advised no to receive the second dose of HPV. At the time of this report, the outcome of the viral illness and vaccine exposure during pregnancy was not known. Follow-up information has been received from the patient''s OB-GYN. A nurse reported that the patient was last seen at 28 weeks gestation on 12-JAN-2007. At that time, she was transfered to the department of maternal-fetal medicine at a local hospital. A nurse at the maternal-fetal medicine department reported that the patient delivered via vaginal delivery a "healthy baby boy but had gastroschisis". The baby was born on 07-APR-2007 and APGAR scores were 8 and 9 at one and five minutes, respectively. The nurse was unable to provide the infant''s birhtweight and indicated that infants born with this congenital anomaly are generally hospitalized for 12 weks. The nurse could not confirm when and if thin infant had been discharged from the hospital. Additional information has been requested.

VAERS ID:264754 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-10-13
Location:Maryland  Entered:2006-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0609USA04922
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Information has been received from a certified medical assistant concerning a female patient between the age of 15 to 18 who was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently, the patient complained of stinging. It was noted that the stinging was only for a moment and resolved quickly. The reporter felt that the stinging could be from the vaccine being cold. No other problems were noted with the administration. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.

VAERS ID:264766 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-10-13
Location:Maryland  Entered:2006-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0609USA07368
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Information has been received from a certified medical assistant concerning a female patient between the age of 15 to 18 who was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently, the patient complained of stinging. It was noted that the stinging was only for a moment and resolved quickly. The reporter felt that the stinging could be from the vaccine being cold. No other problems were noted with the administration. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.

VAERS ID:264767 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-10-13
Location:Maryland  Entered:2006-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0609USA07369
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Information has been received from a certified medical assistant concerning a female patient between the age of 15 to 18 who was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently, the patient complained of stinging. It was noted that the stinging was only for a moment and resolved quickly. The reporter felt that the stinging could be from the vaccine being cold. No other problems were noted with the administration. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.

VAERS ID:264768 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:0000-00-00
Gender:Female  Submitted:2006-10-13
Location:Maryland  Entered:2006-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0609USA07370
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Loss of consciousness, Neurological examination, Pain,