MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 583673 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 584

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584   next


VAERS ID:189290 (history)  Vaccinated:2002-08-15
Age:13.0  Onset:2002-08-16, Days after vaccination: 1
Gender:Male  Submitted:2002-08-21, Days after onset: 5
Location:Michigan  Entered:2002-08-23, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0388M0IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0529AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Pain, Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Came in on 8/16/02 complaining of headache, fever of 103F and aching left arm sore. Had TD on 8/15/02. Seen in office with questionable virus or reaction to TD. No swelling or redness. Viral infection R/O reaction to TD.

VAERS ID:189399 (history)  Vaccinated:2002-08-19
Age:13.0  Onset:2002-08-20, Days after vaccination: 1
Gender:Male  Submitted:2002-08-27, Days after onset: 7
Location:Arizona  Entered:2002-08-27
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: Hematuria-UA P
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0617M1IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0530AA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Haematuria, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: L arm pain, low back CVA pain no dystaria or frequency.

VAERS ID:189404 (history)  Vaccinated:2002-08-07
Age:13.0  Onset:2002-08-07, Days after vaccination: 0
Gender:Female  Submitted:2002-08-19, Days after onset: 12
Location:Ohio  Entered:2002-08-27, 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: After the event, the mother disclosed that child had episodes of fainting seizures for 5 years.
Diagnostic Lab Data: NONE
CDC Split Type: OH0032
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5288A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1483L1SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0342AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Five minutes, post vax, pt stood, walked a few steps and fell to the floor with slight tremors of extremities X 5 seconds.

VAERS ID:189451 (history)  Vaccinated:2002-08-02
Age:13.0  Onset:2002-08-03, Days after vaccination: 1
Gender:Female  Submitted:2002-08-23, Days after onset: 20
Location:Florida  Entered:2002-08-28, 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: Penicillin Erythromycin Carbocaine, Lidocaine, Suprax
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Hypokinesia, Injection site pain, Injection site reaction, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A 2'' long deep red rash appeared on the pt''s arm about an inch below the injection site. She then developed a rash that spread from her arm to her chest and neck area. Her arm was extremely sore for over a weekand therefore she had difficulty in mobilization.

VAERS ID:189585 (history)  Vaccinated:2002-08-12
Age:13.0  Onset:2002-08-14, Days after vaccination: 2
Gender:Female  Submitted:2002-08-22, Days after onset: 8
Location:Alabama  Entered:2002-08-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0368AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Arthralgia, Face oedema, Glomerulonephritis, Headache, Laboratory test abnormal, Musculoskeletal stiffness, Myalgia, Oedema peripheral, Pharyngolaryngeal pain, Pyelonephritis, Pyrexia, Rash, Serum sickness
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received TD 8/12. Started w/ sore throat and fever 8/14. Treated with Rocephin, cot''d w/ fever. Developed myalgias/arthralgias, neck stiffness, headache, rash. Subsequently, admitted 8/17 to hospital. Had (-) spinal tap, (-) CT of head, (-) CXR. urine showed glomerulonephritis. Rash on palms, (-) soles of feet, swollen face and extremities. ? (-). Pt treated with Prednisone 8/18, Benadryl and ??. ?? cont''d with ?? and ??? D/C''d 8/21/02. Nurse follow up on 06/16/04 states: "ADD: Serum Sickness (SERUM SICK) Secondary to Td vax ADD: Pyelonephritis (PYELONEPHRITIS) ADD: (+) ASO Titer (LAB TEST ABNORM)" Nurse follow up on 06/16/04 states: "none."

VAERS ID:189651 (history)  Vaccinated:2002-08-22
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2002-08-22
Location:Michigan  Entered:2002-09-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0343L3 RA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:189802 (history)  Vaccinated:2002-07-03
Age:13.0  Onset:2002-07-04, Days after vaccination: 1
Gender:Male  Submitted:2002-08-28, Days after onset: 55
Location:Missouri  Entered:2002-09-05, 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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.186K0IMLA
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: He broke out in a rash mostly on the arms rash clear in a few days. Used cream for rash to clear.

VAERS ID:189897 (history)  Vaccinated:2002-08-16
Age:13.0  Onset:2002-08-16, Days after vaccination: 0
Gender:Male  Submitted:2002-08-18, Days after onset: 2
Location:California  Entered:2002-09-10, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5313A22 RA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIESU0539AA1 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Cellulitis, Erythema, Injection site induration, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm 16x26 cm area of induration, erythema, tenderness for 2 days, worsening. A follow up report received 9/12/2002 adds: Admitted cellulitis left arm.

VAERS ID:189907 (history)  Vaccinated:2002-08-14
Age:13.0  Onset:2002-08-14, Days after vaccination: 0
Gender:Male  Submitted:2002-08-16, Days after onset: 2
Location:California  Entered:2002-09-10, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type: CA020055
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1264K2IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt c/o dizziness 2 mins after hep B and Tb given. Pt had nothing to eat or drink prior to imms.

VAERS ID:189929 (history)  Vaccinated:2002-08-27
Age:13.0  Onset:2002-08-27, Days after vaccination: 0
Gender:Male  Submitted:2002-08-27, Days after onset: 0
Location:South Carolina  Entered:2002-09-10, Days after submission: 14
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: SC0233
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5287C91IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0524AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure increased, 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), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: After receiving Td and hep B vaccines client passed out-was placed in supine position with feet elevated. DP first reading 90/60, checked BP evening 5min, PB readings 110/80 and 120/80 HR 80. Client drank orange joice and ate crackers. BP stable after 15-20 minutes; left clinic with parents.

VAERS ID:190033 (history)  Vaccinated:2002-09-03
Age:13.0  Onset:2002-09-03, Days after vaccination: 0
Gender:Female  Submitted:2002-09-05, Days after onset: 2
Location:New York  Entered:2002-09-11, 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: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5313A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Neck pain
SMQs:, Arthritis (broad)
Write-up: Immunization given in left deltoid at 10:30am. By 11:00am right side of neck stated to ache. Pain radiated to back of neck and became sharper, then developed into a headache. Headache worsened into evening. Tylenol given with minimal effect. Awoke the next am and pain was gone. No other complaints.

VAERS ID:190167 (history)  Vaccinated:2002-08-29
Age:13.0  Onset:2002-08-29, Days after vaccination: 0
Gender:Male  Submitted:2002-08-30, Days after onset: 1
Location:Missouri  Entered:2002-09-16, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Mother states child had seizure and brain problems.
Diagnostic Lab Data:
CDC Split Type: MO2002030
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5346A20IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU14283SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0521AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1296L0SCLA
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: 8/29/02 Patient was presented with mother to health department where he received Hepatitis B, Td, IPV, and varicella IM and SC. Mother indicated no problems with previous immunizations. Patient admitted to ER with apparent seizure in AM.

VAERS ID:190250 (history)  Vaccinated:2002-08-24
Age:13.0  Onset:2002-08-25, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:2002-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0528AA  LA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Rash macular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Lt deltoid sl edema, pain upon lifting arm, red blotchy below injection site. Hive like appearance.

VAERS ID:190292 (history)  Vaccinated:2002-09-06
Age:13.0  Onset:2002-09-07, Days after vaccination: 1
Gender:Male  Submitted:2002-09-10, Days after onset: 3
Location:Tennessee  Entered:2002-09-18, 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: Viral Bronchitis
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0529AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm swollen. Hot to touch. Fever 101 x 2 days. Real red.

VAERS ID:190293 (history)  Vaccinated:2002-08-26
Age:13.0  Onset:2002-09-08, Days after vaccination: 13
Gender:Female  Submitted:2002-09-09, Days after onset: 1
Location:California  Entered:2002-09-18, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1570L0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0182M0SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU03830IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0287M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Erythema, Pruritus, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 17 Papular with wide erythematous base. 2-3 with vessicles (small) pruritic on trunk, behind ear, scalp, under arms.

VAERS ID:190311 (history)  Vaccinated:2002-09-12
Age:13.0  Onset:2002-09-12, Days after vaccination: 0
Gender:Female  Submitted:2002-09-12, Days after onset: 0
Location:Michigan  Entered:2002-09-18, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5300A IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU06142 IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0484M SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0524AA IMRA
Administered by: Other     Purchased by: Public
Symptoms: Eyelid oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child broke out in welts on both arms and legs, chest, eyelids swollen. No respiratory distress. Benadryl PO and Lopasil given.

VAERS ID:190392 (history)  Vaccinated:2002-09-06
Age:13.0  Onset:2002-09-06, Days after vaccination: 0
Gender:Male  Submitted:2002-09-06, Days after onset: 0
Location:Virginia  Entered:2002-09-19, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: VA02028
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0853L2IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0265M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Chest discomfort, Injection site urticaria, Malaise, Pruritus, Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itching, not feeling well, sl. tightness in chest-seen at medical center. On arrival, lips swollen, throat and chest tight, wheezy, itching, hive on L arm. Given O2, epinephrine 0.1mg, Benadryl 25mg IM and Albuterol nebulizer treatment. O2 sats increase to 99% pt. better.

VAERS ID:190401 (history)  Vaccinated:2002-08-28
Age:13.0  Onset:2002-08-31, Days after vaccination: 3
Gender:Male  Submitted:2002-09-13, Days after onset: 13
Location:Connecticut  Entered:2002-09-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI neg, CT scan neg, CXR neg-wnl negative and normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0376AA0 LA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5300A20 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1092L SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0472M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Injection site pain, Injection site vesicles, Sensation of heaviness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: R arm heaviness, pain in R arm and R foot blistering at site. Lips turned blue and had HA.

VAERS ID:190706 (history)  Vaccinated:2002-08-15
Age:13.0  Onset:2002-08-15, Days after vaccination: 0
Gender:Male  Submitted:2002-08-15, Days after onset: 0
Location:California  Entered:2002-09-27, Days after submission: 43
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: CA020073
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5261A20 LA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM727A20 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0182M  LA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)
Write-up: Pt felt dizzy and fell on the carpet. Sustained no injury pt stated feeling better after few minutes and was sent home with his other after nurse practitioner assessment. Advised to seek medical care if any further symptoms appear.

VAERS ID:190774 (history)  Vaccinated:2002-08-05
Age:13.0  Onset:2002-08-07, Days after vaccination: 2
Gender:Female  Submitted:2002-08-23, Days after onset: 16
Location:South Carolina  Entered:2002-09-30, Days after submission: 38
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: Allergies-codeine
Diagnostic Lab Data:
CDC Split Type: SC0238
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5287C91IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0386AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: RA site red, swollen, warm to touch, no fever. Enc''d to alternate warm/cold compress to site. Mother concerned that this is more than mild reaction. Enc''d mother to seek further evaluation at PCP office.

VAERS ID:190792 (history)  Vaccinated:2001-02-26
Age:13.0  Onset:2001-02-28, Days after vaccination: 2
Gender:Female  Submitted:2001-11-17, Days after onset: 262
Location:Minnesota  Entered:2002-09-30, Days after submission: 316
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: No previous history of migraine
Diagnostic Lab Data:
CDC Split Type: U200100497
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURR11700IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Migraine, Visual disturbance
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)
Write-up: It was reported that a 13 year old female patient received a Typhim VI vaccination on 02/26/01.Reportedly 48 hours after vaccination, the patient developed a migraine headache and lose of vision in one eye for 20 minutes. These symptoms repeated again in 24 hours. Further information is requested.

VAERS ID:191097 (history)  Vaccinated:2002-08-31
Age:13.0  Onset:2002-09-03, Days after vaccination: 3
Gender:Male  Submitted:2002-09-04, Days after onset: 1
Location:Pennsylvania  Entered:2002-10-08, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0159M2IMRA
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU0814AA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Induration at tetanus injection site. Warm to touch, swelling (mild).

VAERS ID:191136 (history)  Vaccinated:2002-09-24
Age:13.0  Onset:2002-09-25, Days after vaccination: 1
Gender:Female  Submitted:2002-09-27, Days after onset: 2
Location:Georgia  Entered:2002-10-08, Days after submission: 11
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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5228A2 IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0365AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site infection
SMQs:
Write-up: Infected subcutaneous tissue td injection site-upper left arm.

VAERS ID:191357 (history)  Vaccinated:2002-09-26
Age:13.0  Onset:2002-09-27, Days after vaccination: 1
Gender:Female  Submitted:2002-09-30, Days after onset: 3
Location:Florida  Entered:2002-10-16, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Hx: Aortic Stenosis; Has Systolic murmur
Diagnostic Lab Data: N/A, No redness, swelling or increased warmth at injection site.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0528AA0IMLL
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Injection site pain, Pyrexia, Tonsillitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 09/27/02 @ 8:00 am-temp. 102 (O). took Tylenol 1000 mg, 09/27/02 @ 12:30 PM, Assessed by RN, Pulse 64/reg, Lungs clear, Temp. 99 (Ax), No S/s of URI; throat, red, but, no exudate or drainage noted. Does not complain if sore throat, but was on "Z Pak" 2 weeks ago for Tonsillitis. Took Tylenol 1000 mg again @ 1:00 pm ,Slept most of day & asymptomatic/febrile by 5:00 pm. Remained symptomatic with exception of soreness @ injection site X 2 days.

VAERS ID:191367 (history)  Vaccinated:2002-09-30
Age:13.0  Onset:2002-10-01, Days after vaccination: 1
Gender:Female  Submitted:2002-10-04, Days after onset: 3
Location:Colorado  Entered:2002-10-16, 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: 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)SMITHKLINE BEECHAM5353B21IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0814AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient telephoned our office on 10/1/02 with report both arms aching; backache; neck ache, overall achiness and febrile 100-101F for 12 hours. Patient had received Hepatitis B in right deltoid and Td in left deltoid on 9/30/02 our offiice Patient sent to hospital 10/1/02.

VAERS ID:191563 (history)  Vaccinated:2002-10-03
Age:13.0  Onset:2002-10-06, Days after vaccination: 3
Gender:Male  Submitted:2002-10-14, Days after onset: 8
Location:South Dakota  Entered:2002-10-21, 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: Clarinex Vioxx, Singulair, Tylenol
Current Illness: URI within 2 weeks
Preexisting Conditions: Allergic pcn, Kawasaki''s disease-age 2.
Diagnostic Lab Data: WBC inc 13,000 L arm swelling, redness; CRP 87.2 17.2
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE33472HA0 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0445H0 RA
Administered by: Private     Purchased by: Unknown
Symptoms: Cellulitis, Hypersensitivity, Injection site reaction, White blood cell count increased
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: L arm allergic reaction with cellulitis 10/6/02. Emycin 333 tid x 10d. Prednisone 10mg 2 x day until gone x 7 days.

VAERS ID:191588 (history)  Vaccinated:2002-10-09
Age:13.0  Onset:2002-10-10, Days after vaccination: 1
Gender:Male  Submitted:2002-10-11, Days after onset: 1
Location:Florida  Entered:2002-10-21, 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: NONE
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.5313A22IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0528AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: P.E.-L axillary lymphadenopathy no increase lymph R ax, no increase lymph, syroclavicular. Denies any other symtpoms.

VAERS ID:191608 (history)  Vaccinated:2002-06-19
Age:13.0  Onset:2002-06-19, Days after vaccination: 0
Gender:Female  Submitted:2002-10-17, Days after onset: 120
Location:Iowa  Entered:2002-10-22, 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: Sickle cell anemia
Diagnostic Lab Data:
CDC Split Type: U200200819
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU10821   
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB076AA   
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB213AA   
Administered by: Other     Purchased by: Other
Symptoms: Eyelid oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received on 10/10/02 from a nurse concerning a 13 year old female that was vaccinated with a dose of YF-VAX (lot number UB213AA), IPOL (lot number U10821), and Menomune (UB076AA) on 6/19/02. She developed hives and swelling of the eyelids two hours after vaccination. She was given oral Benadryl by her mother prior to going to the physician''s office. She was treated with epinephrine and oxygen at the physician''s office. The symptoms resolved per reporter. It was stated by the reporter that the pt, was vaccinated with YF-VAX in the past without incident. Mother denied allergy history. Pt does have sickle cell anemia but is on no medications. It was also reported byt he mother that pt was consuming food prepared by a local vendor when the symptoms developed. Reporter stated, "We are assuming it was the yellow fever vaccine." The cause of the symptoms has not been medically confirmed. Seriousness criteria: other medically significant (OMIC). The follow up received on 7/17/03: New version created in preparation of addendum report (6/1/02-12/31/02): data entry error correction within the system, case is medically confirmed. A 15-day follow up report received 09/09/2003 adds: From additional info received on 09/02/2003 from the vaccine administrator, it was reported that on 06/19/2002 the pt received her second dose of YF-VAX, administered subcutaneously in the left arm, a second dose of Menomune A/C/Y/W-135, administered subcutaneously in the left arm, and a fifth dose of IPOL, administered subcutaneously in the right arm. The pt info and the reporting physician''s info were also updated. Additional info is not anticipated, this case is considered closed.

VAERS ID:191649 (history)  Vaccinated:2002-09-20
Age:13.0  Onset:2002-09-20, Days after vaccination: 0
Gender:Male  Submitted:2002-09-24, Days after onset: 4
Location:Georgia  Entered:2002-10-22, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Hepatic function panel, CBC
CDC Split Type: GA02104
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0525AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Musculoskeletal stiffness, Pyrexia, Sinusitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Elevated temp 105.0 for three day: heavy feeling in head stiffness at base of neck. Has an appt. with MD on 9/23/02. F/U on MD appt; blood work doneon ABT +2. Dx with sinus infection.

VAERS ID:191917 (history)  Vaccinated:2002-01-17
Age:13.0  Onset:2002-01-18, Days after vaccination: 1
Gender:Male  Submitted:2002-10-11, Days after onset: 265
Location:Missouri  Entered:2002-10-24, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhalation
Current Illness: Bronchitis
Preexisting Conditions: Asthma, ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1072L2  
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain upper, Arthralgia, Balance disorder, Cerebrovascular accident, Dizziness, Dysarthria, Gait disturbance, Headache, Hemiparesis, Hypoaesthesia, Hypotonia, Influenza like illness, Liver function test abnormal, Musculoskeletal stiffness, Nausea, Neck pain, Pyrexia, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: According to health room records, patient missed 5 days of school from 8/01 to 1/16/02. On 1/16/02, he was absent with clinic log showing an episode of bronchitis. Patient''s mother took him to his doctor on the 17th for treatment of the bronchitis. While they were there, patient received the first in the series of hepatitis B vaccinations. He was absent the 18th with complaints of fever, stomach ache, vomiting, and diarrhea. He tried to return the 19th, but clinic log shows he went home in the late morning with worsening symptoms. Patient was absent 12 days in February and March with unresolved flu-like symptoms and fever. On 4/2/02, patient had another doctor''s appointment and received the #2 hepatitis B vaccine. The next day he came to school , but had to leave late in the morning because of increasing symptoms of nausea, vomiting, diarrhea, and stiffness in neck and shoulders, fever, fatigue, pain in neck, shoulders, knees and back, and severe right side pain under ribs. Patient continued to have unrelieved symptoms the entire week. On 4/5, patient was taken to the ER with complaint of pain all over the left side of the body, left sided limpness, numbness, and weakness, slurred speech, and severe right side pain, tender to tough. Hepatitis tests were negative. Liver enzymes elevated. Sclera of eyes slightly jaundiced. 4/6 Patient was taken again to ER with increasing severity of above symptoms. Symptoms continued throughout the next week with increasing fatigue and joint pain. On 4/10 the school received a doctor''s excuse for absences for the previous week due to flu. Patient was only able to attend school two days during the month of April and was placed on home bound instruction starting 5/2/02. Patient continued through May and June with episodes of severe right side pain, collapsing on several occasions due to sudden, severe onset of pain that caused him to double over and fall. 5/26 he was taken to ER with an episode of vomiting diarrhea and doubling over with right side pain. Patient was referred to a li

VAERS ID:192331 (history)  Vaccinated:2002-10-17
Age:13.0  Onset:2002-10-19, Days after vaccination: 2
Gender:Male  Submitted:2002-10-31, Days after onset: 12
Location:Arizona  Entered:2002-11-01, 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: Benadryl
Current Illness: NONE
Preexisting Conditions: Truncus ateriosus
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0885AA1IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0008M2IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0689M0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Broke out in hives on Sat. itching all over.

VAERS ID:192335 (history)  Vaccinated:2002-10-23
Age:13.0  Onset:2002-10-25, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:Arizona  Entered:2002-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0689M EXP 05/0IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEUR60814AA EXP 050IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Muscular weakness, Oedema, Urticaria, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received vacc on 10/23/2002. On 10/25/2002 went to hospital- developed hives, weakness, vomiting, chest pain, swelling of face, feet and toes.

VAERS ID:192612 (history)  Vaccinated:2002-08-22
Age:13.0  Onset:2002-08-23, Days after vaccination: 1
Gender:Female  Submitted:2002-08-27, Days after onset: 4
Location:Michigan  Entered:2002-11-05, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MI2002081
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0520AA5IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0423M0SC 
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s mother called and reported that pt had a golf size red raised area on the back this on 8/23 at approxiamtely 11:15am. Mother reported on 8/25/02 the area of redness was approx. baseball size. Mother was encouraged to take pt to her doctor for follow up.

VAERS ID:192822 (history)  Vaccinated:2002-10-17
Age:13.0  Onset:2002-10-19, Days after vaccination: 2
Gender:Female  Submitted:2002-10-29, Days after onset: 10
Location:Arizona  Entered:2002-11-07, Days after submission: 9
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: Allergic rhinitis, ?
Diagnostic Lab Data: Stools test, culture
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0689M IMLA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed diarrhea and hives 2 days after Hep A.

VAERS ID:192984 (history)  Vaccinated:2002-09-23
Age:13.0  Onset:2002-10-15, Days after vaccination: 22
Gender:Male  Submitted:2002-10-23, Days after onset: 8
Location:Pennsylvania  Entered:2002-11-11, Days after submission: 19
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: P
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0960L1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0972L0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Pruritus, Rash maculo-papular
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Three weeks after receiving vaccine, developed a maculopapular rash on body, front and back. When seen at clinic 10/16/02, a few were vesicular and rash was spreading to face, arms and legs. Very itchy. Treatment recommended was palliative-Benadryl, avoid scratching, luke warm bath, and exclude from school for 5 days.

VAERS ID:193028 (history)  Vaccinated:2002-08-07
Age:13.0  Onset:2002-08-07, Days after vaccination: 0
Gender:Female  Submitted:2002-11-10, Days after onset: 95
Location:South Carolina  Entered:2002-11-11, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5314A20IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Given hep B at 10am. Returned at 6pm with urticarial erruption-no systemic sx.

VAERS ID:193123 (history)  Vaccinated:2002-11-04
Age:13.0  Onset:2002-11-05, Days after vaccination: 1
Gender:Male  Submitted:2002-11-08, Days after onset: 3
Location:Maryland  Entered:2002-11-13, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0820AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site swelling, Pyrexia
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: Left arm with swelling, warmth, redness, fever to 103.

VAERS ID:193547 (history)  Vaccinated:2002-11-13
Age:13.0  Onset:2002-11-15, Days after vaccination: 2
Gender:Female  Submitted:2002-11-15, Days after onset: 0
Location:Michigan  Entered:2002-11-19, 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: Amoxicillin 250mg, BID x 10 days
Current Illness: Tx 11/18 for ear infection- on meds
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0521AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0423M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Received Td Left deltoid with problems, next day area was sore, on Friday woke up with redness and warm to touch. (area size of silver dollar) (events and description per phone, per mother.

VAERS ID:193700 (history)  Vaccinated:2002-06-24
Age:13.0  Onset:2002-06-28, Days after vaccination: 4
Gender:Male  Submitted:2002-10-11, Days after onset: 105
Location:Minnesota  Entered:2002-11-20, Days after submission: 40
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: Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1570L0 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0425M1 RL
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0525AA  LL
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Rash pustular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed rash after few days post injection around injection site, the rash has subsequently spread and is still present. It consists of multiple "spots" pustules in various stages of healing.

VAERS ID:193803 (history)  Vaccinated:2002-11-01
Age:13.0  Onset:2002-11-01, Days after vaccination: 0
Gender:Male  Submitted:2002-11-15, Days after onset: 14
Location:California  Entered:2002-11-22, 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: Albuterol, Flovent, Amoxicillin
Current Illness: bilateral otitis
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE of note, Father reports backflow into syringe during injection.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4020045IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Hypoaesthesia, Loss of consciousness, Retching
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 10-15 mins after flu shot, pt in car with father and brother who report he c/o numbness in one arm, then LOC, gagging resps, Tonic/Clonic generalized movements approximately 30 secs. Pt amnesic for events.

VAERS ID:193872 (history)  Vaccinated:2002-11-13
Age:13.3  Onset:2002-11-15, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Maine  Entered:2002-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: ME02010
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM571A2  RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES490367  RL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: extreme swelling after less than 48 hrs of vaccination on right thigh. No fever, no pain, only red on the thigh 4th.

VAERS ID:194016 (history)  Vaccinated:2001-01-28
Age:13.0  Onset:2002-05-15, Days after vaccination: 472
Gender:Male  Submitted:2002-11-20, Days after onset: 189
Location:Connecticut  Entered:2002-11-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash at injection site;Hep B (unknown mfr);2;11;In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy
Diagnostic Lab Data: Full allergy testing done; CXR; Tests for Lupus; RA; LYme; Slight positive ANA; Positive allergy to dust, mold, dog dander; Other tests negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1475K2 LA
Administered by: Private     Purchased by: Other
Symptoms: Hypersensitivity, Injection site rash, Joint stiffness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient had a rash at injection site after 2nd hepatitis B vaccine. Received 3rd hepatitis B vaccine and months later he developed severe chronic hives with occipital joint stiffness. He must be on antihistamines to control the hives.

VAERS ID:194045 (history)  Vaccinated:2002-08-30
Age:13.0  Onset:2002-08-31, Days after vaccination: 1
Gender:Female  Submitted:2002-11-18, Days after onset: 79
Location:Ohio  Entered:2002-11-26, 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: Claritin D-prn
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0376AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Arthralgia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 11-18-02 mother stated that the day following the administration of Td in August, patient had temp of 100, and every joint of her body hurt. Tylenol given.

VAERS ID:194046 (history)  Vaccinated:2002-11-06
Age:13.0  Onset:2002-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-11-15, Days after onset: 9
Location:California  Entered:2002-11-26, Days after submission: 11
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: Urine; Large Bilirubin
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM721A2 IM 
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU0179 IM 
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0382AA IM 
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Blood bilirubin increased, Headache, Nausea, Pyrexia
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received Hepatitis A, IPV, Td on 11/6/02. Within several hours developed nausea, HA, fever, abdominal cramps. Evaluated 11/8 at hospital. 11/9 developed icterus. 11/15/02 Sent to medical center for further work up.

VAERS ID:194050 (history)  Vaccinated:2002-11-14
Age:13.0  Onset:2002-11-15, Days after vaccination: 1
Gender:Female  Submitted:2002-11-18, Days after onset: 3
Location:Massachusetts  Entered:2002-11-26, 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
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0388M0IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0306AC IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Oedema, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received 2 shots on Thursday 11/14/02; Hep B #1 and a Td booster. Karinia came today to the nurse. Showing signs of localized swelling, tenderness, red area approximately 8in. in diameter. Ice applied. Referred to school based health center.

VAERS ID:194404 (history)  Vaccinated:2002-11-13
Age:13.0  Onset:2002-11-15, Days after vaccination: 2
Gender:Female  Submitted:2002-12-02, Days after onset: 17
Location:Mississippi  Entered:2002-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Conarta 54 mg
Current Illness: none
Preexisting Conditions: asthma/Bronchitis fall season
Diagnostic Lab Data: Not applicable.
CDC Split Type: MS02038
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR40971AA5IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0735M1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pts mother, called reporting on 11/18/02 that patient was very weak and had temp of 102.5 over the weekend of the 15th through 17th. On 11/19/02 Dr. called to report patient was ok.

VAERS ID:194518 (history)  Vaccinated:2002-10-29
Age:13.0  Onset:2002-10-30, Days after vaccination: 1
Gender:Male  Submitted:2002-12-03, Days after onset: 34
Location:Kansas  Entered:2002-12-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Creon, MV, Vitamin E, Pulmozyine, Zantac
Current Illness: None
Preexisting Conditions: Cystic Fibrosis
Diagnostic Lab Data: EMG findings consistent with Guillain Barre Strahl Syndrome. Received IVIG tx for 5 days.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0911BA IM 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Balance disorder, Guillain-Barre syndrome, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: Muscle aches < 24 hrs post vaccine. Difficulty with strength and balance (pulling self up the stairs) day 3 or 4 post vaccine. Seen by MD 11/1/02. Did have muscle soreness in area and neck the night of the vaccine. Still balance/muscle sx. EMG-finding consisted with Guillain Barre-strahl synd. Rec''d IVIG tx. x 5 days. Follow-up information received on 3/4/2003 states that large motor coordination not back to baseline. Pt''s energy level is improving but he still tires at school, especially by the end of the week. Patient continues to make slow progress eventhough he is not back to his baseline. Annual follow up on 12/24/03: "Vaccine recipient has recovered from adverse events that was reported for this vaccination."

VAERS ID:194676 (history)  Vaccinated:2002-09-17
Age:13.0  Onset:2002-09-24, Days after vaccination: 7
Gender:Male  Submitted:2002-11-26, Days after onset: 63
Location:Michigan  Entered:2002-12-06, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM313A20 RA
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: Pt''s mother states child''s MD requests VAERS report to be completed.

VAERS ID:194878 (history)  Vaccinated:2001-09-24
Age:13.0  Onset:2002-05-07, Days after vaccination: 225
Gender:Male  Submitted:2002-12-10, Days after onset: 217
Location:New York  Entered:2002-12-10
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations: learning disability;DTP (unknown mfr);1;2;In Sibling
Other Medications: none
Current Illness: cold
Preexisting Conditions: none
Diagnostic Lab Data: blood sugar levels elevated to 1900% pancreas had shut down resulting in a diagnosis of diabetes type#1.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1700K2IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blood glucose increased, Diabetes mellitus, Dry throat, Pollakiuria, Syncope, Thirst
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: After his last in a series of three hep.b#3 immunizations, patient developed sever dryness, always having to drink liquids then go to the bathroom, voiding many times during the night, unable to sleep. He got weaker and weaker till he could no longer stand and became unconcious.

VAERS ID:194851 (history)  Vaccinated:2002-12-03
Age:13.0  Onset:2002-12-03, Days after vaccination: 0
Gender:Female  Submitted:2002-12-03, Days after onset: 0
Location:Michigan  Entered:2002-12-11, 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: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: Negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5355A20 LA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Blotchy red area around injection site (non-raised)

VAERS ID:195017 (history)  Vaccinated:2000-07-25
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2002-12-13
Location:Florida  Entered:2002-12-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0388211A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 2  
Administered by: Other     Purchased by: Other
Symptoms: Autism
SMQs:
Write-up: This report describes the occurrence of "classic symptoms of autism" in a 13 year old female who was vaccinated with hep B vaccine (manuf unk) for prophylaxis. This report was received from the subject''s mother and has not been verified by a physician or other health care professional. The subject''s medical history, concurrent conditions, and concurrent medications were not reported. On 7/25/00, the subject reportedly received her first injection of hep B vaccine (manuf unk). It was reported that the subject subsequently received her second and third injections of hep B vaccine on unspecified dates. The mother stated that at an unspecified time after the third injection of vaccine, her daughter experienced "classic symptoms of autism," which she stated, "are similar to mercury poisoning." As of 12/2/02, the symptoms reportedly persisted. The reporter declined to provide additional info and declined to grant manufacturer authorization to contact the subject''s physician. Therefore, additional info will not be available. The "classic symptoms of autism" in this report are considered medically serious (OMIC).

VAERS ID:195374 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2002-11-25
Location:Rhode Island  Entered:2002-12-26, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? Yes
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
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 2  
Administered by: Public     Purchased by: Other
Symptoms: Antisocial behaviour, Anxiety, Arthralgia, Arthropathy, Depression, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Severe joint point (required knee surgery) inability to participate in sports, eye problems, extreme nausea, anxiety, depression, decline in school performance. 60 Day Follow up states pt has not recovered. Pt continues to have joint problems that have left her unable to participate in sports or recreational (ie skiing) with her family. She has a multitude of problems (eyes, joint, etc) from this vaccine. COMMENTS: Why was this vaccine ever approved? Manufact. and FDA were aware of the risks and did not disclose them. This vaccine has had a severe negative impact on our entire family. What does the future hold for my children? Shame on everyone that was instrumental in approving this vaccine. I hope they (manufact) have family members (although I doubt it) that suffer as much as mine. This entire vaccine trial was a huge scam. Severe joint pain, fatigue, headaches, depression, nausea.

VAERS ID:195418 (history)  Vaccinated:2002-08-05
Age:13.0  Onset:2002-08-05, Days after vaccination: 0
Gender:Male  Submitted:2002-08-05, Days after onset: 0
Location:Wisconsin  Entered:2002-12-26, Days after submission: 143
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Ear infection
Preexisting Conditions: Amoxil and Septro
Diagnostic Lab Data:
CDC Split Type: WI0213
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5230A20 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0895L1 RA
Administered by: Public     Purchased by: Public
Symptoms: Coma, Convulsion, Dyspnoea, Hyperhidrosis, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 04:15 Immediately following second injection for MMR, had slight seizure, pallor, profuse diaphoresis, unresponsive. Ammonia inhalant used; head lowered; slowly responded. Complained of nausea and shortness of breath. Continued to have profuse perspiration and complained of difficulty breathing. Nurse called 911; BP 78/52. Transported to ER.

VAERS ID:195637 (history)  Vaccinated:2002-12-03
Age:13.0  Onset:2002-12-04, Days after vaccination: 1
Gender:Male  Submitted:2002-12-30, Days after onset: 26
Location:Wisconsin  Entered:2002-12-30
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: Allergy to cefadroxil
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5366A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The day after receiving vaccination the patient developed a red, bumpy, itchy rash on the arm of vaccination, that continued to spread two days after vaccination. Saw MD the day after vaccination and was treated with prednisone.

VAERS ID:195783 (history)  Vaccinated:1995-08-15
Age:13.0  Onset:2002-12-27, Days after vaccination: 2691
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2003-01-06
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: Ceclor
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0420B0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Mom noted rash on 12/27/02. Was seen on 12/28/02 and diagnosed with varicella. Zovirax prescribed.

VAERS ID:196070 (history)  Vaccinated:2002-12-05
Age:13.0  Onset:2002-12-07, Days after vaccination: 2
Gender:Male  Submitted:2002-12-09, Days after onset: 2
Location:Arkansas  Entered:2003-01-13, 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:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: AR0265
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0651M1IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0155L1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Cough, Headache, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: At 2 days following MMR and Hep-B, he had increasing headache, temperature 104F, cough and pneumonia, (Per mother).

VAERS ID:196071 (history)  Vaccinated:2002-11-06
Age:13.0  Onset:2002-11-07, Days after vaccination: 1
Gender:Male  Submitted:2002-12-12, Days after onset: 35
Location:Arkansas  Entered:2003-01-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma (seasonal, allergic)
Diagnostic Lab Data: NONE
CDC Split Type: AR0301
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0706M0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Pharyngitis, Rash vesicular, Urticaria
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (narrow), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Per ER report: 6 days after vaccine, he had a rash reported to have started, 1 day after Hep-B vaccine. Rash had blisters. Had hives and some vesicles and had pharyngitis with cough. He was treated with Benadryl.

VAERS ID:196105 (history)  Vaccinated:2002-12-14
Age:13.0  Onset:2002-12-14, Days after vaccination: 0
Gender:Male  Submitted:2003-01-09, Days after onset: 26
Location:New Jersey  Entered:2003-01-13, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN and Keflex
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS746A20IMLA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD30000210PO 
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB307AB0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives, erythema and wheezing started about 1 hour after Hep-A and Yellow Fever shots.

VAERS ID:196504 (history)  Vaccinated:2003-01-07
Age:13.0  Onset:2003-01-07, Days after vaccination: 0
Gender:Female  Submitted:2003-01-10, Days after onset: 3
Location:Florida  Entered:2003-01-21, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0316M1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Headache, Nasal congestion, Pharyngolaryngeal pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Headache, sore throat, nausea, emesis, abdominal pain and head congestion.

VAERS ID:196545 (history)  Vaccinated:2001-08-15
Age:13.0  Onset:2001-08-15, Days after vaccination: 0
Gender:Female  Submitted:2002-03-05, Days after onset: 202
Location:New York  Entered:2003-01-21, Days after submission: 322
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bayer BAYRAB [RABIES IMMUNE GLOBULIN (HUMAN)]
Current Illness:
Preexisting Conditions: Reflect sympathetic dystrophy (RSD), exposure to a bat (greater than 7 days), Pregnant: unknown
Diagnostic Lab Data: UNK
CDC Split Type: U200101145
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)AVENTIS PASTEURR0885 IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Anorexia, Gait disturbance, Hypoaesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)
Write-up: From correspondence received from Bayer Corp (200110163BBE) it was reported: "This report describes a 13 y.o. female treated with BAYRAB [RABIES IMMUNE GLOBULIN (HUMAN)] for rabies post exposure prophylaxis at a dose of 20 iu daily on 8/15/01. PT also received IMOVAX (rabies vaccine) for the indication rabies post exposure prophylaxis on 8/15/01. Relevant history includes reflex sympathetic dystrophy (RSD). "PT received BayRab and Imovax on 8/15/01 at 1 p.m. At 3:30 p.m., the PT experienced difficulty walking. She then fell asleep for 2 hours. At 6 p.m., PT experienced numbness in legs, could not stand or maneuver and vomiting. Stop date of the events were on 8/15/01. The PT is due for a 2nd vaccine shot 3 days later." "For the suspect drug BAYRAB [RABIES IMMUNE GLOBULIN (HUMAN)] (rabies immune globulin, human), difficulty walking, numbness in legs, could not stand or maneuver and vomiting was considered to have a possible relation to the drug. Rechallenge is unknown. Dechallenge is unknown. Outcome of events: improved." From add''l correspondence received on 12/3/01, it was reported at 8:30 p.m. on 8/15/01 the PT needed wheel chair, assistance walking. Seen by physician, recovered at this time. At 11:00 p.m. the PT was able to walk and had good color. The next day the PT slept all day, but couldn''t eat, was force-fed. The day after the PT again experienced difficulty walking. The hospital did not provide the vaccine lot # info. The PT reportedly recovered from this experience. From add''l correspondence received at Aventis Pasteur, Inc. on 2/27/02 the lot # for the Rabies Imovax produce was provided (lot #R0885-2). No further info. is anticipated for this report. This case is closed.

VAERS ID:196556 (history)  Vaccinated:2001-08-15
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2001-08-20
Location:New York  Entered:2003-01-21, Days after submission: 519
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: U200100937
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)AVENTIS PASTEURR0885 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: It was reported by telephone that a 13 y.o. male PT received Imovax IM lot R0885-2 administered in the deltoid on 8/15/01. PT also received Bayrab-Rabies Immune Globulin lot #618W02A in left gluteal. PT experienced numbness and tingling from the waist to hip and down the left leg on the left side.

VAERS ID:196606 (history)  Vaccinated:2003-01-09
Age:13.0  Onset:2003-01-10, Days after vaccination: 1
Gender:Female  Submitted:2003-01-10, Days after onset: 0
Location:New York  Entered:2003-01-22, 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: Pharyngitis
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0934DA1 LA
Administered by: Private     Purchased by: Other
Symptoms: Face oedema, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swollen lips= symptoms Red, raised rash= symptoms

VAERS ID:196708 (history)  Vaccinated:1997-04-10
Age:13.0  Onset:2003-01-22, Days after vaccination: 2113
Gender:Female  Submitted:2003-01-22, Days after onset: 0
Location:Pennsylvania  Entered:2003-01-23, 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: 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)SMITHKLINE BEECHAM2116B9  RA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Rash vesicular
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient received varivax on 4/10/97 without incident. She now has active varicella infection in spite of vaccination.

VAERS ID:197016 (history)  Vaccinated:2002-12-19
Age:13.0  Onset:2002-12-19, Days after vaccination: 0
Gender:Female  Submitted:2002-12-26, Days after onset: 7
Location:Idaho  Entered:2003-01-31, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Recovering from cold
Preexisting Conditions: NONE
Diagnostic Lab Data: BP-110/88, 106/78; R-24, R-22; P-88
CDC Split Type: ID02076
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS709A20IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0381AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dyskinesia, Hypertension, Loss of consciousness, Musculoskeletal stiffness, Pallor, Respiratory rate increased
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: TD given in LD 1st, then 5 minutes later, ped Hep-A given in RD. In 5 more minutes, client stated "I fell dizzy", got pale, head went back, legs straight out, body shook X 5-10 seconds and client lost consciousness briefly then sat straight up and asked "what''s going on"? She was given O2 at 2 liters per minute per NM.

VAERS ID:197158 (history)  Vaccinated:2002-12-16
Age:13.0  Onset:2002-12-17, Days after vaccination: 1
Gender:Male  Submitted:2003-02-12, Days after onset: 57
Location:Georgia  Entered:2003-02-04, Days after submission: 8
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
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0817AA0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Epistaxis, Hypertonia, Hypokinesia, Injection site haemorrhage, Myalgia, Pain, Rash, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Couldn''t move. Was stiff and still is painful and swollen. Bumps broke out. *Follow-up report on 2/20/03: Severe pain, stiffness, rash, bleeding muscle, inside arm soreness.

VAERS ID:197165 (history)  Vaccinated:2003-01-17
Age:13.0  Onset:2003-01-17, Days after vaccination: 0
Gender:Female  Submitted:2003-01-17, Days after onset: 0
Location:California  Entered:2003-02-04, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5367A20IMRA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM755A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0774M0SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU023AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt became pale and dizzy after shots. Vitals taken No wheezing on ausc. Pt left after 15-20 min and felt WNL & vitals stable.

VAERS ID:197437 (history)  Vaccinated:2003-01-20
Age:13.0  Onset:2003-01-20, Days after vaccination: 0
Gender:Male  Submitted:2003-01-22, Days after onset: 2
Location:Wisconsin  Entered:2003-02-07, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;DTP (unknown mfr);2;1;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5230A22IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: All over body rash, red, bumpy and itchy

VAERS ID:197580 (history)  Vaccinated:2003-01-27
Age:13.0  Onset:2003-01-27, Days after vaccination: 0
Gender:Male  Submitted:2003-01-28, Days after onset: 1
Location:Missouri  Entered:2003-02-11, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil, Vistaril
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood work per mother''s report
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5305D9  LA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Fall, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 1/28/03 12:15pm phone call to health room aide to follow up on report of possible seizure experienced by pt. She reports that yesterday 1/27/03 at around 1:20pm while sitting in class, the teacher observed him drop his pencil and when he appeared to retrieve it, she noticed slight shaking with minimal tremors and a few seconds later he "took to the floor like a ton of bricks" to quote the teacher. At this part of the report from, she reported that pt later told him mom he was stretching his arms. Then reported that what the teacher observed was that he did not attempt to break his fall. He fell on his face, sustained a bruise to forehead, scraped tip of nose and a bruised area to right wrist. The teacher went to him and called his name and he came to. The first thing he later remembered was his teacher calling his name. A fellow student walked him to the nurse''s office and the aide reported to me that he was a bit dazed but alert. She called RN who was at another site and she told her to observe him. She reports he was in the sitting position, he was coherent, gave appropriate responses to questions asked and he drank a can. She reported she was with him for the rest of the day and personally accompanied him to the bus. She reported that his mother took him to the ER, where the doctor said he was dehydrated and per mother''s report, gave him IV''s and was sent home some time yesterday evening. He is back at school today, has a brace to his right wrist for a sprain, and appears to be OK. 1/28/03 1pm TC placed to mother left message to call me on her answering machine. 1/29/03 8:10am TC mother to talk with her about pt. She reports he is doing well; that prior to his passing out at school, he''d been experiencing flu type symptoms of body aches, but no fever or nausea. Pt reported to her he stood up in class, stretched and sat back down, at which point he passed out. She reports ER doctor seemed to think he was dehydrated and his BP bottomed out when he sat back down, and he passed out. She reports ER doctor is unsure

VAERS ID:197678 (history)  Vaccinated:2001-11-27
Age:13.0  Onset:2001-12-15, Days after vaccination: 18
Gender:Male  Submitted:2003-01-29, Days after onset: 410
Location:Colorado  Entered:2003-02-12, 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: Amoxicillin, club feet, sub mucous cleft palate, sinusitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.817L   
Administered by: Public     Purchased by: Private
Symptoms: Amnesia, Fatigue, Monocytosis, Oedema, Pain, Thinking abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed mono Dec. 01. Relapsed January & February - symptoms worsened to Chronic Fatigue. Unable to attend school. He was totally exhausted all the time, poor concentration, memory prob. After seeing several MD''s, PT and mother tried many things. Through all this, PT''s tonsils were enlarged and sore. PT & mother had scheduled a tonsillectomy when PT''s mom heard about another treatment. PT had Quantum Xeroid testing, and after a total detox program/diet change, he is now back in school half days. No tonsillectomy!

VAERS ID:197972 (history)  Vaccinated:2002-11-12
Age:13.0  Onset:2002-11-12, Days after vaccination: 0
Gender:Female  Submitted:2002-11-19, Days after onset: 7
Location:Washington  Entered:2003-02-20, Days after submission: 93
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma, allergy to dust
Diagnostic Lab Data:
CDC Split Type: WA021890
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40200251IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0709M0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Oedema, Pain, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Swelling redness very painful down to elbow

VAERS ID:197989 (history)  Vaccinated:2003-01-31
Age:13.9  Onset:2003-02-06, Days after vaccination: 6
Gender:Female  Submitted:2003-02-07, Days after onset: 1
Location:Georgia  Entered:2003-02-20, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to walnuts
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0464M0IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0817AA4IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pain, Urticaria, Viral infection
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother states child began c/o tenderness under left arm in axilla area approximately on 2/6/03. Has now noted "hives" x 20 to axilla area and to side x 1 day (2/7/03). Child is afebrile. Advised mother that s/s probably not related to vaccine since it was given 7 days ago, but instructed mother to call pediatrician and describe symptoms. Instructed mother to call clinic back after MD advise. Child recovered. Doctor stated probaly viral illness.

VAERS ID:198622 (history)  Vaccinated:2003-01-21
Age:13.0  Onset:2003-02-03, Days after vaccination: 13
Gender:Male  Submitted:2003-02-04, Days after onset: 1
Location:South Carolina  Entered:2003-03-03, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: N/A
Preexisting Conditions: PCN
Diagnostic Lab Data: PT saw an MD at Pediatric center on 2/5/03. MD states would not give Varicella, but do titer if necessary for proof of immunity.
CDC Split Type: SC0305
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0451M0SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Vasodilation procedure
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Write-up: Round red area 50-cent size, warm to touch on right arm below deltoid. Denies pain. Mom has been putting cold compresses today

VAERS ID:199020 (history)  Vaccinated:2003-02-04
Age:13.0  Onset:2003-02-05, Days after vaccination: 1
Gender:Female  Submitted:2003-02-20, Days after onset: 15
Location:California  Entered:2003-03-07, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Respeudal(?), Panil, Rectadete, Ritalu(?)
Current Illness:
Preexisting Conditions: Obesity, ADD
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0524AA0 RA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site oedema, 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: Swelling at inject site with itching. No specified (?) induration. Mild erythema. No limitation of movement.

VAERS ID:199076 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2003-03-04
Location:Unknown  Entered:2003-03-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Rhinitis allergic NOS; Splenomegaly
Preexisting Conditions: Ear tube insertion; Lung infection NOS; Otitis Media NOS; Sinus infection
Diagnostic Lab Data: Chest x-ray normal; Pulmonary function test normal; Lymphocyte count normal; Serum hepatitis A IgM absent; Serum immunoglobulin G <48 mg/dL and $g500 mg/dL; Serum immunoglobulin M <4 mg/dL; Serum hepatitis A IgG absent; CBC normal
CDC Split Type: WAES0302USA02696
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody positive, Immune system disorder, Laboratory test abnormal
SMQs:, Systemic lupus erythematosus (narrow)
Write-up: It was reported in a published article that a 13 year old male developed common variable immunodeficiency and negative antibodies after being vaccinated with pneumococcal vaccine 23 polyvalent. The literature article is as followed: A 13 year old boy presented with a 2 year history of recurrent sinopulmonary infections. There was a history of recurrent otitis media in early chidlhood requiring pressure-equalizing tube placement, and he was also evaluated with allergic rhinitis. The family history revealed two health siblings and a mother with allergic rhinitis. Physical examination was physiologic except for splenomegaly. Quantitative Igs showed profound hypogammaglobulinemia with IgG < 48mg/dL (normal range 694 to 1618), IgM < 4 mg/dL (48 to 271), and IgA <17 mg/dL (81 to 463). Immunizations revealed no response to pneumococcal vaccine but an excellent response to Td (pre-vaccine titers <0.5 IU/mL and 0.01 IU/mL, and post-vaccine titers 30 IU/mL and 0.98 IU/mL to tetanus and diphtheria, respectively, with protective titers to tetanus being 0.5 IU/mL and to diphtheria 0.01 IU/mL) with increase of titers by 60- and 100-fold for tetanus and diphtheria, respectively. The patient had a normal complete blood count (CBC), normal lymphocyte subsets by flow cytometry, and a normal delayed type hypersensitivity (DTH) response to tetanus, Candida, and mumps antigens. Anti-igA (IgG or IgM) antibodies were not detected by enzyme immunoassay EIA), and both chest radiograph and pulmonary function test were normal. After receiving all the test results and because of the number of infections, the profound hypogammaglobulinemia, and the poor immune response to Pneumovax, the patient has been receiving antibodies replaced therapy (IVIG) at a dosage of 400 mg/kg every 4 weeks with good trough serum IgG levels ($g500 mg/dL) with no complications and significant improvement in the number of infections. The authors'' discussion is as followed: It is known that there is a sequential acquisition of antibody synthesizing capacity in humans

VAERS ID:199340 (history)  Vaccinated:2003-02-10
Age:13.0  Onset:2003-02-10, Days after vaccination: 0
Gender:Female  Submitted:2003-03-07, Days after onset: 25
Location:Indiana  Entered:2003-03-12, 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: AD/HD
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 2  
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Nausea, Nuchal rigidity, Pallor, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Trouble breathing while lying down, fever, stiff neck, paleness, weakness, nausea, rapid heartbeat.

VAERS ID:199348 (history)  Vaccinated:2003-01-16
Age:13.0  Onset:2003-01-16, Days after vaccination: 0
Gender:Male  Submitted:2003-03-07, Days after onset: 50
Location:New Jersey  Entered:2003-03-12, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC w/diff - normal, mono - negative, Epstein Barr - negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5366A20IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain, Anorexia, Ear pain, Fatigue, Injection site erythema, Injection site induration, Injection site pain, Movement disorder, Respiratory disorder
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad)
Write-up: Sore arm, red knot at site. Progressively became fatigued, loss of appetite. Loss of energy level and unable to play sports at usual level. After 1 month unable to get out of bed, - strep - mono - Epstein Barr, Ear pain developed and upper respiratory problems, intermittent abdominal pain. Symptoms resolved 2 1/2 months after vaccine.

VAERS ID:199353 (history)  Vaccinated:2003-03-05
Age:13.0  Onset:2003-03-06, Days after vaccination: 1
Gender:Female  Submitted:2003-03-07, Days after onset: 1
Location:Virginia  Entered:2003-03-12, 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: NONE
Preexisting Conditions: Acauthesis migraines
Diagnostic Lab Data: Labs at ER - OK per PT''s mother. Do not know what tests were ordered.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0746AC5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Pain, Pyrexia, Rash, Vasodilation procedure
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: School nurse called office stating child had temp of 101.9 deg, arm discomfort, redness and warmth at inject site, raised areas on arms and chest, no SOB, no facial swelling. School activated EMS and PT was transported to a hospital. This event occurred on 3/6/03. Back to school on 3/7/03.

VAERS ID:199504 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2003-03-07
Location:Unknown  Entered:2003-03-14, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0202USA01541
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 3IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Info has been received from a relative of a 13 year old female who was vaccinated with a 4th dose of Hep-B. Subsequently, the pt developed a little bit of swelling around the injection site. The pt had not sought medical attention for her experience. Additional info has been requested.

VAERS ID:199592 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2003-03-07
Location:Tennessee  Entered:2003-03-14, 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: Macrodantin
Current Illness:
Preexisting Conditions: Neurogenic bladder
Diagnostic Lab Data: Skin biopsy reported as dermal reactive dermatitis with extravasated red blood cells.
CDC Split Type: WAES0211USA02190
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis, Extravasation blood, Hypersensitivity, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Info has been received from a health care professional concerning a 13 year old female pt with a neurogenic bladder and no known drug allergies who was vaccinated with a 2nd dose of Hep-B. The pt developed a rash 3-4 days after administration of the vaccine. The rash was located on her hands, arms, legs and trunk. The rash was described as a monomorphus, 2-3mm, generalized papular eruption, non-blanching and pruritic. A skin biopsy was performed to rule out Giacotti-Crosi and vasculitis. No vasculitis was identified. The pt was treated with Triamcinolone cream and Camphor + Menthol + Phenol (Sarna) lotion. The pt''s condition did improve and the physician thought it could be related to the vaccine. Additional info has been requested.

VAERS ID:199772 (history)  Vaccinated:2003-03-10
Age:13.0  Onset:2003-03-10, Days after vaccination: 0
Gender:Female  Submitted:2003-03-11, Days after onset: 1
Location:Maryland  Entered:2003-03-18, 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: Flonase
Current Illness:
Preexisting Conditions: Allergies, dust, cats-denies food allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)AVENTIS PASTEURU13880IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Pain, Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: 3/10/03 Imovax given at 8:30 A and at 1:30 P pt became pale, hurt all over, chills. Mother took pt from school to ER for assess. Pt was released at 5pm. 9pm became cold, pale, body hurt all over, teeth chattering. Pt taken to ER-assessed and released at 12mn given Motrin for pain.

VAERS ID:199779 (history)  Vaccinated:2003-03-03
Age:13.0  Onset:2003-03-03, Days after vaccination: 0
Gender:Female  Submitted:2003-03-11, Days after onset: 8
Location:Maryland  Entered:2003-03-18, 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: Zyrtec
Current Illness: NONE
Preexisting Conditions: Allergies to cats, dust and food allergies.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION3170112IMLA
Administered by: Public     Purchased by: Public
Symptoms: Crying, Dyspnoea, Feeling cold, Nausea, Pallor, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: On 3/3/03, Rabavert given at 08:30 and at 09:00, pt became pale, cold, teeth chattering uncontrollably, crying uncontrollably, body hurt all over, slight nausea and slight difficulty breathing. Symptoms lasted approx. 1 hour per mother.

VAERS ID:200046 (history)  Vaccinated:2003-03-17
Age:13.0  Onset:2003-03-18, Days after vaccination: 1
Gender:Male  Submitted:2003-03-21, Days after onset: 3
Location:Alaska  Entered:2003-03-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUROU885AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1027M0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site pain, 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: Large (4 inches in diameter)red, tender, indurated area on left deltoid where PPV 23 given. Temperature elevation of 100.4 F. Seen by medical provider 3/20 and hot packs prescribed with appointment for follow up in one or four days.

VAERS ID:200437 (history)  Vaccinated:2003-02-18
Age:13.0  Onset:2003-02-18, Days after vaccination: 0
Gender:Female  Submitted:2003-02-27, Days after onset: 9
Location:South Carolina  Entered:2003-03-28, Days after submission: 29
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: UNK
Diagnostic Lab Data:
CDC Split Type: SC0309
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0542M1IM 
Administered by: Public     Purchased by: Public
Symptoms: Pharyngitis, Rash pruritic, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2/19/03 Step-mom called and stated when PT came home yesterday had itchy rash all over body (had Hep B inject); states they called poison control and was advised to give Benadryl - states child still has itchy rash today - advised to s/u? with P/ and let another medical organization know if they think rash is shot related or not. 2/19/03 Spoke with step mom, states school nurse told her child was better (rash better, no itching) - step-mom states PT also "has a cold" - states school was to call her if any prob''s but they haven''t called her back (didn''t to go MD since she was better) - asked step mom to notify center if any further prob''s. 2/20 - Step mom called and said PT was taken to ER last night - rash was on face, neck, all over - state Dx was Hep B reaction, was given prednisone and atarax. She states PT''s doing better today - no school x 48 hrs per MD - asked step mom to ask dad to come by the center and sign ROT for hospital records - she said she would.

VAERS ID:200599 (history)  Vaccinated:2003-01-16
Age:13.0  Onset:2003-01-17, Days after vaccination: 1
Gender:Female  Submitted:2003-01-21, Days after onset: 4
Location:Michigan  Entered:2003-04-01, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swelling, fever;DTP (unknown mfr);2;1;In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Pertusis
Diagnostic Lab Data:
CDC Split Type: MI2003014
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0527AA0IMRA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5314A20IMLA
Administered by: Public     Purchased by: Other
Symptoms: Heart rate increased, Paraesthesia, Respiratory disorder, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Respiratory failure (broad), Hypoglycaemia (broad)
Write-up: Mother of above phoned clinic stating that child was experiencing the "shakes," rapid pulse, "funny breathing" and c/o tingling all over. Encouraged mother of client at that time to phone physician ASAP to have child evaluated.

VAERS ID:200899 (history)  Vaccinated:1997-05-20
Age:13.0  Onset:2003-03-29, Days after vaccination: 2139
Gender:Male  Submitted:2003-03-31, Days after onset: 2
Location:Pennsylvania  Entered:2003-04-04, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0348E0SC 
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Rash vesicular
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Broke out and chicken pox on 3/29/03 generalized.

VAERS ID:200984 (history)  Vaccinated:1993-06-23
Age:13.0  Onset:2003-03-26, Days after vaccination: 3563
Gender:Male  Submitted:2003-03-29, Days after onset: 3
Location:Texas  Entered:2003-04-07, Days after submission: 8
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0413B0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Infection, 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: Mom phoned ofc. 3/26/03 with c/o low grade temp and rash all over. Seen by MD that day w/ diagnosis of chicken pox, given Zovirax. Mom called the next day 3/27/03 w/ increased rash, spoke w/ MD.

VAERS ID:201005 (history)  Vaccinated:2003-03-13
Age:13.0  Onset:2003-03-17, Days after vaccination: 4
Gender:Male  Submitted:2003-03-21, Days after onset: 4
Location:Arkansas  Entered:2003-04-07, Days after submission: 16
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:
Diagnostic Lab Data:
CDC Split Type: AR0310
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5368A22IMLA
Administered by: Other     Purchased by: Public
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash erythema on face, left clavicle, abdomen around 4-5 days after hepatitis B injection. Saw doctor on 3/20/03; prescribed methylprednisoline 4mg dose pack.

VAERS ID:201259 (history)  Vaccinated:2003-03-03
Age:13.0  Onset:2003-03-03, Days after vaccination: 0
Gender:Male  Submitted:2003-04-09, Days after onset: 36
Location:Florida  Entered:2003-04-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Denied illness.
Preexisting Conditions: Denied any at time of vaccination.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0870M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: One hour following vaccine administration, parent reports weakness, dizziness and staggering. Symptoms subsided following 8 hours of bedrest at home. Parent did not report incident immediately to provider. Parent brought patient in on 3/31/03 to report incident.

VAERS ID:201995 (history)  Vaccinated:2003-02-28
Age:13.0  Onset:2003-03-07, Days after vaccination: 7
Gender:Female  Submitted:2003-04-17, Days after onset: 40
Location:Montana  Entered:2003-04-22, 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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0837M0SCRA
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Left neck/scalp mm tenderness/pain developed 7-9 days after vaccination. Resolving 6 weeks later.

VAERS ID:202285 (history)  Vaccinated:2002-11-04
Age:13.0  Onset:2003-11-05, Days after vaccination: 366
Gender:Male  Submitted:2003-03-05, Days after onset: 245
Location:Arkansas  Entered:2003-04-29, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE30422GA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Eczema, Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: Eczematous rash appeared at injection site the day after the injection. Remained for 4 months.

VAERS ID:202322 (history)  Vaccinated:2003-04-14
Age:13.0  Onset:2003-04-15, Days after vaccination: 1
Gender:Male  Submitted:2003-04-16, Days after onset: 1
Location:Texas  Entered:2003-04-29, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0522AA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Chest pain, Injection site oedema, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Pt received TD immz on 4/14/03, some pain was noted in imm site L arm that pm. On the next day ? around 1pm pt c/o sudden sharp pain on R side of chet, then later that day pt c/o pain when attempting to move his neck, not applied prior to this per pt or family. Child seen at MD 4/16/03 talked to mom of child 4/17/03 states MD says not related to shot, possibly inflammed muscle from a possible hx playing sports ? child states feeling better today 4/17/03.

VAERS ID:202764 (history)  Vaccinated:2003-04-04
Age:13.0  Onset:2003-04-05, Days after vaccination: 1
Gender:Male  Submitted:2003-05-07, Days after onset: 31
Location:Wisconsin  Entered:2003-05-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocyline, Hydrochloride
Current Illness: rash
Preexisting Conditions: Penicillin, mold
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEUR   RA
Administered by: Private     Purchased by: Private
Symptoms: Depressed level of consciousness, Fatigue, Hypokinesia, Pain, Staring
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (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), Hypoglycaemia (broad)
Write-up: Can''t step down on left foot and doesn''t use his left arm. Not as alert. Tired and spacy. 60 day follow up on 07/28/03 reports: Vaccine was a TD manufacturer. Was not Aventis. No lot number was listed on the report. The patient did not recover from adverse event. Patient''s personality is back to normal. He is walking better on his left foot, but still does not put his heel down first. He still continues to not use his left arm when needed. Patient used to read constantly. Four or five books a week was not unusual. This reading has been constant since he learned to read. Since April, patient has read one book. Patient has seen a neurologist and a pediatrician. He had an MRI. He saw a physical therapist and an acupuncturist. Now he is seeing a neuropsychologist. Accupuncture and time seem to be healing slowly."

VAERS ID:202975 (history)  Vaccinated:2003-04-25
Age:13.0  Onset:2003-05-07, Days after vaccination: 12
Gender:Female  Submitted:2003-05-07, Days after onset: 0
Location:Texas  Entered:2003-05-13, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1030M0IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0010N0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0812M2SCRA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Nausea, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Mother stated nausea, vomiting, rash, fever swollen lymph nodes x2 days.

VAERS ID:203211 (history)  Vaccinated:2003-05-05
Age:13.0  Onset:2003-05-05, Days after vaccination: 0
Gender:Female  Submitted:2003-05-07, Days after onset: 2
Location:Pennsylvania  Entered:2003-05-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0394AB4IMLA
HEP: HEP B (FOREIGN)MERCK & CO. INC.0781M1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0570M0  
Administered by: Private     Purchased by: Other
Symptoms: Fatigue, Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Temperature: 100.9; shaking, fatigue-severe, vomitted x1

VAERS ID:203225 (history)  Vaccinated:2003-05-07
Age:13.0  Onset:2003-05-07, Days after vaccination: 0
Gender:Female  Submitted:2003-05-10, Days after onset: 3
Location:Illinois  Entered:2003-05-16, 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: Clavinex, Nasonex, allergy shots
Current Illness: NONE
Preexisting Conditions: Allergies as above.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0836AA5 RA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site induration, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Vaccine given right upper arm 5/7/03. Child has multiple severe environmental allergies - on immunotherapy and multiple allergy meds. Seen 5/12/03 with 5 x 5cm area red, hot, indurated, tender. Treated with oral Augementin. Improved within 36 hours.

VAERS ID:203276 (history)  Vaccinated:2003-05-05
Age:13.0  Onset:2003-05-06, Days after vaccination: 1
Gender:Female  Submitted:2003-05-08, Days after onset: 2
Location:Tennessee  Entered:2003-05-19, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 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)SMITHKLINE BEECHAM5374A20 LA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: HBV #1 given 5/5/03. The rest AM face and arm around vaccine site was broken out in red rash. Mom thinks pt was also febrile but did not check temp. Mom gave Tylenol and has started Benadryl. Pt had no previous reported allergies. 5/8/03 pt saw ER doctor who gave her injection for allergy.

VAERS ID:203373 (history)  Vaccinated:2003-05-02
Age:13.0  Onset:2003-05-03, Days after vaccination: 1
Gender:Female  Submitted:2003-05-11, Days after onset: 8
Location:Minnesota  Entered:2003-05-20, Days after submission: 9
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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0817AA   
Administered by: Public     Purchased by: Other
Symptoms: Chills, Hypoaesthesia, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: chills, fever 99.7, sore all over even fingernails, legs felt like jello. tongue was numb, throat was tight feeling, started to feel better when she felt needles sticking into fingers.

VAERS ID:203586 (history)  Vaccinated:2003-05-13
Age:13.0  Onset:2003-05-15, Days after vaccination: 2
Gender:Female  Submitted:2003-05-19, Days after onset: 4
Location:South Carolina  Entered:2003-05-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0830AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Red arm, swollen, started on 5/15/03.

VAERS ID:204150 (history)  Vaccinated:2002-11-06
Age:13.0  Onset:2002-11-07, Days after vaccination: 1
Gender:Female  Submitted:2003-05-28, Days after onset: 201
Location:Unknown  Entered:2003-06-03, 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: NONE
Current Illness: NONE
Preexisting Conditions: Foreign travel
Diagnostic Lab Data: Diagnostic Laboratory (11/18/2002): Hepatitis A positive
CDC Split Type: 0211USA02474
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Hepatitis A
SMQs:, Liver infections (narrow)
Write-up: Information has been received from a registered nurse concerning a 13 year old female with a history of recent foreign travel and no known drug allergies who on 11/06/2002 was vaccinated with a dose of medication. On 11/07/2002, the child developed jaundice and diarrhea. On 11/18/2002 a positive diagnosis of hepatitis "A" was made based on serologic testing. On 11/25/2002 it was reported that there was a possible vaccine failure. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:204399 (history)  Vaccinated:1994-06-10
Age:13.0  Onset:2002-10-11, Days after vaccination: 3045
Gender:Male  Submitted:2003-05-30, Days after onset: 231
Location:Wisconsin  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~Measles + Mumps + Rubella (unknown mfr)~~0~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Serum mumps IgG antibody (11/15/2002): 12 EIA <10 EIA indeterminate; Serum mumps IgG antibody (10/11/2002): <10 EIA <10 EIA not detected; Serum mumps IgM antibody (11/15/2002): <10 EIA <10 EIA not detected; Serum mumps IgM antibody (10/1
CDC Split Type: 0210USA02068
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a registered nurse and physician concerning a 13 year old Caucasian male with no past medical history and no know drug allergies who was vaccinated with a first and second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) on 09/07/1990 and 06/10/1994 respectively. There was no concomitant medication and no illness at the time of vaccination. On 10/11/2002, a titer was drawin from the patient that did not show seroconversion for mumps. On 10/11/2002 the patient''s mumps IgG and IgM were

VAERS ID:204424 (history)  Vaccinated:2002-11-20
Age:13.0  Onset:2002-11-20, Days after vaccination: 0
Gender:Male  Submitted:2003-05-30, Days after onset: 190
Location:Michigan  Entered:2003-06-04, 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: WAES0211USA02023
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0153M2IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0635M2SC 
Administered by: Unknown     Purchased by: Public
Symptoms: Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a registered nurse concerning a 13 year old male pt with no known drug allergies and no past medical history who in the AM of 11/20/02 was vaccinated SQ with the third doses of MMR II (639692/0635M). Concomitant medications that day in the AM included the third dose of hep B vaccine recombinant (641741/0153M) given IM. Concomitant medication on 11/19/02 in the AM included the second dose of MR II (639692/0635M) given SQ and the second dose of hep B vaccine recombinant (641741/0153M) given IM. There was no illness at the time of vaccination. Subsequently, on 11/20/02 at 10am, the pt experienced a headache and arm soreness. Unspecified medical attention was sought. The reporter indicated that on 11/20/02, the pt recovered. No diagnostic tests or lab data were reported. No further info is expected.

VAERS ID:204631 (history)  Vaccinated:2003-05-26
Age:13.0  Onset:2003-05-26, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Tennessee  Entered:2003-06-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: reaction;Hep B (unknown mfr);3;13;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: 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: Broke out on arms, legs, fever 10 hours after, in hospital next day.

VAERS ID:204774 (history)  Vaccinated:2003-05-07
Age:13.0  Onset:2003-05-08, Days after vaccination: 1
Gender:Male  Submitted:2003-06-05, Days after onset: 28
Location:Michigan  Entered:2003-06-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0585CA5IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Injection site mass
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt had red swollen bump after vaccine was given. To our understanding, today there is still a "knot" at the injection site.

VAERS ID:204892 (history)  Vaccinated:2003-05-13
Age:13.0  Onset:2003-05-14, Days after vaccination: 1
Gender:Male  Submitted:2003-06-06, Days after onset: 23
Location:Idaho  Entered:2003-06-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Penicillin, celcor, cephalexia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5288A21  
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A21  
Administered by: Private     Purchased by: Other
Symptoms: Back pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 103 degrees temp - back and neck aches. Vomited. Fever broke 5/15/03.

VAERS ID:204994 (history)  Vaccinated:2003-05-19
Age:13.0  Onset:2003-05-19, Days after vaccination: 0
Gender:Female  Submitted:2003-05-22, Days after onset: 3
Location:Virginia  Entered:2003-06-17, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Headache, nausea that pm
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0830AA  LA
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: Nauseated, head hurt pin post shot, a dime size red area appeared now quarter size 2.5 cm in width

VAERS ID:205076 (history)  Vaccinated:2003-06-10
Age:13.0  Onset:2003-06-10, Days after vaccination: 0
Gender:Male  Submitted:2003-06-11, Days after onset: 1
Location:California  Entered:2003-06-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A20IMLA
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Presented in emergency room with hives on arms/back. No facial swelling. Prescribed antihistamine.

VAERS ID:205527 (history)  Vaccinated:2003-06-16
Age:13.0  Onset:2003-06-17, Days after vaccination: 1
Gender:Male  Submitted:2003-06-23, Days after onset: 6
Location:California  Entered:2003-06-27, Days after submission: 4
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? 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
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5346A22IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0840AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Myelitis transverse
SMQs:, Demyelination (narrow)
Write-up: Called by hospital and informed that child hospitalized in ICU for transverse myelitis on 6/17/03 following immunization on 6/16/03. The 60 day follow up received on 9/17/03 states not completely but greatly improved. Walking with walker now. R hand still with decreased function, needs splint. Gets catheterization q 9 hrs for urination, wears diaper. Tracheostomy removed. Will be discharged this week.

VAERS ID:205530 (history)  Vaccinated:2001-08-21
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2003-06-03
Location:New Hampshire  Entered:2003-06-27, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5206A20 LA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:205531 (history)  Vaccinated:2001-09-25
Age:13.0  Onset:2002-03-01, Days after vaccination: 157
Gender:Male  Submitted:2003-06-03, Days after onset: 458
Location:New Hampshire  Entered:2003-06-27, Days after submission: 24
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: Throat culture
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5206A2  LA
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Pharyngolaryngeal pain
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt had extended period of swollen glands and tonsils and sore throat. Vitamin C, vitamins and natural antibiotics used (Echinecea and Golden seal). Gargled with salt water.

VAERS ID:205673 (history)  Vaccinated:2003-06-23
Age:13.0  Onset:2003-06-24, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2003-07-01
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
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0257N0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, warmth, pain at site of injection-beginning day after-no Rx.

VAERS ID:205966 (history)  Vaccinated:2003-06-19
Age:13.0  Onset:2003-06-19, Days after vaccination: 0
Gender:Male  Submitted:2003-06-27, Days after onset: 8
Location:Minnesota  Entered:2003-07-09, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)SANOFI PASTEURU0746AC IMLA
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Pediatric dose instead of adult dose.

VAERS ID:206264 (history)  Vaccinated:2003-05-15
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2003-05-15
Location:Oklahoma  Entered:2003-07-16, Days after submission: 62
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK0327
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM764A21IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0529AA1IMLA
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: Child ran a 101 temp (mom states).

VAERS ID:206265 (history)  Vaccinated:2003-05-14
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2003-05-15
Location:Oklahoma  Entered:2003-07-16, Days after submission: 62
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: OK0328
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1060M1IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A21IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0529AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Sore arm and high temp.

VAERS ID:206425 (history)  Vaccinated:2003-05-14
Age:13.0  Onset:2003-05-14, Days after vaccination: 0
Gender:Male  Submitted:2003-05-20, Days after onset: 6
Location:Pennsylvania  Entered:2003-07-21, Days after submission: 62
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Complained of headache at time of immunization
Preexisting Conditions: NONE
Diagnostic Lab Data: Seen by MD, EEG performed=WNL. Diagnosed as vaso-vagal response.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5298D90 RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0829AA5 LA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Malaise, Syncope vasovagal, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Health nurse gave immunization at school. Student received Hep B #1, and Td vaccine. Sent to snack area for snack and 10 minute wait. Student reported "he didn''t feel well", stood from sitting position and fell. hoC brief, lost bladder control. Chipped tooth in fall.

VAERS ID:206547 (history)  Vaccinated:2003-06-12
Age:13.0  Onset:2003-06-30, Days after vaccination: 18
Gender:Male  Submitted:2003-07-08, Days after onset: 8
Location:California  Entered:2003-07-23, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pulmicort, Geodon, Concerta
Current Illness: NONE
Preexisting Conditions: IDT, CP, PDD, Partial trisony 15, ADHD, Asthma
Diagnostic Lab Data:
CDC Split Type: CA030081
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS763A2   
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0806M OR 1148M   
Administered by: Public     Purchased by: Public
Symptoms: Blister, Lethargy, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Hep A #1 and Varicella given on 6/12/03. By 6/30/03 pt sent home for lethargy and fever. On 7/3/03 pt break out with blisters all over the body. Mom advised to use Calamine lotion over blisters, Tylenol prn, no ASA, Benadryl 25 mg every 12 hours prn for itching. RTN if not better.

VAERS ID:206549 (history)  Vaccinated:2003-06-26
Age:13.0  Onset:2003-06-28, Days after vaccination: 2
Gender:Male  Submitted:2003-07-02, Days after onset: 4
Location:Oregon  Entered:2003-07-23, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: "cold";Hep B (Engerix-B);2;13;In Patient
Other Medications:
Current Illness: Cold-no fever
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OR200326
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5378A22IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Fatigue, Pharyngolaryngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Had cold when came in for 3rd hep B 6/26/03 - developed more cough, sore throat, fever the night of 6/28 with shaking chills, now tired (exhausted), occ. parox. cough, very sore throat when coughs, says got a cold about 1 week after receiving 2nd hep B. Referred to clinic for follow up.

VAERS ID:206906 (history)  Vaccinated:2003-07-17
Age:13.0  Onset:2003-07-17, Days after vaccination: 0
Gender:Female  Submitted:2003-07-25, Days after onset: 8
Location:Kentucky  Entered:2003-08-01, 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: Advil
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0841AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 25 x 5 cm area of muscle where injected is firm and tender. No erythema noted site of injectin is invisible.

VAERS ID:206978 (history)  Vaccinated:2003-06-30
Age:13.0  Onset:2003-07-06, Days after vaccination: 6
Gender:Female  Submitted:2003-08-01, Days after onset: 26
Location:New Mexico  Entered:2003-08-04, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0288M0 LA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient had redness, swelling to site after 1 week of administration date. Mom states patient had a red ring.

VAERS ID:207294 (history)  Vaccinated:2002-11-21
Age:13.0  Onset:2002-11-22, Days after vaccination: 1
Gender:Male  Submitted:2003-07-30, Days after onset: 249
Location:Maryland  Entered:2003-08-05, 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: Epistaxis; pharyngitis; asthma NOS
Diagnostic Lab Data: UNK
CDC Split Type: WAES0212USA00380
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE31862GA IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0541M0SC 
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis
SMQs:
Write-up: Information has been received from a physician concerning a 13 year old male pt with a history of asthma and pharyngitis and epistaxis at the time of vaccination who on 11/21/02 was vaccinated SC in the right arm with a first dose of pneumococcal vaccine 23 polyvalent (643503/0541M). Concomitant therapy on 11/21/02 included a first dose of influenza virus vaccine (Fluvirin) IM in the left arm (E31862GA). On 11/22/02 the pt developed cellulitis of the right arm (at the injection site) for two days. The pt was treated with antibiotics. It was noted that the pt recovered on 11/24/02. It was also reported that two female patients developed cellulitis at the injection site (WAES0211USA02439) and one female pt (WAES0302USA00556) developed cellulitis in the left arm at the injection site that resolved in two days. The symptoms of two of the patients cleared up without event. Two patients were seen over the weekend within "a day or two of injection" and at the time of this report follow up had not occurred. It was reported that the pt had recovered. Additional info has been requested.

VAERS ID:207574 (history)  Vaccinated:2003-08-06
Age:13.0  Onset:2003-08-06, Days after vaccination: 0
Gender:Male  Submitted:2003-08-06, Days after onset: 0
Location:Texas  Entered:2003-08-07, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS767A21IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0530AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Eye movement disorder
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)
Write-up: According to pt''s dad, child complained of dizziness, 5 minutes after receiving TD and HAV. He laid him on the floor and he observed that ... stiffened...upper..motion and rolled his eyes back for 10-15 seconds x2 at a minute interval. BP 110/80 HP 82, Resp 24/m

VAERS ID:207577 (history)  Vaccinated:2003-06-16
Age:13.0  Onset:2003-06-16, Days after vaccination: 0
Gender:Male  Submitted:2003-08-07, Days after onset: 52
Location:Illinois  Entered:2003-08-07
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 to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER1146M0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Hypersensitivity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: After sitting for a bit after receiving the vaccination, the patient and I proceeded to the appointment desk to schedule the second shot. While talking with the clerk, he fainted and hit his head on the floor. He was taken to an examination room where possible concussion was ruled out, he rested for approximately 45 minutes, and I took him home. He slept at home for approximately two hours and had a headache all that evening for which he refused treatment.

VAERS ID:207609 (history)  Vaccinated:2003-08-05
Age:13.0  Onset:2003-08-05, Days after vaccination: 0
Gender:Female  Submitted:2003-08-07, Days after onset: 2
Location:Georgia  Entered:2003-08-08, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5362A20 RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0821AA5 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0194N0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 1 minute after getting varicella vaccine, patients arm at the site (right arm) turned red and started itching. Administered Benadryl 50mg per mouth. Complained of shortness of breath. No other rashes noted. Patient remained in health department for 20 min. after medication. Redness was almost gone. Patient stated it was not itching as bad. Advised to go to ER if symptoms return or worsen.

VAERS ID:207678 (history)  Vaccinated:2003-08-05
Age:13.0  Onset:2003-08-05, Days after vaccination: 0
Gender:Female  Submitted:2003-08-06, Days after onset: 1
Location:Kentucky  Entered:2003-08-08, 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: Had test done at hospital
CDC Split Type: KY2003079
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3006390IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dyskinesia, Eye movement disorder, Headache, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: After pt. received vaccine, pt became faint, eyes rolled, arms had jerky movements for 30 sec. Pt lost consciousness. Vitals checked. Pt c/o nausia, servere headache. A&O x 4, called, pt sent to hospital per ambulance

VAERS ID:207854 (history)  Vaccinated:2003-04-29
Age:13.0  Onset:2003-06-09, Days after vaccination: 41
Gender:Male  Submitted:2003-08-13, Days after onset: 65
Location:Connecticut  Entered:2003-08-13
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.O7R7L1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Headache, Myalgia, Oral mucosal blistering, Pyrexia, Rash, Rheumatoid arthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient was admitted to hospital with fever, rash. Tested positive for strep. After several days of hospitialization and screening for other diseases, the diagnosis of juvenille rheumatoid arthritis was made and he was started on steroids and anti-inflamatory. Follow up on 08/20/2003: "Mom states Heb B vaccine was not Heptavax but "the other Merk Hep B. She made an error on her web report." The discharge summary received on 1/12/04 confirms diagnosis of juvenile rheumatoid arthritis. Also add asthenia, myalgia, headache, and blisters in mouth.

VAERS ID:207845 (history)  Vaccinated:2003-06-09
Age:13.0  Onset:2003-06-09, Days after vaccination: 0
Gender:Male  Submitted:2003-06-23, Days after onset: 14
Location:Montana  Entered:2003-08-14, Days after submission: 52
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
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0530AA5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pain, Pyrexia, Type III immune complex mediated reaction
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5-6 hours after Td, developed fevers and right arm swelling, erythema and pain at injection site. Arthus-type reaction.

VAERS ID:207909 (history)  Vaccinated:2003-08-05
Age:13.0  Onset:2003-08-06, Days after vaccination: 1
Gender:Female  Submitted:2003-08-08, Days after onset: 2
Location:Texas  Entered:2003-08-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0838AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site mass, Injection site oedema, Pyrexia
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: Swelling, redness, lump ("slightly bigger than a quarter"), warmth to injection site, fever 101.2 degrees F the next day of injection.

VAERS ID:208023 (history)  Vaccinated:2003-08-11
Age:13.0  Onset:2003-08-12, Days after vaccination: 1
Gender:Male  Submitted:2003-08-18, Days after onset: 6
Location:Texas  Entered:2003-08-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (AP-Tuberculin) (Lot # C1260AA) (Left forearm)
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0841AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Fever x 2 days, 3 x 5 cm tender, swollen duoerect mata left deltoid at site of Td injection. when seen 08/15/03 at office.

VAERS ID:208622 (history)  Vaccinated:2003-04-05
Age:13.0  Onset:2003-04-05, Days after vaccination: 0
Gender:Female  Submitted:2003-08-29, Days after onset: 145
Location:North Carolina  Entered:2003-08-29
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)BSI    
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient complained of rash and shortness of breath (SOB) 20-30 minutes after receiving vaccine. She was given both Benadryl 50mg IM and Kenalog 40mg IM. When patient left the clinic, her SOB had resolved and her rash was resolving. She fully recovered from adverse effects over next several days.

VAERS ID:208578 (history)  Vaccinated:2003-08-08
Age:13.0  Onset:2003-08-08, Days after vaccination: 0
Gender:Female  Submitted:2003-08-11, Days after onset: 3
Location:Unknown  Entered:2003-09-02, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0522AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pain, Pyrexia
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: Started feeling achy with ?fever on Fri evening; by Saturday AM had fever 101 degrees, arm swollen, sore, red and hot to touch-feeling better by Sunday evening. By Monday AM, arm still warm and slightly pink borders barely visible.

VAERS ID:208587 (history)  Vaccinated:2003-08-11
Age:13.0  Onset:2003-08-13, Days after vaccination: 2
Gender:Male  Submitted:2003-08-22, Days after onset: 9
Location:Arizona  Entered:2003-09-02, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: Nasal congestion
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0831AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt came in on the 13th, 2 days after shot had arm swollen and red. Pain was 2.5" of diameter. Physician gave pt Mortin with food, if got worse to come back in. Pt has not come in after that visit.

VAERS ID:208651 (history)  Vaccinated:2003-08-01
Age:13.0  Onset:2003-08-02, Days after vaccination: 1
Gender:Male  Submitted:2003-08-25, Days after onset: 23
Location:Oregon  Entered:2003-09-03, Days after submission: 9
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Reactive airway disease
Diagnostic Lab Data: Blood culture, DMSD Scan
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS770A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypotension, Infection, Pyelonephritis, Pyrexia, Sepsis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Seen 8/2/03 with hypotension and fever. Diagnosed with E. coli bacteremia and Pyeconephritis.

VAERS ID:208676 (history)  Vaccinated:2003-07-31
Age:13.0  Onset:2003-08-01, Days after vaccination: 1
Gender:Female  Submitted:2003-08-05, Days after onset: 4
Location:Louisiana  Entered:2003-09-03, Days after submission: 29
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: LA030803
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0466N  RA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0828AA  LA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm has began numb from her right elbow down since she left the Health unit last friday after her shot on 07/31/2003. Actual date. The girl gets on the phone when requested to talk to her. States her right arm has been numb from her elbow down since her injection and her left hand was swollen Saturday for one and one half days. I told them to see their PCP they have recently moved here. I told them they need to go to hospital to have the arm evaluated. Lady wanted to know if it was normal for the arm to be numb. 08/08/2003. Patients mom did not go to hospital with client due to lack of transportation. She said she may take her to another clinic. I gave her the phone # and asked if she would call me with the results. 08/14/2003: Spoke with patients mom-states she called the clinic. Explained situation. She was told to go to hospital. She took her daughter to ER. Was told her reaction was normal she was given an injection in her hip for pain and was told to take Aleve for pain and guaranteed mom that her daughter would be better. Mom said daughter only slightly better. She plans to call hospital for an appointment tomorrow.

VAERS ID:208979 (history)  Vaccinated:2003-08-25
Age:13.0  Onset:2003-08-26, Days after vaccination: 1
Gender:Male  Submitted:2003-09-02, Days after onset: 7
Location:Pennsylvania  Entered:2003-09-09, 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: Allergy injection 8/22/03 R arm
Current Illness:
Preexisting Conditions: Allergy immunotherapy for mites, molds, pollens; also allergic to sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0842AA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema induratum
SMQs:, Vasculitis (narrow)
Write-up: L deltoid erythema from 8/26/03 and progressively enlarged to 10x6cm induration. Resolving by 8/29/03. Totally resolved 9/2/03.

VAERS ID:209435 (history)  Vaccinated:2003-09-08
Age:13.0  Onset:2003-09-08, Days after vaccination: 0
Gender:Female  Submitted:2003-09-18, Days after onset: 10
Location:Michigan  Entered:2003-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illnesss - except for rash on both elbows.
Preexisting Conditions:
Diagnostic Lab Data: Test for mononucleosis - ebstein barre virus and CMV - both negative. Normal blood tests.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0352M1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Ageusia, Anaphylactic reaction, Fatigue, Pharyngolaryngeal pain, Rash, Somnolence, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), 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: Patient got rash on elbows and some tiredness after first dose of vaccine 8/7/03 Rash is still present after 4 weeks. Took my otherwise healthy daughter for her second dosewhich was administered on 9/8/03 at approx. 4:45 pm. Within 15 minutes after 2nd dose patient came down with extreme fatigue (could not stay awake on the way home in the car) and complained of a sore throat. Went to sleep immediately and I(mother) had to shake her to wake her up to see if she was ok. approx. 9:00 pm I woke her to get her to eat and drink. She said she could not taste anything and her hands were sore and felt "tight". Afraid she was having an anaphalatic reaction (tongue swelling) I gave her bennadryl. Continued to sleep through the night and into the next afternoon. I called Dr. who told me to take her to the emergency room. She was complaining of extreme fatigue, legs, hands, both arms, neck and shoulder aches, ear ache, sore throat. Arm which injection was given was "throbbing". Emergency room physician was of no help, although he could see swelling in her throat. Took her home and 9/10/03 she showed no improvement. Had been sleeping conntiniously for 36 hours, I again called Dr. office and the receptionist made an appointment for 9/11/03 at 10:30 am. Still sleeping continiously at 10:00 am on 9/11/03. now it has been approx 50 hours of continious sleep. Dr. drew blood to check for mononucleosis. Tests came back negative for mono. Took her to another physician on 9/16/03 who confirmed adverse reaction which I had suspected. It is now 11 days later and my daughter has shown hardly any improvement - although she isn''t sleeping continiously. She is extremely fatigued, been in bed 11 days, arm that vaccine was given in is throbbing, all of her joints ache, muscles ache, ears and throat ache, hurts when she walks up 6 stairs, has not been back to school. She has shown hardly any improvement for 11 days now. I called CDC in atlanta as well as Dept. of Public Health - they offered no help.

VAERS ID:210045 (history)  Vaccinated:2003-07-30
Age:13.0  Onset:2003-07-30, Days after vaccination: 0
Gender:Female  Submitted:2003-10-06, Days after onset: 68
Location:South Carolina  Entered:2003-10-06
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
Diagnostic Lab Data:
CDC Split Type: SC0337
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5298D90IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0830AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, 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: Red swollen area around injection site. Redness down arm with itching.

VAERS ID:210092 (history)  Vaccinated:2003-09-09
Age:13.0  Onset:2003-09-16, Days after vaccination: 7
Gender:Male  Submitted:2003-09-24, Days after onset: 8
Location:Ohio  Entered:2003-10-07, Days after submission: 13
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: IgG: Positive; IgM: Negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0101N1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Eye oedema, Laboratory test abnormal, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient received an MMR on 09/09/2003. On 09/16/2003 he developed "bumps" on his face. On 09/18/2003 his glands were swollen very large and his left eye was swollen shut. His fever got up to 104 degrees.

VAERS ID:210239 (history)  Vaccinated:2003-09-26
Age:13.0  Onset:2003-09-26, Days after vaccination: 0
Gender:Female  Submitted:2003-09-29, Days after onset: 3
Location:Virginia  Entered:2003-10-10, Days after submission: 11
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 known-not seen by MD as of 9/29/03
CDC Split Type: VA03021
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0946N1IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07041IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1000M1SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0842AA1IMLA
Administered by: Public     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: All over body rash (hives) starting 5 hours after receipt of vaccines on 9/26/03. Denies difficulty breathing, etc. Still with rash on 9/29/03. Referred to PMD for treatment.

VAERS ID:210322 (history)  Vaccinated:2003-10-06
Age:13.0  Onset:2003-10-07, Days after vaccination: 1
Gender:Female  Submitted:2003-10-07, Days after onset: 0
Location:Mississippi  Entered:2003-10-10, 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: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: MS03079
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0217M0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0194N0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10/6 mother reported patient ha a red area l deltoid warm to the touch for 1 wk after vaccination.

VAERS ID:210517 (history)  Vaccinated:2003-10-06
Age:13.0  Onset:2003-10-08, Days after vaccination: 2
Gender:Male  Submitted:2003-10-08, Days after onset: 0
Location:Georgia  Entered:2003-10-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Addenall
Current Illness: NONE
Preexisting Conditions: Attention deficit disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0991AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Td vaccine given 10/6/03 in left arm on morning of 10/8/03. Site noted to be red/warm and swollen. No induration. Symptoms did not start until at least 36-40 hours after vaccine given. Tx''d with ice and Benadryl.

VAERS ID:210776 (history)  Vaccinated:2003-08-22
Age:13.0  Onset:2003-09-24, Days after vaccination: 33
Gender:Male  Submitted:2003-10-13, Days after onset: 19
Location:Ohio  Entered:2003-10-22, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Spinal tap WBC portein elevated 117; MRI brain C-spine normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5367A22IM 
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0521AA5IM 
Administered by: Public     Purchased by: Public
Symptoms: Guillain-Barre syndrome, Laboratory test abnormal, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow)
Write-up: Weakness in arms and legs, onset 9/24/03. Admitted to hospital 10/2/03. Diagnosed w/ Guillain-Barre syndrome 10/3/03. Discharged after treatment 10/8/03.

VAERS ID:210897 (history)  Vaccinated:2003-09-09
Age:13.0  Onset:2003-09-15, Days after vaccination: 6
Gender:Male  Submitted:2003-10-15, Days after onset: 30
Location:Unknown  Entered:2003-10-24, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0310USA01213
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0101N1  
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Oedema genital, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a nurse via company representative concerning a 12 year old male patient who on 01/07/1992 was vaccinated with a first dose of measles virus vaccine live (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) and there were no problems. On 09/09/2003 the patient received his second dose of measles virus vaccine live (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (645267/0101N). On 09/15/2003 the patient developed facial swelling, genital swelling and fever. As of 09/27/2003 the patient''s experiences continued and the patient was started on cephalexin (Keflex). Admission to the hospital was planned due to continued facial swelling. Upon internal review, continued facial swelling was considered to be an important medical event (OMIC). Additional information has been requested. Follow up 3/15/05: Patient has not recovered.

VAERS ID:211123 (history)  Vaccinated:2003-10-21
Age:13.0  Onset:2003-10-21, Days after vaccination: 0
Gender:Female  Submitted:2003-10-21, Days after onset: 0
Location:Wisconsin  Entered:2003-10-28, 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: NONE
Current Illness: NONE
Preexisting Conditions: Not noted
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5367A22IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Fatigue, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Pt reported that about 10 minutes after receiving vaccine, she became lightheaded and sat down. 15 minutes later improved but feels tired and left arm tingling.

VAERS ID:211405 (history)  Vaccinated:2003-10-24
Age:13.0  Onset:2003-10-24, Days after vaccination: 0
Gender:Male  Submitted:2003-10-24, Days after onset: 0
Location:Colorado  Entered:2003-10-31, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Laceration
Preexisting Conditions: NONE
Diagnostic Lab Data: SAO2 OK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1011AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth, Lacrimation increased, Pharyngolaryngeal pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Lacrimal disorders (narrow)
Write-up: Redness, heat, watery eyes, throat hurts

VAERS ID:211533 (history)  Vaccinated:2003-10-05
Age:13.0  Onset:2003-10-08, Days after vaccination: 3
Gender:Female  Submitted:2003-11-02, Days after onset: 25
Location:Illinois  Entered:2003-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None- no s/sx''s noted when PPD given.
Preexisting Conditions: None Known.
Diagnostic Lab Data: TB screening (faxing to us). HIV done, no results yet. 2 CXR-10 Oct 03 A Questionable 7mm nodule posterior lung. 7 Oct 03- Liver Profile test with elevated Globulin. PPD read, tests, and f/u at hospital per MD.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0096N1SCLA
Administered by: Military     Purchased by: Military
Symptoms: Laboratory test abnormal, Lung disorder
SMQs:
Write-up: Annual PPD (PMC C1262AA) done, read @ hospital at a 10mm and positive to some of questions on screening. Radiologist noted a questionable node on Lung. MD started pt. on INH 300mg for 90 days. Pt. is compliant with taking medication. RN checked bottle and questioned pt. No s/sx''s of problems today.Just received report and approached by pt. today.

VAERS ID:211743 (history)  Vaccinated:2003-10-27
Age:13.0  Onset:2003-10-28, Days after vaccination: 1
Gender:Male  Submitted:2003-10-30, Days after onset: 2
Location:Ohio  Entered:2003-11-05, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0824AA5IM 
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: TD given left upper extremity 10/27/2003. 1 day later with erythema and pain at site. 2 days later with escalating pain and redness, better ? 3 week normal range of motion. 7.5x7.5 edema with 5.5x5.5 erythematous. 10/30/2003 recovering. No other symptoms.

VAERS ID:211805 (history)  Vaccinated:2003-10-27
Age:13.0  Onset:2003-10-28, Days after vaccination: 1
Gender:Female  Submitted:2003-10-30, Days after onset: 2
Location:North Carolina  Entered:2003-11-05, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU0760AA0 LA
Administered by: Private     Purchased by: Public
Symptoms: Hypersensitivity, Injection site induration
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left deltoid 1.75 inch induration. Left localized hypersensitivity reaction to Td booster 10/27/03. Motrin 400 mg Q 6hours prn pain, swelling. Ice/heat/massage (10''/10''/10'')

VAERS ID:211816 (history)  Vaccinated:2003-10-24
Age:13.0  Onset:2003-10-26, Days after vaccination: 2
Gender:Male  Submitted:2003-10-28, Days after onset: 2
Location:Georgia  Entered:2003-11-05, 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: Concerta
Current Illness:
Preexisting Conditions: ADHD
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0831AA0 RA
Administered by: Other     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: 2 days after Td, noted redness and swelling. Also pain of area under same arm on right.

VAERS ID:211945 (history)  Vaccinated:2003-10-20
Age:13.0  Onset:2003-10-23, Days after vaccination: 3
Gender:Male  Submitted:2003-11-07, Days after onset: 15
Location:Ohio  Entered:2003-11-07
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: "sports induced asthma"
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5384A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client noted "large bumps" of a two inch diameter around injection site 3-4 days after administration. These bumps itched and did become smaller until disappearing approximately 8 days after administration. Client states no redness at sight and no other symptoms. Client checked with doctor who stated not to get third vaccine and to have titre drawn in one year.

VAERS ID:211956 (history)  Vaccinated:2003-08-04
Age:13.0  Onset:2003-08-06, Days after vaccination: 2
Gender:Male  Submitted:2003-11-03, Days after onset: 89
Location:Unknown  Entered:2003-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hypersensitivity
Diagnostic Lab Data: Allergen skin test showed allergy to thimerosal.
CDC Split Type: WAES0310USA03031
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0316M0IM 
Administered by: Other     Purchased by: Other
Symptoms: Blister, Eye pain, Hypersensitivity, Skin reaction, Visual disturbance
SMQs:, Severe cutaneous adverse reactions (broad), Angioedema (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a consumer concerning her 12 year old son with a skin allergy to thimerosal who on 8/4/03, also reported as 4/5/03, was vaccinated IM with a first dose of hepatitis B virus vaccine (lot # 643247/0316M). There was no concomitant medication. On 8/6/03, the next day, the patient began to have skin reactions. The skin reactions included sunburn-like condition all over and eye pain and blistering and diminished vision during the flare up. The patient has been treated with prednisone, topical creams, and eye drops. It was noted that the reaction begins to go away and within 4-5 days it flares up again. A dermatologist has diagnosed the condition as atopic dermatitis. The reporter indicated that the child has missed 1 to 2 days of school each week, and that he has had all kinds of testing. A skin test showed an allergy to thimerosal. The health staff that administered the vaccine reported that the vaccine the child received was preservative free. Unspecified medical attention was sought. The outcome was reported as not recovered. The reporter indicated that the atopic dermatitis was considered to be disabling. Additional information has been requested. Follow up on 11/17/2003: "Follow up information received on 11/05/2003 from a health care professional which indicated that the child received a diphtheria toxoid (+) tetanus toxoid on 07/21/2003. The reporter indicated that the atopic dermatitis was probably related to the diphtheria toxoid (+) tetanus toxoid immunization that contained thimerosal, and not the hepatitis B virus vaccine rHBsAg (yeast). The reporter indicated that the atopic dermatitis was considered to be disabling. No further information is expected."

VAERS ID:212517 (history)  Vaccinated:2003-10-07
Age:13.0  Onset:2003-10-07, Days after vaccination: 0
Gender:Female  Submitted:2003-10-08, Days after onset: 1
Location:Michigan  Entered:2003-11-18, Days after submission: 41
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: NKA
Diagnostic Lab Data:
CDC Split Type: MI2003059
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0374N1 LA
Administered by: Public     Purchased by: Public
Symptoms: Anaphylactic reaction, Rash papular, Skin ulcer
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received vaccine at about 3:00 PM. Mom noted at about 3:45 PM, child developed small, round, raised papular lesions "a few now, but it looks like more are coming". No respiratory involvement. Directed mom to have child evaluated for anaphylaxis ASAP, mom was turning into ER driveway during end of our phone conversation. After vaccination, pt went out to eat. In ER pt was given Benadryl to which she responded well. Dr informed mother "The reaction wasn''t severe but for her never to get that shot again".

VAERS ID:212519 (history)  Vaccinated:2003-09-24
Age:13.0  Onset:2003-09-25, Days after vaccination: 1
Gender:Male  Submitted:2003-10-01, Days after onset: 6
Location:Michigan  Entered:2003-11-18, Days after submission: 48
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: milk, dairy, corn, barley, Prednisone, Succynlcholine anesthetic
Diagnostic Lab Data:
CDC Split Type: MI2003056
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5376A21IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0839A0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Feeling hot, Injection site erythema, Injection site induration, Injection site oedema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm swollen day after shot, 5-6" diameter and area hard and warm with slight redness. Pt reported pain down entire arm including forearm and wrist. Tx''d with Tylenol and ice packs.

VAERS ID:212565 (history)  Vaccinated:2003-11-04
Age:13.0  Onset:2003-11-06, Days after vaccination: 2
Gender:Female  Submitted:2003-11-06, Days after onset: 0
Location:Michigan  Entered:2003-11-19, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURVO1088AA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Facial palsy, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: Received Fluzone 11/4/03. On 11/6/03 developed Bell''s Palsy with right facial droop. The medical records received on 1/12/04 states talking funny, droop of mouth, and rt sided facial paralysis.

VAERS ID:212723 (history)  Vaccinated:1999-06-07
Age:13.0  Onset:2003-11-17, Days after vaccination: 1624
Gender:Female  Submitted:2003-11-19, Days after onset: 2
Location:Maryland  Entered:2003-11-20, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0135J0 LA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:213334 (history)  Vaccinated:2003-10-30
Age:13.0  Onset:2003-10-30, Days after vaccination: 0
Gender:Female  Submitted:2003-10-30, Days after onset: 0
Location:Georgia  Entered:2003-12-02, Days after submission: 33
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: GA03118
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5393A22IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW12334SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0831AA6IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Right deltoid where vaccine given about 15 minutes after receiving shot area was reddened and client said it was hot. Client was scratching area. Ice pack applied to site for 15 minutes afterwards redness lessened.

VAERS ID:213507 (history)  Vaccinated:2003-10-24
Age:13.0  Onset:2003-10-25, Days after vaccination: 1
Gender:Female  Submitted:2003-11-22, Days after onset: 28
Location:Pennsylvania  Entered:2003-12-05, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1125AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0865N0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, 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 upper arm swollen with red streak; tender to touch. Erythematous streak running anterior to axilla. Dianosis: possible allergic reaction.

VAERS ID:213601 (history)  Vaccinated:2003-10-04
Age:13.0  Onset:2003-11-13, Days after vaccination: 40
Gender:Male  Submitted:2003-12-05, Days after onset: 22
Location:Texas  Entered:2003-12-08, 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: NONE
Current Illness: UNK
Preexisting Conditions: Kidney operation; Bite of other animal exept arthropod
Diagnostic Lab Data: Tested negative for mononucleosis; Had CBC and anemia was ruled out.
CDC Split Type: EM20030373
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION 4IM 
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Difficulty in walking, Fatigue, Headache, Lethargy, Malaise, Muscle spasms, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: A 13 year old male patient was attacked by bats in September 2003. He received 5 doses total of RabAvert for post-exposure treatment. Treatment started on 9/6/03 through 10/4/03. Following treatment of RabAvert, on approximately 11/13/03, he developed headaches, myalgia, extreme malaise, and muscle aches in his legs to the point of being barely able to walk. The patient was unable to go to school for 1 week because he was so lethargic. He also experienced headaches during the time immediately after the RabAvert injections. Last injection of RabAvert was given was on 10/04/03. (OMIC). Follow-up information received 19 Jan 03: Approximately one month after the last rabies vaccine injection, the patient became listless and unable to walk at times. He was fatigued and also experienced muscle spasms for a period of approximately 2 weeks. The patient also had many headaches that continued until the end of Nov 03. According to the reporter, the patient has recovered from these events.

VAERS ID:213785 (history)  Vaccinated:2003-12-01
Age:13.0  Onset:2003-12-03, Days after vaccination: 2
Gender:Female  Submitted:2003-12-04, Days after onset: 1
Location:Nebraska  Entered:2003-12-10, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1131AA1 LA
Administered by: Private     Purchased by: Private
Symptoms: Neck pain, Rash macular, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 12/03/2003 @ 11:53, presented to ER with throat swelling, neck pain for several hours; mild difficulty swelling, no dyspnea. Rash-macular over cheeks, no hives. Given per mouth Benadryl/Ibuprofen. ? Reactions as 2 days later, but thought should be reported.

VAERS ID:213811 (history)  Vaccinated:2003-11-11
Age:13.0  Onset:2003-11-11, Days after vaccination: 0
Gender:Male  Submitted:2003-12-01, Days after onset: 20
Location:Massachusetts  Entered:2003-12-10, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Fever
Preexisting Conditions: UNK
Diagnostic Lab Data: Chest film 11/13/03 confirms penumonia.
CDC Split Type: HQWYE263825NOV03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC 0IN 
Administered by: Private     Purchased by: Other
Symptoms: Pneumonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was considered medically important (OMIC). Information regarding FluMist nasal solution was received from a pediatrician regarding a 13 year old male who developed pneumonia. Relevant medical history was not provided. Indication for FluMist was immunization. Product was administered on an unspecified date. Dose regimen was not provided. Concomitant medications were not reported. The pediatrician reported that the child had a fever on the same day as the FluMist administration. One hour post-immunization, his fever was 104 degrees F. Two days post-immunization, he was diagnosed with pneumonia. No additional information was available at the time of this report. Follow UP: The reporter considered this event medically important. Follow-up information received from the physician on 16-Dec-2003 provided patient identifiers, immunization date, onset date, test results and outcome. Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a pediatrician regarding a 13 year old male who develooped penumonia. At 13 years of age, the child received the first dose on 11-Nov-20003. The pediatrician reported that the child developed a fever 4 hours post -immunization. The fever ranged from 102 deg. F. to 104 deg F and persisted for 2 days. On 13-Nov-2003, the child was seen by the pediatrician and diagnosed with pneumonia. The child recovered. The pediatrician noted that she did not consider this event related to vaccine administratiion.

VAERS ID:213992 (history)  Vaccinated:2003-12-08
Age:13.0  Onset:2003-12-11, Days after vaccination: 3
Gender:Male  Submitted:2003-12-12, Days after onset: 1
Location:Minnesota  Entered:2003-12-12
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
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE)LEDERLE LABORATORIES    
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: migratory urticaria beginning day 4 from vaccine date

VAERS ID:214540 (history)  Vaccinated:2003-12-17
Age:13.0  Onset:2003-12-17, Days after vaccination: 0
Gender:Female  Submitted:2003-12-18, Days after onset: 1
Location:Oregon  Entered:2003-12-31, Days after submission: 13
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1093AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Throat tightness, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccine given at 6:30 PM, by 7:55 PM tight feeling in throat, tongue felt thick. Benadryl given with no progression of symptoms. Medical records confirm allergic reaction. msv

VAERS ID:214609 (history)  Vaccinated:2003-12-08
Age:13.0  Onset:2003-12-08, Days after vaccination: 0
Gender:Male  Submitted:2003-12-18, Days after onset: 10
Location:Maryland  Entered:2004-01-05, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE573512DEC03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Private     Purchased by: Other
Symptoms: Headache
SMQs:
Write-up: Information regarding FluMist (2002-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a consumer regarding her 13 year old male child who received a dose on 12/08/2003. A consumer reported that her 13 year old male child developed a "slight, minor" headache (headache) about 15 minutes after receiving FluMist. Headache resolved without treatment approximately 2 hours later. No additional information was available at the time of this report.

VAERS ID:214613 (history)  Vaccinated:2003-12-09
Age:13.0  Onset:2003-12-10, Days after vaccination: 1
Gender:Male  Submitted:2003-12-16, Days after onset: 6
Location:Texas  Entered:2004-01-05, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anti-depressant, folic acid, Nexium, Vioxx, Plendil, Methatrexate
Current Illness: Raynaud''s disease - mixed connective tissue
Preexisting Conditions: Mixed connective tissue - Raynaud''s disease, NKA
Diagnostic Lab Data:
CDC Split Type: TX03159
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1091AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0257N0IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Pain, Pyrexia
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: Per mother, on 2nd day of pneumococcal vaccine administration, pt had redness and swelling to right deltoid area and had a "low grade fever", did not measure temp increase, and slight pain to arm. On 3rd day of vaccine administration, 12/11/03, swelling and redness diminishing and fever resolved, no more pain to left deltoid area. Used warm compresses as instructed on day of vaccination.

VAERS ID:214680 (history)  Vaccinated:2003-11-05
Age:13.0  Onset:2003-11-06, Days after vaccination: 1
Gender:Female  Submitted:2003-11-07, Days after onset: 1
Location:Ohio  Entered:2004-01-07, Days after submission: 61
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Singulair Flovent
Current Illness: Tinea versicolor
Preexisting Conditions: Asthma, tinea versicolor
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES7657561IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1011AA0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Joint range of motion decreased, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Right arm swollen, tender, decreased movement secondary to pain. No redness, no warmth, no decreased sensation, NL radial and ulnar pulse, no discolor. Tx: ice, elevation x1 day, then movement.

VAERS ID:215017 (history)  Vaccinated:2002-09-17
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2004-01-09
Location:Michigan  Entered:2004-01-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Hep B (Engerix-B);;1;0;In Sibling
Other Medications:
Current Illness: UNK
Preexisting Conditions: The pt reportedly had no allergies. Concurrent conditions and medications were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0387553A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5313A20 LA
Administered by: Public     Purchased by: Other
Symptoms: Anorexia, Arthralgia, Fatigue, Hepatomegaly, Injection site erythema, Injection site inflammation, Injection site reaction, Injection site swelling, Malaise, Myalgia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This report describes the occurrence of swollen liver in a 13-year-old male who was vaccinated with hepatitis B vaccine recombinant (Engerix-B) for prophylaxis. This report was received from the pt''s mother and has not been verified by a physician or other health care professional. The pt reportedly had no allergies. Concurrent conditions and medications were not reported. The pt''s brother experienced an injection site reaction characterized by swelling, redness, inflammation, itching and tightness after receiving his 1st Engerix-B injection. On 09/17/2002, the pt reportedly received his 1st injection of Engerix-B (lot ENG5313A2). "Within a week" he experienced fatigue. Reportedly, he also experienced muscle pain, joint pain, general malaise and loss of appetite. His physician "ran a multitude of tests to rule out other possible causes (of the events)." Reportedly, he only found that the pt''s liver was slightly enlarged and that the pt''s bilirubin was slightly elevated. As of 11/22/2002, the events reportedly persisted. The Engerix-B immunization series was discontinued. This report has been linked to report A0387550A due to same family.

VAERS ID:215142 (history)  Vaccinated:2003-08-05
Age:13.0  Onset:2003-08-05, Days after vaccination: 0
Gender:Male  Submitted:2004-01-09, Days after onset: 157
Location:West Virginia  Entered:2004-01-16, 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: UNK
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: A0419993A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5355A20IM 
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEUR    
Administered by: Private     Purchased by: Private
Symptoms: Headache, 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: This case was reported by a nurse and described the occurrence of fever in a 13 year old male pt who received hep B vaccine recombinant (Engerix B) for prophylaxis. On 8/5/03 the pt received the 1st dose of Engeirx B in the right arm. The pt also received an injection of tetanus and diphtheria toxoids in the left arm. Later that day, at an unspecified time post-immunization, the pt experienced fever of 103 deg F, pain in both arms, vomiting, and headache. The pt''s mother treated the events with Motrin. The events resolved on 8/8/03. The nurse considered the events were possibly related to vaccination with Engerix B and tetanus and diphtheria toxoids. The Engerix B immunization series was discontinued.

VAERS ID:215305 (history)  Vaccinated:2003-12-13
Age:13.0  Onset:2003-12-14, Days after vaccination: 1
Gender:Male  Submitted:2003-12-18, Days after onset: 4
Location:Minnesota  Entered:2004-01-21, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; Singulair;
Current Illness: NONE
Preexisting Conditions: Asthma;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5557A92IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0604N0IM 
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1015AA0IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling of site. Pt received Pneumovax 05/13/03 that was stored below 35 degrees F.

VAERS ID:215589 (history)  Vaccinated:2004-01-22
Age:13.0  Onset:2004-01-23, Days after vaccination: 1
Gender:Female  Submitted:2004-01-26, Days after onset: 3
Location:Ohio  Entered:2004-01-26
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: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS745C90IMLA
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB427AA0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The day following vaccine administration the patient developed a mildly pruititc facial rash and the day after that she developed diarrhea. After 2 more days symptoms were almost completely resolved.

VAERS ID:215830 (history)  Vaccinated:2004-01-27
Age:13.0  Onset:2004-01-27, Days after vaccination: 0
Gender:Male  Submitted:2004-01-30, Days after onset: 3
Location:Illinois  Entered:2004-02-02, 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: PPD
Current Illness: NONE
Preexisting Conditions: Had measles per mom age 6
Diagnostic Lab Data: CT of head, BMP, ESR, CBC, drug screen, EEG pending.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW10026IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0545N0SCRA
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: Pt made three trips to Er with seizurre like behavior on 4 occasions and he fine: being within 1/2 hour after vaccine administeration. Pt is being evaluated by a neurologist pending CT. Dilantin 100mg 1 po CAM 2 poq pt will have EEG done.

VAERS ID:216012 (history)  Vaccinated:2004-01-28
Age:13.0  Onset:2004-01-28, Days after vaccination: 0
Gender:Female  Submitted:2004-02-04, Days after onset: 7
Location:South Carolina  Entered:2004-02-04
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: SC0402
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0529N0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Difficulty in walking, Headache, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Felt dizzy following immunization. Needed support to walk (vaccine administered in arm, not leg). Fever of 102 later in evening around 6:30pm. Complained of headache.

VAERS ID:216076 (history)  Vaccinated:2003-10-18
Age:13.0  Onset:2003-10-19, Days after vaccination: 1
Gender:Female  Submitted:2003-12-15, Days after onset: 57
Location:Texas  Entered:2004-02-05, Days after submission: 52
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza (FluMist);;;9;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE467123OCT03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Nasal congestion, Pharyngolaryngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Follow up information received from the physician included additional events, medical history, patient date of birth, vaccines received within four weeks, and illnesses at the time of vaccination. Information regarding Flumist nasal solution was received from a healthcare professional regarding a 13 year old female patient who experienced a stuffy nose, a runny nose, abdominal pain, fever, and a sore throat. The patient also received product that was stored at a temperature that was higher than allowable and was not frozen. At 13 years of age, the patient received a dose on 10/18/03. The patient had no relevant medical history. Indication for Flumist was immunization. Product was administered on 10/18/03. Dose regimen was 1 dose 1 time per day (IN). Patient was not taking any concomitant therapy. The patient experienced a stuffy nose, a runny nose and abdominal pain on 10/19/03. She was treated with Triaminic. The patient also developed a temperature of 100.2 degrees F. The physician indicated that the patient received product that was stored by the pharmacy at a temperature that was higher than allowable and was not frozen.

VAERS ID:216120 (history)  Vaccinated:2003-12-08
Age:13.0  Onset:2003-12-14, Days after vaccination: 6
Gender:Female  Submitted:2003-12-19, Days after onset: 5
Location:Ohio  Entered:2004-02-05, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE7267
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain, Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a consumer regarding a 13-year-old female patient who experienced diarrhea, abdominal pain and cramping and nausea. At 13 years of age, the patient received a dose on 08-Dec-2003. Medical history: The patient has no relevant medical history. Product details: Indication for Flumist (2003-2004) was immunization. Product was administered on 08-Dec-2003. Dose regimen was 1 dose (intranasal). Concomitant therapy: Patient was not taking concomitant therapy. Event details: the patient experienced diarrhea (diarrhoea), abdominal pain and cramping (abdominal pain) and nausea (nausea) on 14-Dec-2003. As of 15-Dec-2003, her frequent bowel movements have continued. No additional information was available at the date of this report.

VAERS ID:216177 (history)  Vaccinated:2003-12-15
Age:13.0  Onset:2003-12-15, Days after vaccination: 0
Gender:Female  Submitted:2003-12-19, Days after onset: 4
Location:Pennsylvania  Entered:2004-02-05, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza (FluMist);;;15;In Sibling
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE734718DEC03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Pain
SMQs:
Write-up: Information regarding Flumist nasal solution was received from a consumer regarding a 13 year old female patient who experienced a headache and body aches. At 13 years of age, the patient received a dose on 12/15/03. The patient had no relevant medical history. Indication for Flumost was immunization. Product was administered on 12/15/03. Dose regimen was one dose (IN). Patient was not taking concomitant therapy. The patient experienced headache and body aches on 12/15/03. The patient''s sister developed a headache and body aches following receipt of Flumist on 12/15/03, at 15 years of age. No additional information was available at the time of this report.

VAERS ID:216779 (history)  Vaccinated:2004-01-27
Age:13.0  Onset:2004-01-27, Days after vaccination: 0
Gender:Female  Submitted:2004-02-03, Days after onset: 7
Location:Louisiana  Entered:2004-02-24, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: LA040202
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5460A20IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1010AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Decreased LOC, decreased BP after 20 min, suspine, continued decreased BP, again after norm LOC, decreased LOC post 20 min. EMS called. Taken to hospital.

VAERS ID:216986 (history)  Vaccinated:2004-02-11
Age:13.0  Onset:2004-02-11, Days after vaccination: 0
Gender:Female  Submitted:2004-02-11, Days after onset: 0
Location:Mississippi  Entered:2004-02-26, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: allergies to pollen
Diagnostic Lab Data: None
CDC Split Type: MS04004
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0877M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: about 5 minutes after receiving MMR, patient got tingling in just left arm and then spread to whole body followed by numbness. Denied feeling of touch or awareness of heat or cold. Also tongue feels tingling. Also had itching around injection site 30 minutes later.Patient left clinic after about 1 hour and 45 minutes after injection.

VAERS ID:217493 (history)  Vaccinated:2003-05-20
Age:13.0  Onset:2003-05-22, Days after vaccination: 2
Gender:Female  Submitted:2004-03-05, Days after onset: 288
Location:Unknown  Entered:2004-03-09, 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: UNK
Current Illness: Sunburn
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0305USA02441
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: PRURITUS. Information has been received from a registered nurse concerning a 13 year old female with an unknown medical history who on 20-MAY-2003 was vaccinated with a first dose of hepatitis B virus vaccine rHBsAg (yeast). It was unknown if the patient was on concomitant medication. It was reported that at the time of vaccination the patient also "got a sunburn earlier in the week so the child already had redness". On 22-may-2003 the patient developed pruritus on her face. There was no rash or peeling. It was unknown if diagnostic studies were performed. Unspecified medical attention was sought. No additional patient information was provided. No product quality complaint was noted. Additional information has been requested.

VAERS ID:217825 (history)  Vaccinated:2004-02-25
Age:13.0  Onset:2004-02-26, Days after vaccination: 1
Gender:Female  Submitted:2004-02-26, Days after onset: 0
Location:Texas  Entered:2004-03-16, Days after submission: 19
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: TX04009
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM777A20 LA
Administered by: Public     Purchased by: Private
Symptoms: Abasia, Asthenia, Dizziness, Lethargy, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Client''s father called clinic, at 1:40 pm on 2/26/04 stated "daughter having reaction from shot given on 2/25/04. This am had swelling of Lt arm, slight fever and dizziness, unable to walk down stairs. This afternoon, child continues to be lethargic, loss of energy.

VAERS ID:217835 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2004-03-12
Location:New Jersey  Entered:2004-03-16, 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: 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 PASTEURU0833AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Pain
SMQs:
Write-up: Pain in the arm which had immunization.

VAERS ID:218015 (history)  Vaccinated:2004-03-10
Age:13.0  Onset:2004-03-11, Days after vaccination: 1
Gender:Female  Submitted:2004-03-12, Days after onset: 1
Location:California  Entered:2004-03-22, 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: NONE
Current Illness: NONE
Preexisting Conditions: Allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0308N1 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0207N1  
Administered by: Other     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Injection site pain, Injection site swelling, 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: Varicella site LOA red, swollen painful, hot to touch, child has no fever. Area feels itchy otherwise child fine. Also received Hep B RD no signs of problems there.

VAERS ID:218051 (history)  Vaccinated:1990-08-12
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2003-11-14
Location:Florida  Entered:2004-03-23, Days after submission: 130
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: Premature Birth.
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DPP: DIPHTHERIA TOXOID + PERTUSSIS + IPV (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     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: Child seizured within 24 hours of receiving DPT. Child had no prior history of seizures. Dilatin, Phenobarb ordered.

VAERS ID:219018 (history)  Vaccinated:1995-06-22
Age:13.0  Onset:2004-04-06, Days after vaccination: 3211
Gender:Male  Submitted:2004-04-07, Days after onset: 1
Location:Florida  Entered:2004-04-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0402B0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature decreased, Nausea, Rash vesicular, Skin ulcer
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 20-30 lesions. Low temp. Nauseated

VAERS ID:219079 (history)  Vaccinated:2004-04-09
Age:13.0  Onset:2004-04-12, Days after vaccination: 3
Gender:Male  Submitted:2004-04-15, Days after onset: 3
Location:Ohio  Entered:2004-04-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Itchy Rash;Hep B (Engerix-B);2;151;In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: History of Asthma well controlled - NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5394H22IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient given 3rd dose Hepatitis B vaccine 11:00 AM 04/09/2004 - Had itchy rash develop after dose #2 11/04/2003 Provider made contact with CDC NIP Immunization Safety Branch and was advised. "I advise careful discussion and reassurance with parents, re-immunization on schedule, pre-medication with antihistamine and close monitoring withh telephone follow-up for first few days" - Patient given 50mg Benadryl 1 hour prior to administration of vaccine - repeated that evening and next day - child doing well on Sunday evening 04/11/2004 - Monday 8:00AM 4/12/2004 mother received call from school nurse advising of itchy rash - mother states rash on arms , back & chest- no tightness in throat or difficulty breathing - given Benadryl 50 mg family physician notified Benary repeated Monday eve- child returned to school Tuesday 04/13/2004 with some rash but minimal itching

VAERS ID:219088 (history)  Vaccinated:2004-04-14
Age:13.0  Onset:2004-04-15, Days after vaccination: 1
Gender:Male  Submitted:2004-04-15, Days after onset: 0
Location:Pennsylvania  Entered:2004-04-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURERU1019A5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1346N SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling at site of injection - approx. 6 cm

VAERS ID:219192 (history)  Vaccinated:2003-12-15
Age:13.0  Onset:2003-12-16, Days after vaccination: 1
Gender:Male  Submitted:2004-01-02, Days after onset: 17
Location:South Carolina  Entered:2004-04-19, Days after submission: 107
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: HQWYE775319DEC03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500003P IN 
Administered by: Private     Purchased by: Other
Symptoms: Cough, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad)
Write-up: Information regarding Flumist (2003-2004 Formula)(influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a healthcare professional regarding a 13 year old male pt who experienced a sore throat and cough. At 13 years of age, the pt received a dose on 12/15/03. Relevant medical history was not provided. Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 12/15/03. Dose regimen was 0.5mL (IN). Pt was not taking any concomitant therapy. On 12/16/103, 1 day post-immunization, the pt experienced a sore throat and cough. He was being treated with Tanafed. As of 12/17/03, the symptoms persisted. No additional information was available at the time of this report.

VAERS ID:219735 (history)  Vaccinated:2004-04-28
Age:13.0  Onset:2004-04-29, Days after vaccination: 1
Gender:Female  Submitted:2004-04-29, Days after onset: 0
Location:Maine  Entered:2004-04-29
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.0538N1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient received her second dose of varicella vaccine on 04/28/04 at a school immunization clinic without any reaction at that time. I was called to her school to evaluate her left upper arm. There is a round, raised area of redness measuring 5 cms x 6 cms. The area is a bit ''itchy'' and is around the injection site.

VAERS ID:219763 (history)  Vaccinated:2003-09-04
Age:13.0  Onset:2003-09-05, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2004-04-30
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:
Diagnostic Lab Data: High liver function, enlarged liver & spleen, rashes headache.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1210M3  
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Diarrhoea, Fatigue, Headache, Hepatomegaly, Liver function test abnormal, Nausea, Pain, Photosensitivity reaction, Pyrexia, Rash, Splenomegaly, Tremor
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)
Write-up: Third shot experienced severe diarrhea, fever and pain in right side (liver) tremors, rashes, light sensitivity, headaches, joint pain, chronic fatigue, nausea, high liver function AST between 860 and 650 out of school for 6 months to date severe agitation, behavior change.

VAERS ID:219900 (history)  Vaccinated:2004-04-27
Age:13.0  Onset:2004-04-27, Days after vaccination: 0
Gender:Female  Submitted:2004-04-30, Days after onset: 3
Location:Ohio  Entered:2004-05-04, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0824AA0IM 
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Sore 2 days then, size of softball sore, red bumps, no fever.

VAERS ID:219989 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:2004-04-30
Gender:Female  Submitted:2004-05-04, Days after onset: 4
Location:Tennessee  Entered:2004-05-05, 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
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3 days after Hep B vaccine #2. Pt began developing hives; treated x 2 at medical center ER

VAERS ID:220522 (history)  Vaccinated:1995-06-02
Age:13.0  Onset:2003-03-22, Days after vaccination: 2850
Gender:Male  Submitted:2004-05-14, Days after onset: 418
Location:Connecticut  Entered:2004-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ritalin
Current Illness:
Preexisting Conditions: Attention deficit/ hyper-activity disorder: Drug hypersensitivity.
Diagnostic Lab Data: body tem 03/22/03: no fever. VZV strain 04/03/03: WT VZV
CDC Split Type: WAES0303USA02955
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician''s assistant concerning a 13 year old male student with attention deficit/ hypersensitivity disorder and a "sulfa" allergy who on 02JUN1995 was vaccinated with a 0.5ml dose of varicella virus vaccine live. Concomitant therapy included methlyphenidate HCl (RITALIN) 10mg q AM and q noon. There was no history of chickenpox and no recent exposure to chickenpox or herpes zoster. On 22MAR2003, the patient developed herpes zoster, which was noted to be on his right thigh. The patient was seen in the physician''s office The rash did not occur at the site of injection or elsewhere within 42 days of the vaccination. It was noted that the child had no fever, quantified his pain at a 5-6 (0 being the least; 10 being the most), and complained of itching. The patient was placed on famciclovir (FAMVIR) for seven days. After one month, the patient recovered from the herpes zoster. Results of PCR analysis revealed that the zoster lesion contained the WT varicella zoster virus. Additional information is not expected.

VAERS ID:220785 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2004-05-14
Location:Maine  Entered:2004-05-19, 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: UNK
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Serum varicella Zoster ''03? "titer with not immune results".
CDC Split Type: WAES0305USA02695
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Nonspecific reaction
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician concerning a 13 year old female who in 1998 was vaccinated with varicella virus vaccine live. On 27-May-2003 it was reported that the patient "now has a titer with not immune results." The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:220879 (history)  Vaccinated:2000-06-06
Age:13.0  Onset:2003-06-15, Days after vaccination: 1104
Gender:Male  Submitted:2004-05-14, Days after onset: 334
Location:Unknown  Entered:2004-05-19, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0307USA00865
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Rash, Skin ulcer
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 nurse concerning a 13 year old white male who on 6/6/00 was vaccinated with a dose of varicella virus vaccine live (lot # 16875 - invalid). The patient was evaluated by a physician and it was noted that on 6/15/03 the patient developed a generalized rash of approximately 50 lesions that lasted 2 days. No fever was noted. No complications were noted. The patient was not hospitalized. The outcome is recovered. Additional information has been requested.

VAERS ID:220903 (history)  Vaccinated:2003-05-30
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-14
Location:Indiana  Entered:2004-05-19, 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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0307USA02247
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0448M0SC 
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: Information has been received from a certified medical assistant concerning a 13 year old male patient with no past medical history who on 30MAY2003 was vaccinated subcutaneously with a first dose of varicella virus vaccine live. There was no concomitant medication. Subsequently in 2003, the patient developed 20 spots on his face. Unspecified medical attention was sought, but no treatment was required. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:220940 (history)  Vaccinated:2003-08-04
Age:13.0  Onset:2003-08-04, Days after vaccination: 0
Gender:Female  Submitted:2004-05-14, Days after onset: 284
Location:South Carolina  Entered:2004-05-19, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0308USA00483
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a LPN concerning a 13 year old female pt who on 08/04/03 was vaccinated with a second dose of varicella virus vaccine live. Subsequently on approximately 08/04/03, the pt developed an induration and swelling at the injection site. Unspecified medical attention was sought, but no treatment was required. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:221122 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:2003-08-01
Gender:Female  Submitted:2004-05-14, Days after onset: 287
Location:Unknown  Entered:2004-05-20, 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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Serum varicella zoster negative
CDC Split Type: WAES0309USA01864
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Laboratory test abnormal
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a health care professional concerning an approximately 17 year old female with no known medical history or allergies who was vaccinated in approximately 1995 (at the age of 13) with a first dose of varicella virus vaccine live. There was no concomitant medication. The patient did not receive a second dose at that time. In August 2003, at approximately 17 years of age, a titer was negative. On 8/27/03, the patient was vaccinated with a second dose of varicella virus vaccine live. Unspecified medical attention was sought. There was no product quality complaint involved. Follow up information indicated that the only problem we had was that she received her first dose at another facility a few days before she was nine years old, and her college required her to be nine. No further information is available.

VAERS ID:221239 (history)  Vaccinated:1996-12-05
Age:13.0  Onset:2004-02-11, Days after vaccination: 2624
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2004-05-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Public
Symptoms: Dermatitis bullous, Drug ineffective, Dry skin, Infection, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash, fever-sib with chicken pox, skin itchy. Approximately 20 red papules scattered with clear vesicles on trunk.

VAERS ID:221247 (history)  Vaccinated:1995-05-04
Age:13.0  Onset:2004-04-30, Days after vaccination: 3284
Gender:Female  Submitted:2004-05-04, Days after onset: 4
Location:Pennsylvania  Entered:2004-05-21, 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: PE tubes;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Blister, Cough, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed cough 04/29/04. Developed fluid filled blister like rash on trunk and face on 04/30/04. Afebrile. Areas scabbed in 2-3 days. Using over the counter Claritin as needed.

VAERS ID:221281 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:2003-09-15
Gender:Unknown  Submitted:2004-05-14, Days after onset: 242
Location:California  Entered:2004-05-21, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Body temp: 103 degrees F;
CDC Split Type: WAES0310USA03351
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Infection transmission via personal contact, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 13 year old pt who''s 6 year old adopted sister was vaccinated SC in the left thigh with a first dose of varicella virus vaccine live (Lot # 644794/0334N) on 09/03/03 at 2:15PM. The 6 year old, who is being adopted into the family, received the vaccination and did not get a break through or rash or lesions. However, when she went home, the 13 year old (name, gender, and demographics were not reported) in the family got active chickenpox along with lesions on 09/15/03. The chickenpox was described as hundreds of vesicular lesions and a temperature of 103 degrees F. The teenager had never had varicella. It was noted to be "apparent secondary infection". The 13 year old is the biological child of the family. The biological children of the adopting family have not received any vaccinations because "the mother and father feel that vaccinations are not natural". The child has recovered. Unspecified medical attention was sought. There was no product quality complaint. No further information is expected.

VAERS ID:221302 (history)  Vaccinated:1996-11-11
Age:13.0  Onset:2003-11-03, Days after vaccination: 2548
Gender:Male  Submitted:2004-05-14, Days after onset: 192
Location:Connecticut  Entered:2004-05-21, 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: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0311USA00693
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6179080777D0SC 
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Pyrexia, Rhinorrhoea
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 13 year old white male with no pertinent medical history and no known drug allergies who on 11Nov96 was vaccinated with a first dose of varicella virus vaccine live, SC in the left arm. On 04Nov2003 the pt presented to the Dr''s office with break through chickenpox, described as a 24 hour rash with red vesicular lesions over his trunk,arms, and body. The pt also had a mild fever and a runny nose. Medical attention was sought. The child was prescribed desloratadine (Clarinex) for treatment as needed. There was no product quality complaint. The pt recovered. No further information is expected.

VAERS ID:221377 (history)  Vaccinated:2003-02-03
Age:13.0  Onset:2003-02-03, Days after vaccination: 0
Gender:Male  Submitted:2004-03-20, Days after onset: 411
Location:Texas  Entered:2004-05-24, Days after submission: 64
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: TX04022
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5368A20 RA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0302M0 RA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0527AA0 LA
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: Client states he broke out in a rash all over his body. Client reported this on 03/04 clinic visit.

VAERS ID:221471 (history)  Vaccinated:1998-01-08
Age:13.0  Onset:2003-11-18, Days after vaccination: 2140
Gender:Male  Submitted:2004-05-14, Days after onset: 177
Location:New Hampshire  Entered:2004-05-24, 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: UNK
Current Illness:
Preexisting Conditions: Down''s syndrome, Thyroid disorder
Diagnostic Lab Data: NONE
CDC Split Type: WAES0312USA00294
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0990E1  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1323E0  
Administered by: Private     Purchased by: Public
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a woman in a pediatrician''s office concerning a 13 year old white male with Down''s syndrome and "acquired hypothyroid" who on 08JAN1998 was vaccinated with a first dose of varicella virus vaccine live, in the right arm and a second dose of measles virus vaccine live + mumps virus vaccine live+ rubella virus vaccine live, in the left arm. There was no illness at the time of vaccination. On 18NOV2003 the patient developed a "diffuse vesicular rash on arms, legs and trunk." There were no relevant diagnostic tests or laboratory data. The patient recovered on 26NOV2003. No further information is expected.

VAERS ID:221484 (history)  Vaccinated:2003-11-28
Age:13.0  Onset:2003-12-01, Days after vaccination: 3
Gender:Female  Submitted:2004-05-14, Days after onset: 164
Location:Unknown  Entered:2004-05-24, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0312USA00809
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a registered nurse concerning a 13 year old female who on approximately 11/28/03, last week was vaccinated with a first dose of varicella virus vaccine live and in December 2003, now has approximately 24 varicella-like lesions on her body. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.

VAERS ID:221514 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:2003-11-26
Gender:Male  Submitted:2004-05-14, Days after onset: 169
Location:Unknown  Entered:2004-05-24, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: WAES0312USA01355
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Public     Purchased by: Other
Symptoms: Dermatitis bullous, 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 RN concerning a 13 year old white male who was vaccinated with a dose of varicella virus vaccine live. On 11/26/03 the pt had multiple scattered macules and pustules on the face and trunk. A MD''s visit was required and the pt was treated with calamine and given symptomatic care. No diagnostic tests were performed. Subsequently, the pt recovered. Additional information is not expected.

VAERS ID:221568 (history)  Vaccinated:2003-02-19
Age:13.0  Onset:2003-11-02, Days after vaccination: 256
Gender:Male  Submitted:2005-05-16, Days after onset: 560
Location:Minnesota  Entered:2004-05-24, Days after submission: 357
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;chickenpox;Unknown Vaccine;0;9;In Sibling;chickenpox;Varicella (Varivax);0;11;In Sibling
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0401USA00638
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0566M0SCUN
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Rash vesicular, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This is in follow-up to report(s) previously submitted on 5/14/2004. Information has been received from a health professional concerning a 14 year old male child with no known medical history or allergies who on 19FEB2003 at 13:00 was vaccinated SC in the deltoid with a first dose of varicella virus vaccine live (lot # 642994/0566M). The patient''s three siblings were vaccinated the same day. He presented on 01NOV2003 completely covered with chickenpox. It was reported that two of his siblings (WAES #0311USA01047 and 0401USA00639) also developed chickenpox. The reported expressed a concern with the lot. Unspecified medical attention was sought. There was no product quality complaint involved. The records of testing prior to release of this lot have been checked by Quality Assurance and found to be satisfactory. The lot complies with the standards of the Center for Biologics Evaluation and Research and was released. Follow-up information indicated that the on 02-Nov-2003 (previously reported on 01-Nov-2003) the patient broke out into a rash which had now spread. No fever, cough or vomiting were noted. He denied headache or abdominal pain. The patient''s sister (0401USA00639) had chickenpox for a few weeks and his littler brother (0311USA01047) also had chickenpox. No mouth lesions were noted. Small vesicular lesions in various stages were noted, classic appearing pox. The patient was given hydroxyzine hydrochloride (Atarax) (10mg/5cc) 2 teaspoons every 6 hours prn. Subsequently the patient recovered. The patient received additional vaccinations on 22-Jan-2003 at 13:17 which included a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live which was given SC in the thigh, a first dose of diphtheria toxoid (+) tetanus toxoid given IM in the thigh, a first dose of poliovirus vaccine inactivated (unspecified) which was given SC in the deltoid and a first dose of hepatitis virus vaccine (unspecified) given IM in the thigh. No further information is expected.

VAERS ID:221579 (history)  Vaccinated:1971-11-12
Age:13.0  Onset:1971-11-13, Days after vaccination: 1
Gender:Male  Submitted:2004-05-24, Days after onset: 11880
Location:Washington  Entered:2004-05-24
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Alien abduction, turning green, super-strength, rage attacks

VAERS ID:221894 (history)  Vaccinated:2004-03-03
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2004-05-17
Location:Unknown  Entered:2004-05-26, Days after submission: 9
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
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5320C92 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Hep B #3 outdated on 1/11/04 given on 3/3/04 to be regiven.

VAERS ID:221902 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-11
Location:Ohio  Entered:2004-05-26, 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: UNK
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Hep B outdated 1/11/04, given on 3/3/04. Vaccine to be readministered.

VAERS ID:221999 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:2004-02-16
Gender:Female  Submitted:2004-05-14, Days after onset: 87
Location:Ohio  Entered:2004-05-26, 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:
Current Illness: mental retardation severity unspecified, Quadriplegia, convulsion disorder, Gastroesophageal reflux disease.
Preexisting Conditions: Encephalitis herpes, gastrostomy tub insertion, varicella, fundoplication,
Diagnostic Lab Data: VZV strain, positive for Oka strain of VZV, Rubeolo IgG positive, Varicella IgG positive, HIV, antibody screen negative, serum diphtheria toxin normal, serum immunoglobulin G normal, serum mumps IgG antibody positive.2/11/10 Diagnostic laboratory:Rubella IgG positive; Varicella IgG positive; serum immunoglobulin M, IgM antibodies collected on days 16 and 21 after onset of rash were negative; HIV antibody screen, negative; serum rubella IgG, positive
CDC Split Type: WAES0403USA01097
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Activities of daily living impaired, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Convulsion, Encephalitis herpes, Gastrooesophageal reflux disease, HIV antibody negative, Measles antibody positive, Mumps antibody test positive, Profound mental retardation, Pyrexia, Rash, Rash vesicular, Rubella antibody positive, Vaccination failure, Varicella zoster virus serology positive
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a public health professional concerning a 13 year old female with a concurrent condition of presumed perinatal HSV encephalitis (she continues to experience recurrent lesions on her cheek, HIV negative and a medical history of a mild varicella case in 1993 who lived in the same facility with a 16 year old that was vaccinated on 28Jan2004 with a dose of varicella virus vaccine live. It was noted that the child was not on any immunosuppressive medications, though she may be on anticonvulsant medications. On 02Mar2004 (also reported as twelve days later the onset of the 16 year old pt''s varicella rash), varicella was transferred to the 13 year old who had not been vaccinated. Subsequently the pt developed a mild fever and generalized rash with 15 vesicular lesions which had scabbed and the illness resolved. It was noted that there was no information as to the severity of this case. Diagnostic laboratory data included PCR testing of one vesicular lesion that was positive for Oka strain of VZV; there was a single point significantly from the high likelihood that she contacted the Oka strain from the index case. Unspecified medical attention was sought. The reporter also mentioned two other pt''s who were residents of the same long term care facility: a female pt who was vaccinated in 1995 with varicella virus vaccine live and developed varicella in 1999 an on 04Mar2004 developed a rash (WAES0403USA01680) and a 16 year old who was vaccinated with varicella virus vaccine live and developed a varicella rash (WAES0403USA01096). Follow up to report previously submitted on 05/14/2004 information has been received from a physician concerning a 13 year old female who resides in a pediatric long term care facility with profound mental retardation due to presumptive herpes encephalitis as a newborn, spastic quadriplegia, a seizure disorder, gastroesophageal reflux disease, and a history of mild varicella 1993, status post gastrostomy tub insertion and Nissen fundoplication. It was noted that the patient was non ambulatory and dependent on caregivers for all activities of daily living. The patients medications include phenobarbital, valproic acid, melatonin and senna. It was noted that the patient was not on any immunosuppressive medications ore routine steroids. It was noted that the patient lived in the same facility with a 16 year old that was vaccinated on 01/28/2004 with a dose of varicella virus vaccine live. On 2/16/2004, varicella was transferred to the 13 year old who had not been vaccinated. Subsequently, the patient developed a vesicular eruption (less than 15 vesicular lesions) with two days of mild fever. Unspecified medical attention was sought and the patient was treated with acyclovir in five days. An immune work up was normal including serum quantitative IgG, diphtheria antitoxoid antibody, negative HIV, mumps IgG postiive, rubella IgG positive and rubeola IgG positive. PCR testing of one vesicular lesion was positive for OKA strain on VIV (there was a single point mutation VS the index case strain, however, it was believed that this does not detract significantly from the high likelihood that she contracted the OKA strain from the index case. The lesions scabbed and the patient recovered without complication. Published information indicated that the patient was diaabled due to neonatal HSV 1 was exposed to the index, 18 days later she developed mild 15 lesions varicella. Secondary transmisison was noted Analysis of material from this secondary case indicated that it was also OKA vaccine strain, which occurred despite a previous history of wild type varicella. There was no evidence of immunosuppression by clinical history or immunologic testing, and the patient was not taking immunosuppresive medications. No further information is available.

VAERS ID:222083 (history)  Vaccinated:2002-05-07
Age:13.0  Onset:2002-05-07, Days after vaccination: 0
Gender:Female  Submitted:2004-05-21, Days after onset: 745
Location:Unknown  Entered:2004-05-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0306USA03193
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0103M0  
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Diarrhoea, Injection site mass, Nausea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a certified medical assistant concerning a 13 year old female who on 5/7/02 and on 6/19/03 was vaccinated with a first (lot # 642671/0103M) and a second dose (lot # 645482/0153N) of hepatitis A virus vaccine inactivated (0.5ml), respectively. There was no concomitant medication. The patient had some stomach pain and nausea after the first dose, which reportedly subsided. Following the second dose, the patient had a local reaction with a goose egg size bump, nausea, vomiting, abdominal pain, diarrhea and a generalized rash. The patient was taken to the emergency room and required treatment was noted. She was not admitted. Additional information has been requested.

VAERS ID:222507 (history)  Vaccinated:2004-02-27
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-17
Location:Ohio  Entered:2004-06-09, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5320C91IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Medication error
SMQs:, Medication errors (narrow)
Write-up: Hep B outdated on 01/11/04 given

VAERS ID:222768 (history)  Vaccinated:2004-05-06
Age:13.0  Onset:2004-05-06, Days after vaccination: 0
Gender:Female  Submitted:2004-06-08, Days after onset: 33
Location:Washington  Entered:2004-06-17, Days after submission: 9
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1345N0SC 
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema, Skin nodule
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt''s mother states pt had softball sized swelling that was red and warm 2-3 days after injection.

VAERS ID:222787 (history)  Vaccinated:2004-06-07
Age:13.0  Onset:2004-06-08, Days after vaccination: 1
Gender:Male  Submitted:2004-06-09, Days after onset: 1
Location:Indiana  Entered:2004-06-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1016AA0 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Headache, Lymphadenopathy, Malaise, Nausea, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Symptoms began 24-48 hours after vaccine administered. Fever, headache, malaise, nausea, localized swelling , redness, lymphadenopathy of axilla.

VAERS ID:222849 (history)  Vaccinated:1995-08-04
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2004-06-14
Location:Virginia  Entered:2004-06-18, 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: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: TB Skin test
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 4  
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 3  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0404B0SC 
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: Received Varivax 8/4/95. Diagnosed with varicella 10/14/96. Diagnosed with shingles (varicella zoster) at well-child yearly physical 6/11/04.

VAERS ID:222950 (history)  Vaccinated:2003-12-10
Age:13.0  Onset:2003-12-28, Days after vaccination: 18
Gender:Male  Submitted:2004-05-04, Days after onset: 127
Location:South Carolina  Entered:2004-06-22, Days after submission: 49
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: Lumbar puncture: Elevated protein, CSF abnormal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU1097AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, CSF test abnormal, Chronic inflammatory demyelinating polyradiculoneuropathy, Diplopia, Fatigue, Headache, Laboratory test abnormal, Lethargy, Muscular weakness, Neuropathy, Pain, Paraesthesia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Ocular motility disorders (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 2/5/04 Seen with bilateral leg pain. 3/3/04 Seen with bilateral calves and knee pain. 3/22/04 Seen with fatigue, muscle weakness legs, paresthesias legs, difficulty running and climbing of stairs. 4/1/04 Diagnoses: Chronic Guillain Barre, Chronic inflammatory, Demyelinating Polyradiculoneuropathy. Nurse follow up on 07/21/04 states: "CIDP, lethargy, headache, Pruritis, Diplopia."

VAERS ID:223792 (history)  Vaccinated:2004-07-07
Age:13.0  Onset:2004-07-08, Days after vaccination: 1
Gender:Female  Submitted:2004-07-08, Days after onset: 0
Location:Nebraska  Entered:2004-07-09, 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: 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 PASTEURU1016AA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: 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: Fever 101-101.9. Vomiting on 7/8/04 0600 x4

VAERS ID:223933 (history)  Vaccinated:2004-06-14
Age:13.0  Onset:2004-06-14, Days after vaccination: 0
Gender:Female  Submitted:2004-06-15, Days after onset: 1
Location:West Virginia  Entered:2004-07-13, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EKG and Blood work per mother
CDC Split Type: WV0403
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1023N0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Gaze palsy, Hypoaesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), 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: pt received a Hep B inj. IM RD at approx. 2:15PM. Left with parent approx. 2:30 mother noted jerking movements of arms and legs, eyes rolled back and child collapsed in mothers arms. Was taken by private auto to city hospital ER (3:55PM) EKG and Blood work done. Loss of sensation elbow to fingertips per mother.

VAERS ID:224115 (history)  Vaccinated:2004-07-12
Age:13.0  Onset:2004-07-13, Days after vaccination: 1
Gender:Female  Submitted:2004-07-14, Days after onset: 1
Location:Georgia  Entered:2004-07-19, 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: PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5514A20IMRA
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURW017BA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, 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: Scattered nodules on arms, face, firm, red, not itchy, not painful; some nodules surrounded by arm erythema and patch. History of Benadryl. Depo Medrol 30mg IM.

VAERS ID:224571 (history)  Vaccinated:2004-07-13
Age:13.0  Onset:2004-07-14, Days after vaccination: 1
Gender:Male  Submitted:2004-07-20, Days after onset: 6
Location:California  Entered:2004-07-30, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA040050
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5508A20 LA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS770A20 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, 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: Hives to body and "hard induration", tenderness to right injection site starting about 26 hours after injection, lasting for about 4 days. Mom treated with Benadryl/Hydrocortisone cream. All symptoms now gone.