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Found 547676 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 548

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VAERS ID:115443 (history)  Vaccinated:1998-10-02
Age:16.0  Onset:1998-10-04, Days after vaccination: 2
Gender:Female  Submitted:1998-10-26, Days after onset: 22
Location:Louisiana  Entered:1998-10-29, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98100920
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Laryngeal oedema, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 2OCT98 & on 4OCT98 pt exp swelling of epiglottis & tongue;adm to hosp & administered epi & dph;sx went away;

VAERS ID:115555 (history)  Vaccinated:1998-10-28
Age:16.4  Onset:1998-10-28, Days after vaccination: 0
Gender:Female  Submitted:1998-10-29, Days after onset: 1
Location:New York  Entered:1998-11-02, 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: PPD by Connaught lot#248011 given 28OCT98
Current Illness: not a time of visit
Preexisting Conditions: NONE
Diagnostic Lab Data: throat cult
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1304E1IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F917005IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Pharyngitis, Pyrexia, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: devel rash, face, arms, legs by 28OCT early evening;malaise-rash arms, legs;face: rough macular erythematous;29OCT98 fever 100+, h/a, pharynx + erythema;

VAERS ID:115794 (history)  Vaccinated:1997-09-30
Age:16.0  Onset:1997-09-30, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 391
Location:Michigan  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19970301811
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2408A20IM 
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lymphadenopathy, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 30SEP97 & same day exp fever, swollen glands, n/v;

VAERS ID:115847 (history)  Vaccinated:1997-10-01
Age:16.0  Onset:1997-10-01, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 390
Location:Washington  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pt recv #1 Engerix 9/97; exp joint&muscle pain, fever & rash
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: 19980065461
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1  
Administered by: Other     Purchased by: Other
Symptoms: Adverse drug reaction, Arthritis, Asthenia, Oedema peripheral, Osteoarthritis, Pyrexia, Rash, Serum sickness, Similar reaction on previous exposure to drug, Synovitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Pt recv vax in 10/97; post vax pt exp serum sickness w/ synovitis & arthropathy, joint swelling, edema of extremities,arthritis of wrists/ankles/knees, rash, fatigue, fever & scaly rash on dorsal of left foot

VAERS ID:115853 (history)  Vaccinated:1998-03-05
Age:16.0  Onset:1998-03-05, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 235
Location:Michigan  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 19980068001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2424A20IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 3/5/98;on same dy pt exp flushing, itching & hives; pt to E.R.; tx=Prednisone, Tagamet & Benadryl

VAERS ID:115884 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:1998-10-26
Location:New York  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19980107681
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2  
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Headache, Malaise
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax & 5 days p/vax pt exp malaise, stomach pain, h/a;

VAERS ID:115979 (history)  Vaccinated:1998-02-18
Age:16.6  Onset:1998-02-19, Days after vaccination: 1
Gender:Female  Submitted:1998-10-26, Days after onset: 249
Location:Texas  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness:
Preexisting Conditions: bronchitis;NKA
Diagnostic Lab Data: 19FEB98 allergy testing not allergic to PCN;
CDC Split Type: 19980159351
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2403A90IMLA
Administered by: Other     Purchased by: Other
Symptoms: Anaphylactoid reaction, Rash
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 18FEB98 & same day 18FEB98 pt exp a rash from head to toe;the next day 19FEB98 pt devel an anaphylactoid rxn & was brought to ER & kept overnight;

VAERS ID:115994 (history)  Vaccinated:1998-03-20
Age:16.0  Onset:1998-03-22, Days after vaccination: 2
Gender:Female  Submitted:1998-10-26, Days after onset: 218
Location:Rhode Island  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt was pale & faint w/hep b dose 1;
Other Medications:
Current Illness:
Preexisting Conditions: family allergies
Diagnostic Lab Data:
CDC Split Type: 19980166441
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM0553E1IM 
Administered by: Private     Purchased by: Private
Symptoms: Adverse drug reaction, Dizziness, Pallor, Similar reaction on previous exposure to drug
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 20MAR98 & 2 days later felt faint & was pale;

VAERS ID:115612 (history)  Vaccinated:1998-10-27
Age:16.6  Onset:1998-10-28, Days after vaccination: 1
Gender:Female  Submitted:1998-10-29, Days after onset: 1
Location:Pennsylvania  Entered:1998-11-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: N/A
Other Medications: Varivax-MSD-9/23/98-1058H-SC RA; Adult DT-Conn-9/23/98-0967100-Im LA-4 ds; MMR-MSD-9/23/98-1009H-IM LA-1 ds
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.1058H1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: Pt recv vax on 10/27/98; on same day pt exp cellulitis of upper LA (5.5 x 7)

VAERS ID:116331 (history)  Vaccinated:1998-06-01
Age:16.0  Onset:1998-06-15, Days after vaccination: 14
Gender:Male  Submitted:1998-10-29, Days after onset: 136
Location:Pennsylvania  Entered:1998-11-09, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES98070849
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Other
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Urticaria;Pruritis On approximately 15 June 1998 pt developed intermittent erythematous pruritic hives on extremities,abdomen,chest & thighs, tx w/ prednisone & loratadine, urticaria,pruritis

VAERS ID:116672 (history)  Vaccinated:1998-10-12
Age:16.6  Onset:1998-10-13, Days after vaccination: 1
Gender:Female  Submitted:1998-10-14, Days after onset: 1
Location:Michigan  Entered:1998-11-23, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 10/15/98-Blood count
CDC Split Type: MI98134
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1707E2 LA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Oedema peripheral, Pain, Pruritus, Rash maculo-papular, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/12/98; on 10/13/98 pt exp red,raised blotches over entire body w/ itching; swollen/painful hands, legs&arms; vomiting; difficulty breathing; tx=Prednisone & Atarax

VAERS ID:116830 (history)  Vaccinated:1998-09-15
Age:16.6  Onset:1998-09-16, Days after vaccination: 1
Gender:Female  Submitted:1998-09-18, Days after onset: 2
Location:New York  Entered:1998-11-25, Days after submission: 68
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth Control Ortho Novum
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NYS98025
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2405A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.070021SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: started complaining of backache 16SEP98 cont to have back pain;

VAERS ID:116835 (history)  Vaccinated:1998-10-14
Age:16.0  Onset:1998-10-14, Days after vaccination: 0
Gender:Male  Submitted:1998-10-16, Days after onset: 2
Location:New York  Entered:1998-11-25, Days after submission: 40
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: 2wks prior to inj had allergic rxn to bee sting, given epi
Diagnostic Lab Data:
CDC Split Type: NYS98034
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2544A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: At 8PM, 6 1/2hr p/vax pt devel welts, swelling first on rt arm & then on both arms starting @ elbow & going towards wrist-later devel area on chest & upper rt thigh; welts;

VAERS ID:116880 (history)  Vaccinated:1998-11-17
Age:16.5  Onset:1998-11-18, Days after vaccination: 1
Gender:Male  Submitted:1998-11-23, Days after onset: 5
Location:West Virginia  Entered:1998-11-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations: pt exp sz @ 6mo w/DTP dose 2;
Other Medications: Depakote;Adderall;Inderal;Clonidine
Current Illness: conjunctivitis
Preexisting Conditions: autistic, oppositional defiant disorder, epilepsy
Diagnostic Lab Data: NA
CDC Split Type: WV9818
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09605805 RA
Administered by: Public     Purchased by: Public
Symptoms: Paralysis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: temp 103.8;RLE paralysis;

VAERS ID:116998 (history)  Vaccinated:1998-11-18
Age:16.0  Onset:1998-11-19, Days after vaccination: 1
Gender:Female  Submitted:1998-11-19, Days after onset: 0
Location:Unknown  Entered:1998-12-01, 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: Albuterol;Phenegan
Current Illness:
Preexisting Conditions: sinusitis but had not began ATB rx;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0968370 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Nausea, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt recv vax 18NOV98 & 19NOV devel nausea, tremor, wheezing;

VAERS ID:117001 (history)  Vaccinated:1998-04-01
Age:16.5  Onset:1998-04-01, Days after vaccination: 0
Gender:Male  Submitted:1998-04-02, Days after onset: 1
Location:Kentucky  Entered:1998-12-01, Days after submission: 243
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: KY980043
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F916944IMRA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Convulsion, Gaze palsy, Muscle twitching, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt recv vax on 4/1/98; 20 min post vax pt exp nausea, passing out w/ rolled back eyes & jerking x 2 min, pale & weak

VAERS ID:117114 (history)  Vaccinated:1998-08-28
Age:16.4  Onset:1998-08-29, Days after vaccination: 1
Gender:Female  Submitted:1998-08-31, Days after onset: 2
Location:Georgia  Entered:1998-12-07, Days after submission: 98
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: negative hx
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type: GA98104
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0067H1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Lymphadenopathy, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 28AUG98 c/o rash beginning bends of the next day becoming generalized 2 days fever began yesterday-swelling parotid glands yesterday-lack of appetite-T100;seen today;

VAERS ID:117296 (history)  Vaccinated:1998-07-30
Age:16.6  Onset:1998-07-30, Days after vaccination: 0
Gender:Female  Submitted:1998-07-31, Days after onset: 1
Location:Washington  Entered:1998-12-11, Days after submission: 133
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Purified protein derivative by Connaught lot# 248811 given 30JUL98;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WA981501
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0682E0 LA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES453118  RA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow)
Write-up: pt recv vax 30JUL98 & 930AM c/o swollen glands bilat & swollen tonsils;no sore throat or fever;trouble swallowing;better today;

VAERS ID:117539 (history)  Vaccinated:1998-03-04
Age:16.3  Onset:1998-03-06, Days after vaccination: 2
Gender:Female  Submitted:1998-11-16, Days after onset: 255
Location:Idaho  Entered:1998-12-21, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: ID98051
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1251E0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: 2 days p/vax pt exp some vomiting & diarrhea which did resolve p/3-4 days;

VAERS ID:117624 (history)  Vaccinated:1998-11-12
Age:16.3  Onset:1998-11-12, Days after vaccination: 0
Gender:Female  Submitted:1998-11-23, Days after onset: 11
Location:Oregon  Entered:1998-12-22, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PEN VK
Current Illness: gpestrep pharyngitis;
Preexisting Conditions: NONE
Diagnostic Lab Data: +UCG 12NOV98
CDC Split Type: OR9832
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2794A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1020E1SC 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09447804IMRA
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: pt recv vax 6NOV98 & dx w/IUP (+ UCG) 12NOV98;negative UCG 26OCT98;

VAERS ID:117705 (history)  Vaccinated:1998-10-20
Age:16.4  Onset:1998-10-21, Days after vaccination: 1
Gender:Female  Submitted:1998-10-21, Days after onset: 0
Location:Pennsylvania  Entered:1998-12-28, Days after submission: 68
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv varicella vax by MSD lot# 1323E given 18SEP98
Current Illness: NONE
Preexisting Conditions: sleep apnea secondary to tonsils/dermatitis/allergic to PCN
Diagnostic Lab Data: NONE
CDC Split Type: PA9859
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1323E1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain, Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: approx 5x7cm red raised swollen area over site of inj w/in 12-24hr of inj;c/o pain & tender to touch;also c/o abd pain;treated w/antihistamine;

VAERS ID:117785 (history)  Vaccinated:1998-11-12
Age:16.1  Onset:1998-11-12, Days after vaccination: 0
Gender:Female  Submitted:1998-11-16, Days after onset: 4
Location:Alaska  Entered:1998-12-29, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Serevent;albuteral
Current Illness:
Preexisting Conditions: asthma
Diagnostic Lab Data: NONE
CDC Split Type: AK98032
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1141H IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1320H IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1188H1SCLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4528425IMLA
Administered by: Public     Purchased by: Public
Symptoms: Face oedema, Hypertension, Hypoventilation, Laryngospasm, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (narrow), Hypertension (narrow), Hypersensitivity (narrow), Respiratory failure (narrow)
Write-up: c/o throat swelling, tight approx 2-3hr p/immun;pt was taken to hosp assessed & given oral DPH;also exp facial swelling;resp rate 16;heart rate 100; BP 132/82;fullness of the cheeks bilat;

VAERS ID:117887 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:1998-12-23
Location:Louisiana  Entered:1999-01-04, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: Blood pressure 160/80; Pulse irregular
CDC Split Type: LA981204
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0975800  LA
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.043740 RA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4559355 RA
Administered by: Public     Purchased by: Public
Symptoms: Arrhythmia, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)
Write-up: Pt recv vax on unknown day; post vax pt exp passing out x 5 min

VAERS ID:118161 (history)  Vaccinated:1999-01-05
Age:16.0  Onset:1999-01-06, Days after vaccination: 1
Gender:Female  Submitted:1999-01-08, Days after onset: 2
Location:Kansas  Entered:1999-01-19, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4532262PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F917002 RA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Paraesthesia, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: mom states inj site sore & redness an inch or two evening 5JAN99;next AM pt c/o arm hurting;mom stated more redness & aching;6JAN baseball sized redness/swelling;c/o itching & tingling;erythema;

VAERS ID:118229 (history)  Vaccinated:1998-10-29
Age:16.3  Onset:1998-10-30, Days after vaccination: 1
Gender:Female  Submitted:1998-11-05, Days after onset: 6
Location:South Carolina  Entered:1999-01-21, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Mono test-negative
CDC Split Type: SC98071
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2566A90 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.1010H1 LA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09633900 LA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Lymphadenopathy, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt recv vax on 10/29/98; on 10/30/98 pt exp feeling bad, headache, fever (100-103), swollen neck glands

VAERS ID:118321 (history)  Vaccinated:1999-01-13
Age:16.7  Onset:1999-01-13, Days after vaccination: 0
Gender:Female  Submitted:1999-01-13, Days after onset: 0
Location:California  Entered:1999-01-25, 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: CA990001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2726A20IMLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4528414IMLA
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Headache, Hyperhidrosis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 13JAN99 1110AM & stated felt faint, became diaphoretic, c/o h/a, nausea & weakness;Epi given;BP 80/60, P60;

VAERS ID:118341 (history)  Vaccinated:1998-03-12
Age:16.0  Onset:1998-03-16, Days after vaccination: 4
Gender:Male  Submitted:1998-03-20, Days after onset: 4
Location:Rhode Island  Entered:1999-01-26, Days after submission: 312
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: U19980072
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES0937600 UNGM
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chills, Hyperhidrosis, Pain, Paraesthesia, Somnolence
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: pt recv ax 12MAR98 & 4 days p/vax 16MAR98 pt had severe chills & cold clammy sweat w/listlessness & fatigue lasting through the day;also pain in opposite shoulder from shot site w/numbness going down to fingertips;seems to be subsiding;

VAERS ID:118365 (history)  Vaccinated:1997-11-17
Age:16.1  Onset:1997-11-17, Days after vaccination: 0
Gender:Female  Submitted:1998-10-09, Days after onset: 325
Location:Maryland  Entered:1999-01-26, Days after submission: 109
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp itching & muscle aches all over w/dose 1 rabies vax;
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U199800016
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.M08271  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Myalgia, Pruritus, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax 17NOV97 & that same day pt exp pain @ site, itching all over, hives on chest & muscle aches all over;

VAERS ID:118449 (history)  Vaccinated:1998-10-29
Age:16.7  Onset:1998-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-01-18, Days after onset: 81
Location:Florida  Entered:1999-02-01, Days after submission: 14
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations: Pt recv HepB#1;exp nausea, cramps,vomiting,hotflash,headache
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UGI scope-inflammation of duodenum; Bloodwork-liver damage-reduction of RBC; many other tests
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1 A
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Adverse drug reaction, Asthenia, Duodenitis, Eye pain, Gastrointestinal disorder, Headache, Hepatocellular damage, Hypertonia, Infection, Laboratory test abnormal, Red blood cell abnormality, Sepsis, Similar reaction on previous exposure to drug, Vasodilatation, Vomiting
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad)
Write-up: Pt recv vax on 10/29/98; on same day pt exp nausea, cramping, vomiting, hot flashes, headache, shooting pains/ spasms in hands, eye pain; pt seen by specialists

VAERS ID:118600 (history)  Vaccinated:1999-01-08
Age:16.5  Onset:1999-01-08, Days after vaccination: 0
Gender:Female  Submitted:1999-01-08, Days after onset: 0
Location:Louisiana  Entered:1999-02-08, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: amoxicillin/pt stated PCN
Diagnostic Lab Data:
CDC Split Type: LA990201
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1398H0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0029H1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Eye disorder, Face oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & w/in 15-20min eye itching w/swelling;No SOB, wheezing, coughing noted;pt denies any discomfort other than eyes itching;BP 120/90, P 80 faint 930AM;

VAERS ID:118631 (history)  Vaccinated:1998-10-28
Age:16.0  Onset:1998-11-12, Days after vaccination: 15
Gender:Male  Submitted:1999-02-04, Days after onset: 84
Location:New York  Entered:1999-02-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Benzamycin Gel
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 12NOV98 WBC 5.4;RBC 2.8;
CDC Split Type: 19990029071
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2713A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Anaemia, Gastroenteritis, Haemolytic anaemia, Hyperglycaemia, Immune system disorder, Infection, Laboratory test abnormal, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Haemolytic disorders (narrow), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Noninfectious diarrhoea (broad)
Write-up: pt recv vax & approx 15 days p/vax pt devel a low grade fever 102 which was tentatively dx as fever of unk origin;pt hosp;dx was autoimmune hemolytic anemia;tx w/pred;relevant lab data 12NOV98 WBC 5.4;RBC 2.8;

VAERS ID:118934 (history)  Vaccinated:1999-02-02
Age:16.6  Onset:1999-02-02, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:California  Entered:1999-02-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA990006
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1889H0 LA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Sinusitis
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Pt recv vax on 2/2/99; on same day pt exp sinus pressure, tiredness

VAERS ID:119144 (history)  Vaccinated:1998-12-18
Age:16.3  Onset:1998-12-19, Days after vaccination: 1
Gender:Female  Submitted:1999-01-12, Days after onset: 24
Location:Maine  Entered:1999-02-18, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data: NONE
CDC Split Type: ME98002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2712A20 A
Administered by: Public     Purchased by: Public
Symptoms: Angioneurotic oedema, Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: angio-edema day p/vax lip swelling;

VAERS ID:119185 (history)  Vaccinated:1997-12-18
Age:16.8  Onset:1997-12-19, Days after vaccination: 1
Gender:Male  Submitted:1997-12-23, Days after onset: 4
Location:Maine  Entered:1999-02-19, Days after submission: 423
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Autistic, Asthma
Diagnostic Lab Data: UNK
CDC Split Type: ME98037
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 1 A
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt recv vax on 12/18/97; on 12/19/97 pt exp fever, chills, vomiting

VAERS ID:119197 (history)  Vaccinated:1999-01-21
Age:16.5  Onset:1999-01-21, Days after vaccination: 0
Gender:Male  Submitted:1999-01-26, Days after onset: 5
Location:Louisiana  Entered:1999-02-22, Days after submission: 27
Life Threatening? Yes
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: unk
CDC Split Type: LA990202
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2794A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1647H1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Chest pain, Dyspnoea, Face oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: father reports 5min p/vax child c/o of eyes swelling, chest felt tight approx 1hr 15min eyes completely swollen, joints hurting, SOB, chest tight;tx @ ER w/ IV w/ 6 unk shots-swelling reduced 2 1/2 hr-discharged w/joint aches 1 1/2 days.

VAERS ID:119416 (history)  Vaccinated:1997-10-14
Age:16.3  Onset:1997-10-24, Days after vaccination: 10
Gender:Female  Submitted:1998-10-07, Days after onset: 348
Location:Tennessee  Entered:1999-02-22, Days after submission: 138
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp h/a, nausea p/1st dose of rabies vax;
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 7679
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX ID)PASTEUR MERIEUX INST.L05372  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Adverse drug reaction, Anorexia, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 14OCT97 & pt exp nausea that persisted through 24OCT97;also pt reportedly can''t eat & feels very listless;an upper & lower Gi series has been performed w/results unreported (no Gi issues were implied in this ADR report);

VAERS ID:119390 (history)  Vaccinated:1999-02-15
Age:16.4  Onset:1999-02-16, Days after vaccination: 1
Gender:Male  Submitted:1999-02-16, Days after onset: 0
Location:South Carolina  Entered:1999-02-25, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp rxn 16FEB99 @ age 13 w/hep b dose 3;
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.1497E2 LA
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash, itchy all over 15FEB99 @ 6PM;pred-zyrtec;

VAERS ID:119437 (history)  Vaccinated:1999-01-26
Age:16.9  Onset:1999-01-28, Days after vaccination: 2
Gender:Male  Submitted:1999-02-01, Days after onset: 4
Location:Texas  Entered:1999-02-26, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 99TX14
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.1167H0IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0939440 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Face oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 1/26/99; on 1/28/99 pt exp rash on body, swollen lips; tx=Caladryl lotion

VAERS ID:119450 (history)  Vaccinated:1996-05-31
Age:16.1  Onset:1996-09-01, Days after vaccination: 93
Gender:Male  Submitted:1999-02-22, Days after onset: 904
Location:California  Entered:1999-03-01, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: repair of co archtation of aorta in 1983;angioplasty done JUN96 related to co archtation;
Diagnostic Lab Data: ANA positive;platelet count dec;arthritis factor;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1622B0 LA
Administered by: Private     Purchased by: Other
Symptoms: Alopecia, Antinuclear antibody, Asthenia, Chills, Dyspnoea, Peripheral vascular disorder, Systemic lupus erythematosus, Thrombocytopenia
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)
Write-up: feeling cold,tiredness, hands turns blue, diff breathing;@ home home remedy keeping pt warm;asking pt to take deep breath finally took pt to MD;MD did lab work says it is raynaud''s synd, ANA +, platelet count dec, losing hair, dx lupus;

VAERS ID:119465 (history)  Vaccinated:1999-01-04
Age:16.5  Onset:1999-01-05, Days after vaccination: 1
Gender:Female  Submitted:1999-02-09, Days after onset: 35
Location:Georgia  Entered:1999-03-01, Days after submission: 20
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: MRI
CDC Split Type: GA99013
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2566A92IMLA
Administered by: Public     Purchased by: Public
Symptoms: Multiple sclerosis, Myelitis, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Demyelination (narrow)
Write-up: pt recv 4JAN99 & 10FEB99 numbness in rt leg;to MD then to orthopedic & to neurologist;had MRI showing white plaque on upper part of spinal cord affecting nerves on rt side;dx acute transverse myelitis possible first stage of MS;

VAERS ID:119910 (history)  Vaccinated:1998-04-10
Age:16.0  Onset:1998-04-10, Days after vaccination: 0
Gender:Female  Submitted:1999-03-01, Days after onset: 325
Location:Kansas  Entered:1999-03-03, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES98051130
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1168E0IM 
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site inflammation, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 4/10/98; on same day pt exp red/ pain vax x 2 days, inflamed vax site x 30 mins

VAERS ID:120000 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:1999-03-01
Location:New Jersey  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: anemia;leukopenia;
Diagnostic Lab Data: lab test blood test revealed low white blood cell count;
CDC Split Type: WAES98090875
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acne, Ecchymosis, Pruritus, Rash, Skin disorder
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & exp a rash that itches terribly;pt reported itching was worse @ noc & has little pimples on legs, stomach & arms that have lasted for weeks;skin has a black & blue vein-like appearance;pt sought unspecified attention;

VAERS ID:120017 (history)  Vaccinated:1998-08-24
Age:16.2  Onset:1998-08-24, Days after vaccination: 0
Gender:Female  Submitted:1999-03-01, Days after onset: 189
Location:California  Entered:1999-03-03, 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: Ventolin, Motrin
Current Illness:
Preexisting Conditions: Adenoidectomy, asthma, dental extraction, inhalant allergy, milk intolerance, tonsillectomy
Diagnostic Lab Data: 9/17/98 Blood work-serum ANA 1232
CDC Split Type: WAES98100101
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Arthritis, Hypokinesia, Oedema peripheral, Pain, Rheumatoid arthritis, Systemic lupus erythematosus
SMQs:, Cardiac failure (broad), Angioedema (broad), Systemic lupus erythematosus (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow)
Write-up: Pt recv vax on 8/24/98; on same day pt exp pain & unable to walk, joint pain in fingers, knees &feet w/ swelling;dx=post reactive arthritis tx=Prednisone

VAERS ID:120065 (history)  Vaccinated:1998-08-14
Age:16.8  Onset:1998-08-28, Days after vaccination: 14
Gender:Female  Submitted:1999-03-01, Days after onset: 185
Location:Pennsylvania  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: mononuclear leukocytosis, traumatic arthropathy (knee)
Diagnostic Lab Data: muscle biopsy-primary non-specific myopathy, serum creatine kinase-no result available
CDC Split Type: WAES98120122
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Myalgia, Myasthenic syndrome, Myopathy
SMQs:, Rhabdomyolysis/myopathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax & exp muscle weakness in legs & deltoids

VAERS ID:119791 (history)  Vaccinated:1999-02-17
Age:16.5  Onset:1999-02-17, Days after vaccination: 0
Gender:Male  Submitted:1999-02-22, Days after onset: 5
Location:North Dakota  Entered:1999-03-08, 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: Vitamin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ND9903
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES09376000SCLA
Administered by: Other     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 2/17/99; within 1 hr post vax pt exp rash on arms, chest, back & abdomen; tx=Benadryl

VAERS ID:120291 (history)  Vaccinated:1999-02-25
Age:16.0  Onset:1999-02-25, Days after vaccination: 0
Gender:Female  Submitted:1999-02-25, Days after onset: 0
Location:South Carolina  Entered:1999-03-15, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: SC99006
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.1353H1SCRA
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Dehydration, Dyspnoea, Hypoxia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad)
Write-up: Pt recv vax on 2/25/99; approx 20 min post vax pt exp wheezing, hives & shortness of breath; tx=Benadryl, Epinephrine, IV fluids, oxygen

VAERS ID:120342 (history)  Vaccinated:1998-06-10
Age:16.8  Onset:1998-06-10, Days after vaccination: 0
Gender:Female  Submitted:1999-02-01, Days after onset: 236
Location:South Carolina  Entered:1999-03-15, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: SC98099
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2617A20IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F917005IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1568E0SCRA
Administered by: Public     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)
Write-up: approx 2min p/vax pt seized for approx 1minute;

VAERS ID:120344 (history)  Vaccinated:1998-10-20
Age:16.2  Onset:1998-10-21, Days after vaccination: 1
Gender:Female  Submitted:1999-02-17, Days after onset: 119
Location:South Carolina  Entered:1999-03-15, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: SC98102
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2567A90IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0792H0SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09633900IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax 20OCT98 pt ran fever next day 2 days p/vax rt arm exp large amount of swelling;pt did not see MD but family observed reaction;

VAERS ID:120561 (history)  Vaccinated:1998-11-20
Age:16.5  Onset:1998-11-20, Days after vaccination: 0
Gender:Female  Submitted:1999-02-01, Days after onset: 73
Location:Ohio  Entered:1999-03-23, Days after submission: 50
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Pt recvH epB,MSD, 0599H, LA, unknown day previous dose; Comtrex
Current Illness: NONE
Preexisting Conditions: Smokes 1/2 pack a day
Diagnostic Lab Data: NONE
CDC Split Type: OH99016
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0599H2IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypotension, Hypothermia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Accidents and injuries (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/20/98; on same day pt exp urticaria w/ itching; tx=Benadryl

VAERS ID:120602 (history)  Vaccinated:1993-09-30
Age:16.2  Onset:1993-10-01, Days after vaccination: 1
Gender:Female  Submitted:1999-02-25, Days after onset: 1973
Location:Florida  Entered:1999-03-29, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMA
Administered by: Private     Purchased by: Private
Symptoms: Alopecia, Asthenia, Peripheral vascular disorder
SMQs:, Guillain-Barre syndrome (broad)
Write-up: extensive diffuse hair loss;large accumulation of hair in drain when showering;heavy loss approx 1-2yr;onset approx 3wk p/initial dose of vax; cont until present;tx p/ medical consult in 1994

VAERS ID:120669 (history)  Vaccinated:1998-03-26
Age:16.6  Onset:1998-03-26, Days after vaccination: 0
Gender:Male  Submitted:1998-04-01, Days after onset: 6
Location:Colorado  Entered:1999-03-29, Days after submission: 362
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: U199800121
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7J91913  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Cellulitis, Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recv vax 26MAR98 & about 6 to 8hr p/vax pt had cellulitis @ the inj site;pt also had some hip pain;

VAERS ID:120792 (history)  Vaccinated:1999-01-19
Age:16.4  Onset:1999-01-19, Days after vaccination: 0
Gender:Female  Submitted:1999-01-19, Days after onset: 0
Location:Oregon  Entered:1999-03-30, Days after submission: 70
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: BP 80/50, P 40; Pt seen by private M.D.-vagal nerve response
CDC Split Type: OR9901
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2565AU0IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09346004IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anxiety, Convulsion, Pallor, Somnolence, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt recv vax on 1/19/99; immediately post vax pt fainted x3 w/ seizure activity, incontinent of urine, sleepiness; tx=15 min lying down,

VAERS ID:120841 (history)  Vaccinated:1996-03-06
Age:16.0  Onset:1996-03-20, Days after vaccination: 14
Gender:Female  Submitted:1999-03-29, Days after onset: 1104
Location:Ohio  Entered:1999-04-01, Days after submission: 3
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 3/29/80-jaundice, hx: various colds, chicken pox, a few UTI
Diagnostic Lab Data: 19AUG SGOT 389, SGPT 309, bilirubin 2.4;22AUG SGOT 327, SGPT 267, Bilirubin 3.2;27AUG SGOT 208, SGPT 17, bilirubin 3.9;3SEP SGOT 190, Bilirubin 2.6;10NOV SGOT 362, SGPT 256, SGGT 199, Bilirubin 1.5, IGG 3300;28NOV SGOT 720, SGPT 663;
CDC Split Type: OH99021
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4F610450IMRA
Administered by: Public     Purchased by: Public
Symptoms: Amenorrhoea, Anorexia, Arthralgia, Cough, Dizziness, Epistaxis, Eye disorder, Headache, Hepatic function abnormal, Infection, Nausea, Oral candidiasis, Pyrexia, Rhinitis, Urinary tract infection, Vitreous disorder, Weight decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Fertility disorders (broad), Arthritis (broad)
Write-up: p/vax pt periods stop MAR96;1096 periods resume;MAY97 strep throat, loss of weight, sinus infect, 1st nose bleed ever, lost 15-20#;JUN98 eating again;AUG97 joint pain starts, dizzy, h/a, n, rxn to diary food, 2nd nose bleed, T,UTI,chills

VAERS ID:121032 (history)  Vaccinated:1999-03-01
Age:16.0  Onset:1999-03-01, Days after vaccination: 0
Gender:Female  Submitted:1999-03-24, Days after onset: 23
Location:Washington  Entered:1999-04-08, 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:
Current Illness: NONE
Preexisting Conditions: child has asthma-no known allergies except Biaxin
Diagnostic Lab Data:
CDC Split Type: WA991546
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1173E0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: approx 2-3hr post vax pt c/o soreness & redness @ the site;this cont x 2 days when MD was consulted;pt was placed on keflex & advised to use hot packs to arms;was told that it was cellulitis;

VAERS ID:121155 (history)  Vaccinated:1999-03-26
Age:16.0  Onset:1999-03-29, Days after vaccination: 3
Gender:Female  Submitted:1999-03-30, Days after onset: 1
Location:Washington  Entered:1999-04-12, 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: Proventil
Current Illness: NONE
Preexisting Conditions: Asthma-controlled
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM597A21 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt recv vax on 3/26/99; on 3/29/99 pt exp abdomen pain, vomiting, nausea, headache

VAERS ID:121233 (history)  Vaccinated:1999-01-21
Age:16.4  Onset:1999-03-22, Days after vaccination: 60
Gender:Female  Submitted:1999-04-12, Days after onset: 20
Location:Massachusetts  Entered:1999-04-15, Days after submission: 3
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: HIV (ELISA) negative;WBC 5.6;RBC 4.40;HGB 13.8;HCT 41;MCV 92;MCH 31;MCHC 34;RDW 13.7;plat count 9;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0447H2IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Ecchymosis, Immune system disorder, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: 2mo p/vax pt devel ITP-first dx 22MAR99 bruising, dec platelets

VAERS ID:121459 (history)  Vaccinated:1998-12-16
Age:16.0  Onset:1999-01-13, Days after vaccination: 28
Gender:Male  Submitted:1999-01-15, Days after onset: 2
Location:Minnesota  Entered:1999-04-26, Days after submission: 100
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: NONE
Diagnostic Lab Data: lab, blood test, CXR
CDC Split Type: MN99001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2597A20IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Infection, Lymphadenopathy, Malaise, Pharyngitis, Pyrexia, Skin ulcer
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)
Write-up: hosp w/temp 100 throat burning, swollen, glands or lymph nodes rt side of neck, general malaise. Family moved. Not in state. Unsure whether they moved to. Last communication with family was that sonw as recovering. 12/00

VAERS ID:121617 (history)  Vaccinated:1999-03-24
Age:16.3  Onset:1999-03-24, Days after vaccination: 0
Gender:Male  Submitted:1999-04-14, Days after onset: 20
Location:Minnesota  Entered:1999-04-27, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: unk
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120D90 A
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain, Asthenia, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: neck ache (stiff) 20sec p/shot lasted 2 days;sore arm 4 days started first day;tired for 7-10 days or more;sore muscles in legs 3rd day-lasted 2 days or more;cramping in stomach-no appetite for at least 7 days;

VAERS ID:121687 (history)  Vaccinated:1999-01-26
Age:16.5  Onset:1999-02-24, Days after vaccination: 29
Gender:Female  Submitted:1999-04-01, Days after onset: 36
Location:Nevada  Entered:1999-04-29, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: battery of tests for auto-immune disorders performed along w/MRI
CDC Split Type: NV99008
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2566C91 LA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Headache, Paraesthesia, Pharyngitis, Speech disorder, Tremor, Visual disturbance
SMQs:, Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: 24FEB99 pt exp severe h/a w/lt sided numbness both upper & lower extremity;pt exp throat pain & tight chest pain x 2mo;slurred speech & foggy vision noted; cont to exp numbness w/fine & gross motor tremors to lt side w/constant cont h/a, Annual follow-up received on 9/12/00 provided no additional data.

VAERS ID:121698 (history)  Vaccinated:1998-11-17
Age:16.4  Onset:1998-11-18, Days after vaccination: 1
Gender:Male  Submitted:1999-04-22, Days after onset: 154
Location:Massachusetts  Entered:1999-04-29, 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: Zyrtec;Icus multivit/mineral/day
Current Illness: NONE
Preexisting Conditions: allergies to molds, ragweed, trees, grasses (rhinitis) + asthma following some URI''s
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER1094H0 RA
Administered by: Private     Purchased by: Private
Symptoms: Ear pain, Headache, Malaise, Myalgia, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: devel malaise 18hr p/vax no fever, h/a, severe myalgias w/in 20hr of recv vax;these signs cont for 7 days, fever was 102-104, along w/rhinorrhea, lt earache causing pt to miss a week of school;

VAERS ID:121707 (history)  Vaccinated:1998-12-17
Age:16.3  Onset:1998-12-17, Days after vaccination: 0
Gender:Female  Submitted:1999-01-15, Days after onset: 29
Location:Nevada  Entered:1999-04-29, Days after submission: 103
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NV99005
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2586B90 LA
Administered by: Other     Purchased by: Public
Symptoms: Dermatitis exfoliative, Dizziness, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: mom stated child exp dizziness & lightheadedness p/vax;rash on arms, legs & face following rash hands & feet peeled;child''s doctor notified;

VAERS ID:121847 (history)  Vaccinated:1999-04-05
Age:16.9  Onset:1999-04-07, Days after vaccination: 2
Gender:Female  Submitted:1999-04-12, Days after onset: 5
Location:South Carolina  Entered:1999-05-03, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Denies
Current Illness: NONE
Preexisting Conditions: large local reactions to bee stings
Diagnostic Lab Data:
CDC Split Type: SC99019
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2566B90IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0792H1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09633905IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 48hr p/vax pt noticed bilat pruritus;intermit pruritus x 3 days;generalized over body, welts x 2 on rt arm 5 days p/shots, disappeared;reappeared (#2 large welts) on back 7 days p/shots;

VAERS ID:121850 (history)  Vaccinated:1999-04-14
Age:16.8  Onset:1999-04-14, Days after vaccination: 0
Gender:Male  Submitted:1999-04-15, Days after onset: 1
Location:South Carolina  Entered:1999-05-03, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: SC99022
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2566B90IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.10101H1SC 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09705200IM 
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Face oedema, Injury, Skin disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: p/vax pt felt a little light headed p/leaving office;in lobby passed out to the floor;wears glasses, glasses cut under rt eye, small abrasion, sl swollen;ice applied to eye;

VAERS ID:122094 (history)  Vaccinated:1998-08-04
Age:16.1  Onset:1998-08-14, Days after vaccination: 10
Gender:Female  Submitted:1999-02-08, Days after onset: 178
Location:Georgia  Entered:1999-05-12, Days after submission: 92
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: Anti-cardio (Ipin antibody), IgM 24, IgG<10, ANA 1:160, Sedrate 86, P-ANCA 1:320, C-ANCA <1:20
CDC Split Type:
Vaccination
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2559A20IMRA
Administered by: Private     Purchased by: Other
Symptoms: Antinuclear antibody, Arthralgia, Arthritis, Erythema nodosum, Immunoglobulins increased, Osteoarthritis, Red blood cell sedimentation rate increased, Skin discolouration
SMQs:, Systemic lupus erythematosus (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow)
Write-up: Pt recv vax on 8/4/98; on 8/14/98 pt exp joint pain w/ swelling, reactive arthritis, livedo reticularis, erythema nodosum

VAERS ID:123146 (history)  Vaccinated:1997-04-01
Age:16.8  Onset:1997-04-10, Days after vaccination: 9
Gender:Male  Submitted:1999-05-14, Days after onset: 764
Location:California  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: dx te: 5/21, lymphatic structure biop; magnetic resonance imagi; lab te: epstein-barr virus antib
CDC Split Type: WAES98051346
Vaccination
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Lot
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Lymphadenopathy, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: it was rpt pt recv varivax 4/1/97 & 4/10 pt exp massive overall body itch. pt right jaw line started to change p/ itching. tests performed. massive lymph nodes were discovered.

VAERS ID:123549 (history)  Vaccinated:1998-06-15
Age:16.0  Onset:1998-06-17, Days after vaccination: 2
Gender:Female  Submitted:1999-05-14, Days after onset: 331
Location:Michigan  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant Data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98061666
Vaccination
Manufacturer
Lot
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt devel a vesicular rash w/more than one hundred lesions;reporter felt it was d/t wild type virus;

VAERS ID:124162 (history)  Vaccinated:1998-06-15
Age:16.0  Onset:1998-06-17, Days after vaccination: 2
Gender:Female  Submitted:1999-05-14, Days after onset: 331
Location:Texas  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98102177
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Infection, Uveitis
SMQs:, Ocular infections (broad)
Write-up: 2 days p/vax pt devel a generalized case of chickenpox. then 20june pt presented w/uveitis. treated w/topical steroids

VAERS ID:124183 (history)  Vaccinated:1998-10-09
Age:16.4  Onset:1998-10-16, Days after vaccination: 7
Gender:Male  Submitted:1999-05-14, Days after onset: 210
Location:Kansas  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: insulin
Current Illness:
Preexisting Conditions: diabetes mellitus; varicella exposure
Diagnostic Lab Data:
CDC Split Type: WAES98110272
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS 0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0808E0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: 7 days p/vax pt devel chickenpox that consisted of cluster & pustules that were scabbing over.

VAERS ID:124211 (history)  Vaccinated:1998-08-30
Age:16.0  Onset:1998-09-20, Days after vaccination: 21
Gender:Female  Submitted:1999-05-14, Days after onset: 236
Location:Pennsylvania  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No Relevant Data
Other Medications: unk
Current Illness:
Preexisting Conditions: PCN allergy;reaction
Diagnostic Lab Data:
CDC Split Type: WAES98110845
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt devel pox & abd;approx 1wk p/pt devel 3 more pox on scalp & face;2wk later pt devel two more pox on arm & approx 11/4/98 devel 3 more on lt arm;

VAERS ID:124361 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Unknown  Submitted:1999-05-14
Location:Michigan  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98121413
Vaccination
Manufacturer
Lot
Dose
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: it was rpt fr RN concerning a pt who was vax & subsequently pt exp general body aches

VAERS ID:124383 (history)  Vaccinated:1998-12-15
Age:16.0  Onset:1998-12-28, Days after vaccination: 13
Gender:Female  Submitted:1999-05-14, Days after onset: 136
Location:New York  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98121819
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.DTPA888A2 SC 
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: approx 15days p/vax pt exp generalized rash. addl in for requested

VAERS ID:124653 (history)  Vaccinated:1984-09-17
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:1999-05-14
Location:Michigan  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: serum varicella zoster, antibody neg
CDC Split Type: WAES99030897
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: it was rpt fr Medical tech concerning pt who was vax & current antibody titer revealed a seronegative response

VAERS ID:122628 (history)  Vaccinated:1998-12-10
Age:16.3  Onset:1998-12-11, Days after vaccination: 1
Gender:Male  Submitted:1999-05-21, Days after onset: 160
Location:Massachusetts  Entered:1999-05-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No Relevant Data
Other Medications: Ventolin
Current Illness:
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC Split Type: WAES99020049
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1190H0IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1019E1SC 
Administered by: Public     Purchased by: Public
Symptoms: Orchitis, Pain, Testicular disorder
SMQs:, Fertility disorders (narrow)
Write-up: p/vax pt presented to MD office w/bilat testicular pain & diffuse tenderness of both tests;dx w/orchitis;

VAERS ID:123244 (history)  Vaccinated:1999-05-24
Age:16.9  Onset:1999-05-25, Days after vaccination: 1
Gender:Male  Submitted:1999-05-26, Days after onset: 1
Location:Minnesota  Entered:1999-06-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAMA909A2   
Administered by: Private     Purchased by: Unknown
Symptoms: Hypokinesia
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: after vax pt unable to lift left arm; pt seen, no swelling or redness

VAERS ID:123301 (history)  Vaccinated:1999-05-26
Age:16.8  Onset:1999-05-26, Days after vaccination: 0
Gender:Male  Submitted:1999-05-27, Days after onset: 1
Location:Arizona  Entered:1999-06-04, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn on 4/23/99 @ age 16 w/hep b dose #1;
Other Medications: pt recv hep b w/MSD 1287H given 4/23/99 & Td by connaught lot# 0978770 & MMR by MSD 1553H given 10/6/93;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1287H1 RA
Administered by: Other     Purchased by: Other
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: fever & body aches started 1hr p/vax;mom did not mention pt had fever & body aches x 2 days p/vax given 4/23/99;

VAERS ID:123326 (history)  Vaccinated:1999-05-11
Age:16.4  Onset:1999-05-11, Days after vaccination: 0
Gender:Female  Submitted:1999-05-18, Days after onset: 7
Location:Michigan  Entered:1999-06-07, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none
Other Medications:
Current Illness: no
Preexisting Conditions:
Diagnostic Lab Data: in ER had tests for urinary infect & blood drawn to check for generalized infect . nothing found. ER m.d. dx react to vax
CDC Split Type: MI99058
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1887H0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1545H1SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4618544PO 
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Back pain, Lymphadenopathy, Neck pain, Paraesthesia, Tachycardia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: mom states child early eve 6-8pm c/o heart racing, right side of body tingling, back pain, stomach ache, neck pain, swollen lymph nodes back of head. on 5/13 c/o back still hurting . referred to md. did not go on 5/14

VAERS ID:124711 (history)  Vaccinated:1999-05-11
Age:16.8  Onset:1999-05-12, Days after vaccination: 1
Gender:Female  Submitted:1999-05-17, Days after onset: 5
Location:Tennessee  Entered:1999-06-14, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TN99013
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0031H1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09705205IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Injection site hypersensitivity, Injection site mass, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 5/12/99 Pm 6x6cm raised red, warm area lt arm n/v, dizziness ? fever (at home);seen by MD 5/14/99;sx remained @ pt visit;

VAERS ID:124777 (history)  Vaccinated:1996-04-05
Age:16.2  Onset:1997-07-03, Days after vaccination: 454
Gender:Female  Submitted:1999-06-11, Days after onset: 708
Location:New Mexico  Entered:1999-06-15, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: migraine h/a
Diagnostic Lab Data: MRI, spinal tap & blood work abn results dx w/MS;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1664B22IM 
Administered by: Private     Purchased by: Private
Symptoms: Affect lability, Amnesia, Asthenia, Condition aggravated, Deafness permanent, Depression, Dysmenorrhoea, Facial palsy, Gait disturbance, Hyperhidrosis, Hypothermia, Laboratory test abnormal, Menorrhagia, Migraine, Multiple sclerosis, Myasthenic syndrome, Nervousness, Paraesthesia, Personality disorder, Pyrexia, Speech disorder, Urinary tract disorder, Vertigo, Visual disturbance
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hostility/aggression (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Vestibular disorders (narrow)
Write-up: 3/31/98 partially deaf in lt ear;numbness in hands & feet;tingling shocking sensations down legs;unsteady gait;vertigo;bladder trouble;depression;memory loss;visual disturbances;labile mood;temp fluctuation;fatigue;dx multiple sclerosis; Annual follow-up received on 10/4/00 states that the pt has ongoing symptoms of multiple sclerosis, numbness and tingling of hands and feet and in various parts of her body. Cognitive problems, visual problems, labile mood swings and weakness.

VAERS ID:124822 (history)  Vaccinated:1999-06-08
Age:16.6  Onset:1999-06-08, Days after vaccination: 0
Gender:Male  Submitted:1999-06-10, Days after onset: 2
Location:Florida  Entered:1999-06-16, 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: Wellbutrin
Current Illness: NONE
Preexisting Conditions: major depression
Diagnostic Lab Data: NA
CDC Split Type: FL99017
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2937A21IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09507400IMLA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Osteoarthritis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (narrow)
Write-up: hives, joint pain & swelling;

VAERS ID:125297 (history)  Vaccinated:1999-06-03
Age:16.8  Onset:1999-06-04, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Michigan  Entered:1999-07-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: pt recv Td by Connaught lot# 0977220 & hep p by SKB 2808A2 given 4/28/99
Current Illness: NONE
Preexisting Conditions: allergy to ragweed, pork, tuna, dust & mold;cats, feathers etc
Diagnostic Lab Data:
CDC Split Type: MI99062
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER2808A20IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09772200IMLA
Administered by: Public     Purchased by: Public
Symptoms: Adverse drug reaction, Injection site hypersensitivity, Laryngospasm, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & had some redness & warmth @ the inj site p/15-20min;advised to used cool compresses & anti-inflammatory product for 24hr;mom reports some tightness in throat;

VAERS ID:125502 (history)  Vaccinated:1999-06-02
Age:16.8  Onset:1999-06-03, Days after vaccination: 1
Gender:Female  Submitted:1999-06-03, Days after onset: 0
Location:Georgia  Entered:1999-07-12, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: BCP, prevacid
Current Illness: NONE
Preexisting Conditions: allergic rhinitis & gastritis
Diagnostic Lab Data: NONE
CDC Split Type: GA99059
Vaccination
Manufacturer
Lot
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Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09447805IMLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Headache, Infection, Myalgia, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: 6/3/99 sore arm, fever, h/a & back pain-fainted @ 11:00 & was taken to ER via ambulance;blood work indicated virus;

VAERS ID:125867 (history)  Vaccinated:1998-10-15
Age:16.3  Onset:1998-10-16, Days after vaccination: 1
Gender:Male  Submitted:1999-07-12, Days after onset: 269
Location:Pennsylvania  Entered:1999-07-14, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: reactive airway disease/asthma
Current Illness:
Preexisting Conditions: reactive airway disease
Diagnostic Lab Data:
CDC Split Type: WAES98101248
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/recv vax pt devel severe local & systemic react, w/fever 103 & very swollen, red, warm to touch & painful arm;

VAERS ID:126089 (history)  Vaccinated:1999-07-06
Age:16.0  Onset:1999-07-06, Days after vaccination: 0
Gender:Male  Submitted:1999-07-06, Days after onset: 0
Location:Virginia  Entered:1999-07-19, 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:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: VA99033
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2937A21 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1749H1 LA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0798F1PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09973901 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Gaze palsy, Hypotonia, Opisthotonus, Pallor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: immed following vax pt head slumped got pale. pt head snapped back, eyes rolled back & stated to have seizures.

VAERS ID:126168 (history)  Vaccinated:1999-01-11
Age:16.3  Onset:1999-02-11, Days after vaccination: 31
Gender:Male  Submitted:1999-07-14, Days after onset: 152
Location:Maryland  Entered:1999-07-20, 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:
Diagnostic Lab Data: knee XRAY
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Unknown
Symptoms: Osteoarthritis
SMQs:, Arthritis (narrow)
Write-up: approx 1mo p/vax pt exp swelling of right knee

VAERS ID:126308 (history)  Vaccinated:1999-07-06
Age:16.2  Onset:1999-07-17, Days after vaccination: 11
Gender:Female  Submitted:1999-07-21, Days after onset: 4
Location:California  Entered:1999-07-26, 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: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES10005700SC 
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)
Write-up: 11day p/vax pt broke out in rash all over body & began to have difficulty breathing. seen in ER, epinephrine & benadryl

VAERS ID:126398 (history)  Vaccinated:1998-09-23
Age:16.9  Onset:1998-10-14, Days after vaccination: 21
Gender:Female  Submitted:1999-07-21, Days after onset: 280
Location:Alabama  Entered:1999-07-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: HCG-pos;ultrasound-no definite fetal pole identified
CDC Split Type: WAES98091937
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0665H SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: pt vax while preg; LMP was on 8/17/98; preg confirmed by HCG test; EDD 5/24/99; pt exp spontaneous abortion on 10/14/98;

VAERS ID:126554 (history)  Vaccinated:1999-03-24
Age:16.0  Onset:1999-03-24, Days after vaccination: 0
Gender:Male  Submitted:1999-04-23, Days after onset: 29
Location:Wisconsin  Entered:1999-07-30, Days after submission: 98
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999009261
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Anorexia, Asthenia, Fatigue, Myalgia, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: p/vax pt had sore arm; devel sore neck, got tired; sore leg muscles; no appetite & sl stomach cramps; Case, reference number 1999009261-1, is a spontaneous report from a mother referring to her 16 year old son. No allergies, medical history, or concomitant medications. The patient had received three hepatitis B doses and the flu vaccine in the past without any problems. On 24-Mar-99, the patient received the first IM dose of LYMERIX for prevention of LYME disease. 20 seonds later, on 24-MAR-99, he had a sore arm, which lasted four days. Subsequently, he developed a sore neck, which lasted two days, got tired for 7-10 days or more. He had sore leg muscles which lasted two days or more. He had no appetite and slight stomach cramps for at least seven days. All symptoms resolved in April, 1999, within two weeks of receiving LYMERIX. The most recent information, received on 08-Feb-00, reports the condition of the patient resolved.

VAERS ID:126725 (history)  Vaccinated:1999-04-10
Age:16.0  Onset:1999-05-11, Days after vaccination: 31
Gender:Male  Submitted:1999-06-16, Days after onset: 36
Location:Pennsylvania  Entered:1999-07-30, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999013935
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Eye pain, Myalgia, Osteoarthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: p/vax pt exp muscle pain, swollen knee, fatigue & burning eyes;MD visit was required & was treated w/Ibuprofen & eyedrops;pt condition is ongoing;

VAERS ID:126789 (history)  Vaccinated:1999-05-03
Age:16.4  Onset:0000-00-00
Gender:Female  Submitted:1999-07-27
Location:Michigan  Entered:1999-08-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: oral contraceptions, hepB, merck, #1166H, lt arm, 5/29/99
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.1394H1IMRA
Administered by: Other     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: weekend following vax pt devel hives & continued until pt went tubing, then got severe. seen in ER & treated w/IVs

VAERS ID:126899 (history)  Vaccinated:1997-06-10
Age:16.7  Onset:1997-06-15, Days after vaccination: 5
Gender:Female  Submitted:1999-06-29, Days after onset: 744
Location:Florida  Entered:1999-08-04, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: n/a
Other Medications:
Current Illness: none
Preexisting Conditions: mitral valve prolapse
Diagnostic Lab Data: don''t know
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2186A40  
Administered by: Private     Purchased by: Public
Symptoms: Condition aggravated, Lymphadenopathy, Oedema peripheral, Peripheral vascular disorder, Rheumatoid arthritis
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow)
Write-up: 5days p/vax pt devel severe swelling upper & lower extremities; dx w/lymphedema; p/seeing many, many MDs was dx w/RA & Raynauds disease; aggravated

VAERS ID:127404 (history)  Vaccinated:1999-08-09
Age:16.0  Onset:1999-08-09, Days after vaccination: 0
Gender:Female  Submitted:1999-08-12, Days after onset: 3
Location:Washington  Entered:1999-08-17, 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:
CDC Split Type: 1999019939
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0 RA
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)
Write-up: p/vax pt exp sz;this case is considered medically serious;no tx given;most recent info recv 8/9/99 report sz lasted 60 seconds;

VAERS ID:127485 (history)  Vaccinated:1999-06-09
Age:16.4  Onset:1999-06-09, Days after vaccination: 0
Gender:Female  Submitted:1999-06-09, Days after onset: 0
Location:Alaska  Entered:1999-08-23, Days after submission: 75
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: AK9913
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09447804IMLA
Administered by: Public     Purchased by: Public
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: p/vax pt c/o arm feeling numb like when you to to dentis;observed in clinc x 30min & numbness resolved;no resp s/s;

VAERS ID:127499 (history)  Vaccinated:1999-08-20
Age:16.2  Onset:1999-08-20, Days after vaccination: 0
Gender:Male  Submitted:1999-08-21, Days after onset: 1
Location:New Jersey  Entered:1999-08-23, 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: h/a & ear pain
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0850J IMA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1983H IMA
Administered by: Private     Purchased by: Public
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt swelling of rt & lt eye; gave pt prelone at MD office; also gave prednisone; went home p/tx

VAERS ID:127701 (history)  Vaccinated:1999-08-04
Age:16.6  Onset:1999-08-04, Days after vaccination: 0
Gender:Female  Submitted:1999-08-20, Days after onset: 16
Location:Colorado  Entered:1999-08-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49781030IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: lump lt arm w/firm non tender nodule;

VAERS ID:128074 (history)  Vaccinated:1999-08-18
Age:16.7  Onset:1999-08-19, Days after vaccination: 1
Gender:Female  Submitted:1999-08-23, Days after onset: 4
Location:Kansas  Entered:1999-09-07, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: na
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: na
CDC Split Type: KS99013
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09507405IMRA
Administered by: Public     Purchased by: Public
Symptoms: Hypokinesia, Injection site hypersensitivity, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: p/vax pt awoke w/mild T100; had pain in rt arm; site of inj red & limited mobility in arm; saw MD; prescribed cold/heat intermittently to inj site & ibuprofen x4hr; pt still has malaise & pain in arm as of 8/25/99

VAERS ID:128077 (history)  Vaccinated:1999-08-28
Age:16.5  Onset:1999-08-28, Days after vaccination: 0
Gender:Female  Submitted:1999-08-31, Days after onset: 3
Location:Ohio  Entered:1999-09-07, 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: puncture wound lt foot
Preexisting Conditions: codine-muscle weakness; difficulty breathing
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4988034 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt had local red swelling 5x8 cm around area of inj

VAERS ID:128459 (history)  Vaccinated:1999-09-21
Age:16.3  Onset:1999-09-22, Days after vaccination: 1
Gender:Male  Submitted:1999-09-22, Days after onset: 0
Location:Michigan  Entered:1999-09-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none
Other Medications:
Current Illness:
Preexisting Conditions: strep pharyngitis week ago & on ATB
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.092151IM 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0010AA4IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: p/vax pt erythematous rash;no fever, no chills, no SOB, no angioedema, no sore throat;

VAERS ID:128575 (history)  Vaccinated:1999-09-11
Age:16.7  Onset:1999-09-11, Days after vaccination: 0
Gender:Female  Submitted:1999-09-15, Days after onset: 4
Location:Mississippi  Entered:1999-09-27, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2628A2  RA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES   RA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt arm area became red, swollen & painful

VAERS ID:128583 (history)  Vaccinated:1999-09-13
Age:16.5  Onset:1999-09-13, Days after vaccination: 0
Gender:Male  Submitted:1999-09-17, Days after onset: 4
Location:California  Entered:1999-09-27, 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: ulcers age 6-treated;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2962A20 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0541J1 RA
Administered by: Other     Purchased by: Other
Symptoms: Injection site oedema, Oedema peripheral, Pain, Paraesthesia
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: entire rt arm swelled from shoulder to fingers 12hr post vax aches;no local redness;no local warmth;taking advil;arm not swollen-has throbbing & tingling distal worse;

VAERS ID:128650 (history)  Vaccinated:1999-08-03
Age:16.2  Onset:1999-08-04, Days after vaccination: 1
Gender:Female  Submitted:1999-08-13, Days after onset: 9
Location:Alabama  Entered:1999-09-27, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: n/a
Other Medications: na
Current Illness: none
Preexisting Conditions: na
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Public     Purchased by: Other
Symptoms: Hypertonia, Injection site hypersensitivity, Injection site oedema, Injection site pain, Myalgia, Oedema peripheral, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: p/vax pt arm aching a lot w/swelling & redness; pain is worse in evening; redness & swelling noted w/warmth to the site & arm is stiff

VAERS ID:128756 (history)  Vaccinated:1999-08-25
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:1999-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none
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 BEECHAM2948A2 IMRA
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4998114 IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0311J SCLA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt exp varicella rash

VAERS ID:128785 (history)  Vaccinated:1995-10-17
Age:16.3  Onset:0000-00-00
Gender:Female  Submitted:1999-09-23
Location:Indiana  Entered:1999-09-30, 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: Hep b vax by Engerix lot# 1742A2 given 9/19/95;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS01495P0IMRA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM180A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Rash, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: w/in approx 2 wk began noticing purple spots approx 1cm on torso, arms, legs, feet turned purple @ times, especially when elevated;exp leg pain (muscular apparently) & listlessness;rash cont;

VAERS ID:128823 (history)  Vaccinated:1999-09-27
Age:16.8  Onset:1999-09-27, Days after vaccination: 0
Gender:Female  Submitted:1999-09-28, Days after onset: 1
Location:Kentucky  Entered:1999-10-01, 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: Tricyclin
Current Illness: NONE
Preexisting Conditions: hx asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0699J0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Hypertension, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt c/o itching & scattered red rash approx 2 1/2-3" diameter in upper aspect lt arm;no wheezes-no resp distress;color pink-alert/oriented x 3;skin cool-dry-BP 130/70;P62;

VAERS ID:128876 (history)  Vaccinated:1999-09-24
Age:16.9  Onset:1999-09-27, Days after vaccination: 3
Gender:Female  Submitted:1999-09-29, Days after onset: 2
Location:Iowa  Entered:1999-10-04, 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: 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.1055J0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: felt weak;nauseated;felt warm;

VAERS ID:129335 (history)  Vaccinated:1999-09-24
Age:16.7  Onset:1999-09-26, Days after vaccination: 2
Gender:Male  Submitted:1999-09-28, Days after onset: 2
Location:Louisiana  Entered:1999-10-13, 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: NONE
Diagnostic Lab Data:
CDC Split Type: LA991003
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3014A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chills, Headache, Hyperhidrosis, Myalgia, Pain, Tooth disorder, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: 1wk p/1st vax pt had h/a & toothache;feeling sore & tired;had 2nd HBV on 9/24/99 had n/v;9/28/99 stated started feeling nauseated;c/o cold sweats & feeling hot in AM;has not been to MD;

VAERS ID:129584 (history)  Vaccinated:1999-09-16
Age:16.8  Onset:1999-09-16, Days after vaccination: 0
Gender:Male  Submitted:1999-09-27, Days after onset: 11
Location:South Carolina  Entered:1999-10-20, Days after submission: 23
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: SC99059
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3092A90IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0792H1SC 
Administered by: Public     Purchased by: Public
Symptoms: Dry skin, Hypersensitivity, Pain, Rash, Rash maculo-papular, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: p/vax pt noticed a rash around neck-under a silver necklace-exp an inc in rash w/burning of skin;rash has weepy, scalded appearance;itchy;allergic type rxn;maculopapular rash that looks consistent w/allergy;

VAERS ID:129589 (history)  Vaccinated:1999-09-17
Age:16.2  Onset:1999-09-17, Days after vaccination: 0
Gender:Female  Submitted:1999-09-21, Days after onset: 4
Location:South Carolina  Entered:1999-10-20, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NA
CDC Split Type: SC99055
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3092A90 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1357H1 LA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: p/vax pt seen for facial rash & itching;no other s/s reported;child sent home w/instructions to take DPH over the week;

VAERS ID:130039 (history)  Vaccinated:1999-10-04
Age:16.1  Onset:1999-10-05, Days after vaccination: 1
Gender:Female  Submitted:1999-10-15, Days after onset: 10
Location:Michigan  Entered:1999-10-29, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MI99096
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2817A20IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7258BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Headache, Infection, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: p/vax pt devel severe h/a midafternoon;10/5/99 devel body aches (more severe back pain), nausea & fever;body aches;c/o weakness;viral infect;

VAERS ID:132581 (history)  Vaccinated:1999-11-22
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:1999-11-22
Location:Texas  Entered:1999-12-16, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3086AZ0IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09772200IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1011J0SCRA
Administered by: Public     Purchased by: Other
Symptoms: Convulsion, Hyperventilation, Hypotension, Pallor
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Approx. upon rec. vaccine TD, HepB and Varicella, patient went pale and convulsed for approx. 3 seconds - assisted to floor with legs elevated on chair. V/S 100/60 - 56 - 24 - Left clinic walking with pink skin color, alert and oriented.

VAERS ID:132098 (history)  Vaccinated:1999-10-15
Age:16.8  Onset:1999-10-15, Days after vaccination: 0
Gender:Female  Submitted:1999-10-25, Days after onset: 10
Location:Arizona  Entered:1999-12-28, Days after submission: 64
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: CBC,Chem 12,Ca,Mg=wnl; CT brain-negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3069A2 IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0124J IM 
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)
Write-up: 10/15/99:Pt had short generalized tonic clonic seizure after Hep B & MMR vax within sec.

VAERS ID:132140 (history)  Vaccinated:1999-11-18
Age:16.1  Onset:1999-11-18, Days after vaccination: 0
Gender:Male  Submitted:1999-11-29, Days after onset: 11
Location:Michigan  Entered:1999-12-28, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE (parent thinks child has ADHD-but not DR dx''d)
Diagnostic Lab Data: NONE
CDC Split Type: MI99134
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3024A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Injection site hypersensitivity, Pain, Rash maculo-papular, Similar reaction on previous exposure to drug
SMQs:, Angioedema (broad), Hypersensitivity (narrow)
Write-up: Had burning sensation in fingers,lft hand, immed. after HBV #2.This subsided until 7:30pm, a rash began at inject. site & spread to opposite arm, back & chest. Rash was raised,scattered all over,dull & red in color, felt like sand-paper.

VAERS ID:132149 (history)  Vaccinated:1999-11-01
Age:16.5  Onset:1999-11-01, Days after vaccination: 0
Gender:Male  Submitted:1999-11-17, Days after onset: 16
Location:Indiana  Entered:1999-12-28, 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: Prilosec
Current Illness: NONE
Preexisting Conditions: GERD
Diagnostic Lab Data: CBC, Chem, Bood culture was negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982250IMA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.18961H0IMA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.4630150IMA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Diarrhoea, Injection site hypersensitivity, Injection site mass, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt given Hep B and pneumonia vax on 11/1/99.Sent to ER on 11/4/99 w/ red,raised, cellulitis-like injection site.Pt also had increased temp at home,diarrhea,cold chills beginning on 11/1/99.

VAERS ID:132164 (history)  Vaccinated:1999-09-22
Age:16.0  Onset:1999-09-22, Days after vaccination: 0
Gender:Female  Submitted:1999-09-30, Days after onset: 8
Location:Pennsylvania  Entered:1999-12-28, Days after submission: 89
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: PA9989
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2933A20IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.N04923SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Pain, Pallor, Stupor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt lost color in her face,became faint & lost consciousness for 2-3 mins.; started within 30 sec. of receiving IPV. Pt was weak & semiconscious for 1 hr.; complained of pain & soreness in rt arm for 16 hrs.

VAERS ID:132772 (history)  Vaccinated:1999-12-08
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:1999-12-14
Location:California  Entered:1999-12-28, 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:
Current Illness: flu symptoms
Preexisting Conditions: RAD, rhinosinusitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2962A23IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4658960IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Lt upper arm w/ redness,induration, & pain 8cm x 8cm.

VAERS ID:132798 (history)  Vaccinated:1999-12-01
Age:16.0  Onset:1999-12-02, Days after vaccination: 1
Gender:Female  Submitted:1999-12-06, Days after onset: 4
Location:Idaho  Entered:1999-12-28, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tetracycline
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ID99050
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3069A21IMLA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM597A20IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt developed swelling of fingers, hives, & tight jaw 1 day after receiving Hep A #1 & Hep B #2.

VAERS ID:133116 (history)  Vaccinated:1999-10-26
Age:16.0  Onset:1999-10-27, Days after vaccination: 1
Gender:Female  Submitted:1999-11-30, Days after onset: 34
Location:South Carolina  Entered:2000-01-06, Days after submission: 37
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: SC99078
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3093D90IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0792H1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt states whelps & itching started approx 24 hrs after vaccines were given to her. Pt states symptoms lasted approx 1 hr. Also, states she took no medicines and did not receive medical attention.

VAERS ID:133382 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:2000-01-05
Gender:Male  Submitted:2000-01-12, Days after onset: 7
Location:Texas  Entered:2000-01-21, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CVC-nl, ESR-nl (0), CEP < 1
CDC Split Type:
Vaccination
Manufacturer
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hyperaesthesia, Oedema, Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pain, swelling, redness to distal L upper extremity & hand sweating. Hyperaesthesia, s/p vaccine x 2 in WE. Concerned about reflex sympathetic dystrophy. Referred to Neurologist. Possible surgery needed.

VAERS ID:133717 (history)  Vaccinated:1999-12-21
Age:16.5  Onset:1999-12-22, Days after vaccination: 1
Gender:Male  Submitted:2000-01-05, Days after onset: 14
Location:Michigan  Entered:2000-02-03, Days after submission: 29
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Seasonal allergies. 1 1/2 yrs ago had airway closed off - dx environmental allergies.
Diagnostic Lab Data: Platlet counts: 12/24=4000, 12/30=366,000, 1/3=256,000.
CDC Split Type: MI2000002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3093B91IMLA
Administered by: Public     Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Injection site hypersensitivity, Thrombocytopenic purpura, Tongue discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Massive bruising from top of L shoulder to above elbow & 1/2 around L arm. Possible dx-torn ligament. Bloody nose, purple spots on body and blk spots on tongue. Dx ITP.Tx w/ IV gammaglobulin.

VAERS ID:133808 (history)  Vaccinated:2000-01-26
Age:16.0  Onset:2000-01-28, Days after vaccination: 2
Gender:Male  Submitted:2000-02-05, Days after onset: 8
Location:New York  Entered:2000-02-08, 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:
Current Illness: Paraplegia Sp, T8, T9 Laminectomy
Preexisting Conditions: ? Latex, ? Ciprofoxacin, ? Kefzol
Diagnostic Lab Data: Chest Xray, Urine Screen both neg, WBC, Neutrophil , Mono
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982610IMRL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1482J0IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 1/28/00, 2:30am, Febrile 101.2, 4:00am, febrile to 103.2 & chills. 1/29/00, red welt (size of grapefruit), raised at site of 2 injections. Rx''d w/Tylenol, Benadryl po & cream to site. Redness fading by 1/31 & temp down & edema, quarter size

VAERS ID:133889 (history)  Vaccinated:1999-12-06
Age:16.0  Onset:1999-12-07, Days after vaccination: 1
Gender:Female  Submitted:1999-12-10, Days after onset: 3
Location:New York  Entered:2000-02-11, Days after submission: 63
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: NY99046
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1976H0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Had big red blotches, like water blisters, all over back, arms & neck. Felt warm & flushed. Went to ER & was given IV Benadryl & was told to rest. Got blotches again the next day & was told to take po Benadryl. Saw MD, more meds given.

VAERS ID:133923 (history)  Vaccinated:2000-02-01
Age:16.0  Onset:2000-02-01, Days after vaccination: 0
Gender:Female  Submitted:2000-02-02, Days after onset: 1
Location:Georgia  Entered:2000-02-15, 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: UNK
Current Illness: NONE
Preexisting Conditions: Allergic to seafood
Diagnostic Lab Data: UNK
CDC Split Type: GA00004
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2962A22IMRA
Administered by: Public     Purchased by: Other
Symptoms: Face oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt states lips started to swell 30 min post/vax, then had hives that evening on chest & both arms with itching. Pt saw MD & was given hydroxyzine. Lips less swollen, no hives but arms & chest still itchy. States she feels better.

VAERS ID:133924 (history)  Vaccinated:1999-12-14
Age:16.0  Onset:1999-12-14, Days after vaccination: 0
Gender:Male  Submitted:1999-12-15, Days after onset: 1
Location:Idaho  Entered:2000-02-15, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: ID99052
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3024A31IMRA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM594A91IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESP138220IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Headache, Hypoaesthesia, Injection site pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Coughing, injection site pain, fever, headache, numbness in L/hand after getting up in morning (abated by 9:00AM) on 12/15/99.

VAERS ID:133949 (history)  Vaccinated:2000-01-28
Age:16.0  Onset:2000-01-29, Days after vaccination: 1
Gender:Male  Submitted:2000-01-31, Days after onset: 2
Location:Tennessee  Entered:2000-02-15, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES465312 IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0540J1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Moderate local reaction of L/deltoid, within 24 hours, after injection. Deltoid warm, red and swollen.

VAERS ID:134262 (history)  Vaccinated:1999-11-01
Age:16.0  Onset:1999-11-01, Days after vaccination: 0
Gender:Male  Submitted:2000-02-18, Days after onset: 109
Location:New York  Entered:2000-02-29, 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:
Current Illness: none
Preexisting Conditions: Arthritis
Diagnostic Lab Data: Lyme serology & western blot were positive, MRI - possible torn meniscus.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Borrelia burgdorferi serology positive, Condition aggravated, Immunology test, Injury, Nuclear magnetic resonance imaging
SMQs:, Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Arthritis (narrow)
Write-up: Devel arthritis involving knee 12/97. Was treated and well until vax. Post vax, pt exp pain in knee without swelling and continues to do so. Per follow-up: Patient received vaccine in 11/99. Within one week, he experienced recurrence of knee pain accompanied by minimal swelling in his left knee. He had a history of L knee arthritis from 12/97 s/p amoxicillin.

VAERS ID:134316 (history)  Vaccinated:2000-01-03
Age:16.0  Onset:2000-01-07, Days after vaccination: 4
Gender:Male  Submitted:2000-01-10, Days after onset: 3
Location:California  Entered:2000-02-29, Days after submission: 50
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: CA000009
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3088A21IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.72721 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0914J1SCRA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4653151IMLA
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Post vax, measles like rash on face and neck. Also severe swelling of face to point pt unable to open eyes.

VAERS ID:134472 (history)  Vaccinated:1999-11-10
Age:16.0  Onset:1999-11-11, Days after vaccination: 1
Gender:Female  Submitted:2000-02-24, Days after onset: 105
Location:Michigan  Entered:2000-03-01, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0966J1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt states 1 1/2 days post vax, a rash was noted on hips and thighs bilaterally. Pt also experienced hives and itching which resolved in 4-5 days. Rash moved to lateral sides of body then elbows and knees then wrists and ankles. Rash on thighs cleared as the rash progressed or traveled.

VAERS ID:150032 (history)  Vaccinated:1999-09-01
Age:16.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:2000-03-08, Days after onset: 189
Location:Pennsylvania  Entered:2000-03-14, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Red dye allergy.
Diagnostic Lab Data:
CDC Split Type: WAES00030322
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Public     Purchased by: Other
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)
Write-up: Information has been received from the mother of the pt, who, subsequently, who experienced seizures and convulsions

VAERS ID:150052 (history)  Vaccinated:2000-01-27
Age:16.0  Onset:2000-01-27, Days after vaccination: 0
Gender:Female  Submitted:2000-01-31, Days after onset: 4
Location:Georgia  Entered:2000-03-14, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA00011
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3200B90IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt states fine tiny red rash Friday night on arms, legs and back - itchy, Use Benadryl cream, Also completely done by 01/31/00, Did not see MD

VAERS ID:150347 (history)  Vaccinated:2000-01-18
Age:16.0  Onset:2000-01-18, Days after vaccination: 0
Gender:Female  Submitted:2000-01-18, Days after onset: 0
Location:Hawaii  Entered:2000-03-23, Days after submission: 65
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: HI0001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2941A2 IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0930J SCRA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Dizziness, Dyskinesia, Eye movement disorder, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Immediately following vax, pt had a seizure-like episode. Arms were flailing above head, eyes rolled upward for about 5 seconds. Pt stood up right away and sat on chair, complained of dizziness, face, lips appeared pale. EMS was called and pt was taken to the ER. Parents were not available.

VAERS ID:150387 (history)  Vaccinated:2000-03-03
Age:16.0  Onset:2000-03-14, Days after vaccination: 11
Gender:Female  Submitted:2000-03-14, Days after onset: 0
Location:South Dakota  Entered:2000-03-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sores;Hep B (Engerix-B);1;16;In Patient
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 BEECHAM3201AZ2IM 
Administered by: Private     Purchased by: Public
Symptoms: Skin ulcer
SMQs:
Write-up: Breaking out with sores on arms, scab over and then go away.

VAERS ID:150478 (history)  Vaccinated:2000-02-14
Age:16.0  Onset:2000-02-25, Days after vaccination: 11
Gender:Female  Submitted:2000-03-22, Days after onset: 26
Location:Florida  Entered:2000-03-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Ct head, EEG, metabolic panel
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3204A22IMRA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES466250IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1455J0IMLA
Administered by: Private     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)
Write-up: Pt received vaccines on 2/14/00, and experienced a generalized seizure on 2/25/00. Pt''s mother states "shots caused the seizure".

VAERS ID:150565 (history)  Vaccinated:1999-09-15
Age:16.0  Onset:1999-09-22, Days after vaccination: 7
Gender:Male  Submitted:2000-01-19, Days after onset: 119
Location:Massachusetts  Entered:2000-03-29, Days after submission: 70
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: Bone scan
CDC Split Type: 19990267091
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IM 
Administered by: Private     Purchased by: Other
Symptoms: Fracture, Pain
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad)
Write-up: This is a spontaneous report from a physician and a mother referring to her 16 year old son. The pt received second "arm" dose of Lymerix in mid-September, 1999. One week, post vax, the pt experienced lower leg pain (inner calf and shin area) which was considered to be probable stress fractures. Lymerix was discontinued. The results of the bone scan show a local area of increased uptake in the right mid-shaft tibia, consistent with a healing stress fracture and a more diffuse pattern in the left tibia, consistent with medial tibial stress syndrome of shin splints. Dx is probable healed stress fracture right mid-shaft tibia. Physician stated that he was not sure that Lymerix had anything to do with the shin splints or stress fracture. He thought that this was more coincidental than causative. The most recent information, received on 10/25/99, reports the condition of the pt is unknown.

VAERS ID:150718 (history)  Vaccinated:2000-02-29
Age:16.0  Onset:2000-03-01, Days after vaccination: 1
Gender:Female  Submitted:2000-03-27, Days after onset: 26
Location:Delaware  Entered:2000-04-03, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI-nml, EKG-nml, Echocardiogram-nml, EEG-nml, CBC-nml, thyroid-nml, tilt table-epistaxis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1442J0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Epistaxis, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt experienced neurogenic syncope. Pt also experienced epistaxis lasting 15-20 mins but may last as long as one hour. Dizziness and syncope 3-4 times per week, pain on right lateral head preceding syncope occurring 5 time in 2 weeks.

VAERS ID:151705 (history)  Vaccinated:2000-02-29
Age:16.0  Onset:2000-03-01, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Maryland  Entered:2000-05-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Orthocyclen
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.180451IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Client reports on 03/01/2000, she broke out in hives on legs, trunk, and back one day post vax. No shortness of breath reported. She denies any reaction to the first vax in series. She states she did not notify health department of the reaction.

VAERS ID:152177 (history)  Vaccinated:1999-06-16
Age:16.0  Onset:1999-06-16, Days after vaccination: 0
Gender:Female  Submitted:2000-03-07, Days after onset: 265
Location:Pennsylvania  Entered:2000-05-19, Days after submission: 72
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: acne
Diagnostic Lab Data:
CDC Split Type: WAES99080005
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a licensed practical nurse concerning a 16 year old female with a hx of acne, who on 6/16/99 was vaccinated IM with Hep B. It was noted that the pt was on therapy with minocycline. On 6/16/99, immediately post vax, the pt developed hives and a rash that lasted for 3 days. Subsequently the pt recovered from the episodes. It was indicated that the pt sought an unspecified medical attention. No further information is available.

VAERS ID:152280 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2000-03-07
Location:New Jersey  Entered:2000-05-23, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unspecified;RECOMBIVAX HB; ;.00;In Sibling
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES99100684
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Headache
SMQs:
Write-up: Subsequently post vax, the pt experienced terrible headaches. The pt rarely went a day without a headache. The neurologist thought it might be migraines, but they never went away; she went to bed with a headache and woke up with a headache.

VAERS ID:152299 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:1998-08-23
Gender:Female  Submitted:2000-03-07, Days after onset: 562
Location:Massachusetts  Entered:2000-05-23, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: doxycycline, Cytotec, Relafen
Current Illness:
Preexisting Conditions: drug allergy, juvenile chronic arthritis, sulfa allergy
Diagnostic Lab Data:
CDC Split Type: WAES99102124
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Fatigue, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician concerning a 16 year old female who was vaccinated with Hep B vaccine. On approximately 8/23/98, the pt fainted. The pt was seen in the ER. On approximately 9/1/98 the pt experienced daily headaches, dizziness, and fatigue. A strep culture was negative on 9/4/98. Around the end of September 1998, the pt recovered.

VAERS ID:152735 (history)  Vaccinated:2000-01-26
Age:16.0  Onset:2000-01-27, Days after vaccination: 1
Gender:Male  Submitted:2000-06-01, Days after onset: 125
Location:New York  Entered:2000-06-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES00052387
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998261 IMRL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1102J  RL
Administered by: Public     Purchased by: Public
Symptoms: Injection site urticaria, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: On 1/26/00, the pt experienced a grapefruit sized welt at the injection site. On 1/27/00, the pt developed a 101 fever that the reporter felt may be due to influenza virus vaccine. The pt was treated with Benadryl by mouth and cream and ice packs were applied to the welt. Follow-up information from a registered pharmacist indicated that approximately 2 weeks post onset the pt recovered. The pt had been in a 6 week rehab program and the welt at the site of injection did not prolong his stay. The pharmacist stated that the main obstacle in determining what caused the reaction was that the pt had received both the pneumococcal and influenza vax in the same arm.

VAERS ID:152880 (history)  Vaccinated:2000-04-05
Age:16.0  Onset:2000-04-05, Days after vaccination: 0
Gender:Male  Submitted:2000-04-24, Days after onset: 19
Location:Pennsylvania  Entered:2000-06-08, Days after submission: 45
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1660J1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0010AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt experienced mild lightheadedness and nausea for 5-10 minutes. The pt was instructed to lie flat on back with cold compress applied to forehead. Symptoms occurred immediately post administering of MMR.

VAERS ID:152884 (history)  Vaccinated:2000-04-04
Age:16.0  Onset:2000-04-04, Days after vaccination: 0
Gender:Male  Submitted:2000-04-24, Days after onset: 20
Location:Pennsylvania  Entered:2000-06-08, Days after submission: 45
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
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1947J0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1660J1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESUOO10AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cold sweat, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt immediately became lightheaded post administating MMR, Pt was cold & skin was clammy. Pt was instructed to lie on back, cold compresses was applied to neck & face. Pulse & BP were monitored Pt has symptoms X 10 minutes

VAERS ID:152923 (history)  Vaccinated:2000-03-29
Age:16.0  Onset:2000-03-29, Days after vaccination: 0
Gender:Male  Submitted:2000-03-29, Days after onset: 0
Location:Florida  Entered:2000-06-08, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD (Connaught - 250711)
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: FL00012
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1390J IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P1232 SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0935J SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7341AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The pt fainted and had a seizure then recovered. The pt was examined by MD. The event lasted about 2 minutes.

VAERS ID:153036 (history)  Vaccinated:2000-04-19
Age:16.0  Onset:2000-04-27, Days after vaccination: 8
Gender:Female  Submitted:2000-05-05, Days after onset: 8
Location:Tennessee  Entered:2000-06-08, Days after submission: 34
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1715J1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Migraine, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: 8 day post vax, mother phoned to report daughter had a migraine headache with nausea and vomiting and severe vertigo. Has seen MD, to see Neurologist. Migraine and nausea and vomiting improved but still complaining of vertigo.

VAERS ID:153103 (history)  Vaccinated:2000-04-05
Age:16.0  Onset:2000-04-05, Days after vaccination: 0
Gender:Female  Submitted:2000-04-10, Days after onset: 5
Location:Texas  Entered:2000-06-08, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor
Current Illness: NONE
Preexisting Conditions: allergy to sulfa
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3230090IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09787700IMRA
Administered by: Other     Purchased by: Public
Symptoms: Pruritus, Rash, Skin nodule
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Within 2 hours of receiving vax, the pt broke out with bumps on arms. By the next day the pt had a rash and was itching all over most of body. Saw an MD on 4/6/00 and was told allergic to either TD or Hep B. The pt was given Allegra and steroids. To get further Hep B at MD''s office.

VAERS ID:153304 (history)  Vaccinated:1998-11-23
Age:16.0  Onset:1998-11-23, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Louisiana  Entered:2000-06-09
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: LA000501
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0987H0IM 
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: About 1 hour, post vax, pt complained of difficult and painful respirations. Went in a office MD after shot. Seen doctor on 6/10/99 and dx''d as a reaction to vaccine. Just advised pr MD of this on 4/26/00.

VAERS ID:153329 (history)  Vaccinated:2000-05-03
Age:16.0  Onset:2000-05-04, Days after vaccination: 1
Gender:Female  Submitted:2000-05-09, Days after onset: 5
Location:Illinois  Entered:2000-06-09, Days after submission: 31
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: Pt has multiple contact allergies.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM649A20IMLA
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Headache, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: On 5/4/00 at 18:00, pt began itching and broke out all over her body with hives. Hives remain. Pt stated she was dizzy for 2 days following the injection and had a headache. Pt was referred to physician.

VAERS ID:153446 (history)  Vaccinated:2000-05-14
Age:16.0  Onset:2000-05-15, Days after vaccination: 1
Gender:Male  Submitted:2000-05-17, Days after onset: 2
Location:Michigan  Entered:2000-06-09, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Laceration hand
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES470536 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Infection, Injection site erythema, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Fever to 38C and had 6.5cm X 11cm area of erythema overlying injection site. Axillary lymphadenopathy. ? infection versus vaccine reaction. Treated with antibiotics.

VAERS ID:153546 (history)  Vaccinated:2000-04-20
Age:16.0  Onset:2000-04-21, Days after vaccination: 1
Gender:Female  Submitted:2000-05-12, Days after onset: 21
Location:Washington  Entered:2000-06-09, 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: Claritin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7302845IMRA
Administered by: Private     Purchased by: Public
Symptoms: Aphasia, Cough, Dyspnoea, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: About 12-15 hours, post vax, child started coughing type problem, by 24 hours later, could not talk, breathing was a whistling sound. Hyperventilation was in progress. Lungs clear but breathing was obstructed.

VAERS ID:153614 (history)  Vaccinated:2000-03-17
Age:16.0  Onset:2000-03-17, Days after vaccination: 0
Gender:Female  Submitted:2000-03-17, Days after onset: 0
Location:Arkansas  Entered:2000-06-09, Days after submission: 83
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: AR0010
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1778H0IMLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4653174IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0293J0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Coma, Eye movement disorder, Musculoskeletal stiffness, Pallor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Within 5 min. or less, post vax, pt drawed up right fist and became stiff. Eyes rolled back, pt very pale and became unconscious for 3-4 seconds. B/P 104/60, mom to report back. Pt left alert after 10-15 min.

VAERS ID:153689 (history)  Vaccinated:2000-01-07
Age:16.0  Onset:2000-01-07, Days after vaccination: 0
Gender:Female  Submitted:2000-01-10, Days after onset: 3
Location:Tennessee  Entered:2000-06-09, Days after submission: 150
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: TN00001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.MEDE30899LA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A few hours post vax, pt broke out with a "whelpy rash" on face and trunk. No difficulty breathing, wheezing, weakness or dizziness. Mother gave 50mg Benadryl. Symptoms gone by the next morning.

VAERS ID:153725 (history)  Vaccinated:2000-05-24
Age:16.0  Onset:2000-05-24, Days after vaccination: 0
Gender:Female  Submitted:2000-05-24, Days after onset: 0
Location:Kentucky  Entered:2000-06-09, 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: cephalexin, Excedrin and ibuprofen, Depo-Provera
Current Illness: Inflammed knees
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: KY2000016
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0847J1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness at site shortly post vax, complaint of itching, swelling and pain at site. Redness extended down to antecubital. Benadryl given and ice.

VAERS ID:153853 (history)  Vaccinated:2000-06-05
Age:16.0  Onset:2000-06-05, Days after vaccination: 0
Gender:Female  Submitted:2000-06-05, Days after onset: 0
Location:New York  Entered:2000-06-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mantoux/Pasteur-Merieux/C0016AA/SC/LFA/1 previously
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1982H1IMLA
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49980914IMRA
Administered by: Private     Purchased by: Private
Symptoms: Coma, Convulsion, Muscle rigidity
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Petite mal seizure after vax. Rigid body, moaning, unresponsive total time 4 min from unresponsive to full alertness. Transfer to ER.

VAERS ID:154301 (history)  Vaccinated:1999-11-01
Age:16.0  Onset:1999-11-04, Days after vaccination: 3
Gender:Unknown  Submitted:1999-11-22, Days after onset: 18
Location:Alabama  Entered:2000-06-15, Days after submission: 205
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ5926217NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4623570IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Within a few days post vax, pt developed an injection site reaction characterized by a brawny induration and swelling. Pt was treated with Augmentin and as of 11/11/1999 the symptoms were resolving.

VAERS ID:154403 (history)  Vaccinated:1999-06-25
Age:16.0  Onset:1999-06-25, Days after vaccination: 0
Gender:Female  Submitted:1999-09-29, Days after onset: 96
Location:Massachusetts  Entered:2000-06-15, Days after submission: 260
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 19990177931
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Influenza like illness, Malaise, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad)
Write-up: Two hours post vax, the pt experienced flu-like symptoms, joint pain, malaise, shakiness, chills, and a fever of 101. Tylenol was given and Lymerix was discontinued.

VAERS ID:155037 (history)  Vaccinated:1998-10-12
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2000-05-24
Location:Alaska  Entered:2000-06-21, 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: vitamins
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: ultrasound-pregnant
CDC Split Type: WAES98100923
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: The pt received vax 22 weeks after LMP. An ultrasound confirmed pregnancy. The pt sought unspecified medical attention. She took prenatal vitamins during the pregnancy. A targeted fetal survey at 25 weeks from LMP was unremarkable, however fluid was increased. There were no pregnancy complications. On 2/16/99, the pt gave birth to a normal healthy female.

VAERS ID:155207 (history)  Vaccinated:2000-06-08
Age:16.0  Onset:2000-06-08, Days after vaccination: 0
Gender:Female  Submitted:2000-06-08, Days after onset: 0
Location:South Carolina  Entered:2000-06-22, 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: Allergy amoxicillin
Diagnostic Lab Data:
CDC Split Type: SC00034
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3204A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1357H1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0011AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Dizziness, Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Post vax, at about 10:58, pt stood up, color pale, diaphoretic and stated that she felt dizzy and couldn''t hear nurse speaking to her but sat down and reclined. BP 80/50; P-88; R-16. At 11:05 her P-80; R-16 and BP 75/50 lying down. She was complaining of abdominal cramps. At 11:15, BP 100/58; P-72; R-16. Abdominal cramps improved. At 11:25, BP 110/68; P-76; R-16; skin was warm and dry, lips pink. Attempted to phone pt''s mom x 2 at home and at work but unable to reach her. Friend and nurse remain with pt. At 11:35, she is feeling better, alert and ambulatory. Stated that she feels well enough to leave with friend. Advised to seek medical care if condition worsens and to call health dept or doctor with questions. At 11:40, she was discharged alert and ambulatory without complaints accompanied by friend.

VAERS ID:155537 (history)  Vaccinated:1999-03-19
Age:16.0  Onset:1999-03-19, Days after vaccination: 0
Gender:Female  Submitted:1999-04-15, Days after onset: 26
Location:California  Entered:2000-06-28, Days after submission: 440
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: Allergies: soybean and yeast.
Diagnostic Lab Data:
CDC Split Type: U1999001800
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0977220   
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site reaction, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: The same day post vax, this pt experienced nausea and vomiting, headache, and malaise within 2 hours post vax. She also experienced a large local reaction the next day. She reportedly recovered.

VAERS ID:155569 (history)  Vaccinated:1999-07-22
Age:16.0  Onset:1999-08-06, Days after vaccination: 15
Gender:Male  Submitted:1999-10-05, Days after onset: 60
Location:New York  Entered:2000-06-28, Days after submission: 267
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: U1999005620
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7301BA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: It was reported that a 16 year old male received TD Adult vaccine on 7/22/99. Reportedly, on 8/6/99, the pt returned to the office with a generalized urticarial reaction most extensive on legs. From additional information received on 9/23/99, additional physician information was provided.

VAERS ID:155610 (history)  Vaccinated:2000-04-13
Age:16.0  Onset:2000-04-14, Days after vaccination: 1
Gender:Male  Submitted:2000-05-15, Days after onset: 31
Location:Georgia  Entered:2000-06-28, Days after submission: 44
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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: WBC - 275000, ESR - 48, SGPT - 54, ESR (repeat) - 87, WBC (repeat) - 18200, HCT - 43.2, Platelets - 308000, CMP - nml, LDH - elevated, uric acid - 7.6 (elevated), ANA - neg, ASO - 86 (low), blood culture - neg, ultrasound abdomen
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2962A20IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0953J0IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0011AA6IMLA
Administered by: Private     Purchased by: Private
Symptoms: Alanine aminotransferase increased, Arthralgia, Blood disorder, Blood lactate dehydrogenase increased, Blood uric acid increased, Night sweats, Pyrexia, Red blood cell sedimentation rate increased, Serum sickness, Upper respiratory tract infection, Urticaria, Vomiting, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tumour lysis syndrome (broad)
Write-up: The pt received his vaccines on 4/13/00 and returned to the MD''s office on 4/17/00 with an urticarial rash, and was placed on Benadryl and Prednisone. He returned to the office on 4/18/00 at which time there was no rash, but he now had arthralgias of his knees, hips, elbows and shoulders. He was diagnosed with serum sickness and increased his Prednisone and added Ibuprofen. On 4/20/00 his joints were normal, but he again had urticaria. Meds were continued. On 4/22/00 the Prednisone was discontinued and on 4/24/00 he developed joint pain. The Prednisone was resumed. On 4/25/00 an urticarial rash was still present but his joint exam was normal. Prednisone will be tapered off over the next 3-4 days. By 5/12/00 the pt had developed a fever, vomiting and night sweats, URI symptoms. The pt is having further evaluation by another MD. At this time it is not clear whether his medical problems were caused by any of the vaccines.

VAERS ID:155628 (history)  Vaccinated:2000-06-19
Age:16.0  Onset:2000-06-19, Days after vaccination: 0
Gender:Female  Submitted:2000-06-19, Days after onset: 0
Location:Louisiana  Entered:2000-06-28, 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
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3230B90IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0101K1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Hyperhidrosis, Pallor, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The pt became very faint, pale, diaphoretic, tachycardic. This episode lasted approximately 3-5 minutes.

VAERS ID:155671 (history)  Vaccinated:2000-02-21
Age:16.0  Onset:2000-02-23, Days after vaccination: 2
Gender:Female  Submitted:2000-03-03, Days after onset: 9
Location:Arizona  Entered:2000-06-28, Days after submission: 116
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: U2000001170
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3082A4 IM 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0977220 IM 
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: On 2/23/00, the pt experienced numbness and tingling in her face. A physician did not evaluate her.

VAERS ID:156043 (history)  Vaccinated:2000-06-26
Age:16.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-27, Days after onset: 0
Location:New Jersey  Entered:2000-07-05, 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:
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)CONNAUGHT LABORATORIESU0072AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Back pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 8 hours post vax pt developed a temperature of 101; severe abdominal pain; back pain; shoulder pain; and nausea.

VAERS ID:156278 (history)  Vaccinated:2000-05-05
Age:16.0  Onset:2000-05-05, Days after vaccination: 0
Gender:Male  Submitted:2000-05-05, Days after onset: 0
Location:California  Entered:2000-07-11, Days after submission: 67
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: UNK
Diagnostic Lab Data: NONE
CDC Split Type: CA000062
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1949J IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1325J SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0072AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt felt nauseated, dizzy and looked pale.

VAERS ID:156376 (history)  Vaccinated:2000-05-22
Age:16.0  Onset:2000-05-22, Days after vaccination: 0
Gender:Male  Submitted:2000-07-01, Days after onset: 40
Location:Wisconsin  Entered:2000-07-12, 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: Monodox
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY144B91IMRA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Injection site erythema, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: Received 2nd dose of Lymes vaccine and within an hour, developed fever, chills, malaise, dizziness and he felt like he would faint. This lasted until around 08:00 the next morning. Also, had redness around area of injection.

VAERS ID:156483 (history)  Vaccinated:2000-05-17
Age:16.0  Onset:2000-05-17, Days after vaccination: 0
Gender:Female  Submitted:2000-05-31, Days after onset: 14
Location:Washington  Entered:2000-07-13, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WA001662
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0147K2IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0099K0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0917J1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site vesicles
SMQs:
Write-up: One minute post vax pt reported fluid filled vesicle near injection site; pt given diphenydramine; pt and vesicle were assessed; applied ice to injection site; reaction resolved.

VAERS ID:157300 (history)  Vaccinated:1996-04-24
Age:16.0  Onset:1999-07-20, Days after vaccination: 1182
Gender:Female  Submitted:2000-05-16, Days after onset: 301
Location:Texas  Entered:2000-07-19, Days after submission: 64
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:
CDC Split Type: WAES99071931
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Subsequent to receiving one dose of varicella virus vaccine live the pts varicella zoster virus IgG antibody was less than 10 ETA units which is indicative of a low titer. Consequently the pt received a second dose of varicella virus vaccine live.

VAERS ID:157529 (history)  Vaccinated:1999-08-11
Age:16.0  Onset:1999-08-15, Days after vaccination: 4
Gender:Female  Submitted:2000-05-16, Days after onset: 275
Location:Florida  Entered:2000-07-19, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfatrim
Current Illness: UTI, allergic rhinitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES99082088
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0IM 
Administered by: Private     Purchased by: Public
Symptoms: Rash morbilliform
SMQs:, Hypersensitivity (narrow)
Write-up: On 8/15/99, the pt experienced a very faint morbilliform rash that began on her arms and upper neck. The rash was not pruritic initially but the next day did become pruritic, however, the pt did note that she had been out in the sun that day. Additionally, it was noted that the pt had just finished a course of Sulfatrim for a UTI. On 8/27/99, the rash had spread to the pt''s face, arm, feet, and neck and was pruritic. The physician dx the condition as an allergic reaction and stated the rash is not varicella like, however, not sure which agent caused it. The pt was treated with Atarax. On 8/31/99, the pt recovered. No further information is available.

VAERS ID:158114 (history)  Vaccinated:2000-05-24
Age:16.0  Onset:2000-05-27, Days after vaccination: 3
Gender:Male  Submitted:2000-06-13, Days after onset: 17
Location:New York  Entered:2000-07-28, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu-like symptoms, pain at injection site;LYMERIX;2;15.00;In Patient
Other Medications: minocycline
Current Illness: Acne
Preexisting Conditions: Acne
Diagnostic Lab Data:
CDC Split Type: 20000174621
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 2IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Malaise, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: In 4/99, the pt received his 1st dose of Lymerix. 24 hours, post vax, he experienced pain at the injection site, then flu-like symptoms. He had a low-grade fever which lasted 3 days. Outcome:resolved. In 5/99, the pt received his 2nd dose of Lymerix. 24 hours, post vax, he experienced pain at the injection site and flu-like symptoms. Symptoms lasted 24 hours and then resolved. On 5/24/00, the pt received his 3rd dose of Lymerix. 3 days later, on 5/27/00, he experienced pain at the injection site, and did not feel well. The pt felt "achey". Additionally, he developed a tiny, red, flat rash behind one ear. On 5/29/00, the rash spread around his back, behind both ears, and down his back and chest. No treatment was given. Outcome: unresolved. The most recent information, received on 5/30/00, reports the condition of the vaccinee as unresolved.

VAERS ID:158219 (history)  Vaccinated:1999-05-11
Age:16.0  Onset:1999-05-11, Days after vaccination: 0
Gender:Male  Submitted:1999-05-14, Days after onset: 3
Location:Florida  Entered:2000-08-01, Days after submission: 445
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: FL99048
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1605H0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1183H1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0009671000IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Dyspnoea, Eye oedema, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: At 16:10, pt complains of coughing and itching and edema under each eye. Pt received epinefrine. At 16:20, he started having difficulty breathing. EMS notified, was given Benadryl IM and EMS arrived at 16:25 and assisted then took client to ER. On 5/12/99, client was contacted, mom stated pt had returned to school. Pt received cortisone and Benadryl in the ER.

VAERS ID:158250 (history)  Vaccinated:1999-11-18
Age:16.0  Onset:1999-11-25, Days after vaccination: 7
Gender:Male  Submitted:2000-07-24, Days after onset: 241
Location:New Jersey  Entered:2000-08-02, Days after submission: 9
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ceftin
Current Illness:
Preexisting Conditions: gradually worsening encephalitis, asthma, seasonal allergies
Diagnostic Lab Data: B/P-150/85-170/95, heart rate-95-110
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Anxiety, Cognitive disorder, Depression, Disturbance in attention, Encephalitis, Eye pain, Fatigue, Gastrointestinal disorder, Headache, Hypoglycaemia, Memory impairment, Vertigo
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (narrow)
Write-up: One week after 1st shot, the pt developed head and eye pain. He also had severe head pain, vertigo, extreme fatigue, bowel mucus; no stool. With each shot after 1st, the got worse. He is currently undergoing gammaglobulin treatments for the next 6 months. On 60-Day FU his gammaglobulin treatments have been doubled. Still out of school with memory problems, concentration issues, head and eye discomfort, as well as stomach problems. The annual follow-up states,"Patient is left with significant memory and cognitive impairment from the encephalitis that he suffered as a result of receiving the hep b vaccine. He''s taking Valtrex (to control viruses present in his blood stream), Paxil (to control depression and anxiety), Allegra (to control allergies that came on after he went off gamma-globulin treatments). He is also on a diabetic diet because he has become hypoglycemic. (The doctor feels it''s another result of the brain damage, and he is still chronically fatigued. Therefore, struggling to maintain a normal life style. All of us around patient are also struggling for normality." A follow up report received 8/3/2000 adds: Spoke to mother of pt - her son has been diagnosed with immuno-encephalitis and is being treated with gammaglobulin. Tx''s 1x month x 6 months. Additional symptoms - dizziness, lack of concentration, irritability - eye pain is occasional, headaches come and go-more before each Tx. Diagnosis not confirmed until 5/2000.

VAERS ID:158297 (history)  Vaccinated:2000-01-29
Age:16.0  Onset:2000-04-15, Days after vaccination: 77
Gender:Male  Submitted:2000-05-26, Days after onset: 41
Location:California  Entered:2000-08-02, Days after submission: 68
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA000070
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49983045IMRA
Administered by: Private     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Post vax, the pt''s parents felt a bubble in his right arm, which ruptured and 3 days later he felt a bump which kept on growing.

VAERS ID:158327 (history)  Vaccinated:1999-09-08
Age:16.0  Onset:1999-09-08, Days after vaccination: 0
Gender:Female  Submitted:1999-09-10, Days after onset: 2
Location:Unknown  Entered:2000-08-02, Days after submission: 327
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0349N1SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0779D1PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09507401IMRA
Administered by: Other     Purchased by: Other
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: The pt experienced nausea.

VAERS ID:158384 (history)  Vaccinated:2000-07-01
Age:16.0  Onset:2000-07-24, Days after vaccination: 23
Gender:Male  Submitted:2000-08-02, Days after onset: 9
Location:Unknown  Entered:2000-08-03, 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: UNK
Current Illness: head wound
Preexisting Conditions: UNK
Diagnostic Lab Data: blood creatinine-3.3, blood urea-26
CDC Split Type: HQ9255901AUG2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Other
Symptoms: Blood creatinine increased, Haematuria, Malaise, Nausea, Polyuria, Renal failure acute
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad)
Write-up: On 7/24/00, the pt developed polyuria. On 7/25/00, he developed hematuria. He also experienced nausea and malaise. A dx of acute renal failure was made.

VAERS ID:158403 (history)  Vaccinated:1999-07-01
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:2000-08-02
Location:Connecticut  Entered:2000-08-04, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000228431
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Disturbance in attention
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad)
Write-up: In the spring of 2000, the pt experienced finger joint, wrist, and elbow pain. His concentration began to decrease and his grades fell.

VAERS ID:158464 (history)  Vaccinated:2000-05-27
Age:16.0  Onset:2000-06-14, Days after vaccination: 18
Gender:Female  Submitted:2000-08-03, Days after onset: 50
Location:Unknown  Entered:2000-08-07, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lyme disease (1996)
Diagnostic Lab Data: ESR-elevated, AST-223, ALT-388, LDL-262, DNA antibody (both single and double stranded)-pos.
CDC Split Type: 2000022416
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM2152743IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Arthralgia, Aspartate aminotransferase increased, Insomnia, Joint swelling, Low density lipoprotein increased, Red blood cell sedimentation rate increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Dyslipidaemia (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 18 days post vax, the subject reported generalized joint pain with swelling and slight redness in the joints. She had trouble sleeping, but no rash, respiratory or gastrointestinal symptoms. She was seen in an ER and treated with ibuprofen and Naprosyn. The follow up states the subject had a history of typical expanding erythema chronicum migrans lesion on 6/7/96 for which she was treated with doxycycline 100mg twice daily for three weeks, successfully. The subject''s previously participated in study, receiving LYMErix on 7/1/98, 8/6/98 and 7/1/99. On 10/16/99, the subject complained of joint pains, fatigue, and of "not feeling well" for "weeks or months." Examination revealed tender joints including both elbows, both wrists, multiple interphalangeal and metacarpal-phalangeal joints and both knees. Her left wrist was particularly tender and warm to the touch, although not swollen or red. Laboratory tests included a nmal erythrocyte sedimentation rate (ESR) of 14; a negative rheumatoid facotr. Antinuclear antibody (ANA) titer of 1:150 in a diffuse pattern, and a positive Lyme ELISA with a western blot consistent with prior immunization. Immunoglobulin G 31 and 41kD bands were present. There were two immunoglobulin bands of doubtful significance. The subject was treated with sulindac for symptomatic relief. The subject was seen by another physician for consultation. Further tests showed mild anemia, minor elevations of liver function tests AST, ALT and parovirus B19 titers, which revealed a positive IgG and negative IgM consistent with her prior hisotry of fifth disease. The sbuject received a booster dose of LYMEri on 5/27/00. On 6/14/00, 18 days after receiving the booster dose of study vaccine, the subject reported generalized joint pain with swelling and slight redness joints. She had trouble sleeping, but no rash, respiratory or gastrointestinal symptoms. She was seen in an ER, and was treated with Advil and Naprosyn. Lab results included an elevated ESH of 34, AST 223, ALT 386, LDL 262, negative rheumatoid fac

VAERS ID:158788 (history)  Vaccinated:2000-07-14
Age:16.0  Onset:2000-07-14, Days after vaccination: 0
Gender:Female  Submitted:2000-07-19, Days after onset: 5
Location:South Carolina  Entered:2000-08-14, 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: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: SC00040
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1023J0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1272J1SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0072AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Face oedema, Hypoaesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Mom called back about 3-4 hours, post vax, stating pt was complaining of facial numbness and mild swelling. No rash or respiratory distress per mom''s report. Advised to give pt Benadryl and see PMD if no relief or improvement in 30-40 minutes or go to ER if she has any respiratory distress. Called on 7/18/00 and pt stated Benadryl was effective and had no further problems.

VAERS ID:159170 (history)  Vaccinated:2000-08-21
Age:16.0  Onset:2000-08-21, Days after vaccination: 0
Gender:Female  Submitted:2000-08-23, Days after onset: 2
Location:Florida  Entered:2000-08-28, 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: BCP
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.0152K IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0176K SC 
TTOX: TETANUS TOXOID (NO BRAND NAME)LEDERLE LABORATORIES4171638 IM 
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Dyspnoea, Heart rate increased, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The pt experienced shortness of breath, difficulty breathing, weakness, passed out, very shaky and dizziness. Fast heart beat, have very scary feeling throughout whole body. Was in ER from 6:30 - 11:00 PM.

VAERS ID:159215 (history)  Vaccinated:1999-07-07
Age:16.0  Onset:1999-07-14, Days after vaccination: 7
Gender:Male  Submitted:2000-08-25, Days after onset: 408
Location:Georgia  Entered:2000-08-29, 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: Luvox
Current Illness:
Preexisting Conditions: obsessive compulsive disorder
Diagnostic Lab Data: ELISA test-positive
CDC Split Type: 20000252351
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY128A21IMLA
Administered by: Public     Purchased by: Private
Symptoms: Fatigue, Infection, Laboratory test abnormal, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: One week post vax, the vaccinee experienced swelling in injected arm, elbow swelling, pain, and fatigue. Initially, cancer was suspected and the vaccinee was referred to an oncologist. The oncologist believed these symptoms were related to vax. Unspecified treatment was given. Testing indicated positive results for Lyme disease.

VAERS ID:159296 (history)  Vaccinated:2000-08-24
Age:16.0  Onset:2000-08-25, Days after vaccination: 1
Gender:Female  Submitted:2000-08-25, Days after onset: 0
Location:Pennsylvania  Entered:2000-08-29, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Sulfa, Ceclor
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5100A20IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 10-12 hours post vax pt awoke with fever and nausea. Temperature 107.8 for a duration of 4-6 hours. No diarrhea. Pt felt better with no other symptoms.

VAERS ID:159429 (history)  Vaccinated:2000-03-08
Age:16.0  Onset:2000-03-08, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2000-09-07
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 42 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: sinus infection
Preexisting Conditions: esophageal reflux, irritable bowel syndrome, pollen/mold allergies, asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0989580   
Administered by: Public     Purchased by: Private
Symptoms: Systemic lupus erythematosus
SMQs:, Systemic lupus erythematosus (narrow)
Write-up: Pt developed lupus SLE.

VAERS ID:159824 (history)  Vaccinated:2000-07-18
Age:16.0  Onset:2000-07-18, Days after vaccination: 0
Gender:Male  Submitted:2000-07-19, Days after onset: 1
Location:Georgia  Entered:2000-09-15, Days after submission: 58
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: allergy to PCN
Diagnostic Lab Data: NONE
CDC Split Type: GA00086
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1821J0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Stomach discomfort, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Same day post vax, the pt began to have an upset stomach. The next day, the pt vomited at noon and again about 2 pm. He also had a low grade fever.

VAERS ID:159830 (history)  Vaccinated:2000-08-18
Age:16.0  Onset:2000-08-18, Days after vaccination: 0
Gender:Female  Submitted:2000-08-18, Days after onset: 0
Location:Georgia  Entered:2000-09-15, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: BP-80/60
CDC Split Type: GA00092
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3329A20IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0055AA4IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0521K1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure decreased, Cold sweat, Dizziness, Flushing, Nausea, Pallor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Pt had cold hands, pale skin, nausea, diaphoresis, dizziness, and face flush.

VAERS ID:159889 (history)  Vaccinated:2000-09-10
Age:16.0  Onset:2000-09-11, Days after vaccination: 1
Gender:Female  Submitted:2000-09-13, Days after onset: 2
Location:Minnesota  Entered:2000-09-19, 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: Allegra
Current Illness:
Preexisting Conditions: sinus symptoms
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3199091IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Upon awakening 9/11/2000, noticed a rash on chest stomach back and under arms, was red itchy it raised. She took Benadryl, symptoms a little better in am. Took no more Benadryl as had school. She saw MD and was started on Zantac, uses Benadryl PRN. She states hair is gone around injection site.

VAERS ID:159906 (history)  Vaccinated:2000-08-29
Age:16.0  Onset:2000-08-29, Days after vaccination: 0
Gender:Female  Submitted:2000-09-08, Days after onset: 10
Location:Washington  Entered:2000-09-19, 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: NONE
Diagnostic Lab Data:
CDC Split Type: WA001674
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1739J0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site hypersensitivity, Pain
SMQs:, Hypersensitivity (narrow)
Write-up: L deltoid with redness, warm to touch. Pain radiating from shoulder to elbow increased pain in am . Aches all day long. Getting worse and more painful since vax, it has been 10 days since vax.

VAERS ID:159972 (history)  Vaccinated:2000-09-11
Age:16.0  Onset:2000-09-11, Days after vaccination: 0
Gender:Female  Submitted:2000-09-20, Days after onset: 9
Location:New Jersey  Entered:2000-09-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1161K1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES60267AA4IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt experienced a tender and swollen area at the injection site.

VAERS ID:160455 (history)  Vaccinated:2000-09-22
Age:16.0  Onset:2000-09-22, Days after vaccination: 0
Gender:Female  Submitted:2000-09-27, Days after onset: 5
Location:Florida  Entered:2000-10-11, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unspecified reaction;UNK. HEPATITIS B;1;16.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: FL00039
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0150K1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Client noted redness with hives on both sides of face, with redness. Same radiated to neck and side of left arm. Treated with Benadryl X 2 days, given by child''s mother.

VAERS ID:160459 (history)  Vaccinated:2000-08-09
Age:16.0  Onset:2000-08-09, Days after vaccination: 0
Gender:Female  Submitted:2000-08-09, Days after onset: 0
Location:Tennessee  Entered:2000-10-11, Days after submission: 63
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: 10:45 BP-98/68 P-100; 10:54 BP 90/60 P-88; 10:52 BP-90/60 P-100
CDC Split Type: TN00034
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0132J1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure decreased, Chills, Dizziness, Heart rate increased, Hypoaesthesia, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt became dizzy, nauseated immediately, post vax. O2 began SC/mask. Pt then complained of chills and hands numb. Benadryl/IM was given. EMS notified and transported to ER.

VAERS ID:160467 (history)  Vaccinated:2000-08-02
Age:16.0  Onset:2000-08-03, Days after vaccination: 1
Gender:Female  Submitted:2000-08-04, Days after onset: 1
Location:Georgia  Entered:2000-10-11, Days after submission: 68
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: GA00097
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0078K0SCRA
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: Varicella shot given on 8/2/00. Call today from pt complaining of red, swollen right arm "where I got the chickenpox shot on Wednesday". Taking Tylenol 2 every 4 hours. Denies fever and no complaint of increased warmth to right arm.

VAERS ID:160701 (history)  Vaccinated:2000-09-13
Age:16.0  Onset:2000-10-04, Days after vaccination: 21
Gender:Female  Submitted:2000-10-10, Days after onset: 6
Location:New Jersey  Entered:2000-10-18, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: seasonal allergy, sinusitis
Diagnostic Lab Data: EEG-neg, CT Scan of head/sinuses-neg, increased LFT 3-4 X normal; (+) Monospot test
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5158A2   
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1168K   
Administered by: Private     Purchased by: Private
Symptoms: Bradycardia, Dehydration, Gait disturbance, Headache, Liver function test abnormal, Mononucleosis syndrome, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Post vax, pt had an episode of syncope after running 3 miles. She was found to be bradycardic, dehydrated, wobbling gait and severe headache. She was admitted in the hospital for hydration and further evaluation. Over 4 days in the hospital her gait, headache and nausea improved.

VAERS ID:160761 (history)  Vaccinated:2000-10-14
Age:16.0  Onset:2000-10-18, Days after vaccination: 4
Gender:Male  Submitted:2000-10-19, Days after onset: 1
Location:Connecticut  Entered:2000-10-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin, Motrin
Current Illness: pharyngitis
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5151822IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0939K0SCRA
Administered by: Private     Purchased by: Private
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: The pt experienced local redness, mild swelling and pain.

VAERS ID:160788 (history)  Vaccinated:2000-10-03
Age:16.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-17, Days after onset: 14
Location:California  Entered:2000-10-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00100590
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Immediately post vax, the pt experienced seizure activity with clonic movement of upper arm and loss of consciousness. The pt was dx in the ER with syncopal episode. Upon internal review, seizure activity with clonic movement of upper arm was considered to be an important medical event. It has been determined that WAES00100590 is a duplicate report of WAES 00102006. Therefore WAES00100590 is being deleted from our files and the reports consolidated into WAES00102016. Follow up on 03/28/2001: "Patient date of birth and Lot # for vaccine 1 is not provided."

VAERS ID:160891 (history)  Vaccinated:2000-10-10
Age:16.0  Onset:2000-10-11, Days after vaccination: 1
Gender:Male  Submitted:2000-10-16, Days after onset: 5
Location:California  Entered:2000-10-25, Days after submission: 9
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma
Diagnostic Lab Data: all labs and x-rays-nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3141A20IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0323AA5IMRA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain, Angioneurotic oedema, Dizziness, Dyspnoea, Pruritus, Swelling
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Post vax, the pt developed an itchy throat and some shortness of breath; came to office and given Benadryl. On 10/12/00, the pt experienced abdominal pain, lightheadedness and shortness of breath; couldn''t breathe, taken to ER. Had Benadryl in ambulance which resolved her symptoms. Same thing happened on 10/13/00 and he was started on Prednisone. On 10/14/00, he was carried into office gasping for air with angioedema and uvula swelling. Epinephrine and Benadryl given without relief. Transported to ER for admission. Never had similar problem. Being discharged today, will closely follow-up.

VAERS ID:162879 (history)  Vaccinated:2000-06-16
Age:16.0  Onset:2000-06-22, Days after vaccination: 6
Gender:Male  Submitted:2000-07-21, Days after onset: 29
Location:Delaware  Entered:2000-10-26, Days after submission: 97
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000194151
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM146A90IMLA
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Six days post vax, the pt developed a nodule on his chin above his adam''s apple. Outpatient treatment was required. The physician diagnosed the pt with adenitis and treated him with antibiotics. He stated that he has no reason to believed the pt''s adenitis was due to the Lymerix vaccine. The most recent information received on 7/20/00 reports the outcome of the event as unknown.

VAERS ID:161053 (history)  Vaccinated:2000-08-25
Age:16.0  Onset:2000-08-26, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2000-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: VA00038
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1086J1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash macular
SMQs:, Hypersensitivity (narrow)
Write-up: Next day post vax, the pt noticed rash on legs described as blotchy. Awoke Sunday with rash on face and arms. Pt was seen and treated with Atavax and Benadryl.

VAERS ID:161375 (history)  Vaccinated:2000-10-20
Age:16.0  Onset:2000-10-21, Days after vaccination: 1
Gender:Female  Submitted:2000-10-30, Days after onset: 9
Location:Michigan  Entered:2000-11-06, 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: Zyrtec
Current Illness: NONE
Preexisting Conditions: allergies
Diagnostic Lab Data: arthritis panel, metabolic panel, CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0403AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Pruritus, Red blood cell sedimentation rate increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt experienced itching on 10/21/00, no hives. 10/22/00 told mother hives on extremities and on body. Seen at a walk-in clinic. MD ordered arthritis screen, metabolic panel and CBC. All labs were negative per mother with the exception of Sed Rate that was elevated. The pt was treated with Prednisone, Zyrtec and Vioxx. Was advised to consult a rheumatologist. It was felt that the symptoms were due to the vaccine.

VAERS ID:161429 (history)  Vaccinated:2000-10-03
Age:16.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-11-02, Days after onset: 30
Location:California  Entered:2000-11-07, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: blood pressure - 100/40, pulse 100
CDC Split Type: WAES00102026
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3199A21IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERR050621SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1083J1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0061AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Coma, Dyskinesia, Hyperhidrosis, Hypotension, Hypoventilation, Nausea, Pallor, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)
Write-up: Information has been received from an RN concerning a 16 year old Hispanic female pt who on 10/03/00 was vaccinated with a 2nd dose of MMRII, a 2nd dose of DT, a 2nd dose of poliovirus, and a 2nd dose of Hep-B. "Client received 3 vaccines (TD, HEP-B, IPV) and while receiving MMRII, the client became unresponsive, jerked back and experienced fine motor tremors. Blood pressure was 100/40, RR were shallow, pulse was thready a 100 BPM. On admin. at 51. Pt placed in trendelenberg. Pt experienced nausea without emesis. Pt remained pale, diaphoretic with knowledge of event until transported via 911 to hospital. No tests or laboratory work done." Subsequently, the pt recovered. Additional information has been requested. F/U upon internal review, the pt''s experience of fine motor tremors/seizures activity with clonic movement of upper arm was considered to be an important medical event. The pt''s 12 year old sister had a similar experience after vaccination with a first dose of MMR (WAES00100792). It has been determined that WAES00100590 is a duplicate report of WAES00102026. Therefore WAES00100590 is being deleted from our files and the reports consolidated into WAES00102026. This is an amended report. Upon internal review of the pt''s information it was determined that hospitalization was not required as previously reported. This is a corrected report as amended.

VAERS ID:161901 (history)  Vaccinated:2000-10-02
Age:16.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-17, Days after onset: 15
Location:Michigan  Entered:2000-11-14, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5151A20IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Pt was given Hep-B vaccine. Mother called about 1/2 hour later, said that pt had red rash. Pt brought back to office and checked by doctor and was given Benadryl 50 mg IM and Aristocort Forte 40 mg IM and observed. No difficulty or anything.

VAERS ID:163273 (history)  Vaccinated:1999-10-08
Age:16.0  Onset:1999-10-08, Days after vaccination: 0
Gender:Female  Submitted:1999-10-20, Days after onset: 12
Location:Pennsylvania  Entered:2000-11-14, Days after submission: 391
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: seasonal allergies
Diagnostic Lab Data:
CDC Split Type: 19990276741
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3001A40IMRA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Subsequent to receiving vax the pt experienced a diffuse rash over her entire body. The most recent information received, reports the symptoms as resolved.

VAERS ID:163353 (history)  Vaccinated:1999-12-24
Age:16.0  Onset:1999-12-24, Days after vaccination: 0
Gender:Male  Submitted:2000-03-17, Days after onset: 84
Location:New Jersey  Entered:2000-11-14, Days after submission: 242
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, environmental allergies. There were no concomitant mediations.
Diagnostic Lab Data:
CDC Split Type: 20000066481
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3074A21IM 
Administered by: Other     Purchased by: Other
Symptoms: Anorexia, Asthma, Blood pressure increased, Dizziness, Headache, Hypersensitivity, Migraine, Vertigo
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Hypersensitivity (narrow)
Write-up: this case reference number 2000006648-1, is a spontaneous report from a physician referring to a 16 year old male patient. Follow up information from the patient''s mother was forwarded by a pharmacist. The patient has a history of environmental allergies and has a history of asthma. On 11/18/99, the patient received his first injection of Engerix-B at an unspecified dose for Prophylaxis, with no untoward effects. On 12/24/99, he received the second dose and afterward experienced headache and dizziness. On 02/07/00, the boy received the third injection of Engerix-B while the symptoms were ongoing. Follow up information from the pharmacist reveals, the child has severe migraine headaches, and severe vertigo. Also, he experienced elevated systolic blood pressure running 170-175 and loss of appetite. The other reported to the pharmacist, her son her son has not been in school for two months. The migraine headaches and vertigo (dizziness) have been deemed serious as the patient missed school and thus are incapacitating. The information received on 03/08/00 reports the symptoms are ongoing.

VAERS ID:163399 (history)  Vaccinated:2000-05-18
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2000-06-26
Location:Pennsylvania  Entered:2000-11-14, Days after submission: 141
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: allergic reaction;UNK. MEASLES & RUBELLA VIRUS LIVE;;1.00;In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to MMR: The pt had an allergic reaction to measles-mumps-rubella vaccine at age 15 months.
Diagnostic Lab Data:
CDC Split Type: 20000191821
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Subsequent to receiving vax, the pt experienced dizziness. The most recent information received reports the outcome of the event as resolved.

VAERS ID:163422 (history)  Vaccinated:2000-06-21
Age:16.0  Onset:2000-06-22, Days after vaccination: 1
Gender:Male  Submitted:2000-07-27, Days after onset: 35
Location:Pennsylvania  Entered:2000-11-14, Days after submission: 110
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000226921
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3094A20IM 
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: One day post vax, the pt experienced an itching face and ears, swelling ear and urticaria on neck. Outpatient treatment was required, and the pt was treated with prednisone and Chlortrimeton. The most recent information received reports the outcome of the event as unknown.

VAERS ID:162183 (history)  Vaccinated:2000-10-11
Age:16.0  Onset:2000-10-11, Days after vaccination: 0
Gender:Male  Submitted:2000-11-15, Days after onset: 35
Location:Unknown  Entered:2000-11-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MA20000638
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION 3IMLA
Administered by: Other     Purchased by: Other
Symptoms: Bradycardia, Convulsion, Hypotension, Injection site pain, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The pt experienced convulsions, loss of consciousness, pain in the left arm, blood pressure of 80/40, and an irregular pulse rate (48). Causality is stated to be unrelated. The most likely cause is a circulatory reaction due to the injection rather than the vaccine.

VAERS ID:162489 (history)  Vaccinated:1997-02-18
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Colorado  Entered:2000-11-22
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:
Diagnostic Lab Data: ANA, FTA, ESR Thyroid profile, CBC, Creatinine, Random glucose, triglycerides, cholesterol, all nml in the past.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0644D2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Hearing impaired, Otitis media, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow)
Write-up: 02/24/1997 Fever 100, vomiting, stomach ache. 02/26/1997 clinic visit, temp of 100.8, left otitis media. Prescribed Amoxicillin then Septra. 03/05/1997, ENT - bilateral, otitis media, significant bilateral hearing loss. PEETS. Hearing has returned to normal in the right ear. Left - severe sensory neural hearing loss at certain frequencies.

VAERS ID:163024 (history)  Vaccinated:2000-10-15
Age:16.0  Onset:2000-10-16, Days after vaccination: 1
Gender:Male  Submitted:2000-11-24, Days after onset: 39
Location:Ohio  Entered:2000-12-04, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to IV administration of amoxicillin; causes a rash.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0417AA6IM 
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Injection site pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Arm pain X 2 weeks, post vax, especially with swimming. Pain only with overhead use of arm, localized to exertion of the deltoid.

VAERS ID:163186 (history)  Vaccinated:2000-10-12
Age:16.0  Onset:2000-10-12, Days after vaccination: 0
Gender:Male  Submitted:2000-10-13, Days after onset: 1
Location:Texas  Entered:2000-12-06, Days after submission: 54
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: TX00142
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LTD.73608A  RA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1031K0 LA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Feeling hot, Hypertension, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)
Write-up: At approximately 8:30 AM, I gave a TD in the right arm and Hepatitis B in the left arm. The patient was apprehensive, said he didn''t like shots and complained at length with the Hepatitis B shot which was given second. The patient was in the lobby waiting with shots when he felt dizzy, weak, hot, and sick to his stomach. His mother laid him in the floor. He did not faint, but probably came very close to it. We gave him a coke and he sat up after a few minutes, but complained of dizziness. After about 15-20 minutes, I moved him to the inside office / computer room and had him sitting in a chair with his mother beside him for another 20 minutes or so. The patient did not feel better and complained of his left arm hurting at antecubital and forearm. He had not fallen though; so nothing was noting on its appearance. I moved him to my office when he was not improving and asked another Dr''s nurse to have that Dr come see this patient. The patient''s mom stated that another Dr was to be his Dr, but she was not taking new patients until now. A another Dr saw him approximately 1 hour after his shots, BP was 120/70. The patient felt dizzy upon standing and sitting. The patient had finished a cake and peanut butter sandwich. We laid him back down for approximately 1 more hour and he sat up,then stood there took a couple of steps feeling more and more dizzy. The Dr recommended sending the patient to the ER, which we did. Spoke to the mom around 5:00 PM she stated ER gave the patient Tylenol and observed him awhile and sent him home. She stated the patient had been sleeping and was fine.

VAERS ID:163189 (history)  Vaccinated:2000-11-09
Age:16.0  Onset:2000-11-10, Days after vaccination: 1
Gender:Male  Submitted:2000-11-13, Days after onset: 3
Location:Texas  Entered:2000-12-06, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Environmental allergies, takes med for pollen allergy.
Diagnostic Lab Data:
CDC Split Type: TX00153
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7345AA  RA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1031K1 LA
Administered by: Public     Purchased by: Other
Symptoms: Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: On 11/13/00, the mother of the patient called to say son''s tongue swelled the day after his second Hepatitis B shot. It hadn''t gotten worse, but had stayed the same. The parent did not give Benadryl. It was suggested the the parent call their physician and he suggested that the patient load up on Benadryl today. If the swelling not gone by tomorrow the mother should bring the patient in.

VAERS ID:163574 (history)  Vaccinated:1997-04-22
Age:16.0  Onset:2000-12-04, Days after vaccination: 1322
Gender:Male  Submitted:2000-12-05, Days after onset: 1
Location:Pennsylvania  Entered:2000-12-11, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2170A20IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1552D0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Infection
SMQs:
Write-up: Post vax, the pt developed a mild case of varicella.

VAERS ID:163619 (history)  Vaccinated:2000-04-17
Age:16.0  Onset:2000-07-01, Days after vaccination: 75
Gender:Female  Submitted:2000-10-11, Days after onset: 102
Location:New Jersey  Entered:2000-12-12, Days after submission: 62
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergy to PCN
Diagnostic Lab Data: ESR (07/31/2000) 5 MM/hr. ANA (HEP-2) titer (07/31/2000) negative. RA factor (07/31/2000) negative. Lyme IgG/IgM by EIA (07/31/2000) positive. Lyme 1gK/IgG/IgA NY Western Blot (08/30/2000) pattern of reactivity consistent with response to
CDC Split Type: 20000351731
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY136B92IM 
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Headache
SMQs:
Write-up: Approximately 3 months post 3rd dose, the pt began experiencing severe headaches and fatigue. She has not sought medical attention. The headaches and fatigue persisted as of 12/06/00. A 15-day follow up report received 01/12/2001 adds: Report 2000035173-1 describes headaches in a 16-year-old female who received Lyme disease vaccine (Lymerix). This report was received from the pt''s father and has been confirmed by a physician. Concurrent medical conditions include recurrent right knee offusion subsequent to an injury with hemarthrosis in April 1999. The pt is allergic to penicillin. She was taking no concurrent medications at the time of immunization. Theh pt''s father stated that family history is significant for headaches in this pt''s sister following receipt of Lymerix. This pt received her 1st injection of Lymerix (lot LY12009) on 04/14/1999 and her second injection of Lymerix (lot LY12079) on 05/29/1999. She had no adverse experiences following receipt of her first 2 doses of vaccine. She received her 3rd injection of Lymerix (lot LY23609) on 04/17/2000). The pt''s father reported that the pt began experiencing severe headache and fatigue in July 2000 (precise date unknown) approx 3 months post-immunization. The vaccine provider stated that the pt underwent a routine, annual physical examination on 07/06/2000; she had no complaints at that time. Subsequently, the pt''s mother reported to the vaccine provider that the pt began experiencing fatigue in May 2000. The mother reported that headaches began in August 2000, and became severe on 08/20/2000. The father indicated that the pt had not sought medical attention. However, the vaccine provider stated that the pt was seen by 2 pediatric neurologists. Each neurologist prescribed unspecified antidepressants, however the mother did not give the antidepressants to the pt. The vaccine provider reported a diagnosis of possible psychogenic headaches and stated, "I don''t think headaches are due to Lyme disease vaccine." The pt has been treating her headaches with ibupro

VAERS ID:163682 (history)  Vaccinated:1999-05-08
Age:16.0  Onset:1999-07-08, Days after vaccination: 61
Gender:Female  Submitted:2000-12-02, Days after onset: 513
Location:Wisconsin  Entered:2000-12-13, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft, Claritin
Current Illness: Depression
Preexisting Conditions: Depression
Diagnostic Lab Data: EKG-possible right ventricular hypertrophy (1 episode of tachycardia above 140); ECG-nml; Blood sugar-61-nml; Sed rate-32; CBC-nml; WBC-10,600-nml; Quick Lyme-positive but had 2 vaccines so that would be positive; WA-nml; Blood cultures-nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM118A21IM 
Administered by: Private     Purchased by: Other
Symptoms: Abasia, Arthralgia, Arthritis bacterial, Cardiovascular disorder, Fatigue, Hypertrophy, Joint swelling, Polyarthritis, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Pt had the 1st 2 vaccines in a series of 3, in April and May of 1998. She was hospitalized in July of that year because of her ankles and wrists were very swollen and she could not walk. She was also exhausted. They put her through a gamma of tests and came up with migratory arthritis. She suffers off and on with fatigue and joint pain since then. It flares up from time to time. She is always quite fatigued and has constant low-grade pain. The 1st onset with swelling and joint pain lasted at least 4 months, then down to a minimum. Flares up. Needs to sleep a lot and return from work early because of pain and swelling. She was hospitalized from 7/11/99 to 7/13/99. 8/3/99, returned for a check-up and report on all other tests were nml. Dx''d with probable viral arthritis but to us they called it Migratory Arthritis. They seemed to be a little baffled and simply choose to call it Migratory Arthritis. They said it would go away in time. In time it did settle down, but pt still lives with a certain degree of pain most of the time and she has flare ups of swelling and stiffness, causing her to leave school and work at times. None of these symptoms occurred before she had the Lyme vaccination.

VAERS ID:164000 (history)  Vaccinated:2000-12-08
Age:16.0  Onset:2000-12-09, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Alabama  Entered:2000-12-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Seizure disorder;DTP (unknown mfr);;0;In Patient
Other Medications: Depakote, Phenobarbital
Current Illness: Seizure disorder
Preexisting Conditions: CP; encephalopathy, seizure disorder
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5151A2 IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0259K SCRA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES468868 IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1148K SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Post vax, pt awoke with swollen face, lips and hands. Treated with Benadryl and Decadron per ER report. Symptoms resolved.

VAERS ID:164012 (history)  Vaccinated:2000-10-16
Age:16.0  Onset:2000-10-21, Days after vaccination: 5
Gender:Female  Submitted:2000-10-24, Days after onset: 3
Location:South Carolina  Entered:2000-12-20, Days after submission: 57
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: SC00082
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5167A21 LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site abscess, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This patient received Hepatitis B vaccine on 10/16/00. The mother called today to report of pus oozing from the site on the left arm, beginning 10/21-10/22/00 weekend. Denies pain at site but does have redness / swelling. Nothing used on the site except alcohol . Denies fever 11/27/00 several attempts to follow up more has not responded.

VAERS ID:164970 (history)  Vaccinated:2001-01-08
Age:16.0  Onset:2001-01-10, Days after vaccination: 2
Gender:Female  Submitted:2001-01-12, Days after onset: 2
Location:New Jersey  Entered:2001-01-22, 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: 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.0001K0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0109K1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES40343AA0IMRA
Administered by: Public     Purchased by: Other
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: The pt presented to office 2 days post vax complaining of swelling and discomfort at injection site. Reaction to the right deltoid measured 3cm x 2 1/2 cm, was warm to the touch with erythema.

VAERS ID:165699 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:2001-07-20
Location:Unknown  Entered:2001-02-02, Days after submission: 167
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: Lyme disease
Diagnostic Lab Data: Serology revealed antibodies to 93, 66, 41, 31, 30, 28 and 21 kDa antigens on IgG and 93 and 41 on IgM.
CDC Split Type: 20000339071
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 2IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthritis, Synovitis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Four months subsequent to receiving the third dose of Lymerix, the pt presented with monoarticular knee synovitis. His serology at the time revealed antibodies to 93, 66, 41, 31, 30, 28 and 21 kDa antigens on IgG and 93 and 41 on IgM. The authors stated that since it was difficult for clinicians to differentiate either between either vaccine induced arthritis or Lyme arthritis in a pt, the pt was treated with a full course of doxycycline therapy. Four months later the pt was asymptomatic. It was commented by the autho. that this was likely a delayed vax induced arthritis. The events of the knee synovitis and arthritis do not meet ICH serious criteria, but are being submitted as an expedite report by special FDA request.

VAERS ID:165925 (history)  Vaccinated:2000-10-26
Age:16.0  Onset:2000-10-26, Days after vaccination: 0
Gender:Male  Submitted:2001-01-18, Days after onset: 84
Location:Florida  Entered:2001-02-16, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Snake bite
Preexisting Conditions: Allergies to PCN and acetylsalicylic acid; drug hypersensitivity
Diagnostic Lab Data: UNK
CDC Split Type: HQ2950530OCT2000
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Vaccination