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Found 593235 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 594

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VAERS ID:394518 (history)  Vaccinated:2010-08-04
Age:12.0  Onset:2010-08-04, Days after vaccination: 0
Gender:Male  Submitted:2010-08-06, Days after onset: 2
Location:Maryland  Entered:2010-08-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0597Z0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3336AA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061BA0UNRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large, flat erythematous, warm, pruritic patch B/L arms following vaccine administration. (L) arm lesion 4cm diameter. (R) arm lesion 2.5cm. Advised BENADRYL and heat.

VAERS ID:395722 (history)  Vaccinated:2009-10-22
Age:12.0  Onset:2009-10-23, Days after vaccination: 1
Gender:Male  Submitted:2009-10-23, Days after onset: 0
Location:Michigan  Entered:2010-08-06, Days after submission: 287
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: MEDI0009226
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Appetite disorder, Epistaxis, Fatigue
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: A non-serious, spontaneous report of nosebleeds, tired and hungry has been received from the patient''s mother concerning a 12-year-old male patient subsequent to FLUMIST administration. Medical history and concomitant medications were not reported. On 22-Oct-2009 at 3:00pm, the patient received FLUMIST. The next day, 23-Oct-2009, the patient developed nosebleeds. At 12:05 PM, the patient had a nosebleed lasting 25 minutes (first 10 minutes, mostly clotted blood was present). At 2:15 PM, he had another nosebleed and then one more 30 minutes prior to receiving the report from the mother. She indicated the patient also felt tired and hungry. The outcome of the events was not reported.

VAERS ID:394501 (history)  Vaccinated:2010-08-06
Age:12.0  Onset:2010-08-06, Days after vaccination: 0
Gender:Female  Submitted:2010-08-06, Days after onset: 0
Location:Michigan  Entered:2010-08-09, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: ADD; Pt on CONCERTA 54mg Q day.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y1UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Fall, Immediate post-injection reaction, Tonic clonic movements, Urinary incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Convulsions (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: Immediately post vaccine pt slumped to floor, had tonic clonic movement of arms and legs and was incontinent of urine - After 10 minutes she had improved somewhat but upon trying to ambulate she vomited x 2. She was then transported to the ER by ambulance.

VAERS ID:394781 (history)  Vaccinated:2010-07-27
Age:12.0  Onset:2010-07-27, Days after vaccination: 0
Gender:Female  Submitted:2010-07-27, Days after onset: 0
Location:Minnesota  Entered:2010-08-10, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB382AA1UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0672Y2UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Fainting after vaccines.

VAERS ID:394784 (history)  Vaccinated:2010-07-28
Age:12.0  Onset:2010-07-28, Days after vaccination: 0
Gender:Male  Submitted:2010-08-02, Days after onset: 5
Location:Arkansas  Entered:2010-08-10, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B052AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0002Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Pain, Pruritus generalised, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Generalized itching and stinging, beginning in left arm at vaccine site and spreading throughout body. Lasted at least 5 days. Treated with BENADRYL only.

VAERS ID:394810 (history)  Vaccinated:2010-08-06
Age:12.0  Onset:2010-08-08, Days after vaccination: 2
Gender:Male  Submitted:2010-08-10, Days after onset: 2
Location:New York  Entered:2010-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS0907010IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.047171SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Subcutaneous injection of varivax given in back of right arm on 8/6/10. On 8/8 patient seen by MD in office for local reaction to injection. Complained of pain at site and redness 13cmx13cm with hardness no lymphadenopathy noted, afebrile.

VAERS ID:394811 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-09, Days after vaccination: 0
Gender:Female  Submitted:2010-08-10, Days after onset: 1
Location:Ohio  Entered:2010-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Allergy to aspirin
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB365AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1318Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3336AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3353AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure decreased, Dyskinesia, Heart rate normal, Hyperhidrosis, Immediate post-injection reaction, Musculoskeletal stiffness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Client fainted immediately after 4th of 4 vaccines administered. Skin pale, diaphoretic with jerking activity and stiffness of upper extremities. Regained consciousness after being laid prone within seconds. Treatment included monitoring vital signs, positioning prone with legs elevated above heart. Recovery at 45 minutes post administration of vaccines at which time she was sent with mother with instructions if further adverse events should occur. B/P 90/50 at lowest to 100/60 when no further symptoms, pulse 60-64.

VAERS ID:394816 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-09, Days after vaccination: 0
Gender:Female  Submitted:2010-08-10, Days after onset: 1
Location:South Carolina  Entered:2010-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1178Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3443BA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B049CA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Diarrhoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)
Write-up: Patient fainted, then developed abdominal pain and diarrhea. Patient also on menstrual cycle at visit.

VAERS ID:394911 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-10, Days after vaccination: 1
Gender:Female  Submitted:2010-08-11, Days after onset: 1
Location:Michigan  Entered:2010-08-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy symptoms: stomach ache, stuffy nose, itchy eyes.
Preexisting Conditions: Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3100AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063CA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0413Z1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Softball sized swollen area, red and itchy. Pt treated w/Orapred 15mg/5mL; 5mL qd x 5 days, OTC Benadryl qd prn.

VAERS ID:394927 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-10, Days after vaccination: 1
Gender:Female  Submitted:2010-08-11, Days after onset: 1
Location:Montana  Entered:2010-08-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3052BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1659Y1SCLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Pain in extremity, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt complaining of pain, itching in upper left arm (underside). Area is 10cmx8.5cm redness with swelling, warmth. No other s/s present. Pt to apply ice off/on, take Tylenol/Benadryl and come to clinic if changes.

VAERS ID:394935 (history)  Vaccinated:2010-08-06
Age:12.0  Onset:2010-08-07, Days after vaccination: 1
Gender:Male  Submitted:2010-08-11, Days after onset: 4
Location:Minnesota  Entered:2010-08-11
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: Questionable allergy to cats; allergic rhinitis; childhood obesity
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3074AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3052CA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.028271UNRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Immunization 8/6/10. On 8/7/10 had small blisters distal to site of Varicella vaccine which became 2 large blisters per mother''s report. At clinic 8/11/10 and noted 2 red areas each 1 1/2cm round to Rt arm distal administration site of Varicella. Mother will continue to monitor.

VAERS ID:394938 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-09, Days after vaccination: 0
Gender:Male  Submitted:2010-08-09, Days after onset: 0
Location:Arkansas  Entered:2010-08-11, 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:
Current Illness: Cough (allergic post nasal drip)
Preexisting Conditions: No known other than mild seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3514AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3049CA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0642Z1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest pain, Dyspnoea, Lip swelling, Paraesthesia oral
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: About 5-10 minutes after administration, began to have tingling sensation on tongue/mouth, sharp chest pain and difficulty breathing. BP and HR remained stable, no wheezing, pulse ox upper 90s throughout. Received BENADRYL 25mg PO as well as Sprite. Symptoms resolved but developed some swelling of bottom lip on (R) side.

VAERS ID:394957 (history)  Vaccinated:2010-08-04
Age:12.0  Onset:2010-08-04, Days after vaccination: 0
Gender:Female  Submitted:2010-08-12, Days after onset: 8
Location:Colorado  Entered:2010-08-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known.
Preexisting Conditions: None known.
Diagnostic Lab Data: Unknown. Unable to contact mother of child.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB789AA3IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3355BA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1747Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Cold sweat, Dizziness, Feeling abnormal, Feeling hot, Nausea, Pain, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Quiet, calm preteen. Pt. received immunizations without incidence. Pt. picked out sucker and was advised to stand up slowly. Approximately 3-4 minutes after receiving immunizations, she c/o being dizzy. Laid supine with knees bent. Pts. facial color appeared normal. Cold packs placed at nape of neck and forehead. Pt. never lost consciousness. C/o being hot and dizzy. 15:47 BP 112/64 (rt. arm) P-64, breathing normal without signs of respiratory distress. Pts. skin felt "clammy". 15:55 BP 112/70 (rt. arm) P-72. Pt. stated she had eaten breakfast and a snack prior to appointment. C/o body aches and dizziness. Assisted to a sitting position, took several sips of water. Legs and hand were trembling. C/o nausea, no vomiting. States she feels like she was "beat up". 16:00 BP 112/70 (rt. arm) P-76, R-14. C/o lower abdominal pain around umbilicus. States pain is less when pressure is applied (mother of child was firmly stroking lower abdomen). Feet held above level of heart, trembling in legs disappeared. Instructed to lay arms along side of body and stretch and relax finger, trembling in hands disappeared. Assisted into sitting position, drank several sips of water. Laid supine with knees bent. 16:10 BP 108/68 (rt. arm) P-72. Stated pain around umbilicus has stopped but ribs hurt with localized pain under lt. lowest rib. Pain rated on a scale from 1 (no pain) to 10 (worst pain imaginable) as a 9. At approximately 16:25 911 was called BP 118/68. 16:30 BP 128/68 P-24. Legs and hands trembling. Approximately at 16:35 paramedics arrived, pt. conversed with paramedics, vital signs taken, pt. assisted up and walked a few steps and laid down on stretcher, transported to hospital.

VAERS ID:394969 (history)  Vaccinated:2010-08-05
Age:12.0  Onset:2010-08-05, Days after vaccination: 0
Gender:Male  Submitted:2010-08-07, Days after onset: 2
Location:Florida  Entered:2010-08-12, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: lymph nodes swollen~Varicella (no brand name)~1~1.00~Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: None Known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3468AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0248Z1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling, warm to touch, starting night of immunization, worsening over 2 days.

VAERS ID:394983 (history)  Vaccinated:2010-08-02
Age:12.0  Onset:2010-08-02, Days after vaccination: 0
Gender:Male  Submitted:2010-08-12, Days after onset: 10
Location:Texas  Entered:2010-08-12
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: AUGMENTIN ALLERGY-RASH
Diagnostic Lab Data: NONE
CDC Split Type: TX20100077PR
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER0290110IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Dizziness, Dyspnoea, Flushing, Malaise, Pallor
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: ABOUT 45 MINUTES AFTER RECEIVING VACCINE AND LEAVING OFFICE, PATIENT STARTED FEELING UNWELL. WEAK, FLUSHED, SOB, PANTING ALSO PALE AND DIZZY. CALLED ON CALL PHYSICIAN. FEELING BETTER, STRONGER BY 02:30 PM. PATIENT DECLINED IN TO CHECK.

VAERS ID:395027 (history)  Vaccinated:2010-07-29
Age:12.0  Onset:2010-07-29, Days after vaccination: 0
Gender:Male  Submitted:2010-08-12, Days after onset: 14
Location:Texas  Entered:2010-08-12
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: TX20100080
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1316Y0IMRA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU3016AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B043BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dry skin, Erythema, Skin warm, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 9:05 MON STATED NOTED CLIENTS NOSE GOT RED. CLIENT COMPLAINED OF ITCHING TO THROAT, CLEARING THROAT. 911 CALLED. VIS 121/70, P85 RESP20 SKIN WARM AND DRY TO TOUCH. NO SOB NOTED. 9:15 121/73, P88, RESP 20 9:25 129/86, P84 RESP 20. CLIENT STATED FEELS BETTER. MOM AND CLIENT THEN STATED CLIENT HAS SEASONAL ALLERGIES TO ENVIRONMENT, TAKEN CLARITIN 2 DAYS AGO. 9:40 VIS 129-84, P88, RESP 20. MOM REFUSED TO WAIT FOR AMBULANCE, STATED WOULD TAKE TO MD IF NEEDED. CLIENT ESCORTED BY NURSE TO CAR. NO SOB, CONVERSIVE ABOUT VIDEO GAMES. ALERT.

VAERS ID:395058 (history)  Vaccinated:2010-08-10
Age:12.0  Onset:2010-08-10, Days after vaccination: 0
Gender:Male  Submitted:2010-08-11, Days after onset: 1
Location:Indiana  Entered:2010-08-12, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Decreased appetite, Dizziness, Fatigue, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Fainting, 5-10 minutes post injection, weakness, paleness, dizziness, fatigue. No appetite. Received 3 vaccine on 8-10-10 at 4:45 pm. cont''s with symptom at 1:00pm 8-11-10.

VAERS ID:395061 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-10, Days after vaccination: 1
Gender:Male  Submitted:2010-08-11, Days after onset: 1
Location:Texas  Entered:2010-08-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0549Z1UNRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Varicella vaccine (R) upper arm now with redness, swelling, itching, blistering at site of injection.

VAERS ID:395071 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-10, Days after vaccination: 1
Gender:Male  Submitted:2010-08-12, Days after onset: 2
Location:Kansas  Entered:2010-08-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB417AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF484CA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site swelling, Injection site warmth, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Left deltoid swollen, warm to touch. C/o pain when raises arm to shoulder level. Rates pain as 5 on 0-10 scale with movement.

VAERS ID:395167 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-09, Days after vaccination: 0
Gender:Male  Submitted:2010-08-12, Days after onset: 3
Location:Oregon  Entered:2010-08-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB437AA1IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF484AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Hand sized area of redness and marked swelling distal to immunization injection site involving distal upper arm circumferentially. Tenderness at site and swelling and redness started about 8 hrs after injections - worsening over first 36 hrs. Still with mild redness and warmth on 8/12/10 but resolving.

VAERS ID:395208 (history)  Vaccinated:2010-08-11
Age:12.0  Onset:2010-08-13, Days after vaccination: 2
Gender:Female  Submitted:2010-08-13, Days after onset: 0
Location:Missouri  Entered:2010-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: NKDA or medical conditions
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3511AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.067521SCRA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling described as 3" in size, with redness. Moderate pain.

VAERS ID:395328 (history)  Vaccinated:2010-08-03
Age:12.0  Onset:2010-08-03, Days after vaccination: 0
Gender:Female  Submitted:2010-08-09, Days after onset: 6
Location:Iowa  Entered:2010-08-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Urinalysis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1539Y2IMLA
Administered by: Other     Purchased by: Public
Symptoms: Malaise, Pyrexia, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Malaise fever started 3 pm. IBU & TYLENOL BACTRIM DS

VAERS ID:395331 (history)  Vaccinated:2010-08-04
Age:12.0  Onset:2010-08-05, Days after vaccination: 1
Gender:Female  Submitted:2010-08-16, Days after onset: 11
Location:Florida  Entered:2010-08-16
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: mild RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.05692 UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3468AA UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA UNRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left deltoid has a 3 inch erythematous painful to touch extremely warm area. Place on KEFLEX 500mg bid x 10 days.

VAERS ID:395340 (history)  Vaccinated:2010-08-12
Age:12.0  Onset:2010-08-12, Days after vaccination: 0
Gender:Female  Submitted:2010-08-12, Days after onset: 0
Location:Tennessee  Entered:2010-08-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None noted.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB401AA0UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y0UNLL
TDAP: TDAP (ADACEL)SANOFI PASTEURC3448AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0341Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dyskinesia
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad)
Write-up: Pt reported (R) arm jerking within 15 minutes of getting vaccine in (R) upper arm. 8-13-09 F/U at ph # given per dad. Spoke with G.M. "pt went to school today" "ok as far as she is aware".

VAERS ID:395361 (history)  Vaccinated:2010-08-12
Age:12.0  Onset:2010-08-13, Days after vaccination: 1
Gender:Male  Submitted:2010-08-14, Days after onset: 1
Location:Texas  Entered:2010-08-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3473AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0247Z1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash started 8/13/10 at 1200 pm at vaccine site rash progressed. On 8/14/10 pt had fever at 103 degrees at 8pm, pt took OTC TYLENOL, fever reduced to 100.7. When seen at clinic, pt is to take OTC MOTRIN 2 tabs q 6 hrs prn for fever and to follow up in 48 hrs. Rash & swelling to varicella & TDAP sites only on right arm.

VAERS ID:395368 (history)  Vaccinated:2010-08-16
Age:12.0  Onset:2010-08-16, Days after vaccination: 0
Gender:Female  Submitted:2010-08-16, Days after onset: 0
Location:California  Entered:2010-08-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None, healthy.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B054BA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt fainted about 3 minutes after vaccine. 100 degree weather, no air conditioning inside. Reports no lunch.

VAERS ID:395988 (history)  Vaccinated:2009-09-25
Age:12.0  Onset:2009-10-06, Days after vaccination: 11
Gender:Female  Submitted:2009-10-07, Days after onset: 1
Location:Texas  Entered:2010-08-16, Days after submission: 313
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: Influenza serology, 10/06/09, positive
CDC Split Type: MEDI0009017
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500719P IN 
Administered by: Private     Purchased by: Other
Symptoms: Cough, Fatigue, Influenza, Influenza virus test positive, Oropharyngeal pain, Pyrexia, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A non-serious, spontaneous report of Flu has been received from a registered nurse concerning a 12-year-old female patient subsequent to FLUMIST. The patient''s medical history and concomitant medications were not reported. The patient received FLUMIST on 25-Sep-2009. On 06-Oct-2009, the patient experienced fever, sore throat, cough, congestion, and tiredness. The patient went to the doctor and tested positive for the Flu. The event outcome was not reported.

VAERS ID:396535 (history)  Vaccinated:2009-09-10
Age:12.0  Onset:2009-09-11, Days after vaccination: 1
Gender:Male  Submitted:2009-09-17, Days after onset: 6
Location:Georgia  Entered:2010-08-16, Days after submission: 333
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: MEDI0008904
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Nasal congestion, Rhinorrhoea
SMQs:
Write-up: A non-serious report of runny nose and nasal congestion has been received from a consumer, patient''s parent, concerning a 12-year-old male subsequent to FLUMIST. The patient''s medical history and concomitant medication were not provided. The patient received FLUMIST on 10-Sep-2009. He received a total of one dose of FLUMIST before the onset of the events given on 10-Sep-2009. On 11-Sep-2009, he experienced running nose and nasal congestion. Per reporter, these symptoms were progressively getting worse. Outcome of the event was not reported.

VAERS ID:396603 (history)  Vaccinated:2009-08-27
Age:12.0  Onset:2009-08-28, Days after vaccination: 1
Gender:Female  Submitted:2009-08-31, Days after onset: 3
Location:California  Entered:2010-08-16, Days after submission: 350
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: 31-Aug-2009: Test for B flu - Positive
CDC Split Type: MEDI0008817
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500677P IN 
Administered by: Other     Purchased by: Other
Symptoms: Chills, Influenza B virus test positive, Lymphadenopathy, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A non-serious, spontaneous report of swollen glands, fever, chills, runny nose and positive B flu has been received from a registered nurse concerning a 12-year-old female patient subsequent to FLUMIST. The patient''s medical history and concomitant medications were not reported. The patient received FLUMIST on 27-Aug-2009. On 31-Aug-2009, the patient presented with fever of 102.5 degrees for two to three days, swollen glands, chills and runny nose. She tested positive for B flu. The outcome of the events was not reported.

VAERS ID:397048 (history)  Vaccinated:2009-08-18
Age:12.0  Onset:2009-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-08-19, Days after onset: 1
Location:Georgia  Entered:2010-08-16, Days after submission: 362
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: MEDI0008784
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500589P IN 
Administered by: Private     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: A non-serious Spontaneous report of administration of expired dose was received from a health professional concerning a 12 year-old female. The patient''s medical history was not reported. On 18 Aug 2009, the patient inadvertently received FLUMIST that expired on 05 Apr 2009. There was no adverse event associated with this medication; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved.

VAERS ID:397050 (history)  Vaccinated:2009-09-04
Age:12.0  Onset:2009-09-05, Days after vaccination: 1
Gender:Female  Submitted:2009-09-08, Days after onset: 3
Location:South Carolina  Entered:2010-08-16, Days after submission: 342
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: MEDI0008845
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Malaise, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: A spontaneous, non-serious report of headache and sore throat has been received from a consumer concerning a 12-year-old female patient subsequent to FLUMIST use. Medical history and concomitant medications were not reported. On 04-Sep-2009, the patient received FLUMIST. On 05-Sep-2009, the patient developed a headache, sore throat without fever over the weekend. The patient still did not feel well, so she was sent home from school. No further information was available. The outcome of the events of headache and sore throat were ongoing.

VAERS ID:397084 (history)  Vaccinated:2010-02-03
Age:12.0  Onset:2010-02-03, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Rhode Island  Entered:2010-08-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0010442
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500729P IN 
Administered by: Military     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: A non-serious spontaneous report of gave expired FLUMIST was received from a nurse concerning a 12-year old male. On 03-Feb-2010, the patient received FLUMIST that expired on 2-Feb-2010. There is no adverse event associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. No late occurring adverse events were reported. Additional information was received on 11-May-2010 and incorporated into the narrative: information on late occurring adverse events.

VAERS ID:397101 (history)  Vaccinated:2010-02-22
Age:12.0  Onset:2010-02-22, Days after vaccination: 0
Gender:Female  Submitted:2010-03-04, Days after onset: 10
Location:Idaho  Entered:2010-08-16, Days after submission: 164
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: MEDI0010670
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500741P IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: A non-serious spontaneous report of administration of expired product was received from a clinic administrator concerning a 12-year-old female subsequent to the administration of FLUMIST. The patient''s medical history and concomitant medications were not reported. On 22-Feb-2010, the patient was administered FLUMIST. There was no adverse event associated with this vaccination error; therefore treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. No late occurring adverse events were reported. Additional information was received on 13-May-2010 and incorporated into the narrative: information on late occurring adverse events.

VAERS ID:397150 (history)  Vaccinated:2010-01-05
Age:12.0  Onset:2010-01-05, Days after vaccination: 0
Gender:Female  Submitted:2010-01-07, Days after onset: 2
Location:Texas  Entered:2010-08-16, Days after submission: 220
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: MEDI0010098
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500697P IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: A non-serious spontaneous report of administration of expired FLUMIST was received from a registered nurse concerning a 12-year old female patient. Neither relevant medical history nor concomitant medications have been reported for this patient. On 05-Jan-2010, the patient received FLUMIST (expiration date 31-Dec-2009). There was no adverse event associated with this medication error; treatment and reporter/sponsor causality assessments are not applicable, and the events are considered resolved.

VAERS ID:397157 (history)  Vaccinated:2010-01-20
Age:12.0  Onset:2010-01-20, Days after vaccination: 0
Gender:Male  Submitted:2010-01-21, Days after onset: 1
Location:Texas  Entered:2010-08-16, Days after submission: 206
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: MEDI0010278
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500721P IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: A non-serious spontaneous report of inadvertent administration of expired FLUMIST was received from a licensed practical nurse concerning a 12-year-old male. The product expired on 19-Jan-2010. On 20-Jan-2010, the patient received expired product. There was no adverse event associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved.

VAERS ID:395394 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-16
Location:Unknown  Entered:2010-08-17, 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:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1008USA01126
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Information has been received from a registered nurse concerning a 12 year old female patient with no pertinent medical history who on an unknown date was vaccinated with her first dose of GARDASIL. About 6 hours after receiving her first dose of GARDASIL, the patient developed shortness of breath. She went to the Emergency Room but was not admitted to the hospital. No specific treatment was given. The patient had gone to two different doctors and was still experiencing symptoms. The reporting registered nurse considered "shortness of breath" to be an other important medical event due to visit to the Emergency Room. No further information is available.

VAERS ID:395428 (history)  Vaccinated:2007-08-16
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-10
Location:Unknown  Entered:2010-08-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~HPV (no brand name)~3~15.00~Patient|~HPV (no brand name)~3~12.00~Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: had breast asymmetry prior to HPV #1
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0469U0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Breast enlargement
SMQs:, Lipodystrophy (broad)
Write-up: Mom alleges that childs breast asymmetry (Rt breast larger) was caused by HPV vaccine?

VAERS ID:395455 (history)  Vaccinated:2010-08-16
Age:12.0  Onset:2010-08-16, Days after vaccination: 0
Gender:Female  Submitted:2010-08-16, Days after onset: 0
Location:South Carolina  Entered:2010-08-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1332Y1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: C/o felt light headed, after telling her mom this pt took off in a run. Pt found in floor a few feet away from checkout desk, this occurred within 10 min of receiving vaccine for HPV GARDASIL. Pt assisted to w/c and rested in treatment room. BP originally 94/34 after resting a few minutes 100/70. Checked by office PNP and released home with mom.

VAERS ID:395458 (history)  Vaccinated:2010-08-10
Age:12.0  Onset:2010-08-10, Days after vaccination: 0
Gender:Male  Submitted:2010-08-17, Days after onset: 7
Location:New Jersey  Entered:2010-08-17
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: No pre-existing conditions Father states child hadn''t eaten breakfast. Also stated he didn''t go to sleep until 3AM
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1727X1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3046AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF500AA4IMRA
Administered by: Public     Purchased by: Public
Symptoms: Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: After receiving three vaccines, child had apparent vaso-vagal event, syncope, loss of consciousness, lasting approx. 30sec. Child was seated. Head lowered. BP 118/74, P 72/reg. Observed for 30" before releasing. Dad present entire time.

VAERS ID:395484 (history)  Vaccinated:2010-08-10
Age:12.0  Onset:2010-08-12, Days after vaccination: 2
Gender:Female  Submitted:2010-08-13, Days after onset: 1
Location:Alabama  Entered:2010-08-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB437AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3056AA0SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3356AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Induration, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 12 yo female with increased redness, swelling induration 48 hrs after vaccine given- (Tdap) with increased pain. 3.2 x 4.5cm area of induration no redness no fever.

VAERS ID:395490 (history)  Vaccinated:2010-08-11
Age:12.0  Onset:2010-08-11, Days after vaccination: 0
Gender:Male  Submitted:2010-08-17, Days after onset: 6
Location:Iowa  Entered:2010-08-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported to RN
Preexisting Conditions: None reported to RN
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3090AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3351AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1436Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: RN administered 3 vaccinations. Client stood up shortly after vaccinations were administered and went to waiting area to sit with parents and 2 siblings. RN heard yelling, looked out in waiting room and visualized client laying back in dad''s arms. RN grabbed anaphylactic kit and was to client in seconds. RN yelled for help immediately when visualized client laying in dad''s arms. When RN with client, client waking up and started conversing. This episode lasted no more than 20-30 seconds. When client awoke stated, "Why is everyone around me?" States, "I sat down, got dizzy and that is all I remember." Client alert and oriented to person, place and time. BP and assessment completed. EMT called per parents request. No further treatment completed. Followed up with family following day and mom states, "He is back to his normal self."

VAERS ID:395507 (history)  Vaccinated:2010-08-17
Age:12.0  Onset:2010-08-17, Days after vaccination: 0
Gender:Female  Submitted:2010-08-17, Days after onset: 0
Location:Virginia  Entered:2010-08-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Neurological examination
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB427BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0787Z0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3443BA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3352BA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Neurological examination, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Patient received vaccines approx 0920-0925: 4 shots 2 on each deltoid. After receiving vaccines patient complained of feeling dizzy. Rested on table in exam room in 5-7 minutes, when questioned: Patient stated she felt fine. Patient escorted to chair seated with dad in 0945 noticed patient to have laid head back in chair with hands in a fist unresponsive quickly brought patient to floor and she awaken right away.

VAERS ID:395553 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-18, Days after vaccination: 0
Gender:Female  Submitted:2010-08-18, Days after onset: 0
Location:Ohio  Entered:2010-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVB362CA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000010IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1748Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Patient came in to receive vaccinations for school. Patient received Hepatitis A, Varicella, Tdap, and Meningococcal. After patient received vaccinations had patient stay in chair. I finished up information in ECW, patient fainted I placed cold pack behind patient''s neck, elevated feet, and fanned patient. Called out patient''s name she responded and stated " I think I have to throw up." I placed trash can beside patient, patient did not throw up. I pulled out an orange juice for patient to drink she started feeling better. While leaving clinic room walked behind patient. Patient left with no signs or symptoms of distress.

VAERS ID:395557 (history)  Vaccinated:2010-08-12
Age:12.0  Onset:2010-08-13, Days after vaccination: 1
Gender:Male  Submitted:2010-08-18, Days after onset: 5
Location:Alabama  Entered:2010-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies
Preexisting Conditions: Denies
Diagnostic Lab Data:
CDC Split Type: AL1021
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1099Y IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3074AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3353AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1704Y SCLA
Administered by: Public     Purchased by: Other
Symptoms: Diet refusal, Feeling abnormal, Nausea, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4:30 AM T-103.5, Rt. arm swollen and sore, mom giving Advil 200mg q6 hr. for fever, c/o nausea, will not eat or drink. Feels real bad according to mom referred to MD or ER for eval of fever. 103-104 and feeling really bad.

VAERS ID:395593 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-18, Days after vaccination: 0
Gender:Female  Submitted:2010-08-18, Days after onset: 0
Location:Florida  Entered:2010-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA088BC2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dyskinesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: fainting episode with 2-3 seconds jerking

VAERS ID:395595 (history)  Vaccinated:2010-06-24
Age:12.0  Onset:2010-08-13, Days after vaccination: 50
Gender:Male  Submitted:2010-08-18, Days after onset: 5
Location:Idaho  Entered:2010-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1318Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3077AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3353AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1558Y0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Herpes zoster, Mobility decreased, Musculoskeletal pain, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Parkinson-like events (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Started having pain in right shoulder on 8/13. On 8/15 developed a red rash on right shoulder and arm. Pain increased. Saw MD on 8/15/10, diagnosed herpes zoster, started on Acyclovir 800mg 5x daily. 8/16 Parent reports severe pain and limited mobility of right shoulder/arm.

VAERS ID:395596 (history)  Vaccinated:2010-08-12
Age:12.0  Onset:2010-08-13, Days after vaccination: 1
Gender:Male  Submitted:2010-08-18, Days after onset: 5
Location:Ohio  Entered:2010-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: neuronal migration disorder with seizures on RX
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR0290110IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC528053BB0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Increase in number seiures noted. Previously about 2 / week. Now 2-5 per day.

VAERS ID:395821 (history)  Vaccinated:2010-08-17
Age:12.0  Onset:2010-08-18, Days after vaccination: 1
Gender:Female  Submitted:2010-08-19, Days after onset: 1
Location:Minnesota  Entered:2010-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.131842IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3246BA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.015921SCLA
Administered by: Public     Purchased by: Public
Symptoms: Discomfort, Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: REDNESS AT INJECTION SITE OF VARICELLA VACCINE, SIZE PALM OF HAND AND SOME DISCOMFORT

VAERS ID:395844 (history)  Vaccinated:2010-08-16
Age:12.0  Onset:2010-08-17, Days after vaccination: 1
Gender:Male  Submitted:2010-08-18, Days after onset: 1
Location:Arkansas  Entered:2010-08-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough
Preexisting Conditions: Meconium stained at birth - Reoccurring lung problems
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B053BB0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Headache, Oedema peripheral, Pyrexia, Skin warm, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. received TDAP in (L) deltoid on 081610. On 081710 mother called c/o redness & swelling the size of a quarter - told to apply warm moist heat and take anti-inflammatory. Pt. presented to clinic 081810 at 3:30 pm with arm swollen to 90 x 75 mm, red, hot to touch, instructed to continue heat and anti-inflammatorys & to see private MD if worsens or no improvement. Also c/o mild headache and low grade temp.

VAERS ID:395893 (history)  Vaccinated:2010-08-16
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2010-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3341AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3052CA IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1177Y SCLA
Administered by: Private     Purchased by: Private
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Patient was given ZOSTAVAX instead of Varicella - No adverse reaction was reported.

VAERS ID:395904 (history)  Vaccinated:2010-08-17
Age:12.0  Onset:2010-08-18, Days after vaccination: 1
Gender:Male  Submitted:2010-08-18, Days after onset: 0
Location:Montana  Entered:2010-08-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000010UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swollen, warm to touch 5 inch diameter around shot site.

VAERS ID:396016 (history)  Vaccinated:2010-08-17
Age:12.0  Onset:2010-08-17, Days after vaccination: 0
Gender:Male  Submitted:2010-08-17, Days after onset: 0
Location:Texas  Entered:2010-08-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB379BA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3053AA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B054BA5UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.120741UNLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal discomfort, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: 8/17/10 approx. 10:30 am child present with mother fainted post vaccination onto chair. B/P taken. 98/60 (L) arm HR=72. Res=14 unlabored, alert & oriented after few secs. EMS contacted arrived after 5 mins VS taken B/P 110/70 P=74 R=14. O2 Sat=97% mother requested EMS transport to ER at hospital, child x1 vomited outside clinic prior to transport. Child Disch from hospital ER at 12:36, F.U call from MOC doing well at home slight upset stomach.

VAERS ID:396104 (history)  Vaccinated:2010-08-06
Age:12.0  Onset:2010-08-06, Days after vaccination: 0
Gender:Male  Submitted:2010-08-20, Days after onset: 14
Location:Montana  Entered:2010-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMRA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEUR  IM 
TDAP: TDAP (ADACEL)SANOFI PASTEUR  IM 
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: BECAME PALE AND PASSED OUT AFTER HPV VACCINE # 1

VAERS ID:396109 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-20, Days after vaccination: 0
Gender:Female  Submitted:2010-08-20, Days after onset: 0
Location:Texas  Entered:2010-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None but mother has epilepsy and her aunt has a history of epilepsy
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1778Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3075AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B049BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1207Y1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Convulsion, Dyskinesia, Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Rcvd Tdap, Varicella, MCV4 and HPV. After receiving the last dose (was HPV) - started to seize - lasted approximately 30 seconds of jerking and then went limp. Came to immediately and was alert and oriented.

VAERS ID:396147 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-19, Days after vaccination: 1
Gender:Male  Submitted:2010-08-20, Days after onset: 1
Location:Arkansas  Entered:2010-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic Rhinitis; ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3433AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3448AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0713Z1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, warmth, pain, and itching to left posterior arm, 8/19/10 BENADRYL syrup given at home 8/19/10.

VAERS ID:396149 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-20, Days after vaccination: 0
Gender:Male  Submitted:2010-08-20, Days after onset: 0
Location:Arizona  Entered:2010-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CBC; CMP; CK; UA; UDS; Referred for EEG; MRI brain
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC3250BA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1436Y1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Blood creatine phosphokinase, Drug screen, Electroencephalogram, Full blood count, Hypotonia, Metabolic function test, Nausea, Nuclear magnetic resonance imaging brain, Pallor, Tremor, Urine analysis
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: TDAP and MCV4 and varicella given. About one minute after varicella given, patient stated he felt nauseated. I asked him to lie down and he crumpled up, I laid him down and he started to shake, got pale, lasted about 45 seconds.

VAERS ID:396168 (history)  Vaccinated:2010-08-16
Age:12.0  Onset:2010-08-17, Days after vaccination: 1
Gender:Male  Submitted:2010-08-20, Days after onset: 3
Location:Minnesota  Entered:2010-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR 5IMLA
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site vesicles, Vaccination site pain, Vaccination site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: At vaccine site, blisters, redness size of small apple, hot to touch, pain, tenderness.

VAERS ID:396173 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-20, Days after vaccination: 0
Gender:Female  Submitted:2010-08-20, Days after onset: 0
Location:Ohio  Entered:2010-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS100001 IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt. received TDAP and MENVEO, was taken to the checkout window where she fainted.

VAERS ID:396190 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-18, Days after vaccination: 0
Gender:Female  Submitted:2010-08-23, Days after onset: 5
Location:New York  Entered:2010-08-23
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: asthma. seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site erythema, Lethargy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever of 100 degress, lethargy, pain in arm, unable to lift arm, red raised quarter sized spot on her arm where vaccine was administered. We went to the doctor''s office and she was given Keflex 500 mg to take 4 times a day.

VAERS ID:396202 (history)  Vaccinated:2010-08-13
Age:12.0  Onset:2010-08-17, Days after vaccination: 4
Gender:Male  Submitted:2010-08-18, Days after onset: 1
Location:Nebraska  Entered:2010-08-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0795Z0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3514AA0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0436Z0SCUN
Administered by: Private     Purchased by: Other
Symptoms: Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 20 pox-type areas on chest, naval, axilla and back. Mother used Calamine lotion for itching.

VAERS ID:396225 (history)  Vaccinated:2010-08-12
Age:12.0  Onset:2010-08-14, Days after vaccination: 2
Gender:Female  Submitted:2010-08-23, Days after onset: 9
Location:Utah  Entered:2010-08-23
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
HPV4: HPV (GARDASIL)MERCK & CO. INC.0644Z0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3440AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3049AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0436Z1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, hot to touch, swollen and tender right arm. Started on Keflex for cellulitis.

VAERS ID:396622 (history)  Vaccinated:2010-08-19
Age:12.0  Onset:2010-08-19, Days after vaccination: 0
Gender:Male  Submitted:2010-08-19, Days after onset: 0
Location:Texas  Entered:2010-08-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: (5 - 10 minutes later) P - 74 regular; BP 110/82; Pupils PERRLA x 3 before leaving clinic.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB379BA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3362AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B043BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0410Z1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Head injury, Immediate post-injection reaction, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: Less than 1 minute after receiving shots, pt. said "I''m going down" but his mother who was between him and his sister (getting a shot by nurse) thought he didn''t mean it literally. He fell back toward door, touched it with his head, then fell to floor. His color was pale when he passed out. After a few minutes, he was able to walk with help to exam room to lay down.

VAERS ID:396276 (history)  Vaccinated:2010-08-11
Age:12.0  Onset:2010-08-11, Days after vaccination: 0
Gender:Female  Submitted:2010-08-24, Days after onset: 13
Location:Texas  Entered:2010-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3100AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3357AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0093Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: PATIENT FAINTED APPROXIMATELY 5 MIN AFTER RECIEVING VACCINE, PATIENT BUMPED HEAD ON CHAIR

VAERS ID:396345 (history)  Vaccinated:2010-08-16
Age:12.0  Onset:2010-08-16, Days after vaccination: 0
Gender:Female  Submitted:2010-08-24, Days after onset: 8
Location:Ohio  Entered:2010-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU2936BA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Injection site erythema, Injection site rash, Injection site swelling, Pallor, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Patient had a slightly raised red rash at the injection site, patient felt dizzy, heart beating fast, pale in color, tingling in fingers. HR=97 and BP=131/85 immediately after report of symptoms. Dr informed of reaction. Dr assessment: lungs clear, heart regular, some redness around vaccine site. Instructed patient to lay down on exam table and practicing relaxing breathing in through the nose and out through the mouth. After attempting to use the restroom the patient again started feeling "bad". Patient given a popsicle, laying flat and again doing relaxing breathing. After being monitored in the office for approximately 1 hour after injection the patient was feeling better and allowed to leave. Repeat HR=81 and BP=116/66. Educated patient''s mom on signs and symptoms to report to our office.

VAERS ID:396361 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-21, Days after vaccination: 1
Gender:Male  Submitted:2010-08-24, Days after onset: 3
Location:Minnesota  Entered:2010-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: none reported
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR 0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0610Z1SCLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, swollen and painful at site of vaccine. Required ER visit on 8/22/10 where Decadron and Ceftriaxone were administered.

VAERS ID:396380 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-19, Days after vaccination: 1
Gender:Female  Submitted:2010-08-23, Days after onset: 4
Location:Florida  Entered:2010-08-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1778Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3360AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Aphagia, Dyspnoea, Gastroenteritis viral, Hypersensitivity, Pruritus, Rash, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash over arms, legs, body itching - slight SOB. Mom saw pharmacist -$g BENADRYL given. Allergic reaction started next day after vaccines given. Child also used new soap and possibly this was the cause of the reaction. Child also c/o abdominal cramps. Unable to eat but able to drink fluids. Probable stomach virus. Vomited x 1 at home. When seen rash was resolving but still visible. No SOB noted. Mother instructed to continue BENADRYL PRN. Watch for SOB. Keep child hydrated. See MD or go to ER if symptoms worsen or if child unable to take fluids.

VAERS ID:396393 (history)  Vaccinated:2010-08-21
Age:12.0  Onset:2010-08-22, Days after vaccination: 1
Gender:Female  Submitted:2010-08-24, Days after onset: 2
Location:Florida  Entered:2010-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to Penicillin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Client received TDAP on 8/21/10 at R deltoid IM. Client reports on 8/22/10 that area of injection site with redness, swelling, warmth and mild pain. The swelling was extensive at area of R deltoid. Ice Pack applied without reduction in swelling. Client will follow-up with Primary Care Physician for further evaluation.

VAERS ID:396420 (history)  Vaccinated:2010-08-13
Age:12.0  Onset:2010-08-18, Days after vaccination: 5
Gender:Unknown  Submitted:0000-00-00
Location:Ohio  Entered:2010-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0475Z0IMLG
Administered by: Private     Purchased by: Private
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash all over leg on 8/18/10 received varicella vaccine 08/13/2010.

VAERS ID:396407 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-19, Days after vaccination: 1
Gender:Female  Submitted:2010-08-25, Days after onset: 6
Location:Arkansas  Entered:2010-08-25
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: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3514AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3111BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0675Z1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Erythema, Skin warm, Varicella
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Warm, erythematous area to posterior right arm measuring 16cm x 15cm, with blisters to center of erythema consistent to varicella.

VAERS ID:396457 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-24, Days after vaccination: 1
Gender:Female  Submitted:2010-08-25, Days after onset: 1
Location:Kansas  Entered:2010-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1457Y1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness swelling and warm to touch at injection site, cold compress to site. 7 out of 28 students had same reaction.

VAERS ID:396459 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-23, Days after vaccination: 0
Gender:Male  Submitted:2010-08-25, Days after onset: 2
Location:Kansas  Entered:2010-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1457Y1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness swelling and warm to touch at injection site, cold compress to site. 7 out of 28 students had same reaction.

VAERS ID:396460 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-23, Days after vaccination: 0
Gender:Male  Submitted:2010-08-25, Days after onset: 2
Location:Kansas  Entered:2010-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1457Y1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness swelling and warm to touch at injection site, cold compress to site. 7 out of 28 students had same reaction.

VAERS ID:396495 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-20, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Indiana  Entered:2010-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3306AA0UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS03052BA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0550Z1UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swelling.

VAERS ID:396519 (history)  Vaccinated:2010-08-24
Age:12.0  Onset:2010-08-24, Days after vaccination: 0
Gender:Female  Submitted:2010-08-25, Days after onset: 1
Location:Minnesota  Entered:2010-08-26, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.078622UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4hr after dizzy -lightheaded- headache. Stomach nausea with temp.

VAERS ID:396523 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-22, Days after vaccination: 2
Gender:Female  Submitted:2010-08-26, Days after onset: 4
Location:Michigan  Entered:2010-08-26
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: Environmental allergies - runny nose, cough; Allergic Rhinitis, Tonsillectomy, Adenoidectomy, Tympanostomy Tube Placement.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3355BA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURA52B061CA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0339Z1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Erythema multiforme (minor) - tx = SOLU MEDROL 125mg MEDROL dose pak cetirizine 10mg ranitidine 150mg. See notes.

VAERS ID:396533 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-09, Days after vaccination: 0
Gender:Male  Submitted:2010-08-26, Days after onset: 17
Location:Texas  Entered:2010-08-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHAVB730AA3 LA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB427BA0 LA
Administered by: Military     Purchased by: Military
Symptoms: Loss of consciousness, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt received Hep A And Hep B vaccine (child). Pt got pale and passed out for a few seconds on chair. Pt vomited, First responders were called. Pt was placed on exam table elevated feet. cold packs were placed. Vitals were normal. Pt was observed for 30 minutes then released.

VAERS ID:396586 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-19, Days after vaccination: 1
Gender:Male  Submitted:2010-08-24, Days after onset: 5
Location:Texas  Entered:2010-08-26, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Not reported
CDC Split Type: 201004457
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3080AA UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC3170 IJUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.06112 UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Eyelid oedema, Lip swelling, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report was received 19 August 2010 from a health care professional. A 12-year-old male patient had received an injection of ADACEL, lot number U2936DA (Sanofi Pasteur Ltd. lot number C3170), and MENACTRA, lot number U3080AA, and VARIVAX (manufacturer Merck), lot number 06112 on 18 August 2010 and the following morning, he experienced swelling of the lips and eyelids, and a puffy tongue. He was seen by his physician and received BENADRYL as corrective treatment. He had no past medical history, no concurrent illness, and he had not been taking any concomitant medications. He had not received any other vaccinations within four weeks of ADACEL, MENACTRA and VARIVAX. At the time of the report, recovery status was reported as unknown. Documents held by sender: None.

VAERS ID:396614 (history)  Vaccinated:2010-08-11
Age:12.0  Onset:2010-08-11, Days after vaccination: 0
Gender:Male  Submitted:2010-08-26, Days after onset: 15
Location:Nevada  Entered:2010-08-26
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: seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU3053AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B043BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Eye pruritus, Eye swelling, Lacrimation increased, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client developed mild cough, some "wheezing", swollen, watery, itchy eyes, large thick wheals (hives) over body. No fever. Mom took client to Urgert Care Facility. No tests performed, no meds prescribed. Mom gave Chlorpheniramine 8 mg. x1 8/11/2010 then gave client Zyrtec x2 days.

VAERS ID:396620 (history)  Vaccinated:2010-08-12
Age:12.0  Onset:2010-08-13, Days after vaccination: 1
Gender:Female  Submitted:2010-08-26, Days after onset: 13
Location:Texas  Entered:2010-08-26
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: TX20100088
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0795Z0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0339Z1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site swelling, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: REC''D HEP A AND VARICELLA AT NURSE VISIT 8/11/2010 ABOUT 1:30PM. HAD VISIT ON 8/13/2010 48 HOURS LATER SECOND TO SWELLING AND ERYTHEMA AT SITE. 9 1/2 X 9 CM OF EDEMA CIRCULAR AND CENTRAL ERYTHEMA AREA 4 CM. NO FEVER. DX: LOCAL REACTION. ON 8/14 REDNESS SPREAD. GIVEN CLINDAMYCIN 150 MG ONE PO TID X 10 DAYS. PHONE 8/15 BETTER.

VAERS ID:396625 (history)  Vaccinated:2010-08-26
Age:12.0  Onset:2010-08-26, Days after vaccination: 0
Gender:Female  Submitted:2010-08-26, Days after onset: 0
Location:Tennessee  Entered:2010-08-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: Allergies to 18 different foods, nuts, & fruits (list not available)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0569Z0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3356BA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3448AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0550Z1SCRA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Convulsion, Crying, Dizziness, Dyskinesia, Gaze palsy, Immediate post-injection reaction, Muscle rigidity, Mydriasis, Pain in extremity, Pallor, Posture abnormal, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Immunizations given R deltoid- Hepatitis A, R arm SQ- varicella, L upper D- TdaP, L lower D- Menactra. Immediately after giving Menactra child stated "ouch that one hurt," then slumped back on exam table, skin pale, pupils dilated, eyes rolled back, no response from patient. Child''s mom by her side calling her name, instructed mom to get help. Patient''s body became rigid, legs flexed, jerking- seizure like activity for about 10-15 seconds. RN called 911. After approximately 30-45 seconds child then responds "what happened" and began crying, c/o R arm pain. Vitals at 11:30 b/p 104/63, HR 66. Child alert to person, place, and surroundings, but unsure about what was happening to her. Skin color WNL, vaccine sites WNL. EMS arrived to transport. Patient sat up on exam table still c/o weakness and dizziness. Child placed on stretcher with help of EMS. Mom with child. To be transported to Hospital.

VAERS ID:396647 (history)  Vaccinated:2010-08-24
Age:12.0  Onset:2010-08-26, Days after vaccination: 2
Gender:Male  Submitted:2010-08-26, Days after onset: 0
Location:Montana  Entered:2010-08-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB437BA0UNLA
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER1000010UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3049AA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Induration, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) arm - 6cm x 4cm raised, indurated, warm area. (L) 3-4 1cm Indurated areas no systemic effects.

VAERS ID:396653 (history)  Vaccinated:2010-08-24
Age:12.0  Onset:2010-08-24, Days after vaccination: 0
Gender:Male  Submitted:2010-08-25, Days after onset: 1
Location:California  Entered:2010-08-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0597Z0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Anxiety, Asthenia, Dizziness, Feeling cold, Nervousness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: HPV given at 2:15 PM. Pt waited 15 mins. After vaccine in order to see if any reaction occurred. Pt was fine after the 15 mins. and left. At 4:00PM mother came back to office stating pt was feeling shaky and arm where vaccine was given was hurting. He was put in a room. And O2 sats and BP were observed. He was given Orapred 3os PO x 1 At 4:10 PM, Then given Benadryl 2 TSP at 4:26PM. At 4:26 PM. He was a little anxious and continued to have pain. At 4:15 he still had pain and felt weak/cold. At 5:34 He had less pain, but felt dizzy. He had a good BP. He was observed until 6:12 PM. He was sent to ER in order for observation to continue. He was given Morphine and oxygen in ER. He was released at 1:30AM.

VAERS ID:396673 (history)  Vaccinated:2010-08-25
Age:12.0  Onset:2010-08-26, Days after vaccination: 1
Gender:Male  Submitted:2010-08-27, Days after onset: 1
Location:Georgia  Entered:2010-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CELLULITIS TO LEFT FOOT
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BO46AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1706Y1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Rash, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RED, SWOLLEN, HOT, RAISED PATCH ON OUTER LEFT ARM (2 1/2 BY 1 1/2 INCH)

VAERS ID:396736 (history)  Vaccinated:2010-08-04
Age:12.0  Onset:2010-08-10, Days after vaccination: 6
Gender:Male  Submitted:2010-08-27, Days after onset: 17
Location:Ohio  Entered:2010-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: acne - on topical meds
Preexisting Conditions: none
Diagnostic Lab Data: See ENT report enclosed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B061BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Deafness, Dizziness
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: August 10th onset of hearing loss and dizziness - see ENT report enclosed.

VAERS ID:396797 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-21, Days after vaccination: 3
Gender:Female  Submitted:2010-08-23, Days after onset: 2
Location:New York  Entered:2010-08-30, 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: Allergic to PCN; Latex; Corn; Banana; Peanuts
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0096Z1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS0290110IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Local swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction with erythema and swelling, firmness, tender to palpation.

VAERS ID:396830 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-24, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Alabama  Entered:2010-08-30
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: Pt returned 8/26/10 with mild increased swelling/erythema with new urticarial rash on trunk. Rx steroids x 5 days for allergic rx.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0714Z1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Injection site erythema, Injection site macule, Injection site swelling, Pain, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 9x11cm slightly raised erythematous macule on the upper left arm. Pain to palpation. ALLEGRA and MOTRIN given. BENADRYL 25mg, cool compress.

VAERS ID:396892 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-20, Days after vaccination: 0
Gender:Male  Submitted:2010-08-29, Days after onset: 9
Location:Illinois  Entered:2010-08-31, 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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3514AA UNUN
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Agitation, Arthralgia, Body temperature increased, Diarrhoea, Fatigue, Irritability, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Friday - slight fever, aches, easily agitated, irritable. Saturday - irritable, stomach pain, afternoon temp increase. Sunday - diarrhea, feeling of nausea, hip pain. Monday stomach pain, hip and thigh pain, tired.

VAERS ID:396909 (history)  Vaccinated:2010-08-18
Age:12.0  Onset:2010-08-18, Days after vaccination: 0
Gender:Female  Submitted:2010-08-25, Days after onset: 7
Location:Minnesota  Entered:2010-08-31, 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: No
Preexisting Conditions: Speech therapy ongoing
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0075Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS0290110IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B040BA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0280Z1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Seen 8/20. Increased redness (no induration), (+) warmth site of Varicella, 6.5 cm x 7 cm erythema (symptoms started that night).

VAERS ID:396910 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-23, Days after vaccination: 0
Gender:Female  Submitted:2010-08-23, Days after onset: 0
Location:Florida  Entered:2010-08-31, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.085121IJRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0664Z0IJLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3473AA0IJRA
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Fatigue, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Over course of 90 minutes, pt. had 3 syncopal episodes and nausea. Unable to walk w/o having syncope. Very pale and tired.

VAERS ID:396922 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-25, Days after vaccination: 2
Gender:Male  Submitted:2010-08-25, Days after onset: 0
Location:Minnesota  Entered:2010-08-31, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3111CA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Marked swelling, ? cellulitis site of vaccine about 3 x 6".

VAERS ID:397875 (history)  Vaccinated:2010-08-10
Age:12.0  Onset:2010-08-10, Days after vaccination: 0
Gender:Male  Submitted:2010-08-20, Days after onset: 10
Location:Texas  Entered:2010-08-31, 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:
Current Illness:
Preexisting Conditions: Not reported
Diagnostic Lab Data: None reported
CDC Split Type: 201004327
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3444B0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC33120IMRA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Felt faint, nauseated, sweating.

VAERS ID:397897 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-24, Days after vaccination: 1
Gender:Female  Submitted:2010-08-31, Days after onset: 7
Location:California  Entered:2010-08-31
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: No concurrent illnesses. No known allergies. It was unknown if the patient was taking any other medications at the time of the event, or if she had received any other vaccinations with 4 weeks prior to the MENACTRA vaccination on 23 August 2010. The mother of the patient reported that the patient had received a prior dose of MENACTRA on 07 October 2005. The mother also stated the patient had experienced headaches prior to MENACTRA vaccination on 23 August 2010.
Diagnostic Lab Data: None
CDC Split Type: 201004614
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Headache, Migraine, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report received on 27 August 2010 from a health care professional. A 12-year-old female patient had received a second dose of MENACTRA vaccine on 23 August 2010. It was reported the patient had received the first dose of MENACTRA vaccine on 07 October 2005. On 24 August 2010, i.e. the following day after receiving the MENACTRA vaccination, the patient started to experience headache and fever. Two days later, the headaches were of a migraine type nature. The patient was evaluated by her physician the following day, but it was not reported whether the patient required any treatment. No relevant diagnostic tests or laboratory data were performed. The patient had no concurrent illnesses at the time of the vaccination on 23 August 2010, and had no known allergies. Per the mother of the patient, the patient had experienced headaches prior to receiving the MENACTRA vaccination on 23 August 2010. The patient''s recovery status was not reported. Documents held by sender: None.

VAERS ID:397062 (history)  Vaccinated:2010-08-30
Age:12.0  Onset:2010-08-31, Days after vaccination: 1
Gender:Male  Submitted:2010-09-01, Days after onset: 1
Location:Missouri  Entered:2010-09-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB417BA IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0664Z IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3468AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063BA IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left upper arm swollen and red, warm to touch.

VAERS ID:397182 (history)  Vaccinated:2010-08-26
Age:12.0  Onset:2010-08-26, Days after vaccination: 0
Gender:Female  Submitted:2010-08-27, Days after onset: 1
Location:New Jersey  Entered:2010-09-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0337Z2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pale, Diaphoretic in office.

VAERS ID:397189 (history)  Vaccinated:2010-08-26
Age:12.0  Onset:2010-08-26, Days after vaccination: 0
Gender:Male  Submitted:2010-08-30, Days after onset: 4
Location:Wisconsin  Entered:2010-09-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU2969BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0996Y1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Fall, Head injury, Lethargy, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Hit head on floor after passing out. passed out a minute or 2 later, after getting the shot. Acted lethargic, and he vomited about one hour later.

VAERS ID:397226 (history)  Vaccinated:2010-09-01
Age:12.0  Onset:2010-09-01, Days after vaccination: 0
Gender:Female  Submitted:2010-09-02, Days after onset: 1
Location:Texas  Entered:2010-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1IJRA
Administered by: Unknown     Purchased by: Private
Symptoms: Dyspnoea, Eye swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling of patient''s left eye. Difficulty breathing.

VAERS ID:397227 (history)  Vaccinated:2010-08-31
Age:12.0  Onset:2010-08-31, Days after vaccination: 0
Gender:Female  Submitted:2010-09-02, Days after onset: 2
Location:Texas  Entered:2010-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient had received the meningococcal vaccine in the month prior to Pneumovax but this was administered at the primary care office and I do not have specific records for this vaccine
Current Illness: No
Preexisting Conditions: Lupus
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1188Y0 LA
Administered by: Private     Purchased by: Other
Symptoms: Generalised erythema, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Generalized redness, throat tightening given oxygen, Benadryl 50 mg IM prednisone increased to 40 mg BID for 5 days

VAERS ID:397259 (history)  Vaccinated:2010-08-31
Age:12.0  Onset:2010-09-01, Days after vaccination: 1
Gender:Female  Submitted:2010-09-02, Days after onset: 1
Location:Arkansas  Entered:2010-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063CA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0636Z SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Posterior right arm swollen and red, warm to touch.

VAERS ID:397277 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-21, Days after vaccination: 1
Gender:Female  Submitted:2010-09-03, Days after onset: 13
Location:Pennsylvania  Entered:2010-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3336AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1560Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initially started with a headache, then developed fever of 101, then left arm became red and swollen to elbow. Symptoms lasted 3-4 days. MD called and suggested cold compresses and Ibuprofen as needed.

VAERS ID:397374 (history)  Vaccinated:2010-08-30
Age:12.0  Onset:2010-09-02, Days after vaccination: 3
Gender:Female  Submitted:2010-09-03, Days after onset: 1
Location:Pennsylvania  Entered:2010-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0795Z0IMRA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU3334A0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3035BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0064Z1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives all over body. Itching on hands and feet.

VAERS ID:397453 (history)  Vaccinated:2010-09-01
Age:12.0  Onset:2010-09-02, Days after vaccination: 1
Gender:Male  Submitted:2010-09-04, Days after onset: 2
Location:North Carolina  Entered:2010-09-03, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3083CA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local reaction, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local reaction x 3d - erythema, pruritus - progressive. 1) Symptomatic tx. 2) Prophylactic tx (antibiotic). 3) Follow up if symptoms persist $g 7d.

VAERS ID:397499 (history)  Vaccinated:2010-08-17
Age:12.0  Onset:2010-08-25, Days after vaccination: 8
Gender:Female  Submitted:2010-08-27, Days after onset: 2
Location:Maryland  Entered:2010-09-07, 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:
Current Illness: None
Preexisting Conditions: Mild mitral regurg with LAE; Complex partial seizure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0714Z1SCUN
Administered by: Private     Purchased by: Private
Symptoms: Lip swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives, swollen lips.

VAERS ID:397514 (history)  Vaccinated:2010-08-27
Age:12.0  Onset:2010-08-27, Days after vaccination: 0
Gender:Female  Submitted:2010-08-27, Days after onset: 0
Location:Maryland  Entered:2010-09-07, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Felt Faint~HPV (Gardasil)~2~10.00~Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB311AA1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0570X2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Heart rate decreased, Hyperhidrosis, Nausea, No reaction on previous exposure to drug, Respiratory rate increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Patient was given GARDASIL #3 and Hep A #2 no hx reactions in past. She felt faint,, diaphoresis, dizzy, nausea, pulse was slow 50 bpm. Increased resp. rate given water, cool compresses, oxygen.

VAERS ID:397597 (history)  Vaccinated:2010-08-06
Age:12.0  Onset:2010-08-17, Days after vaccination: 11
Gender:Male  Submitted:2010-09-07, Days after onset: 21
Location:D.C.  Entered:2010-09-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1456Y1IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0415Z0IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD00421UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0034Z1UNRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2864AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0097Z1UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Cellulitis, Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 8/16/10 pt. received vaccines & 24 hrs. later develop redness & warmth on (R) deltoid. Seen 8/18 dx with cellulitis treated with abx. 8/20/10 - much improved.

VAERS ID:397642 (history)  Vaccinated:2010-09-01
Age:12.0  Onset:2010-09-02, Days after vaccination: 1
Gender:Female  Submitted:2010-09-08, Days after onset: 6
Location:Michigan  Entered:2010-09-08
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0444Z1SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3516AA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting x 24 hours after receiving TDAP and MMR. (Mom requested that we report).

VAERS ID:398177 (history)  Vaccinated:2009-06-30
Age:12.0  Onset:2009-06-30, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 400
Location:Arizona  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0907USA00259
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0548X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a medical assistant concerning a 12 year old female with no pertinent medical history who was vaccinated with the first 0.5 ml dose of GARDASIL (IM, lot number 661044/0548X) on 30-JUN-2009 and fainted. Concomitant therapy included MCV4. Unspecified medical attention was sought. There was a "finger stick to check her sugar" (results were not reported). At the time of the report, the patient recovered. Follow-up information has been received from a member of the office. It was reported that the patient received GARDASIL and about 10 minutes later she fainted. However, it was reported that the patient walked to the office that day and it was hot outside. Follow-up information has been received from another member in the office who confirmed the above information as well the patient''s birth date, vaccination date and lot number. She also added that the day the patient came into the office it was hot outside, their air conditioning was not working and the patient did walk to the office. Therefore, it could not be certain if the fainting was from the GARDASIL or from heat exhaustion. This is one of several reports from the same source. No further information is available.

VAERS ID:398372 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Washington  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0907USA01860
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient who on an unspecified date was vaccinated with a dose of GARDASIL. There was no concomitant medication or vaccine reported. It was reported that the patient fainted for about 45 seconds. She had no other events or issues. It was reported that no treatment was needed and the patient was recovering at the time of the report. Additional information has been requested.

VAERS ID:398476 (history)  Vaccinated:2009-05-18
Age:12.0  Onset:2009-05-18, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 443
Location:Utah  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0907USA02607
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1497X1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from an office manager concerning a 12 year old female patient who was vaccinated with a first dose of GARDASIL (lot# 662229/1497X, expiration 15-APR-2011, site and route not reported) on 16-JUN-2008, the second dose (lot# 662229/1497X, expiration 15-APR-2011) on 18-MAY-2009 and the third dose (lot# 662229/1497X, expiration 15-APR-2011) on 13-JUL-2009. After receiving the second dose of GARDASIL, the patient had injection site lump and tenderness that lasted for 7 weeks. It was unknown if the patient sought medical attention. Additional information has been requested.

VAERS ID:398492 (history)  Vaccinated:2009-07-16
Age:12.0  Onset:2009-07-16, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 384
Location:Texas  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0907USA02804
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1497X1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient who on 16-JUL-2009 was vaccinated with the second dose of GARDASIL (Lot number 662229/1497X) 0.5 mL IM. On 16-JUL-2009, the patient "fainted" and "hit her head on the table next to her right after getting her second GARDASIL shot". They did a TB test just before giving her the GARDASIL. On the same day, the patient recovered. The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:398589 (history)  Vaccinated:2008-09-16
Age:12.0  Onset:2008-09-16, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 687
Location:D.C.  Entered:2010-09-08, Days after submission: 35
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: Rash; Rhinitis allergic; Obesity
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0910USA01726
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning an approx 12 year old female with rhinitis allergic and obesity who on 16-SEP-2008 was vaccinated with a dose of GARDASIL, 0.5 ml, IM (Lot #659184/0843X). There was no concomitant medication. Physician reported that the patient developed a syncopal episode. The physician considered the syncopal episode occurred after the patient left the office. The patient went to the emergency room and was hospitalized for 3 days for her syncopal episode. It is noted on the patient''s chart that when she received dose 1, she had a rash (the rash was present before she received Dose 1). She was prescribed hydrocortisone cream and BENADRYL. The patient has not received any additional doses of GARDASIL. At the time of this report, the patient was recovered. This is one of several reports received the same source. All telephone attempts to obtain follow up information have been unsuccessful. Additional information has been requested.

VAERS ID:398590 (history)  Vaccinated:2009-06-15
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Nebraska  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes insipidus
Diagnostic Lab Data: body temp, 103 degre, fever
CDC Split Type: WAES0909USA00013
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0570X0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Pyrexia, Vaccine positive rechallenge, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 12 year old female who in June 2009, was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot number not reported). Concomitant vaccination included ADACEL. In June 2009, after receiving the vaccination the patient started vomiting and had a fever of 103 degrees. She vomited 20 times in 24 hours. After 24 hours of the vaccination, the patient was then given promethazine and the AE went away. Unspecified medical attention was sought. It was also reported that in August 2009, the patient was vaccinated intramuscularly with the second 0.5ml dose of GARDASIL (lot number not reported). Concomitant vaccination included MENACTRA. Subsequently the patient experienced the same AE. The patient was again given promethazine and the AE went away. The patient stopped to receive the GARDASIL. Follow-up information was received from a employee in the physician''s office concerning a 12 year old female patient with a medical history of diabetes insipidus who on 15-JUN-2009 was vaccinated intramuscularly into the arm with the first dose of GARDASIL (lot number 660616/0570X, expired date 02-NOV-2010) and on 21-AUG-2009 was vaccinated intramuscularly into the arm with the second dose of GARDASIL (lot number 661952/1129X, expired date 12-MAR-2011). On 21-AUG-2009 at 18:00 the patient experienced fever, severe vomiting requiring antiemetics. On an unspecified date the patient recovered. Fever and severe vomiting were considered to be an other important medical event by the reporter. Additional information is not expected.

VAERS ID:398954 (history)  Vaccinated:2009-07-15
Age:12.0  Onset:2009-07-21, Days after vaccination: 6
Gender:Female  Submitted:2010-08-04, Days after onset: 379
Location:California  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Wheezing; Reactive airways disease
Preexisting Conditions: Respiratory tract infection
Diagnostic Lab Data: Arterial blood O2, 07/21/09, 99%; Respiratory rate, 07/21/2009, 16; Vital sign, 07/23/2009, within normal limits
CDC Split Type: WAES0907USA04363
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURUF471AA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0312Y0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0554Y1SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2918AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dyspnoea, Dyspnoea exertional, No reaction on previous exposure to drug, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Information has been received from a consumer concerning his 12 year old daughter with no pertinent medical history and no known allergies who on 15-JUL-2009 was vaccinated with the first dose of GARDASIL(lot number not reported). Secondary suspect drug included MMR II (MSD). Concomitant therapy included meningococcal vaccine (unspecified) and diphtheria toxoid (+) poliovirus vaccine inactivated (Vero) (+) tetanus toxoid (VACCIN DTP). On 19-JUL-2009 the patient started experiencing difficulty breathing. Unspecified medical attention was sought. The patient''s physician prescribed her prednisone 40 mg (manufacturer unspecified) and the patient had been taking it for 4 days. At the time of the report, the patient was not recovered. Follow-up information has been received from a physician concerning the 12 year old female patient with reactive airway disease usually triggered by respiratory infection who on 15-JUL-2009 at 4:05 PM was vaccinated IM in the left deltoid with the first dose of GARDASIL (lot number 622404/0312Y). Secondary suspect vaccination on the same day at 4:05 PM included a second SQ dose of MMR II (lot number 664363/0554Y) in the right arm. Concomitant vaccinations on the same day at 4:05 PM included a first IM dose of MENACTRA (lot number U2918AA) in the right deltoid and a first IM dose of DTAP (UF471AA) (Sanofi Pasteur) in the left deltoid. There was no illness at the time of vaccination and no adverse event following prior vaccination. On 21-AUG-2009 the patient saw the physician for a 3 day history of cough with a 4 days history of afebrile upper respiratory infection (URI). It was noted by the patient that the shortness of breath (SOB) worsened with physical exertion (PE). The patient''s mother started albuterol metered dose inhaler (MDI) 2 days before the office visit. The patient had a physical exam and an arterial blood oxygen saturation test performed with a result of 99%. A respiratory rate measurement was also performed with a result of 16 (unit not provided). The patient stated that she had a decreased voluntary air exchange. The patient was placed on XOPENEX (versus Albuterol) and prednisone for 5 days. On 23-JUL-2009, the patient saw the physician for subjective SOB. The patient vital signs and physical examination were within normal limits. On 25-JUL-2009, the patient recovered. Additional information is not expected.

VAERS ID:399169 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:New York  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES1001USA02557
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient with no pertinent medical history, drug reactions or allergies reported, who "about a year ago", in approximately 2009, was vaccinated with the first dose of GARDASIL (route and lot # unknown). There was no concomitant medication. In approximately 2009, "about a year ago", after the patient received the first dose of GARDASIL she fainted. No lab diagnostic studies performed. The patient did not seek medical attention. The physician reported that the patient recovered after fainting and was able to leave the office that same day. Additional information has been requested.

VAERS ID:399180 (history)  Vaccinated:2009-10-01
Age:12.0  Onset:2009-11-01, Days after vaccination: 31
Gender:Female  Submitted:2010-08-04, Days after onset: 276
Location:Indiana  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1001USA01302
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Alopecia
SMQs:
Write-up: Information has been received from a licensed practical nurse concerning a 12 year old female with no medical history or drugs allergies, who in October 2009, was vaccinated with a first dose of GARDASIL. In November 2009, less than four weeks after the GARDASIL, she started to lost all her hair. The patient was treated with CLODERM. The patient sought medical attention through an office visit. At the time of this report the patient was recovering and the hair has started to grow back. Additional information has been requested.

VAERS ID:399229 (history)  Vaccinated:2009-08-19
Age:12.0  Onset:2009-08-19, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 350
Location:Montana  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BUSPAR
Current Illness: Pregnancy NOS (LMP = Unknown); Anxiety
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0912USA01408
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0670Y2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Nausea, Oropharyngeal pain, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a registered nurse for the GARDASIL pregnancy registry, concerning a 12 year old female patient with anxiety who on 04-DEC-2008, 02-FEB-2009 and 19-AUG-2009 was vaccinated IM with a 0.5 mL first, second and third dose of GARDASIL (LOT # for third dose 0670Y). Concomitant therapy included BUSPAR. It was reported that at the time of receiving the third dose of GARDASIL the patient was pregnant. On 20-AUG-2009, 24 hours after the third dose of GARDASIL was administered, the patient developed nausea and vomiting which the nurse attributed to the patient''s pregnancy. No laboratory or diagnostic tests were performed. On an unknown date, the patient recovered from nausea and vomiting. The patient''s last menstrual period was not reported and the estimated delivery date is 03-MAY-2010. Information received on 09-DEC-2009 contained the following adverse experiences: sore throat (onset on approximately 09-DEC-2009) which was treated with amoxicillin. Additional information has been requested.

VAERS ID:399242 (history)  Vaccinated:2009-12-02
Age:12.0  Onset:2009-12-02, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 244
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0912USA00719
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0070X0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a Registered Nurse concerning a 12 year old female patient without a pertinent medical history or without drug reactions or allergies who on 02-DEC-2009 was vaccinated with her 0.5 ml first dose of GARDASIL intramuscularly in the deltoid region of the left arm. Concomitant medications were not reported. The reporter mentioned that on 02-DEC-2009 the patient developed redness on, warmth and itching on the ulnar aspect of the left lower arm 45 minutes after receiving GARDASIL. No laboratory or test diagnostics were performed. It was reported that the nurse applied cold compress and BEANDRYL gel topically to the affected area and symptoms resolved within 1 hour. Follow up has been received from the registered nurse regarding the 12 year old female patient with no known drug reactions or allergies or pertinent medical history who on 02-DEC-2009 was intramuscularly vaccinated with her first 0.5 ml dose of GARDASIL (Lot#660553/0070X) in the deltoid muscle of the left arm. It was reported that approximately 30 min later, on 02-dec-2009, the patient reported to the school clinic complaining of severe itching of radial aspect of the left forearm. The patient was examined and an itching area of approximately 6 inches which was erythematous and warm, that resemble phlebitis that disappeared very quickly. It was reported that there was no mark that indicated possible injury, sting or bite in the immediate area and that there was no inflammation presented at the time or later. An ice pack was applied and within 20-30 min all symptoms and signs had disappeared. It was reported by the registered nurse that a correct injection technique was performed and that when the needle was inserted in to the muscle no blood was withdrawn. The registered nurse stated that it was difficult to determine if the event was related to the administration of GARDASIL, because there was some distance between the reaction and the injection site. Other causes such insect bite could not be ruled out. No further information is available.

VAERS ID:399312 (history)  Vaccinated:2009-08-03
Age:12.0  Onset:2009-08-03, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 366
Location:Nevada  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0910USA03075
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0087Y0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Fall, Hyperhidrosis, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a patient who on an unspecified date was vaccinated with a dose of GARDASIL (route and lot # unknown) and experienced sweating and fainted at the physician''s office. At the time of this report the patient''s outcome was unknown. Follow up information has been received concerning the 12 year old female patient with no illness at the time of vaccination and with no known drug allergies, who on 03-AUG-2009 was vaccinated with the first dose of GARDASIL intramuscularly into her right upper extremity (lot # 662518/0087Y) at the private doctor''s office/hospital with private funds at 12:30. It was reported that on 03-AUG-2009 the patient received the vaccine in the exam room, then walked to their checkout desk where she stood for approximately 3-4 minutes and then she lost consciousness and felt backwards. The patient was taken back to room and was placed O2 via nasal cannula, she stayed there until she fully recovered on 03-AUG-2009. This is one of several reports from the same source. No further information is available.

VAERS ID:399313 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:South Carolina  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0911USA02861
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IJUN
Administered by: Other     Purchased by: Other
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient who on an unspecified date was vaccinated with the first dose of GARDASIL. Subsequently the patient experienced irregular bleeding and decided not to complete the series of injections. At the time of the report the status of the patient was unspecified. The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:399377 (history)  Vaccinated:2009-08-06
Age:12.0  Onset:2009-09-06, Days after vaccination: 31
Gender:Female  Submitted:2010-08-04, Days after onset: 332
Location:Indiana  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0911USA00187
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0653X0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Alopecia
SMQs:
Write-up: Information has been received from a licensed practical nurse concerning a 12 year old female patient with no previous medical history who on 06-AUG-2009 was vaccinated with the first dose of GARDASIL (Lot number 661841/0653X). There was no concomitant medication. About one month after vaccination, approximately on 06-SEP-2009, the patient had hair loss. The patient''s hair loss persisted. The patient sought medical attention, was seen in the office. Additional information has been requested.

VAERS ID:399405 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0911USA02097
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pallor, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a patient''s father concerning his 12 year old daughter, who on an unspecified date was vaccinated with the first 0.5ml dose of GARDASIL (lot # not provided). Subsequently the patient turned white and nearly fainted after getting the first dose of GARDASIL. At the time of the report the patient''s outcome was unknown. No laboratory diagnostics studies were performed. The patient did not seek medical attention. No further information is available.

VAERS ID:399417 (history)  Vaccinated:2009-07-28
Age:12.0  Onset:2009-09-22, Days after vaccination: 56
Gender:Female  Submitted:2010-08-04, Days after onset: 316
Location:California  Entered:2010-09-08, Days after submission: 35
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: Premature atrial contraction
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0911USA01939
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0318X0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Sinusitis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a nurse concerning a 12 year old female patient with a history of a premature atrial contraction who on 28-JUL-2009 was vaccinated with the first dose of GARDASIL (lot# 661046/0381X). There was no concomitant medication. On 22-SEP-2209 the patient''s mother called 911 and the patient was taken to the Emergency Room (ER) and diagnosed with syncope and sinusitis. The mother believed it was due to the vaccine; however the nurse did not think that it was. There as an about two month''s delay, almost a three month between the injection and the syncope. The patient received AUGMENTIN. At the time of the report, the patient was doing well. Additional information has been requested.

VAERS ID:399533 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2010-08-04
Location:South Dakota  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1006USA00627
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a "12 or 13 year old male patient who on an unspecified date was vaccinated with a dose of GARDASIL (lot number not reported). The patient received therapy a dose of dose of diphtheria toxoid and pertussis acellular vaccine (unspecified and tetanus toxoid and a dose of MENACTRA on the same visit. On an unspecified date the patient experienced rash. Unspecified medical attention was sought. The patient was given 3 days of prednisone and it cleared. Additional information has been requested.

VAERS ID:399593 (history)  Vaccinated:2010-03-16
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Texas  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1005USA04401
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1178Y UNUN
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a practice manager concerning a 12 year old female patient who on 16-MAR-2010 was vaccinated with one dose of GARDASIL (Lot # 663559/1178Y). The practice manager reported that the patient experienced edema of the extremities. At the time of this report, the patient had not recovered. It was unknown if the patient sought medical attention. Additional information has been requested.

VAERS ID:399619 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:2010-05-13
Gender:Male  Submitted:2010-08-04, Days after onset: 83
Location:Texas  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1005USA02009
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old male who was vaccinated with a dose of GARDASIL. Concomitant medication included 2 other unspecified vaccines. It was reported that on 13-MAY-2010 "the patient had fainted after the vaccination. The patient recovered on 13-MAY-2010 and went home." The patient received unspecified medical attention. Additional information has been requested.

VAERS ID:399624 (history)  Vaccinated:2010-05-12
Age:12.0  Onset:2010-05-12, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 84
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES1005USA02056
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0075Y1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Dizziness, Expired drug administered
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Medication errors (narrow)
Write-up: Information has been received from a nurse concerning a 12 year old female patient with none drug allergies who on 09-MAR-2010 was vaccinated IM with the first dose 0.5 ml of GARDASIL (lot number not available). On 12-MAY-2010 the patient was vaccinated IM with the second dose of GARDASIL (lot number 661954/0075Y, expiration 15-MAR-2010). Within 10 minutes of receiving the second dose, the patient experienced dizziness. The following morning (13-MAY-2010) the patient had diarrhea. The patient was treated with clear liquid diet. Unspecified medical attention was sought. No lab studies were performed. On an unknown date, the patient recovered. Additional information has been requested.

VAERS ID:399684 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:California  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1006USA01302
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Fatigue, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient who on an unspecified date was vaccinated with the first dose of GARDASIL intramuscularly. Concomitant therapy included MENACTRA and (unspecified) TDAP received on the same day. The patient went to the emergency room twice. The patient had weak muscles, fatigue and shortness of breath and difficulty breathing. At the time of the report the patient was recovering from weak muscles, fatigue and shortness of breath and difficulty breathing. Additional information has been requested.

VAERS ID:399750 (history)  Vaccinated:2009-12-22
Age:12.0  Onset:2009-12-22, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 224
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic reaction to antibiotics
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1003USA01987
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site movement impairment, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a consumer concerning her 12 year old daughter with allergic reaction to AUGMENTIN who on 220DEC-2009 was vaccinated with the first dose of GARDASIL (lot # not reported). On 23-FEB-2010 the patient was vaccinated with the second dose GARDASIL (lot# not reported). It was reported the patient experienced swelling, stiffness and stinging at the injection site after each of the two doses of GARDASIL. No medical attention was sought. Vaccination with GARDASIL was continued. At the time of this report, the patient had recovered after being on therapy. Additional information has been requested.

VAERS ID:399804 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Utah  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1003USA00490
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Amenorrhoea, Laboratory test
SMQs:, Fertility disorders (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient with unspecified medical history, drug reactions or allergies, who in "November" (year unspecified), was vaccinated with a 0.5 mL dose of GARDASIL, intramuscular route (lot # unknown). Concomitant therapy included MENACTRA administered at same time with GARDASIL. The physician reported that "in September", the patient began her first menstrual cycle and since the patient received GARDASIL and MENACTRA she had no experienced a menstruation. Lab diagnostic studies performed were unspecified. The patient did not seek medical attention. At the time of the report the patient''s outcome was unknown. No further information is available.

VAERS ID:399962 (history)  Vaccinated:2009-12-01
Age:12.0  Onset:2009-12-01, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 245
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1002USA03470
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Lethargy, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a 13 year old female patient who in December 2009, was vaccinated with a dose of GARDASIL. In December 2009, the patient experienced weakness, lethargy, pins and needles in her fingers and toes and muscle pain after receiving the vaccination. The patient visited the doctor and was prescribed NOROXIN but no improvement was seen. At the time of the report, the patient had not recovered. Additional information has been requested.

VAERS ID:399991 (history)  Vaccinated:2009-07-20
Age:12.0  Onset:2010-01-23, Days after vaccination: 187
Gender:Female  Submitted:2010-08-04, Days after onset: 192
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES1002USA00336
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Vaginal inflammation
SMQs:
Write-up: Information has been received from a consumer concerning 12 year old daughter with allergies and no drug allergies who on 20-JUL-2009 was vaccinated with a first dose of GARDASIL (lot # not reported). Concomitant therapy included allergy medication (caller did not specify which medication). The caller stated daughter missed the second and third doses of GARDASIL. On 23-JAN-2010 the patient experienced inflammation in the vaginal area (daughter was not sexually active). The patient did not seek medical attention. No diagnostic laboratory tests were performed. At the time of the report, the patient had not recovered. Additional information has been requested.

VAERS ID:399995 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Mississippi  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1001USA03014
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site discolouration, Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning his/her 12 year old daughter who at 9 year old was vaccinated with the first dose of GARDASIL (route and LOT # not reported). After receiving the vaccine, the patient developed a rash. The rash had cleared but skin hypopigmentation at the area had occurred. The area was 3 to 5 inches in circumference and located at the site of injection. Unspecified medical attention was sought. The patient''s skin hypopigmentation was not recovered. She was not going to continue with the series. No further information is available.

VAERS ID:400022 (history)  Vaccinated:2009-07-21
Age:12.0  Onset:2009-07-28, Days after vaccination: 7
Gender:Female  Submitted:2010-08-04, Days after onset: 372
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0908USA03800
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information has been received from a consumer concerning his 12 year old daughter with no pertinent medical history and no known drug allergies/drug reactions who "about a month ago", on approximately 21-JUL-2009, was vaccinated with a dose of GARDASIL. There was no concomitant medication reported. It was reported that "about a week after first dose", on approximately 28-JUL-2009, the patient had been experiencing headaches and nausea. The patient did not seek medical attention. There were no laboratory diagnostic tests performed. It was reported that the patient had not recovered at the time of the report. No further information is available.

VAERS ID:400030 (history)  Vaccinated:2009-08-11
Age:12.0  Onset:2009-08-18, Days after vaccination: 7
Gender:Female  Submitted:2010-08-04, Days after onset: 351
Location:Louisiana  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0908USA04297
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Skin papilloma
SMQs:
Write-up: Information has been received from a physician concerning a 12 year old female patient who 2 weeks ago (on approximately 11-AUG-2009), was vaccinated with the first dose of GARDASIL. One week after vaccination (on approximately 18-AUG-2009) the patient had an outbreak of plantar warts. The plantar warts were on both knees, fingers on both hands, both elbows and both feet. The patient''s outbreak of plantar wart persisted. The patient sought medical attention by visit to an unspecified dermatologist. No further information is available.

VAERS ID:400073 (history)  Vaccinated:2008-06-21
Age:12.0  Onset:2008-07-22, Days after vaccination: 31
Gender:Female  Submitted:2010-08-04, Days after onset: 743
Location:Pennsylvania  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seasonal allergy; Past concussion syndrome
Diagnostic Lab Data: magnetic resonance, ?/?/07, normal; computed axial, ?/?/07, normal
CDC Split Type: WAES0907USA03049
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0070X0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Computerised tomogram normal, Headache, Myalgia, Nuclear magnetic resonance imaging normal
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient with a history of seasonal allergies and post concussion headaches from an unspecified accident in 2007 (MRI, CAT scan normal) who on 21-JUN-2008 was vaccinated intramuscular with the first and only dose of GARDASIL on left arm (lot # 660553/0070X). Concomitant therapy included CLARITIN, NASONEX and PATANOL. Starting the day after vaccination with GARDASIL on 22-JUL-2008 the patient developed severe muscular ache in the shoulder and neck and lasting no more than a week. Four days after vaccination, the ache became progressively more painful. There were no reports of weakness, numbness of tingling. Nine months after vaccination, on approximately 22-APR-2009 the patient developed headaches. She was recently diagnosed with chronic daily headaches. It was also mentioned that the patient may be seeing a chiropractor and neurologist. Additional information has been requested.

VAERS ID:400075 (history)  Vaccinated:2009-06-23
Age:12.0  Onset:2009-07-12, Days after vaccination: 19
Gender:Female  Submitted:2010-08-04, Days after onset: 388
Location:New Jersey  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy; Latex allergy; Gastric pain
Preexisting Conditions: Convulsion
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0907USA03051
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Computerised tomogram, Syncope, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a consumer concerning a 12 year old female with penicillin allergy, latex allergy and "stomach pain from erythromycin" and a history of seizure (at five years age) who on 23-JUN-2009 was vaccinated intramuscularly with the first 0.5mL dose of GARDASIL (LOT# not reported). Concomitant therapy included erythromycin. On 12-JUL-2009 the patient had fainted. She sought medical attention at an emergency room and was seen by a physician. The patient was recovering as of 12-JUL-2009, she was not admitted to the hospital. Laboratory or diagnostic tests were performed and included: urine test, blood test and CAT scan, but outcome were not provided. The patient''s outcome was unknown at the time of this report. Additional information has been requested.

VAERS ID:400129 (history)  Vaccinated:2009-07-03
Age:12.0  Onset:2009-07-03, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 397
Location:Ohio  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: blood pressure, 05/02/09, "low"; blood glucose, 09/02/09, 98; total heartbeat count, 09/02/09, 68
CDC Split Type: WAES0909USA00581
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0315Y0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood glucose normal, Disorientation, Dyskinesia, Gaze palsy, Hyperhidrosis, Hypotension, Loss of consciousness, Pallor, Staring, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 12 year old female with no pertinent medical history reported and no known drug allergies who on 03-JUL-2009 was vaccinated intramuscularly with her first 0.5mL dose of GARDASIL (Lot number 659054/0315Y). There was no concomitant medication. On 03-JUL-2009, the patient experienced fainted in the waiting room of the office a few minutes after vaccination. She exhibited jerking movements and her eyes rolled back. The patient was monitored and fully recovered while in the office. It was reported that on 02-SEP-2009, the patient was vaccinated intramuscularly with the second dose 0.5mL of GARDASIL (Lot number 659054/0315Y). As the needle was withdrawn from her arm, she exhibited a blank stare and was unresponsive. She exhibited jerky movements and was diaphoretic. After regaining consciousness, she was pale and disoriented. Her blood pressure was "low", her pulse was 68, and her blood glucose was 98. The patient was monitored and fully recovered within 30 minutes. Follow up information was received from the licensed practical nurse. She reported that the patient did not received any vaccines at the time of the two GARDASIL doses. She reported that the physician did not comment as to whether or not the jerky movements were considered tonic-clonic, or whether or not the patient experienced a seizure. The licensed practical nurse felt that based on the speed and way in which the patient recovered, the patient did not experience a seizure. No further information is available.

VAERS ID:400149 (history)  Vaccinated:2009-08-20
Age:12.0  Onset:2009-08-20, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 349
Location:Virginia  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0909USA00610
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood pressure systolic decreased, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient with no pertinent medical history, who "about 2 weeks ago", on approximately 20-AUG-2009 was vaccinated intramuscularly with the first dose of GARDASIL, 0.5ml. The doctor stated that "about 2 weeks ago", on approximately 20-AUG-2009, the patient experienced dizziness, syncope and her systolic blood pressure dropped 20 points. It was reported that "about 2 weeks ago", on approximately 20-AUG-2009, the patient recovered from dizziness, syncope and systolic blood pressure dropped 20 points. The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:400183 (history)  Vaccinated:2009-03-12
Age:12.0  Onset:2009-08-16, Days after vaccination: 157
Gender:Female  Submitted:2010-08-04, Days after onset: 353
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0908USA04752
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Feeling abnormal, Headache, Hypoaesthesia facial, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a registered nurse concerning her 13 year old daughter with no pertinent medical history and no known drug allergies, who was vaccinated with the first dose of GARDASIL (0.5ml, IM, lot # unknown) on 31-JUL-2008, the second dose (0.5ml, IM, lot # unknown) on 24-NOV-2008 and the third dose (0.5ml, IM, lot # unknown) on 12-MAR-2009. There was no concomitant medication. On 16-AUG-2009 the patient experienced a headache above her left eye. About 30 to 45 minutes after the start of headache she experienced numbness on the right side of her tongue and face which lasted 1 to 3 hours. Prior to the onset of headache she felt a "little out of it". She was examined in the emergency department on 16-AUG-2009. She was treated with ibuprofen. On 17-AUG-2009 she was examined by a neurologist. Labs and diagnostic tests included CT scan and lab work (results not reported). The patient recovered on 18-AUG-2009. Additional information has been requested.

VAERS ID:400271 (history)  Vaccinated:2009-08-06
Age:12.0  Onset:2009-08-06, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 363
Location:New York  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: chest X-ray, Normal; electrocardiogram, Normal
CDC Split Type: WAES0908USA01353
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1604X0UNLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0381X0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0804Y0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Chest X-ray normal, Electrocardiogram normal, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Initial and follow-up information has been received from a physician concerning a 12 year old female with no medical history and no illness at time of vaccination who on 06-AUG-2009 was vaccinated with her first dose of GARDASIL, Lot# 661046/0381X into her right arm at PM time. Concomitant therapy included her first dose of VARIVAX Lot# 664719/0804Y into her left arm and her first dose of VAQTA Lot# 663548/1604X into her left arm. On 06-AUG-2009, the patient experienced syncope. The patient dropped to the floor five minutes after vaccination, lasted less than 2 minutes and she was oriented right after she was picked up. The patient required emergency room/doctor visit. Laboratory tests included a chest X-ray and an ECG that were normal. On 06-AUG-2009, the patient recovered from syncope. No further information is available.

VAERS ID:400491 (history)  Vaccinated:2009-08-17
Age:12.0  Onset:2009-08-17, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 352
Location:Michigan  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0909USA01732
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Headache, Hypoaesthesia, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient who on 17-AUG-2009 was vaccinated with a first dose of GARDASIL. Subsequently, that same day, on 17-AUG-2009, the patient experienced a headache that was on the top of her forehead, numbness of the right shoulder and arm, blurry vision in her right eye, and vomited once. The physician reported that the symptoms lasted "a couple of hours", and had not had any symptoms since. Medical attention was sought by calling the physician. Conflicting information has been received from a physician who reported: "No problems - Not sure why I received". Additional information has been requested.

VAERS ID:400513 (history)  Vaccinated:2009-09-09
Age:12.0  Onset:2009-09-10, Days after vaccination: 1
Gender:Female  Submitted:2010-08-04, Days after onset: 328
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0909USA01800
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Blister, Dizziness, Nausea, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a nurse practitioner concerning a 12 year old female patient with no known drug reactions or allergies and no pertinent medical history, who on 09-SEP-2009 was vaccinated with the first dose of GARDASIL (Lot # 663452/0671Y). Concomitant therapy included MENACTRA. The nurse practitioner reported that on 10-SEP-2009 the patient developed nausea, dizziness, stomach ache, fever (100.5 degrees F) and blisters on both ears after vaccination with her first dose of GARDASIL. The reporter stated the blisters were on the top of the patient''s ear, and were about 2 cm by 0.5 cm in size. The patient sought medical attention; she was seen in the office. At the time of the report the patient had not recovered. There were no lab diagnostic studies performed. Additional information has been requested.

VAERS ID:400518 (history)  Vaccinated:2009-07-28
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0908USA02982
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Depression, Mood swings
SMQs:, Dementia (broad), Depression (excl suicide and self injury) (narrow)
Write-up: Information has been received from a licensed practical nurse concerning her 12 year old granddaughter with no pertinent medical history and no known drug allergies who was vaccinated with the first dose of GARDASIL "2-3 weeks ago" (approximately 28-JUL-2009) (dose, route, and lot# not reported). There was no concomitant medication. The nurse reported that the patient was experiencing depression and mood swings. The nurse did not think this was related to GARDASIL and thought her granddaughter might be getting her monthly cycle. No lab diagnostics study was performed. The patient sought medical attention through a telephone call to the nurse. At the time of the report, the patient''s outcome was unknown. No further information is available.

VAERS ID:400577 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-08-04
Location:Indiana  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fever
Preexisting Conditions: Unknown
Diagnostic Lab Data: Blood pressure, low; total heartbeat count, went down to 48; temperature measurement, 100 degrees; rapid Streptococcus, negative
CDC Split Type: WAES0909USA04242
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Heart rate decreased, Hypotension, Streptococcus test, Streptococcus test negative, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient who on unspecified date was vaccinated with a dose of GARDASIL, 0.5 ml, IM, (Lot # not provided). Physician reported that a patient fainted and her heart rate went down to 48 and her blood pressure was low. The patient had a temperature before the vaccination of 100 degrees. She came in for a sick visit. The patient had a negative strep test. The patient has sought medical attention. At the time of this report, the patient''s outcome was unknown. Additional information has been requested.

VAERS ID:400581 (history)  Vaccinated:2009-06-17
Age:12.0  Onset:2009-07-01, Days after vaccination: 14
Gender:Female  Submitted:2010-08-04, Days after onset: 399
Location:Maryland  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0909USA02140
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Amenorrhoea, Infectious mononucleosis
SMQs:, Fertility disorders (broad)
Write-up: Information has been received from a physician concerning a 12 year old female patient with no known drug allergies or pertinent medical history who on 17-JUN-2009 was vaccinated intramuscularly with the first 0.5 mL dose of GARDASIL (Lot number not provided). On 17-AUG-2009 the patient was vaccinated intramuscularly with the second 0.5 mL dose of GARDASIL (Lot number not provided). There was no concomitant medication. In approximately July 2009, the patient experienced amenorrhea. Her last menstrual period was in June 2009. In early August 2009, the patient was diagnosed with mononucleosis, but has recovered completely. The patient sought unspecified medical attention. No laboratory diagnostic studies were performed. At the time of the report, the patient''s amenorrhea persisted. Additional information has been requested.

VAERS ID:400653 (history)  Vaccinated:2009-08-30
Age:12.0  Onset:2009-09-26, Days after vaccination: 27
Gender:Female  Submitted:2010-08-04, Days after onset: 312
Location:Unknown  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Juvenile diabetes
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0910USA00815
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abnormal dreams, Anxiety, Dizziness, Dry mouth, Fatigue, Fear, Hallucination, auditory, Nervousness
SMQs:, Anticholinergic syndrome (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Information has been received from a nurse practitioner concerning a 12 year old female patient with juvenile diabetes "not well under control" who on 30-AUG-2009 was vaccinated intramuscularly with her 0.5 ml second dose of GARDASIL. Concomitant therapy included FLUMIST received on 16-SEP-2009. According to the reporter, on 26-SEP-2009 the patient experienced acute anxiety, started feeling dizzy, scared, nervous, extremely tired, had bad dreams and also experienced auditory hallucinations and dry mouth. The nurse thought she had symptoms of a psychotic breakdown. The nurse also stated that the patient was first taken to the pharmacist who informed the patient''s guardian that it was caused by GARDASIL. It was also reported that the patient started her first menstrual cycle on 16-SEP-2009. Therapy with GARDASIL was discontinued. No diagnostic tests were performed. The patient sought medical attention by an office visit. Additional information has been requested.

VAERS ID:397763 (history)  Vaccinated:2010-08-30
Age:12.0  Onset:2010-09-01, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2010-09-09
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
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site cellulitis
SMQs:
Write-up: 14x14 cm cellulitis around injection site. Treated with antibiotics, BENADRYL and oral steroids.

VAERS ID:397815 (history)  Vaccinated:2010-08-30
Age:12.0  Onset:2010-08-30, Days after vaccination: 0
Gender:Female  Submitted:2010-09-10, Days after onset: 11
Location:Virginia  Entered:2010-09-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0607Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Disorientation, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt passed out for 5 seconds after vaccines were given. Pt was awaken but disoriented, vital signs were within normal limits.

VAERS ID:397946 (history)  Vaccinated:2010-09-08
Age:12.0  Onset:2010-09-08, Days after vaccination: 0
Gender:Female  Submitted:2010-09-08, Days after onset: 0
Location:Pennsylvania  Entered:2010-09-10, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3090AA UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU2969BA UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0091Z UNLA
Administered by: Public     Purchased by: Public
Symptoms: Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt. was sitting with mother in waiting area after her immunization when she suddenly became pale and passed out momentarily as per mother. Upon arrival found pt. coming to, very pale, asking what happened. Vital signs taken P - 82 regular, R - 16 BP 120/78 Accucheck done 91. Mother stated that daughter has not been eating as usual - trying to lose weight. Also stated that fainting episode occurred approximately 2 years ago not related to immunization. Pt. stayed in dept x 20 mins. No other complaints or occurences. Instructed to follow with FMD. 9-9-10 10AM call to pt''s family. No further symptoms. Pt went to school.

VAERS ID:397994 (history)  Vaccinated:2010-07-15
Age:12.0  Onset:2010-07-23, Days after vaccination: 8
Gender:Female  Submitted:2010-09-10, Days after onset: 49
Location:California  Entered:2010-09-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1099Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3077AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3357AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Appendicectomy
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Child developed abdominal pain 07/23/10. Subsequently she was admitted at Med. Ctr., where she underwent appendectomy 07/26/10.

VAERS ID:398026 (history)  Vaccinated:2010-09-09
Age:12.0  Onset:2010-09-11, Days after vaccination: 2
Gender:Male  Submitted:2010-09-13, Days after onset: 2
Location:Michigan  Entered:2010-09-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADD
Diagnostic Lab Data: Blood cultures; blister cultures done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3541AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0817Z1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Blood culture, Culture, Injection site erythema, Injection site pain, Injection site swelling, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, deltoid - area (left) of shot. Pain, blisters varying sizes shot site. Patient sent to ER, secondary VARIVAX (given left arm) treated with steroids.

VAERS ID:398241 (history)  Vaccinated:2010-09-11
Age:12.0  Onset:2010-09-11, Days after vaccination: 0
Gender:Male  Submitted:2010-09-14, Days after onset: 3
Location:Michigan  Entered:2010-09-14
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: None
Diagnostic Lab Data: Vitals (see attached notes)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH182AD0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB453BA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3513AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3281BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0676Z1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Body temperature normal, Cough, Dizziness, Feeling hot, Headache, Hypophagia, Malaise, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: See attached notes. Pt is here for symptoms starting after immunizations given 3 days ago. Starting Saturday didn''t feel well - some dizziness. Next day, while in church, felt hot "inside" but not hot to touch. HA, dizzy. SA briefly - not nausea. Yesterday didn''t feel well - HA, dizzy, felt "hot" but normal temperature. Felt weak. Drank 2 water and 3 gatorade bottles, but didn''t help. Feels a little better today. HA fairly constant. Eating ok but less. Ate chicken, raw veggies, pumpkin bread for dinner last night. Some cough and sore throat this morning. IB being used - for comfort.

VAERS ID:398278 (history)  Vaccinated:2010-09-09
Age:12.0  Onset:2010-09-10, Days after vaccination: 1
Gender:Male  Submitted:2010-09-14, Days after onset: 4
Location:New Jersey  Entered:2010-09-14
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: Pt suffers from anxiety depression esp since father''s death.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Anxiety, Condition aggravated, Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)
Write-up: Rec''d flu shot 9/9/10. On 9/10/10 night pt very agitated & hallucinating. Seen in ER as mtr felt pt might hurt himself. Medication hx: ATIVAN given PRN. Recd doses 9/9 & 9/10 without relief of anxiety, agitation. Rec''d lower dose of LEXAPRO (30mg on 9/8) reduced to 20mg on 9/9 & 9/10.

VAERS ID:398284 (history)  Vaccinated:2010-09-11
Age:12.0  Onset:2010-09-12, Days after vaccination: 1
Gender:Male  Submitted:2010-09-15, Days after onset: 3
Location:Indiana  Entered:2010-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: None. Hx of childhood asthma. Controlled.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3088AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1411Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Injection site cellulitis, Injection site pain, Injection site urticaria, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. mother, called on Monday, 9/13/2010 and reported on 9/12/10 son had c/o welt to Left arm at injection site area. Was sore to touch. Instructed over the phone that it sounded to be in the area of MCV4 injection and to apply cold compress and take 600mg Ibuprofen q 6 hours. To call MD if not relieved, worsens, or new symptoms appear. 9/14 Dr. office calls to inform that they believe pt. has cellulitis of left upper arm. Tx with Keflex and Zyrtec. 9/15/10 Called pt. mother. Reports fever broke through night and arm seems to be improving. States pt. c/o headache this am. Instructed to call MD to report headache and provide update. To return to MD/ER for worsening or new symptoms. Mom verbalized understanding.

VAERS ID:398289 (history)  Vaccinated:2010-08-04
Age:12.0  Onset:2010-08-06, Days after vaccination: 2
Gender:Male  Submitted:2010-09-15, Days after onset: 40
Location:Kentucky  Entered:2010-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB379BA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURV3030AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.165841SCRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash generalised, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: MD office reported lacey maculopapular rash head to toe with fever of 102.

VAERS ID:398339 (history)  Vaccinated:2010-08-30
Age:12.0  Onset:2010-08-30, Days after vaccination: 0
Gender:Male  Submitted:2010-09-03, Days after onset: 4
Location:Minnesota  Entered:2010-09-15, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3460BA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3082BA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0643Z1SCLA
Administered by: Other     Purchased by: Unknown
Symptoms: Axillary pain, Injection site cellulitis, Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Had VARIVAX, TDAP & MENACTRA given on 8/30/10. 1 hr after the immunizations his (L) arm was red, slightly itchy. C/O axillary pain also was seen in office 9/2/10 and started on PO antibiotic for cellulitis at the site of VARIVAX immunization.

VAERS ID:398369 (history)  Vaccinated:2010-05-19
Age:12.0  Onset:2010-05-19, Days after vaccination: 0
Gender:Female  Submitted:2010-09-07, Days after onset: 111
Location:Colorado  Entered:2010-09-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0381X0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF452CA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1007Y1UNRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Client complains of general soreness at site of a subcutaneous injection, intermittent pain, noticeably when walking. Upon examination; no swelling or pitting, no pain on palpation, no change in color, no induration, no warmth, and no other systemic symptoms.

VAERS ID:398386 (history)  Vaccinated:2010-08-20
Age:12.0  Onset:2010-08-20, Days after vaccination: 0
Gender:Female  Submitted:2010-08-23, Days after onset: 3
Location:Pennsylvania  Entered:2010-09-15, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0216Y0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: 8/20/10 patient given GARDASIL #1 LD/IM. Approximately 2 min later, patient passed out.

VAERS ID:398435 (history)  Vaccinated:2010-09-13
Age:12.0  Onset:2010-09-15, Days after vaccination: 2
Gender:Male  Submitted:2010-09-15, Days after onset: 0
Location:Illinois  Entered:2010-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3356BA0UNRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swollen, heat, redness injection site starting Monday after injection.

VAERS ID:398510 (history)  Vaccinated:2010-08-06
Age:12.0  Onset:2010-08-07, Days after vaccination: 1
Gender:Female  Submitted:2010-09-16, Days after onset: 40
Location:Indiana  Entered:2010-09-16
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.A041520UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3446AA0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Acute respiratory failure, Ataxia, Hemiparesis, Nuclear magnetic resonance imaging
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (broad), Respiratory failure (narrow)
Write-up: Patient developed ataxia, left-sided weakness, was admitted to hospital 9/13/2010. She ultimately had acute respiratory failure related to her weakness. Weakness was progressive, imaging (MRI) with possible demyelinating process.

VAERS ID:398563 (history)  Vaccinated:2010-09-15
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-09-16
Location:California  Entered:2010-09-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA; No known medical hx
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1013Y0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS1000220IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B053BB0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0094Z1SCUN
Administered by: Private     Purchased by: Private
Symptoms: Incorrect drug dosage form administered
SMQs:, Medication errors (narrow)
Write-up: Powder component admin. with sterile water instead of with liquid component which is supplied with vaccine. (MENVEO).

VAERS ID:398587 (history)  Vaccinated:2010-09-16
Age:12.0  Onset:2010-09-17, Days after vaccination: 1
Gender:Male  Submitted:2010-09-17, Days after onset: 0
Location:Massachusetts  Entered:2010-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3433AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0279Z1UNRA
Administered by: Private     Purchased by: Public
Symptoms: Mass, Tenderness
SMQs:
Write-up: 2 inch tender lump right arm.

VAERS ID:398607 (history)  Vaccinated:2010-09-13
Age:12.0  Onset:2010-09-14, Days after vaccination: 1
Gender:Female  Submitted:2010-09-13, Days after onset: 1
Location:Arizona  Entered:2010-09-17, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1316Y1UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3077AA1UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B052AA1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RD - low grade fever, 8 cm round red, tenderness started 9-14 day after administered (MCV4, HPV). LD - 4cm round, low grade tenderness started 9-14-2010 (Tdap).

VAERS ID:398617 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:2010-09-16
Gender:Female  Submitted:2010-09-17, Days after onset: 1
Location:Indiana  Entered:2010-09-17
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 as of now
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB401AA IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3442BA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B060BA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0750Z SCLA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Burning sensation, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: L arm. 1/2 dollar raised welt on arm, burning sensation, hurts to raise arm, defined area circular pillows within the area "bubbled" appearance. Pt was sent home from school.

VAERS ID:398678 (history)  Vaccinated:2008-02-13
Age:12.0  Onset:2009-03-24, Days after vaccination: 405
Gender:Female  Submitted:2010-09-17, Days after onset: 542
Location:Florida  Entered:2010-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I''m not sure who the manufactuer
Current Illness: No
Preexisting Conditions: Peanut and egg allergy
Diagnostic Lab Data: On 08/31/2010 CT scan normal lab normal and on 09/01/1010 EEG normal and MRI normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1487U IMLA
Administered by: Private     Purchased by: Other
Symptoms: Computerised tomogram normal, Convulsion, Electroencephalogram normal, Laboratory test normal, Nuclear magnetic resonance imaging normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Had a seizure. EEG normal CT scan normal lab normal went to ER by ambulance. Had another seizure on 08/31/2010.

VAERS ID:398801 (history)  Vaccinated:2010-08-25
Age:12.0  Onset:2010-08-25, Days after vaccination: 0
Gender:Female  Submitted:2010-09-13, Days after onset: 19
Location:Oregon  Entered:2010-09-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: OR201024
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0819Y0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pruritus, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother reports to RN as follows: 45 minutes post injection c/o headache. 5 hrs post injection c/o itching on face. Noted pinpoint rash (raised) over chest, arms & face which resolved by next day. No fever. No observable local reaction. Advise have MD administer next dose. Did not consult provider after injection.

VAERS ID:398868 (history)  Vaccinated:2010-09-07
Age:12.0  Onset:2010-09-10, Days after vaccination: 3
Gender:Female  Submitted:2010-09-20, Days after onset: 10
Location:Florida  Entered:2010-09-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0850Z0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3463AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3170BA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen left arm. Prednisone 20 mg tab 2 tablets QD X 3 days. Continue MOTRIN PRN & ice.

VAERS ID:399061 (history)  Vaccinated:2010-09-07
Age:12.0  Onset:2010-09-08, Days after vaccination: 1
Gender:Female  Submitted:2010-09-08, Days after onset: 0
Location:Indiana  Entered:2010-09-21, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Sed rate - neg; CBC and BMET - neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3530AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3111AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Full blood count normal, Injection site pain, Metabolic function test normal, Nausea, Red blood cell sedimentation rate normal, Tenderness
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received MENACTRA and TDAP on 9/7/2010. Came to office on 9/8 with radiating pain from (L) shoulder & (L) arm nauseated, Temp 100. Tenderness to even sl palpation of (L) arm. Sent to ER.

VAERS ID:399119 (history)  Vaccinated:2010-08-30
Age:12.0  Onset:2010-08-31, Days after vaccination: 1
Gender:Male  Submitted:2010-09-21, Days after onset: 21
Location:California  Entered:2010-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501009P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Malaise, Nasopharyngitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: FEVER, FATIGUE, COLD TYPE SYMPTOMS, MALAISE.

VAERS ID:399517 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-09-22
Location:Florida  Entered:2010-09-22
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: BS 78 PO 100%
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0651X1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Dizziness, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 3 minutes after receiving GARDASIL - pt c/o feeling faint, had seizure activity lasting 10 sec. Nonresponsive 5 second following episode. 911 called, pt transported to hospital.

VAERS ID:399519 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2010-09-22
Location:Michigan  Entered:2010-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3519AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3488BA5UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Chills, Erythema, Headache, Musculoskeletal stiffness, Nausea, Oedema peripheral, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Nausea, 102 degree fever, body aches, chills, HA. Within 12 hours of immunization, arm (L) swelling & redness, neck stiffness.

VAERS ID:399534 (history)  Vaccinated:2010-09-20
Age:12.0  Onset:2010-09-20, Days after vaccination: 0
Gender:Female  Submitted:2010-09-22, Days after onset: 2
Location:California  Entered:2010-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: She was send to Emergency Room for evaluation.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501017P1IN 
Administered by: Unknown     Purchased by: Public
Symptoms: Anger, Dizziness, Fall, Head injury, Loss of consciousness, Memory impairment, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Black out, paleness, hotheadedness, and dizziness. She felt while standing and hit the back of her head. She recovered after 1 minute that she collapse and was unable to remember anything that happened, but was was able to remember her name. She was then given Epinephrine 0.1 sbq.

VAERS ID:399653 (history)  Vaccinated:2010-09-20
Age:12.0  Onset:2010-09-21, Days after vaccination: 1
Gender:Male  Submitted:2010-09-23, Days after onset: 2
Location:Ohio  Entered:2010-09-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Reaction~Vaccine not specified (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions: Per mother child had a previous reaction to an unknown vaccine either MMR or TD - had temp & swelling in arm.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3032AA UNLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Erythema, Headache, Nausea, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: TDAP (L) deltoid 9/20/2010 Received vaccine - TDAP. 9/21/2010 woke up at 3:30AM c/o pain in arm. Arm not swollen or red. Mother gave TYLENOL & applied ice. In the morning client then c/o headache, stomach ache, had a fever - temp was unknown, arm slightly swollen red. 9/22 (L) arm deltoid area redness & swelling increased c/o stomach ache. Red area was reported to be from the front to the back of his deltoid area. 9/23 still c/o nausea - increased in redness & size. 9/24 - no nausea- mother states deltoid area is red swollen & increased size to about 4" x 6".

VAERS ID:399921 (history)  Vaccinated:2010-09-17
Age:12.0  Onset:2010-09-17, Days after vaccination: 0
Gender:Female  Submitted:2010-09-23, Days after onset: 6
Location:Georgia  Entered:2010-09-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Diagnosed with cellulitis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB762BA2IMRA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU3357BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0547Z1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Cellulitis, Flushing, Headache, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Friday night- nausea, HA, weak, body soreness Sat.-nausea, HA, swelling at injection site of varicella, site was red and hot to touch. Sun.- HA, nausea, flushed face, weakness, injection site red, swollen and hard. Mom states it was size of softball. Went to ER and was given antibiotics.

VAERS ID:399923 (history)  Vaccinated:2010-09-21
Age:12.0  Onset:2010-09-22, Days after vaccination: 1
Gender:Female  Submitted:2010-09-23, Days after onset: 1
Location:Indiana  Entered:2010-09-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions: HX: ASTHMA ALLERGIES: LATEX, CHOCOLATE, RICE, ONIONS
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3439AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B058AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0750Z1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site nodule, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: "KNOT, BIG AS AN ORANGE, HOT" RIGHT UPPER POSTERIOR ARM. PER MOTHER

VAERS ID:399930 (history)  Vaccinated:2010-09-21
Age:12.0  Onset:2010-09-22, Days after vaccination: 1
Gender:Female  Submitted:2010-09-23, Days after onset: 1
Location:Wisconsin  Entered:2010-09-23
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 known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3051BA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Warm red swelling at injection site about 2" in diameter. Self described as itchy.

VAERS ID:399984 (history)  Vaccinated:2010-09-23
Age:12.0  Onset:2010-09-23, Days after vaccination: 0
Gender:Female  Submitted:2010-09-23, Days after onset: 0
Location:Indiana  Entered:2010-09-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB444BA0UNLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0664Z0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3460BA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF499BA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0719Z1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Dyskinesia, Fatigue, Muscle rigidity, Mydriasis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Parkinson-like events (narrow), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: After adm. of vaccine pt. body became rigid and jerking. Eyes open with complete dilation of pupils. Episode lasted a few seconds. Pt then fainted for a few seconds Dr. entered room pt awake, hot, pale and nauseated. Took BP which was normal, gave crackers and Sprite. Pt well other than fatigue.

VAERS ID:400184 (history)  Vaccinated:2010-09-23
Age:12.0  Onset:2010-09-24, Days after vaccination: 1
Gender:Male  Submitted:2010-09-24, Days after onset: 0
Location:Florida  Entered:2010-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known.
Current Illness: Mother stated HX of stable hydrocephalis. Client had recieved routine vaccines in past. No current treatment or assessment per Mother.
Preexisting Conditions: Stable Hydrocephalis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB444BA0 RA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU3474AA0 RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063BA0 LA
Administered by: Public     Purchased by: Other
Symptoms: Fatigue, Nausea, Pain, Photophobia, Pyrexia, Skin warm, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 09/23/10@12:00AM - c/o nausea, fever (104.3 at 4:30am), fatigue, body aches (9),. Mom stated she gave client 2/St Joseph ASA and 2/Acetaminophen p.o. Client presented with sensitivity to light, wheezing in upper lobes, skin dry and hot to touch, Temp noted at 104.3. Mother stated client had Rice, Pork roast with gravy and chicken noodle soup.

VAERS ID:400245 (history)  Vaccinated:2010-08-09
Age:12.0  Onset:2010-08-11, Days after vaccination: 2
Gender:Female  Submitted:2010-09-24, Days after onset: 44
Location:Minnesota  Entered:2010-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pervasive developmental disorder and Anxiety disorder. Allergic to Augmentin.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0337Z0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS0280110IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0364Z1SCRA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Golf ball redness, swelling, warmth, and itching at injection site (right deltoid) reported by Mother to clinic 08/11/2010.

VAERS ID:400392 (history)  Vaccinated:2010-08-21
Age:12.0  Onset:2010-08-21, Days after vaccination: 0
Gender:Male  Submitted:2010-08-30, Days after onset: 9
Location:Texas  Entered:2010-09-24, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seasonal allergies per mother''s report
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B043BA SCLA
Administered by: Other     Purchased by: Other
Symptoms: Rash macular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient developed a macular rash within 15 minutes of vaccine administration. He did not have any respiratory symptoms, hives/induration or signs of anaphylaxis. Diphenhydramine 25 mg, orally, was administered immediately after the patient noticed the rash. It had already began to subside/resolve within a couple of minutes of taking diphenhydramine. He was evaluated by our medical doctor on site and left our vaccine clinic in no apparent distress.

VAERS ID:400395 (history)  Vaccinated:2010-09-09
Age:12.0  Onset:2010-09-16, Days after vaccination: 7
Gender:Male  Submitted:2010-09-20, Days after onset: 4
Location:Georgia  Entered:2010-09-24, 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: Asthma
Diagnostic Lab Data: Chest xray; CBC with d; CMP; Not admitted
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0664Z0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Back pain, Chest X-ray, Differential white blood cell count, Erythema multiforme, Full blood count, Metabolic function test, Neck pain, Ocular hyperaemia, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Back pain x2 days. Severe red eyes. Fever up to 103.6. Abdominal pain x2 days. Neck pain. Diagnosis (695.11) Erythema multiforme.

VAERS ID:400522 (history)  Vaccinated:2010-06-30
Age:12.0  Onset:2010-08-19, Days after vaccination: 50
Gender:Female  Submitted:2010-09-27, Days after onset: 39
Location:Massachusetts  Entered:2010-09-27
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: still undergoing EEGs had MRI had labs at ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1 AR
Administered by: Unknown     Purchased by: Other
Symptoms: Abdominal pain upper, Depressed level of consciousness, Drooling, Electroencephalogram, Fall, Grand mal convulsion, Headache, Laboratory test, Nuclear magnetic resonance imaging
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Patient was sleeping over our friend''s house. Got a call that patient had stood up and fallen to ground and had a grand mal seizure. Ambulance arrived to verify asked if we had a history and we said no she eventually came to in ambulance met her at ER and she was out of it bad headache/stomach pain she said she remembered having a stomach ache got up to go get our friend (her friend''s mom) went to put her shoes on that''s the last thing she remembers her friend saw her seizing ran to get her mother her mom said she was seizing in fetal position drool coming out of mouth had already called 911

VAERS ID:400523 (history)  Vaccinated:2010-09-22
Age:12.0  Onset:2010-09-22, Days after vaccination: 0
Gender:Male  Submitted:2010-09-27, Days after onset: 5
Location:Wisconsin  Entered:2010-09-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3100AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Erythema, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client developed a large reddened area (4 inches in diameter) a couple inches below the injection site by 9/24/2010. Treatment included ice packs and 3 doses of Benadryl over the weekend. Today, child is vomiting, but feeling a little better with that also. Home from school today.

VAERS ID:400539 (history)  Vaccinated:2010-09-06
Age:12.0  Onset:2010-09-06, Days after vaccination: 0
Gender:Female  Submitted:2010-09-07, Days after onset: 1
Location:California  Entered:2010-09-27, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: No lower pooling at departure BP 102/70 onset BP 110/74 departure
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111776P11UNLA
Administered by: Other     Purchased by: Other
Symptoms: Crying, Dizziness, Fear, Ocular hyperaemia, Pulse pressure decreased
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)
Write-up: Child stated fear/dizzy following FLUVIRIN. Pulse weakened, legs elevated with 1 l po water. BP monitored & normal at 35 min. No wheal/flare neck-face-arms. Eyes red from crying.

VAERS ID:400679 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-08-25, Days after vaccination: 2
Gender:Female  Submitted:2010-09-17, Days after onset: 23
Location:Texas  Entered:2010-09-27, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Blood CX, negative; CRP, 41 -$g 29.8; CBC, Wnl; LUE U/S, negative; ESR, 28
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0565Z3IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3511AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3083CA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0721Z1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Blood culture negative, C-reactive protein increased, Full blood count normal, Injection site erythema, Injection site pain, Injection site swelling, Red blood cell sedimentation rate increased, Ultrasound scan normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Rec''d vaccination on Monday. Returned Wed with LUE erythema, pain, and swelling from axilla to elbow. Rapidly enlarging. Admitted for IV Abx septic w/u. Monitored for possible abscess, compartment syndrome. Given IV BENADRYL no pain medications. Resolved after 2 days inpatient. All cx negative.

VAERS ID:400723 (history)  Vaccinated:2010-09-15
Age:12.0  Onset:2010-09-17, Days after vaccination: 2
Gender:Female  Submitted:2010-09-20, Days after onset: 3
Location:Ohio  Entered:2010-09-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0307Z1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site warmth, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt with (L) arm swelling, redness, warm over injection site.

VAERS ID:400987 (history)  Vaccinated:2010-09-27
Age:12.0  Onset:2010-09-27, Days after vaccination: 0
Gender:Female  Submitted:2010-09-28, Days after onset: 1
Location:California  Entered:2010-09-28
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: History of Asthma (controlled); Allergy: dust mites
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH180AC UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3440AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3111BA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: About 40 minutes after giving the vaccines patient developed hives around the eyes some on cheeks. No respiratory problems advised to go to ER given EPIPEN and DECADRON and observed for 3 hours. Stable and sent home on Prednisone x 4 days and BENADRYL as needed. F/up visit done in the office 9-28-10 patient is doing fine, no more hives, stable.

VAERS ID:401653 (history)  Vaccinated:2009-07-29
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2010-09-20
Location:Alabama  Entered:2010-09-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0802333A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B041CA UNAR
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Rash papular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a physician and described the occurrence of red raised skin on arms in a 12-year-old female subject who was vaccinated with BOOSTRIX (GlaxoSmithKline). There were no concurrent medications. On 29 July 2009 the subject received unspecified dose of BOOSTRIX in an unknown arm. The subject went back to the office on 31 July 2009 and a red raised area about 3 to 4 inches in diameter was noted at the injection site. The official onset date was not known. At the time of reporting the outcome of the event was unspecified.

VAERS ID:401218 (history)  Vaccinated:2010-09-08
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2010-09-29
Location:Michigan  Entered:2010-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no known
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)SANOFI PASTEURU3421CA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: none

VAERS ID:401271 (history)  Vaccinated:2010-09-29
Age:12.0  Onset:2010-09-29, Days after vaccination: 0
Gender:Female  Submitted:2010-09-30, Days after onset: 1
Location:Massachusetts  Entered:2010-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No except allergic to strawberries
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3697AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0092Z1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Nausea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Nausea, chest pain, tightening of throat.

VAERS ID:401305 (history)  Vaccinated:2010-08-23
Age:12.0  Onset:2010-09-28, Days after vaccination: 36
Gender:Female  Submitted:2010-09-28, Days after onset: 0
Location:Colorado  Entered:2010-09-30, 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: None
Preexisting Conditions:
Diagnostic Lab Data: Physical exam
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1528X1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Given VARIVAX - 5 weeks later developed VARICELLA like rash.

VAERS ID:401312 (history)  Vaccinated:2010-08-13
Age:12.0  Onset:2010-08-13, Days after vaccination: 0
Gender:Female  Submitted:2010-09-30, Days after onset: 48
Location:Iowa  Entered:2010-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1311X0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1113Y1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. notified RN on 9/29/10, of a reaction that occurred after GARDASIL injection in (R) arm on 8/13/10. Baseball sized redness and swelling with itching. Duration 2-3 days. Took BENADRYL and resolved.

VAERS ID:401363 (history)  Vaccinated:2010-09-27
Age:12.0  Onset:2010-09-28, Days after vaccination: 1
Gender:Male  Submitted:2010-09-30, Days after onset: 2
Location:Ohio  Entered:2010-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0425Z1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0782Z1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Body temperature increased, Erythema, Incisional drainage, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother called to report child had redness and swelling of arm with a temp of 100.8. Took child to ER. Area was "drained" and child given antibiotics (cephalexin 500mg TID and bactrim 800 mg BID).

VAERS ID:401375 (history)  Vaccinated:2010-09-27
Age:12.0  Onset:2010-09-27, Days after vaccination: 0
Gender:Male  Submitted:2010-09-30, Days after onset: 3
Location:Texas  Entered:2010-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3462AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3487AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0937Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dysphonia, Pain in extremity, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: wheezing, hoarseness, pain in legs and fever of 102+ degrees and Mom unable to get it down

VAERS ID:401405 (history)  Vaccinated:2010-09-15
Age:12.0  Onset:2010-09-15, Days after vaccination: 0
Gender:Female  Submitted:2010-09-30, Days after onset: 15
Location:Texas  Entered:2010-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported at time of visit.
Preexisting Conditions: None recorded.
Diagnostic Lab Data: No diagnostic tests or laboratory data were indicated.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1484Y1IMRA
Administered by: Other     Purchased by: Other
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: The patient is a 12 year old female that received two Pediatric doses of Hepatitis B vaccination instead of one dose. The patient did not exhibit any reaction or adverse event at the clinic and no adverse events have been reported to date.

VAERS ID:401408 (history)  Vaccinated:2010-09-29
Age:12.0  Onset:2010-09-30, Days after vaccination: 1
Gender:Male  Submitted:2010-09-30, Days after onset: 0
Location:Indiana  Entered:2010-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted by mother
Preexisting Conditions: None noted by mother
Diagnostic Lab Data: Per mom (nursing student), EKG, urine CBC and other lab.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB441AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3433AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3353AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0750Z1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Body temperature increased, Ear infection, Electrocardiogram normal, Full blood count normal, Headache, Heart rate increased, Laboratory test normal, Loss of consciousness, Muscular weakness, Nausea, Sinus operation, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Day following vaccines attended school during first hour of school had intermittent episodes of H/A described to mother as throbbing. Lasting several seconds to a few minutes. During second hour of school no c/o of H/A and felt good, during third hours of school H/As returned but now continuous, nauseated, no emesis, just felt weak and "legs like rubber", child then "passed out"; regained consciousness within a few minutes without intervention. H/A still present and felt pulse racing. Sent to ER, per mom EKG, Urine, lab (CBC) all within normal limits, Temp 99.9 H/A remained, pulse in ER regular, ER physician noted "ear infection and nasal drainage", sent home with antibiotics and mom to observe for other s/s.

VAERS ID:401458 (history)  Vaccinated:2010-09-24
Age:12.0  Onset:2010-09-25, Days after vaccination: 1
Gender:Male  Submitted:2010-09-28, Days after onset: 3
Location:Tennessee  Entered:2010-10-01, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy to Codeine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAB453BA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU344BA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B058BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.033921SCRA
Administered by: Private     Purchased by: Private
Symptoms: