National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Found 652423 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 653

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 650 651 652 653   next


VAERS ID: 285016 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-03-09
Onset:2007-06-01
   Days after vaccination:84
Submitted: 2007-07-18
   Days after onset:47
Entered: 2007-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. N/A / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Anaemia, Arthralgia, Haematocrit normal, Haemoglobin normal, Juvenile arthritis, Red blood cell sedimentation rate increased, Rheumatoid factor increased
SMQs:, Haematopoietic erythropenia (broad), Arthritis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: RF 343sed rate 110hgb 11hct 33other labs pending
CDC Split Type:

Write-up: Gardasil adverse reaction resembling RA pauciarticular joint pain elevated sed rate, elevated RF, anemia


VAERS ID: 285206 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Wyoming  
Vaccinated:2007-06-29
Onset:2007-06-30
   Days after vaccination:1
Submitted: 2007-07-19
   Days after onset:19
Entered: 2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0717U / 2 LA / SC

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

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

Write-up: Patient received Varicella booster 6/29/07, Parent phones office on 7/18/07. Reported patient presented with edema, redness at site of injection, no blisters noted. Edema, redness showed up 6/30/07 - lasted approx 3 days.


VAERS ID: 285221 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-07-05
Onset:2007-07-06
   Days after vaccination:1
Submitted: 2007-07-13
   Days after onset:7
Entered: 2007-07-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0369U / 2 LL / SC

Administered by: Private       Purchased by: Public
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)

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

Write-up: Swollen pink red area, itchy


VAERS ID: 285227 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-07-10
Onset:2007-07-12
   Days after vaccination:2
Submitted: 2007-07-12
   Days after onset:0
Entered: 2007-07-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0599U / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Local reaction, Pallor, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Local reaction left posterior arm. Moderate swelling warmth, blanching erythema medical to vaccine site. Increase vascular markings.


VAERS ID: 285288 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Colorado  
Vaccinated:2007-07-18
Onset:2007-07-19
   Days after vaccination:1
Submitted: 2007-07-20
   Days after onset:1
Entered: 2007-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / 2 RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Blister, Erythema, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 11x11 cm area of erythema and swelling with central large vesicles over 3x3 cm base


VAERS ID: 285335 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Ohio  
Vaccinated:2007-07-09
Onset:2007-07-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2007-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB139BA / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1145F / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Oedema peripheral, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Right arm edematous, slight warmth, tender to touch


VAERS ID: 285359 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Idaho  
Vaccinated:2007-05-23
Onset:2007-05-23
   Days after vaccination:0
Submitted: 2007-05-24
   Days after onset:1
Entered: 2007-07-20
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14BAA / 5 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1327F / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cold compress therapy, Erythema, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID07018

Write-up: Red, warm to touch, tender X 24 hours. Treated with ice.


VAERS ID: 285563 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2007-07-23
Onset:2007-07-23
   Days after vaccination:0
Submitted: 2007-07-23
   Days after onset:0
Entered: 2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0517U / 2 UN / SC

Administered by: Public       Purchased by: Public
Symptoms: Angioedema, Chest pain, Cough, Eye swelling, Nasal congestion, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD; Multiple none recent
Current Illness: none
Preexisting Conditions: GGPD def, atopic dermatitis; PTSD; Previous anaphylaxis - unknown cause, asthma. PMH: Asthma. G6PD. Bee sting allergy, Seasonal allergies, ASA and sulfa drugs.
Allergies:
Diagnostic Lab Data: none. Labs: RAST to latex (-).
CDC Split Type:

Write-up: nasal congestion, puffy eyes, cough, chest pain, hives, angioedema < 1 hr. 08/13/2007 MR received for ER visit 7/23/2007 for c/o itching, swelling, and rash. Pt received Varivax, immediately felt ill, vomited, and developed chest pain. He developed a rash on the face. Txd with epi and benadryl at PCP office. PE WNL by arrival at ED. DX: Allergic reaction.


VAERS ID: 285914 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Arizona  
Vaccinated:2007-07-17
Onset:2007-07-17
   Days after vaccination:0
Submitted: 2007-07-18
   Days after onset:1
Entered: 2007-07-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0304U / 1 LA / IM

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

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

Write-up: Mom stated pt. broke out in a rash on trunk 3 hrs post injection. Mom stated injection site was free from redness or rash but did report warmth at site.


VAERS ID: 285948 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-05-22
Onset:2007-05-29
   Days after vaccination:7
Submitted: 2007-07-25
   Days after onset:57
Entered: 2007-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB3101AA / 4 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0369U / 2 LA / UN

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

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

Write-up: Patient developed chicken pox 10 days after receiving vaccine and fevers 7 days after vaccine placed


VAERS ID: 285952 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2007-07-23
Onset:2007-07-25
   Days after vaccination:2
Submitted: 2007-07-25
   Days after onset:0
Entered: 2007-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0605U / 2 LA / SC

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

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

Write-up: 2 days after vaccine 4 inch by 4 inch raised reddened area aroung vaccine site. Pt given Attarax and cold compresses.


VAERS ID: 286022 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-05-04
Onset:0000-00-00
Submitted: 2007-07-11
Entered: 2007-07-26
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 5 LA / SC
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B007AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1509F / 1 RA / SC

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

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

Write-up: Tdap ordered and given on 5/4/07 in place of Td as required by age. No known SFX.


VAERS ID: 286039 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-07-17
Onset:2007-07-18
   Days after vaccination:1
Submitted: 2007-07-19
   Days after onset:1
Entered: 2007-07-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1062F / 2 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Blister, Erythema, Swelling, Tenderness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2"x3" area of solid red raised, blistery skin. Tender to touch.


VAERS ID: 286040 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-07-16
Onset:2007-07-17
   Days after vaccination:1
Submitted: 2007-07-19
   Days after onset:2
Entered: 2007-07-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0442U / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0644U / 2 RL / UN

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

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

Write-up: 3" diameter area of solid red - tenderness, itchy skin.


VAERS ID: 286104 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-04-10
Onset:2007-04-12
   Days after vaccination:2
Submitted: 2007-07-18
   Days after onset:97
Entered: 2007-07-27
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1509E / 2 LL / UN

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

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

Write-up: 3cmx3cm macular erythema on thigh and 1cmx0.5cm inguinal node reactive 2" to Varivax.


VAERS ID: 286113 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Colorado  
Vaccinated:2007-01-22
Onset:2007-01-23
   Days after vaccination:1
Submitted: 2007-07-12
   Days after onset:169
Entered: 2007-07-27
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1209F / 2 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1057F / 2 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Pruritus, Red blood cell abnormality, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Both sites red, swollen. Left thigh itchy.


VAERS ID: 286388 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-07-23
Onset:2007-07-30
   Days after vaccination:7
Submitted: 2007-07-31
   Days after onset:1
Entered: 2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0125U / 2 LA / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: 5x6 cm area of warm erythematous induration at site of vaccine noted ~7days post injection


VAERS ID: 286433 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Iowa  
Vaccinated:2007-07-27
Onset:2007-07-29
   Days after vaccination:2
Submitted: 2007-08-01
   Days after onset:3
Entered: 2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0495U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0829U / 2 LA / SC

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

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

Write-up: 5x5 cm area or erythema at site of Varivax injection. Slight tenderness


VAERS ID: 286513 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2007-07-25
Onset:2007-07-26
   Days after vaccination:1
Submitted: 2007-07-26
   Days after onset:0
Entered: 2007-08-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0781U / 2 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Pruritus, Rash, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash and redness around vaccine area about 2 cm diameter. As per pt felt warm and itchy.


VAERS ID: 286549 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2007-06-07
Onset:2007-06-09
   Days after vaccination:2
Submitted: 2007-07-21
   Days after onset:42
Entered: 2007-08-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2690AA / 3 RL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Adverse drug reaction, Blood test, Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autism~Measles + Mumps + Rubella (MMR II)~UN~1.50~In Patient|Autism~Measles + Mumps + Rubella (MMR II)~UN~1.50~In Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: Autism
Allergies:
Diagnostic Lab Data: Blood lab work has been ordered
CDC Split Type:

Write-up: Pt is an autistic child who when he received the booster DTaP vaccine shot had a very adverse reaction that has lasted over a month. The reaction was apparent within 2 days of the shot


VAERS ID: 286915 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2007-06-19
Onset:2007-07-28
   Days after vaccination:39
Submitted: 2007-07-30
   Days after onset:2
Entered: 2007-08-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0601U / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Secondary transmission, Skin lesion, Varicella
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Varicella~Varicella (Varivax)~1~3.00~In Sibling
Other Medications:
Current Illness: Infected molluscum
Preexisting Conditions: Heart murmur - innocent
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Exposed to varicella about 5 weeks ago. Has about 10 vesicular lesions on upper thighs.


VAERS ID: 287585 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-08-02
Onset:2007-08-02
   Days after vaccination:0
Submitted: 2007-08-03
   Days after onset:1
Entered: 2007-08-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 0824U / 2 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. AHAVB162CB / 2 LA / UN

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

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

Write-up: Pt. developed same redness around injection site following administration. Ice applied to site x 10 minutes. Redness subsided. Mother advised to give pt. Benadryl


VAERS ID: 287587 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2007-08-01
Onset:2007-08-02
   Days after vaccination:1
Submitted: 2007-08-03
   Days after onset:1
Entered: 2007-08-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0517U / 2 LA / SC

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)

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

Write-up: hives, widespread, 24 hr after administration of Varicella booster


VAERS ID: 287938 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-08-06
Onset:2007-08-07
   Days after vaccination:1
Submitted: 2007-08-07
   Days after onset:0
Entered: 2007-08-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0007U / 3 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0494U / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / SC
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2771AA / 3 RL / IM

Administered by: Private       Purchased by: Private
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)

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

Write-up: Pt dizzy, nauseated, has headache. Temp 102.7.


VAERS ID: 288106 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2007-03-28
Onset:2007-08-10
   Days after vaccination:135
Submitted: 2007-08-14
   Days after onset:4
Entered: 2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503F / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: 29 wk premie IVH with VP shunt, PPH, RDS
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Atypical zoster


VAERS ID: 288142 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-08-14
Entered: 2007-08-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Eye swelling, Pharyngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0708USA01568

Write-up: Information has been received from a physician concerning a 7 year old female who, on an undisclosed date, was vaccinated with 0.5 ml of Varivax. After being vaccinated the patient developed swollen eyes and her throat was swollen, and was subsequently rushed to the emergency room (ER). The reporting physician considered the events to be immediately life-threatening. No lot number was provided. At the time of reporting the patient''s status was unknown. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested.


VAERS ID: 288221 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Alabama  
Vaccinated:2007-08-08
Onset:2007-08-08
   Days after vaccination:0
Submitted: 2007-08-10
   Days after onset:2
Entered: 2007-08-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B056CA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z05482 / 5 RA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1395F / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Pain
SMQs:

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

Write-up: c/o pain 8-8-07 2 hrs after inj. mom rubbed clear alcohol on shoulder x 2


VAERS ID: 288383 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-08-09
Onset:0000-00-00
Submitted: 2007-08-10
Entered: 2007-08-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1985AB / 5 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0183U / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: No adverse effect
SMQs:

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

Write-up: Mother states no side effects. "No fever, no redness, no soreness, no problems."


VAERS ID: 288398 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-08-03
Onset:2007-08-03
   Days after vaccination:0
Submitted: 2007-08-17
   Days after onset:14
Entered: 2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. UNKNOWN / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. UNKNOWN / 2 LA / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Ear pain, Eye swelling, Lip swelling, Swollen tongue, Throat irritation, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: hives on the face&neck stiffness~Measles + Mumps + Rubella (MMR II)~2~5.40~Patient
Other Medications:
Current Illness: none
Preexisting Conditions: peanuts allergy
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Soon after patient had the shots(about 3 minutes), she complained of ear ache and something in the throat.(10:00am) So, she was returned to the Dr.''s examination room.(10:05am) While waiting(about another 4 minutes), patient''s corners of of her eyes had hives and soon became swelling. The doctor came in and gave her two teaspoons of Beneydrl. But the swelling of the eyes did not get better, so the doctor gave patient the epipine and the steroids.The doctor noted that there was swelling of patient''s lips and tongue. Also, she was coughing and wheezing. So, doctor gave patient some oxygen.At that point, the doctor had dialed 911 and patient was sent to Emergency room.(10:10am) She was stable after the paramedic arrived. She was in the ER for four hours to see if there is any more adverse reaction. She was fine and was discharged (3:00pm).


VAERS ID: 288508 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Kansas  
Vaccinated:2007-07-25
Onset:2007-08-08
   Days after vaccination:14
Submitted: 2007-08-10
   Days after onset:2
Entered: 2007-08-20
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0796U / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0366U / 2 - / SC

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

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

Write-up: 8-8-2007 Mother noticed red "pimple" looking spots on left side of waist and 2 spots on lower back


VAERS ID: 288598 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2007-08-21
Onset:2007-08-21
   Days after vaccination:0
Submitted: 2007-08-21
   Days after onset:0
Entered: 2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0605U / 2 RA / SC

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

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

Write-up: Within 2-3 minutes after vaccine area around injection site became red and raised. Pt was given Benadryl and a cold pack. After 25 minutes site had not increased nor decreased in size. Site was marked with instructions for mom to call FSP if site increased in size.


VAERS ID: 288615 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-08-14
Onset:2007-08-15
   Days after vaccination:1
Submitted: 2007-08-15
   Days after onset:0
Entered: 2007-08-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0726U / 2 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Induration, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: hard, and warm to no fever no diarrhea: Prescribed Hc.25.


VAERS ID: 288865 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Utah  
Vaccinated:2007-08-14
Onset:2007-08-14
   Days after vaccination:0
Submitted: 2007-08-15
   Days after onset:1
Entered: 2007-08-23
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0605U / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site swelling, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), 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)

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

Write-up: Child received varicella vaccine 08/4/07 at 9:00 AM. By evening, left arm was sore: slightly swollen at site. In the morning, it was red, hot, and swollen from shoulder to elbow.


VAERS ID: 289007 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2007-08-13
Onset:2007-08-17
   Days after vaccination:4
Submitted: 2007-08-23
   Days after onset:6
Entered: 2007-08-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0825U / 2 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Contusion, Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Bruise appeared 5 days after vaccine - 2 days later arm became itchy and red. Bruise still present 10 days after vaccine.


VAERS ID: 289018 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Indiana  
Vaccinated:2007-08-14
Onset:2007-08-16
   Days after vaccination:2
Submitted: 2007-08-20
   Days after onset:4
Entered: 2007-08-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B044AA / 5 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z1069 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 02834 / 2 LL / IM

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

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

Write-up: Received DTaP 8/14/07 right thigh. 8/16/07 c/o of 1/2 dollar size red and swollen thigh. 8/17/07 went to Ed - cellulitis given Keflex 550mg PO right thigh red 4 1/2 x 4" in size.


VAERS ID: 289051 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: West Virginia  
Vaccinated:2007-03-22
Onset:0000-00-00
Submitted: 2007-08-27
Entered: 2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1635CA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0421 / 3 LA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1553P / 2 RA / SC

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

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

Write-up: Pt received DTaP on 3-22-07 and was 7 years old.


VAERS ID: 289325 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Washington  
Vaccinated:2007-08-20
Onset:2007-08-21
   Days after vaccination:1
Submitted: 2007-08-21
   Days after onset:0
Entered: 2007-08-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0838U / 2 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 7cm x 8cm area of induration. 4cm x 4cm area of erythema.


VAERS ID: 289752 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:2007-07-25
Onset:2007-07-25
   Days after vaccination:0
Submitted: 2007-09-04
   Days after onset:41
Entered: 2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dyspnoea, Erythema, Reaction to previous exposure to any vaccine, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: diff. breathing, swelling~Measles + Mumps + Rubella (no brand name)~UN~5.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Allergy to Amoxicillin. Hx of reacting to MMR vax. RAD.
Allergies:
Diagnostic Lab Data: Pt. had similar reaction to MMR in 2005.
CDC Split Type:

Write-up: Difficulty breathing, swelling of face, red face, hives. 09/10/2007 MR received for ER visit 6/27/2007 for c/o facial swelling and trouble breathing s/p varicella vaccine. PE (+) for wheezing, hives, at the injection site and on back, facial redness and edema. Impression: Allergic reaction.


VAERS ID: 290050 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Illinois  
Vaccinated:2007-08-29
Onset:2007-08-29
   Days after vaccination:0
Submitted: 2007-08-29
   Days after onset:0
Entered: 2007-09-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB129A / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1030 / 6 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0631F / 3 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1731BA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1500F / 3 LA / SC

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

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

Write-up: Pt developed reels and red areas around neck and chest area, no c/o difficulty breathing or SOB. Pt given 200mg Benadryl PO and observed in exam room for one hr.


VAERS ID: 290250 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2005-08-18
Onset:2007-09-07
   Days after vaccination:750
Submitted: 2007-09-10
   Days after onset:3
Entered: 2007-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 987654321 / 3 RA / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER 12345 / 3 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)

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

Write-up: crying......awake all night...


VAERS ID: 290281 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Maryland  
Vaccinated:2007-05-11
Onset:2007-05-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2007-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0217U / UNK LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0367U / UNK LA / SC

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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same~Varicella (no brand name)~~0.00~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Next day and for 4 weeks thereafter, out arm front shoulder to elbow was red, swollen, hot to the touch, hard. Benadryl PO


VAERS ID: 290339 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New York  
Vaccinated:2007-08-28
Onset:2007-08-29
   Days after vaccination:1
Submitted: 2007-08-30
   Days after onset:1
Entered: 2007-09-12
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0651U / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086908 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Skin nodule, Tenderness
SMQs:, Cardiac failure (broad), 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)

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

Write-up: Swelling, redness, tenderness 3x3ccm 7x5 cm (R) upper arm. 1.5 x 1.5cm lump over (R) upper arm.


VAERS ID: 290486 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-09-04
Onset:2007-09-05
   Days after vaccination:1
Submitted: 2007-09-12
   Days after onset:7
Entered: 2007-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1005U / 2 LA / SC

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

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

Write-up: Area of erthema & swelling & itching on arm where Varicella vaccine was administered


VAERS ID: 290528 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: South Dakota  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-09-07
Entered: 2007-09-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0473M / 1 UN / SC

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

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

Write-up: Diagnosed with Herpes zoster 9-6-07


VAERS ID: 290565 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-09-13
Onset:2007-09-13
   Days after vaccination:0
Submitted: 2007-09-13
   Days after onset:0
Entered: 2007-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Grand mal 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)

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

Write-up: 1 hour after vaccine administration patient had generalized seizure tonic-clonic for 1 minute that self-resolved. She has no history of seizures and a normal neurodevelopmental history.


VAERS ID: 290994 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2007-09-13
Onset:0000-00-00
Submitted: 2007-09-19
Entered: 2007-09-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB211A / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated


VAERS ID: 291445 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New York  
Vaccinated:2007-06-15
Onset:2007-06-15
   Days after vaccination:0
Submitted: 2007-06-28
   Days after onset:13
Entered: 2007-09-20
   Days after submission:84
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Oedema peripheral, Pain in extremity, Paraesthesia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200702227

Write-up: Initial report received from a parent of a patient on 16 June 2007. A 7 year old male patient (with no known allergies) developed hives on his face, neck, arms and lower back, 3 1/2 to 4 hours after is received Adacel (lot number unknown intramuscularly in the left deltoid on 15 June 2007. He was treated with Benadryl and it resolved. He also complained of pain and swelling in the left arm and pain from the left clavicle extending to the right clavicle. He also complained of pins and needles in the "LLE" radiating from the hip. The patient did not have any illness and was not on any medications at the time of the vaccination. At the time of the report, he had not recovered.


VAERS ID: 291277 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-09-18
Onset:2007-09-19
   Days after vaccination:1
Submitted: 2007-09-21
   Days after onset:2
Entered: 2007-09-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB182AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1105U / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Heat therapy, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Grapefruit size redness to left arm, warm to touch. Benadryl 2 tsp q 6-8hrs prn/ warm compress.


VAERS ID: 291279 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-08-07
Onset:2007-08-08
   Days after vaccination:1
Submitted: 2007-09-10
   Days after onset:33
Entered: 2007-09-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0496U / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0721U / 2 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Erythema, Haematocrit decreased, Haemoglobin decreased, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Sickle cell disease
Allergies:
Diagnostic Lab Data: Hgb 7.9/22.9 Hct
CDC Split Type: NC07093

Write-up: Patient received vaccine on 8/7/07. The afternoon of 8/8/07 patient started complaining of itching in area vaccine given in the left leg. The next morning mom noted red, warm area to touch. Patient still complaining of itching. Mom brought patient to our office at 4pm - 9cm x 9cm redness, swelling and area, warm to touch. Patient denied pain.


VAERS ID: 291280 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-08-06
Onset:2007-08-07
   Days after vaccination:1
Submitted: 2007-09-10
   Days after onset:34
Entered: 2007-09-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0496U / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0721U / 2 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Erythema, Haematocrit normal, Haemoglobin normal, Mass, Oedema peripheral, Pruritus, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metadate
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Hgb -12.9 Hct 39.4
CDC Split Type: NC07094

Write-up: Patient received vaccine - next morning patient awake - left leg swollen, warm to touch and hard knot under skin. Patient complained of lots of itching. Leg was swollen approximately 15cm area and raised with redness. Swelling and redness after 24 hours on Benadryl.


VAERS ID: 291294 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Florida  
Vaccinated:2007-01-01
Onset:2007-01-01
   Days after vaccination:0
Submitted: 2007-09-24
   Days after onset:265
Entered: 2007-09-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abscess, Abscess drainage, Blood culture negative, C-reactive protein increased, Cellulitis, Culture wound, Headache, Injection site abscess, Injection site swelling, Injection site warmth, Pyrexia, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: blood culture - negative, wound culture 09/19/07 - pending, WBC count - increased, serum C-reactive - increased
CDC Split Type: WAES0709USA03403

Write-up: Information has been received from a physician, concerning a 7 year old male child, who on 2007 was vaccinated with the first dose of Pneumovax 23 (lot # not provided). Approximately 12 hours after the vaccination, the child developed swelling and warmth at the injection site. Two days later, he developed a fever of 104 F, with vomiting and a headache. He also had an increased white blood cell count (WBC) and increased c-reactive protein (CSF) (values not specified), and was hospitalized (date not specified). Treatment during hospitalization included antibiotics (not specified), and the physician indicated the child had a diagnosis of cellulitis. Cultures during the hospitalization were negative, and the child was discharged to home. On 19-SEP-2007, the child was seen in follow up at the Infectious Disease department and found to have an abscess at the injection site. a total of 3cc of pus was drained from the site, and a culture of the abscess was pending. At the time of this report, the outcome of the events was unknown. The reporting physician considered the events to be serious due to hospitalization and as an other important medical event. The physician also reported that since March 2007, an 18 year old male patient developed cellulitis after vaccination with Pneumovax 23 (lot # not provided (WAES #0707USA03967); and 3 other patients had serious injection site reactions following vaccination Pneunomax 23 (lot # not provided) (WAES #0707USA04149). Additional information has been requested.


VAERS ID: 291352 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Florida  
Vaccinated:2007-04-25
Onset:2007-09-20
   Days after vaccination:148
Submitted: 2007-09-20
   Days after onset:0
Entered: 2007-09-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 00174 / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 01256 / UNK LA / SC

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

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

Write-up: Few bumps on back, arms. Child feels well happen 2 days go kids in class with chicken pox. This is Varivax #2.


VAERS ID: 294332 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:2007-06-19
Onset:2007-06-19
   Days after vaccination:0
Submitted: 2007-09-24
   Days after onset:97
Entered: 2007-09-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0461U / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: No adverse reaction, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0706USA03456

Write-up: Information has been received from a physician concerning a 7 year old health male child who on 19-JUN-2007 was vaccinated with Zostavax (Oka/Merck) (lot # 657558/0461U) instead of booster for Varivax (Oka/Merck) (MSD). No symptoms were reported. The physician noted that these cases of human error, not product confusion. This is one of 2 reports received from the same source. Additional information has been requested.


VAERS ID: 295296 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-07-06
Onset:2007-07-06
   Days after vaccination:0
Submitted: 2007-09-24
   Days after onset:80
Entered: 2007-09-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1406F / UNK UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0707USA01096

Write-up: Information has been received from a healthcare worker concerning a 7-year-old female who on 06-JUL-2007 was vaccinated subcutaneously with "one vial" of Zostavax (Oka/Merck) (lot# 654604/1406F) instead of Varivax. Medical attention was not sought. The outcome was not provided. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 291636 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2007-09-18
Onset:2007-09-19
   Days after vaccination:1
Submitted: 2007-09-20
   Days after onset:1
Entered: 2007-09-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1071U / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

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

Write-up: See picture


VAERS ID: 291754 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2007-09-26
Onset:2007-09-26
   Days after vaccination:0
Submitted: 2007-09-26
   Days after onset:0
Entered: 2007-10-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1011U / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: 2nd dose Epi, IV Benadryl, and Decadron in ED
CDC Split Type:

Write-up: Acute onset of cough, SOB, facial swelling w/i 5 minutes of receiving vaccine. Received Epi-pen, Benadryl, O2 in office. Transferred to ED via ambulance.


VAERS ID: 291911 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-09-25
Onset:2007-09-26
   Days after vaccination:1
Submitted: 2007-09-26
   Days after onset:0
Entered: 2007-10-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0729U / 2 RA / -

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

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

Write-up: Injection site swelling/ redness right deltoid developed 24 after vaccination.


VAERS ID: 292208 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New York  
Vaccinated:2007-10-03
Onset:2007-10-03
   Days after vaccination:0
Submitted: 2007-10-04
   Days after onset:1
Entered: 2007-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2476HA / 6 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1268U / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Eyelid oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma, Pierre-Robin (S/P Cleft palate repair)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large swelling of Right lower eyelid, apparently with clear fluid. No erythema. No respiratory symptoms-within 15 minutes of shots given 0.4 Epi IM (1:1000) and 40 mg Benadryl p.o. swelling decreased over PM. Observed in ED over 4 hours


VAERS ID: 292231 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-08-29
Onset:2007-08-29
   Days after vaccination:0
Submitted: 2007-08-30
   Days after onset:1
Entered: 2007-10-04
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1018U / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins, Extenderol, Nasonex, Advair, Zyrtec, Singulair, Xopenex, HFA inhaler
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: redness, hot and hurting (R) UA from Varivax immunization, 1/2 dollar size on 8/29/07 at 3.25. On 8/30/07 size 3 1/4" long red-warm to touch and oozing clear fluid


VAERS ID: 292307 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Unknown  
Location: Michigan  
Vaccinated:2007-10-05
Onset:2007-10-05
   Days after vaccination:0
Submitted: 2007-10-05
   Days after onset:0
Entered: 2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1116U / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Erythema, Lip swelling, Rash macular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Was treated in ER on 10/02/2007 for croup. Received IV solumedrol.
Preexisting Conditions: allergic to Eggs, milk & nuts
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented for 9 yr PE at 10:00 am. Approx 10:30 am, Varivax was given SC in Left arm. 1105 Pt returned to office with c/o swollen lips, red face, red macular rash on trunk, anterior and posterior, dizziness stating "I don''t feel good". No respiratory distress. BP 104/60 Benadryl 50mg given IM. 1125 BP 100/72 pulse 84, O2 sat 92%. Face swollen and red. Ambulance called, patient transported to Hospital ER in stable condition


VAERS ID: 292453 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:2001-02-02
Onset:2007-10-07
   Days after vaccination:2438
Submitted: 2007-10-08
   Days after onset:1
Entered: 2007-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0253K / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473342 / 2 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Rash papular, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Eryth mac papules ~ 1/2cm size trunk pubic area few vesicular.


VAERS ID: 292522 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Indiana  
Vaccinated:2007-10-08
Onset:2007-10-09
   Days after vaccination:1
Submitted: 2007-10-09
   Days after onset:0
Entered: 2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB288AA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0416U / 1 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1704A / 4 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0854U / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cold compress therapy, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Pain, redness at injection site Rt arm. Denies fever. Father states child did not go to school today. Recommended child be given either Tylenol or Ibuprofen for pain. Cool compresses to site; may use warm compresses for relief if cool not helpful.


VAERS ID: 292664 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Wyoming  
Vaccinated:2007-09-25
Onset:2007-09-25
   Days after vaccination:0
Submitted: 2007-09-26
   Days after onset:1
Entered: 2007-10-10
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1282F / 2 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1104U / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Fatigue, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mom called on Wed., 9-26-07 in the am and stated that child was very nauseated, fatigued and had a low grade fever. Advised mom to give Tylenol and take child to Dr if no better by Fri - 9-28-07. Mom verbalized understanding. 9-28-07 TC to mom for follow up - no answer. 10-1-07 TC to mom - no answer.


VAERS ID: 292731 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-10-09
Onset:2007-10-09
   Days after vaccination:0
Submitted: 2007-10-11
   Days after onset:2
Entered: 2007-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2443AA / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0860U / 1 LA / IM

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

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

Write-up: Pain, fever to 103.7 tx - cool compress - PRN Tylenol with Codeine - PRN pain q 4-6 hrs.


VAERS ID: 293171 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2007-10-10
Onset:2007-10-11
   Days after vaccination:1
Submitted: 2007-10-15
   Days after onset:4
Entered: 2007-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1225U / 2 LA / SC

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

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

Write-up: (L) upper arm erythematous macular spot after 24 hours. Placed on Keflex.


VAERS ID: 293295 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-09-24
Onset:0000-00-00
Submitted: 2007-10-16
Entered: 2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289BA / 4 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

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

Write-up: Client rec''d a DTaP instead of a Td vaccine


VAERS ID: 293551 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2007-09-13
Onset:2007-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2007-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1003U / 2 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Cough, Erythema, Hypersensitivity, Lip swelling, Ocular hyperaemia, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Acute allergic rxn, cough, red swollen eyes, and face, "throat felt funny" tightness, lips swollen. Benadryl, Epi-pen Jr, ER observation for several hrs.


VAERS ID: 293748 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Missouri  
Vaccinated:2007-08-07
Onset:2007-08-07
   Days after vaccination:0
Submitted: 2007-10-15
   Days after onset:69
Entered: 2007-10-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2657AA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dyskinesia, Excessive eye blinking, Tardive dyskinesia, Tic
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness:
Preexisting Conditions: The patient has a history of PDD (Pervasive Development Disorder) and environmental allergies (not specified). The patient had no illness at the time of vaccination. The patient had no other vaccinations within four weeks prior to 07 August 2007. Claritin and Cogentin were reported as ''Other medications''; however, Cogentin was also reported as a treatment medication.
Allergies:
Diagnostic Lab Data: None
CDC Split Type: 200703413

Write-up: Initial report received from a patient''s parent on 08 October 2007. An 7-year-old male with history of Pervasive Development Disorder and unspecified environmental allergies received a left deltoid intramuscular injection of Daptacel (Lot number C2657AA) on 07 August 2007. By that evening, the patient began showing signs of eye blinking, facial tics and uncontrolled movement which was more pronounced by the next day. The parent reported that the patient was suffering from possible tardive dyskinesia. The patient was seen by a physician and was referred to a neurologist whom he has seen three to four times. The patient was treated with Cogentin. Outcome was reported as ''not recovered''. No additional information had been provided at the time of this report.


VAERS ID: 293784 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-10-17
Onset:2007-10-18
   Days after vaccination:1
Submitted: 2007-10-19
   Days after onset:1
Entered: 2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2463AA / UNK LL / UN

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)

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

Write-up: Left thigh red and swollen on injection site, warm to touch. Seen by Dr. today at 10:00 am.


VAERS ID: 293849 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Georgia  
Vaccinated:2007-10-08
Onset:2007-10-12
   Days after vaccination:4
Submitted: 2007-10-19
   Days after onset:7
Entered: 2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500487P / 1 NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: prematurity EGA 31 wk, allergic rhinitis
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: wheeing and cough, started about 4 days after administration of flumist


VAERS ID: 293890 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Georgia  
Vaccinated:2007-09-20
Onset:2007-09-20
   Days after vaccination:0
Submitted: 2007-10-05
   Days after onset:15
Entered: 2007-10-19
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB163AB / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD159 / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1102U / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: `
CDC Split Type: GA07050

Write-up: Red spots noted to right upper arm after receiving Hep A. Bled at site, informed would have bruise. Bandaid removed, redness noted under bandaid. Area warm to touch. No itching, swelling or SOB noted. Had appt with private MD after left facility.


VAERS ID: 294081 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2007-10-18
Onset:2007-10-20
   Days after vaccination:2
Submitted: 2007-10-22
   Days after onset:2
Entered: 2007-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1256U / 2 LA / SC

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

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

Write-up: Localized swelling, redness and itching at injection site.


VAERS ID: 294424 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: North Dakota  
Vaccinated:2007-10-10
Onset:2007-10-10
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:15
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0852U / 2 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dysphonia, Dyspnoea, Erythema, Hypersensitivity, Increased upper airway secretion, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Mom reports blood work was drawn.
CDC Split Type:

Write-up: Mom reports 10 minutes after leaving clinic site, child was experiencing wheezing, hoarsenss, shortness of breath, phlem, and difficulty breathing. He was very red in color. No rash present. Mom took him immediately to the local emergency room, which was within 30 minutes. She reports patient received Benadryl and she thinks Zyrtec po X1 dose. She states the doctor diagnosed the episode as an allergic reaction. They remained in the ER for 3 hours. She reports patient has not experienced any further problems.


VAERS ID: 294438 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-09-21
Onset:2007-09-22
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:33
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08354 / 2 LA / SC

Administered by: Private       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)

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

Write-up: Erythema, swelling and pain at the injection site. Supportive care instructions given- no antibiotics required.


VAERS ID: 294497 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-10-18
Onset:2007-10-25
   Days after vaccination:7
Submitted: 2007-10-25
   Days after onset:0
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0855U / 2 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1 Week after Varivax #2 erythema multiforme rash on trunk also has mild URI Rx Benadryl and observation


VAERS ID: 294617 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Utah  
Vaccinated:2007-09-12
Onset:2007-09-13
   Days after vaccination:1
Submitted: 2007-09-17
   Days after onset:4
Entered: 2007-10-27
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0798U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1023U / 2 LA / SC

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

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

Write-up: Patient, age 7, received Hep A and Varicella in her left arm. The next morning her mother noticed that the deltoid area was swollen, red, and hard. Mom states it feels like a "knot" 2 1/2 inches in diameter but is not warm to the touch. Child has no fever and states it only hurts if it is pushed on. On 9/17/07 mother stated child had marked improvement and was feeling better.


VAERS ID: 294768 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-10-17
Onset:2007-10-18
   Days after vaccination:1
Submitted: 2007-10-19
   Days after onset:1
Entered: 2007-10-29
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB143BA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 07244 / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Takes Zyrtec for allergies last dose 10-16-07
Current Illness: None
Preexisting Conditions: Environmental / Seasonal allergies
Allergies:
Diagnostic Lab Data: As of 10/19/07 1000 no tests ordered
CDC Split Type:

Write-up: At approximately 0900 on 10/18/07 fine pinpoint rash over body. Rash more red body not itchy no itchy no drainage no trouble breathing or swallowing has appointment at 4:15 with doctor on 1019.


VAERS ID: 294772 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-10-15
Onset:0000-00-00
Submitted: 2007-10-19
Entered: 2007-10-29
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1338U / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD skin test given
Current Illness:
Preexisting Conditions: Increase lead; Ecchymosis; Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient returned to clinic on 10/17/07 for PPD skin test reading right upper arm noted to be redness with rash. Antibiotics given for cellulitis. Patient to return for follow up in 2 days.


VAERS ID: 294864 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:2007-10-27
Onset:2007-10-28
   Days after vaccination:1
Submitted: 2007-10-30
   Days after onset:2
Entered: 2007-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1106U / 2 RA / SC

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

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

Write-up: Patient had erythematous papules at injection site and on abdomen area. Patient was given .3cc dex and 12.5mg of Diphenhydramine injection. Patient was given rx for Prapred 15/5cc 1tsp BID x 5 days. Patient is to RTC in 1 week.


VAERS ID: 295074 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-22
   Days after onset:0
Entered: 2007-10-31
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB18AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249U / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Anxiety, Dizziness, Injection site pain, Pallor
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt felt dizzy, anxious 10 min after administration of vaccines. Reported 2/10 pain in (L) arm radiating to hand. Facial pallor. BP=84/60; pulse 90. Observed pt in clinic for 15 mins. All sx resolved.


VAERS ID: 295193 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Oregon  
Vaccinated:2007-10-24
Onset:2007-10-26
   Days after vaccination:2
Submitted: 2007-11-01
   Days after onset:6
Entered: 2007-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2476JA / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. O554U / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Body temperature increased, Erythema, Limb discomfort, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known.
Preexisting Conditions: Frequent history of pheumonia and respiratory problems.
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Mother reports extreme left arm discomfort from time of injection for 3 days. Day after injection had temp of 101.2 for 4 hours. 2 days after injection arm bright red, hot area 3" x 3"; lasted 48 hours.


VAERS ID: 295518 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Ohio  
Vaccinated:2007-10-31
Onset:0000-00-00
Submitted: 2007-11-05
Entered: 2007-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289BA / 1 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0152U / 1 LA / SC

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

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

Write-up: none--given wrong vaccine for age


VAERS ID: 295572 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2007-10-17
Onset:2007-10-17
   Days after vaccination:0
Submitted: 2007-10-24
   Days after onset:7
Entered: 2007-11-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2510AA / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Lt. upper arm red, hot and indurated 8x6.5 cm on 10-18-07 14.5 x 11 cm on 10-19-07 Rx: Augmentin 1 1/2 tsp BID x 10 d; Tylenol with QOD prn. Redness and pain started decreasing 10-19-07 p.m.


VAERS ID: 295763 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2007-10-19
Onset:2007-10-22
   Days after vaccination:3
Submitted: 2007-10-30
   Days after onset:8
Entered: 2007-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500487P / 1 NS / IN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1015U / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Blood creatine phosphokinase increased, Borrelia burgdorferi serology negative, Culture throat negative, Myalgia, Myositis, Pain in extremity, Pyrexia, Streptococcus identification test, Streptococcus identification test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Quick Strep and throat culture (-), bloodwork, ASO + Lyme were (-) but total CK 5554
CDC Split Type:

Write-up: vaccines administered on 10/19/07, seen on 10/22/07 with muscle aches and fever. Quick strep and throat culture (-), mother states on 10/24/07 c/o severe calf pain and still has fever up to 103 deg, seen in office again on 10/25/07 with muscle pain and weakness and sent for bloodwork. ASO + Lyme were (-) but total CK 5554, diagnosed with acute benign myositis


VAERS ID: 295787 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Oregon  
Vaccinated:2007-10-18
Onset:2007-10-19
   Days after vaccination:1
Submitted: 2007-10-23
   Days after onset:4
Entered: 2007-11-06
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2499AA / 3 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Child has history of reactive airway disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR200745

Write-up: Child c/o itching the next AM. Mom looked at the site and noted redness of approx "slightly larger than a 50 cent piece with swelling noted at that time. Given 10 mg (1 1/2 tsp) Benadryl. By that afternoon the erythema and swelling had progressed down to elbow and was spreading to the underside of the arm. Given 2nd dose of Benadryl. Areas also flat to touch and was swollen with what appeared as one large contiguous hive. By Saturday AM 10/20/07, color fading, Sunday 10/21, no longer hot to touch, could see border on where red rash had been on Monday. Today appears as a bruise of smaller rxn.


VAERS ID: 296244 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Arizona  
Vaccinated:2007-10-30
Onset:2007-10-30
   Days after vaccination:0
Submitted: 2007-11-02
   Days after onset:3
Entered: 2007-11-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR V2490AA / UNK LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1031V / UNK UN / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site cellulitis
SMQs:

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

Write-up: Cellulitis around site of injection - Started on Clindamycin


VAERS ID: 296378 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2007-11-12
Onset:2007-11-12
   Days after vaccination:0
Submitted: 2007-11-12
   Days after onset:0
Entered: 2007-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80074 / 1 RA / 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)

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

Write-up: Patient received influenza vaccination and while walking to waiting room patient passed out. Patient turned pale and mother carried him back to a room. Vitals were monitored and legs elevated.


VAERS ID: 296517 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2004-12-21
Onset:2004-12-22
   Days after vaccination:1
Submitted: 2007-11-13
   Days after onset:1056
Entered: 2007-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER U1516AA / 1 RA / ID

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Asthma, Influenza like illness, Nasopharyngitis, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Viral Induced Asthma~Influenza (Seasonal) (no brand name)~3~7.00~In Patient
Other Medications:
Current Illness: Well Visit check up
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient went to Doctors office for seven year well visit. Patient was healthy with no symptons of cold or flu. Flu shot was offered and given to patient. Patient developed cold and flu like symptons overnight and begin weezing. The following day went back to doctor and he prescribed pulmicort and Xopenex to help with the viral induced asthma. Overnight developed pain in joints. Went back on third day and treated joint pain with Motrin. Ashtma cleared after two weeks of treatments of pulmicort and Xopenex. Each time patient gets a cold, an asthma attack occurs and breathing treatments are given (pulmicort and xopenex.) The patient never had asthma or any related symptons prior to the flu shot.


VAERS ID: 299508 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2006-10-31
Onset:2006-11-03
   Days after vaccination:3
Submitted: 2007-03-12
   Days after onset:128
Entered: 2007-11-14
   Days after submission:247
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2239AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC
Current Illness:
Preexisting Conditions: No illness at vaccination time, no medical conditions, no concomitant vaccinations were given, unsure of any adverse events occurred post prior vaccinations. Allergic to amoxicillin.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200603007

Write-up: Initial report received from a health care professional, on 08 November 2006. A 7 year old female patient, received on 31 October 2006 Fluzone (lot number U2239AA) (multidose vial), intra-muscular, into the right deltoid. On 03 November 2006, three days later, she experienced red raised rash and itchiness at injection site. No systemic reaction was reported. The patient required a doctor visit. Corrective treatment was not reported. The patient''s outcome was unknown. No concomitant vaccinations were given. No information on prior exposure to Fluzone was reported. The patient had allergy to amoxicillin and no other medical conditions. The patient''s concomitant medications included "Zertec" as needed (PRN). No illness at vaccination time were reported. Follow-up information received on 12 March 2007 from a health care professional. Number of previous doses of Fluzone SV 2006-2007 was none. Concomitant medication was amended to Zyrtec (previously reported as Zertec). At the time of this report, the patient had recovered.


VAERS ID: 296820 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-11-13
Onset:2007-11-15
   Days after vaccination:2
Submitted: 2007-11-15
   Days after onset:0
Entered: 2007-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2502AA / 2 LL / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0200U / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1343U / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction, Local reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LANTUS, NOVOLOG
Current Illness: TYPE 1 DM
Preexisting Conditions: ALLERGIC TO CINNAMON
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: LOCALIZED REACTION ON RIGHT THIGH 7X7 CM LARGER ON DAY 2 THAN DAY ONE POST INJECTION TREATED WITH ZYRTEC 10 MG PO DAILY FOR A WEEK


VAERS ID: 296977 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Washington  
Vaccinated:2007-11-07
Onset:2007-11-07
   Days after vaccination:0
Submitted: 2007-11-12
   Days after onset:5
Entered: 2007-11-15
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80958 / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1174U / 3 LA / SC

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

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

Write-up: Warm, red, Swollen 3" erythemia 2 inches induration on left upper arm.


VAERS ID: 297348 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-10-31
Onset:2007-11-03
   Days after vaccination:3
Submitted: 2007-11-09
   Days after onset:6
Entered: 2007-11-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB200AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0417U / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1358U / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth, Scratch
SMQs:, Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: noted today 3" red warm patch where varicella was given on 10/31 - patient scratched area - parent did not report to me until today during physical exam


VAERS ID: 297350 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-09-17
Onset:2007-09-17
   Days after vaccination:0
Submitted: 2007-09-27
   Days after onset:10
Entered: 2007-11-19
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0036F / 2 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1009U / 2 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Lip swelling, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 10/27/05~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: Previous reaction to DTap and MMR/ h/o hypospadias
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lip swelling/hives/wheezing; Rx Epinephrine(1:1000) 0.2ml IM; Zyrtec 10mg po x1./ Recovered <30


VAERS ID: 297464 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-09-10
Entered: 2007-11-20
   Days after submission:71
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1014U / 2 LA / SC

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)

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

Write-up: Redness, swelling, warmth at site of injection and pt of arm.


VAERS ID: 297517 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: South Dakota  
Vaccinated:2007-11-15
Onset:2007-11-17
   Days after vaccination:2
Submitted: 2007-11-21
   Days after onset:4
Entered: 2007-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2502AA / 5 LA / IM

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

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

Write-up: 11-15-07 1553 Client received flu shot at 1553 Sanofi Lot U2502AA in left deltoid IM. 11-19-07 Mom came into office in afternoon and told clerical the patient had to go to the Dr. on Saturday November 17, 2007 because the spot where he got the flu shot was all red. The Dr. told her it was an infection. 11-20-07 1120 Left message at client''s house for mom to return my call and let me know details of what happened. 11-20-07 Saw client''s mom in evening at flu clinic and she reported details to me. She stated on Friday November 16 her son (client) told her that his arm itched. On Saturday November 17 her son was getting dressed and felt a bump on his arm. He went to show his mom and she stated it was red, warm and sore. No fever was present. Mom felt the redness was the size of an orange or a grapefruit. She took him to acute care in the am and he saw a PA. He was given an antibiotic. Mom is unsure of the name but knew it started with a ''C''. He was prescribed 10 days worth for three times a day. She gave him two doses on Saturday and by Sunday the redness was the size of a dime.


VAERS ID: 297568 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Maryland  
Vaccinated:2007-10-06
Onset:2007-10-31
   Days after vaccination:25
Submitted: 2007-11-21
   Days after onset:21
Entered: 2007-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / UNK - / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS ALTAVB207AA / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 11830 7/24/09 / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Alopecia, Anaemia, Arthralgia, Chest X-ray normal, Computerised tomogram normal, Constipation, Epistaxis, Fatigue, Gingival bleeding, Granuloma annulare, Immunoglobulins, Laboratory test, Laboratory test normal, Lip blister, Platelet count decreased, Pyrexia, Rash, Red blood cell count decreased, Skin exfoliation, Syncope, Ultrasound abdomen normal, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gingival disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: children vitamins
Current Illness: none
Preexisting Conditions: granuloma annularre (skin condition), seasonal sinus problems
Allergies:
Diagnostic Lab Data: She was admitted to the Hospital on November 7, 2007. She was tested for everything from cancer to lupus, of which all tests were negative. She also was tested for infectious diseases and several viruses, that also had negative results. She had a chest x-ray before being hospitalized on Tuesday, November 6th. She had another chest x-ray on Wednesday, November 7, at Hospital - both results were normal. Labs and Diagnostics: CBC with WBCs 8.7, H/H 10.5/31.9, platelets 16,000. CMP with Na 133, AST 81-314, ALT 34-64. LDH 606-1024. Platelets down to 7,000. Sed rate 71. UA (+) for sediment. Blod cx (-). Lupus labs (ANA, ds DNA, anti-Sm, RNP, SSA, SSB) all (-). CK 893, complement WNL. PT 16.7, UA with trace protein, EBV IgG (+). CMV IgG and IgM (+).Head CT (-). Abd US and doppler shows thin renal parenchyma of the R kidney maybe 2'' to pyelonephrotic scarring, normal liver.
CDC Split Type:

Write-up: Within a week of the vaccination, she was tired, and she had a few nose bleeds (that were hard to stop). Her gums started bleeding when brushing her teeth a few weeks after the vaccine. She then started having high fevers around October 31, 2006,(103, 104, 105)and was eventually hospitalized on November 7, 2007, after a blood test revealed that her blood platelet count was down to 16,000. She had two chest x-rays that were normal. She was diagnosed as having high fever, a low platelet count (platelets got as low as 7,000), and low red blood cells count (which resulted in anemia). While hospitalized, she was twice treated with IVIG that caused her platelet count to rise. She also received intravenous antibiotic treatments that she did not respond to. She was also given Tylenol and later Motrin while hospitalized to control the fever. She is now taking Prednisone for a short period. In addition, she is taking iron pills and Protonix (to protect her stomach from the affects of the steroid medicine). While hospitalized, she also had a CAT Scan (of the head) and ultrasounds of her abdominal area (tests were normal). 12/06/2007 MR received for DOS 11/7-17/2007 with D/C DX: Evan''s Syndrome. Presented to local ED with fever x days, thrombocytopenia and anemia. Pt initially developed cough, rhinorrhea, fatigue and fever. Treated symptomatically for suspected viral infection. Pt developed increasing fatigue and difficulty leaving bed. Seen again by PCP with labs and CXR done. Admitted for further w/u of FUO and thromobcytopenia. PE (+) for purpura of the external ear, lip ecchymosis (blood blisters), violaceous scaly skin patches involving the malar eminence, and upper extremities. Started on abx and IVIG PMH: Skin disorder x 1.5-2 yrs c/w granuloma annulare. Rash on face/cutaneous lesions c/w Lupus. Constipation. Recurrent sinus infections. Pt developed nausea, dizziness and blurred vision and had a near syncopal episode. New onset RUQ pain on day 8 with increased LFTs. Multiple consults by Heme/Onc, Rheum, GI, Neuro and ID. DX of Evan''s Syndrome on Day 10 and tx with steroids begun to be continued and F/U as outpt. Per 60 day follow up: She is still experiencing low platelets, which is being controlled by steroid usage (presnisone). 1/15/2010 Patient rec''d other vaccine, hep A on 7/31/08 and she had to be readmitted to the hospital she experienced hair loss, skin rash, fevers, low plackets and joint pain.


VAERS ID: 297711 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Ohio  
Vaccinated:2007-11-19
Onset:2007-11-22
   Days after vaccination:3
Submitted: 2007-11-26
   Days after onset:4
Entered: 2007-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Diet refusal, Pain, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Received vaccine on Monday, November 19, 1007. Became ill with fever, vomiting and aches on Thursday, November 22, 2007. Symptoms continued on Friday, November 23, 2007. Mom reports child felt "better" on Saturday, but was sleepy on Sunday. Still refusing food on Monday, November 26. Advised by nurse completing report to contact child''s pediatrician.


VAERS ID: 297723 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2007-11-16
Onset:2007-11-17
   Days after vaccination:1
Submitted: 2007-11-26
   Days after onset:9
Entered: 2007-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2528AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1355U / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration, Nodule, Oedema peripheral, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), 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)

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

Write-up: Mother called clinic day after (11-17) vaccines were given to repot a 2 inch bump underneath the arm the vaccines were given. No fever at that time. Patient was scheduled to be seen in the office that day. Evaluated by a provider and area of approx. 3cm in diameter of redness and swelling that was warm to touch noted. Area is posterior area of R) arm. Parent instructed to apply cool pack and observe. Mother called back the next day (11-18) and patient is seen again by provider. Redness has spread outside the area of a line drawn the day before. Overall however there is less intense redness and the hardness int he middle and swelling seems improved. No drainage or skin breakdown noted. Area is more warm and tender than is was yesterday. Patient was started on Amoxil the day of the immunizations due to an ear infection. Amoxil is stopped and patient is started on Augmentin.


VAERS ID: 297821 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2007-11-10
Onset:2007-11-11
   Days after vaccination:1
Submitted: 2007-11-19
   Days after onset:8
Entered: 2007-11-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2493AA / 7+ RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: N 26 hours after Flu vaccine right arm felt like it was "on fire", stinging. Had well demarcated raised very erythematous 5cm X 8cm (prox-distal) hot to touch area over most of the upper lateral arm starting at sire of injection. 36 hours later decreased symptoms with redness, swelling, fading. Benadryl given PRN


VAERS ID: 297836 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-11-10
Onset:2007-11-10
   Days after vaccination:0
Submitted: 2007-11-24
   Days after onset:14
Entered: 2007-11-26
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2460CA / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site urticaria, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mom Called approx 90 min after vaccine and reported hives beginning at vaccine site and spreading to legs and trunk. TX with Benadryl and Baking soda baths.


VAERS ID: 297874 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Indiana  
Vaccinated:2007-10-16
Onset:2007-10-17
   Days after vaccination:1
Submitted: 2007-11-12
   Days after onset:26
Entered: 2007-11-27
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500488P / 1 NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Chest X-ray normal, Respiratory distress, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec, Flonase
Current Illness:
Preexisting Conditions: Past Disease: Allergic rhinitis
Allergies:
Diagnostic Lab Data: CXR normal
CDC Split Type: MEDI0006101

Write-up: A serious report of respiratory distress and wheezing was received from a physician concerning a seven-year-old male. The patient had a history of allergic rhinitis but did not have a history of wheezing or asthma. Concomitant medications include Zyrtec and Flonase nasal spray, both taken once a day for allergic rhinitis since Aug 2007. The patient received FluMist on 16-Oct-2007. On 18-Oct-2007, the patient presented to the reporting physician''s office complaining of respiratory distress and wheezing, which started on 17-Oct-2007. The patient''s chest x-ray was normal. Per the reporter, the patient "cleared" with Xopenex but returned later in the day with increased distress. The patient was admitted to the hospital for 24 hours and was discharged on oral steroids and Xopenex treatments. The patient recovered from the wheezing. No outcome was provided for the event of respiratory distress. The discharge summary has not been received. Rechallenge is not applicable. The reporter did not provide an assessment of causality for the events. The reporting source of this case is spontaneous, thus the sponsor''s comment is not applicable.


VAERS ID: 297961 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-11-26
Onset:2007-11-27
   Days after vaccination:1
Submitted: 2007-11-27
   Days after onset:0
Entered: 2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0414U / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357U / 2 LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Erythema, Induration, Oedema peripheral, Pruritus, Vaccination complication
SMQs:, Cardiac failure (broad), 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Guanfacine 1mg
Current Illness: ADHD
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data: vaccine adverse effect
CDC Split Type:

Write-up: Left upper outter arm red, hard and swollen, itchy seen by PCP 11/27/07 TX: Tylenol and Benadryl, Follow-up visit in 1 week.


VAERS ID: 298002 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2007-11-26
Onset:2007-11-26
   Days after vaccination:0
Submitted: 2007-11-28
   Days after onset:2
Entered: 2007-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0986U / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Had MMR 10/23/06; Varicella 7/26/04
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: erythma at site of vaccination right deltoid about 12 hrs after shot. It progressed to vesicles in center. I saw her at 9 pm 11/27/2007.4" erythmatous ring with raised edge central vesicles with on about 1"x1/3" denuded oozing slightly brown scabbed surrounded by slightly mor intnse red. Area very itchy not much pain


VAERS ID: 298046 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Georgia  
Vaccinated:2007-11-14
Onset:2007-11-15
   Days after vaccination:1
Submitted: 2007-11-16
   Days after onset:1
Entered: 2007-11-28
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2476HA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1120U / 3 LA / UN

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

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

Write-up: Arm swollen and red, vesicle x 2 on arm.


VAERS ID: 298119 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-10-05
Onset:2007-10-05
   Days after vaccination:0
Submitted: 2007-11-29
   Days after onset:55
Entered: 2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1179U / 2 LA / IM

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

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

Write-up: Patient developed achiness, then diffuse swelling at immunization site within 24 hours of administration. When seen in office 48 hours later area of overlying erythema consistent with large local reaction to immunization vs cellulitis. Placed on course of Keflex and improved.


VAERS ID: 298167 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-11-08
Onset:2007-11-10
   Days after vaccination:2
Submitted: 2007-11-29
   Days after onset:19
Entered: 2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2528AA / 5 RL / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Pruritus, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 15mg/day, Lexapro 5mg/day
Current Illness: none
Preexisting Conditions: none (autism spectrum disorder)
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received flu vaccine in thigh on Thursday, 11/8/07, around 3pm. Friday afternoon, 11/9, he complained that his "feet were itchy". Saturday morning 11/10 he awoke with fever (101.6 F) headache, and HIVES all over his thighs, calves, ankles, and feet. We were out of town called our pediatrician who advised giving him oral Benedryl and taking him to an acute care center. We did so. Patient responded to the Benedryl (hives began to fade) and Tylenol for headache and fever. Felt bad for the day. Hives faded in two days.


VAERS ID: 298497 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Puerto Rico  
Vaccinated:2007-10-30
Onset:2007-10-30
   Days after vaccination:0
Submitted: 2007-11-13
   Days after onset:14
Entered: 2007-12-03
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2490AA / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0880F / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Injection site inflammation, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: Hermansky Pudlak
Allergies:
Diagnostic Lab Data:
CDC Split Type: PR0712

Write-up: The patient''s mother referred that after vaccination her daughter had fever for 3 days, inflammation in the injection site (left arm), seizures and vomiting.


VAERS ID: 298690 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Oregon  
Vaccinated:2007-12-03
Onset:2007-12-03
   Days after vaccination:0
Submitted: 2007-12-04
   Days after onset:1
Entered: 2007-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500488P / 2 NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain upper, Dizziness, Headache, Pharyngolaryngeal pain, Pyrexia
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)

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

Write-up: FEVER 103 LESS THAN 12 HOURS AFTER FLUMIST ADMINISTERED. ALSO COMPLAINED OF SORE THROAT, STOMACH ACHE, DIZZINESS, HEADACHE.


VAERS ID: 298781 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-11-27
Onset:2007-12-01
   Days after vaccination:4
Submitted: 2007-12-05
   Days after onset:4
Entered: 2007-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 5004483P / 1 NS / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Dysphonia, Glossodynia, Pallor, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient woke-up up with a fever of 103.1. She was shaking and was weak, dizzy, & a little pale. She complained that her tongue was burning. This was on the 1st of December. I took her to the weekend doctor and had forgot that she had this vaccination, so did not inform them of it. They said they found nothing wrong with her, but again, I did not inform them of this vaccination, because I forgot that she had it. On Sunday, December 2nd, she was hoarse the whole day. To my knowledge she is ok, but I will call to possibly set up another appointment, if they want to see her. She had this vaccine done at her school. They sent home a note with the vaccine information, but I cannot tell the name of the person who administered it.


VAERS ID: 298942 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-11-01
Onset:2007-11-01
   Days after vaccination:0
Submitted: 2007-11-19
   Days after onset:18
Entered: 2007-12-06
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / UNK UN / -

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Pyrexia, Rash macular, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Big red hive on left cheek which was hot and to touch, then migrated to the ear 2 days later. Cheek was then blotchy with a red mark across the upper lip. Physical symptoms ceased on 11-19-07. Later ran a fever for 6 days on and off.


VAERS ID: 298948 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-11-12
Onset:2007-11-25
   Days after vaccination:13
Submitted: 2007-11-28
   Days after onset:3
Entered: 2007-12-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2476HAAR / UNK LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: 13 days after the flu vaccine, patient developed Bell Palsy right side of face. Patient recovered p.o. steroid. 12/18/07 Reviewed ER medical records which reveal patient experienced acute onset right sided facial droop, unable to close right eye or furow forehead. Tx w/steroids & antiviral meds & to tape eye at night. PMH: seasonal allergies FINAL DX: Bell''s palsy.


VAERS ID: 299006 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New York  
Vaccinated:2007-09-13
Onset:2007-09-13
   Days after vaccination:0
Submitted: 2007-12-03
   Days after onset:81
Entered: 2007-12-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAV06AB / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1104U / 2 RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Anaphylactic reaction, Eye swelling, Pruritus, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Resolved with Prednisone and oral meds
Current Illness: None
Preexisting Conditions: Asthma, eczema
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Anaphylactic reaction. -wheezing -swelling of eyes -Body itch (-) rash


VAERS ID: 299044 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2007-12-06
Onset:2007-12-06
   Days after vaccination:0
Submitted: 2007-12-07
   Days after onset:1
Entered: 2007-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 5004908 / 1 NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unknown~ ()~NULL~~In Patient|unknown~ ()~NULL~~In Sibling1|unknown~ ()~NULL~~In Sibling2
Other Medications: Ibuprofen syrup 2 tsp., Zyrtec 7.5 ml.
Current Illness: None
Preexisting Conditions: Seasonal allergies, history of hives
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had Intranasal Flu vaccine at around 2:00 p.m. and went back to school, after receiving 2 tsp. Ibuprofen syrup. Mother brought him back about 4 p.m. saying he got off the bus itching and with hives on neck, chest, abdomen, back, no difficulty breathing. We gave him Zyrtec 7.5 ml. and kept him about 40 minutes. He developed no further symptoms but remained with hives. Sent him home with Benadryl chewable tablets to take at bedtime for hives. Called mother this morning, she said he was fine, hives were gone by time they got home yesterday.


VAERS ID: 299187 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New Hampshire  
Vaccinated:2007-12-07
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2524AA / 5 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1559U / 3 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metamucil, MVI, Albuterol PRN
Current Illness: Well
Preexisting Conditions: Stable asthma
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: NH0746

Write-up: Inadvertently administered three doses of varicella (2/14/03) (12/01/06). No known s/sx.


VAERS ID: 299332 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2007-12-10
Onset:2007-12-10
   Days after vaccination:0
Submitted: 2007-12-11
   Days after onset:1
Entered: 2007-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2502AA / 1 - / -

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

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

Write-up: Rash and itchiness within one hour after administration of influenza vaccine. Patient given Benadryl 25 mg by mouth per mother.


VAERS ID: 299338 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-11-26
Onset:2007-11-27
   Days after vaccination:1
Submitted: 2007-11-28
   Days after onset:1
Entered: 2007-12-11
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB213AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1495U / 2 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Cough, Erythema, Headache, Pyrexia, Skin warm, Streptococcus identification test negative, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol Jr and Benadryl
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC - WBC 13.6; Strep test neg
CDC Split Type: NC07121

Write-up: Rt arm (on back of arm) redness 4x5 cm and warm. Fever 101.7. H/A, cough. Tx: Augmentin, Xopenex.


VAERS ID: 299427 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New York  
Vaccinated:2007-11-19
Onset:2007-11-20
   Days after vaccination:1
Submitted: 2007-12-06
   Days after onset:16
Entered: 2007-12-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1354U / 2 LA / SC

Administered by: Private       Purchased by: Unknown
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0.00~In Patient|None~ ()~~0.00~In Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 11/20/07 mom called office to inform Dr. pt. had 4 1/2 x 4 1/2cm erythematosis, swollen, warm area. Benadryl/warm compresses recommended. On 11/21 pt. in to office with 11x11cm rash & erythemic area. Tx with Omnicef 250mg po BID. On 12/3/07 pt. in for follow up- resolved.


VAERS ID: 300458 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-11-12
Onset:2007-11-13
   Days after vaccination:1
Submitted: 2007-12-19
   Days after onset:36
Entered: 2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42526AA / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram normal, Electrocardiogram, Electroencephalogram, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Questionable syncopal episode.


VAERS ID: 300820 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Oregon  
Vaccinated:2007-12-11
Onset:2007-12-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2007-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 0741F / 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1509U / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site swelling, Pyrexia, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Received immunizations Varivax & Hep A #2 in L delt. Following a.m. had fever & arm swelling with redness L injection site. Symptoms stable until 24 hrs after injection, developed lip tingling & throat tightness with pain & arm. This occurred after a nap. He was given Benadryl & presented to office with resolution of symptoms. Exam was normal except for erythema around injection. Some residual h/a. Was prescribed Albuterol inhaler although no wheeze on exam. Completely resolved 12/17/07.


VAERS ID: 301001 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-12-18
Onset:2007-12-21
   Days after vaccination:3
Submitted: 2007-12-21
   Days after onset:0
Entered: 2007-12-26
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0005U / 1 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0169 / 4 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0869U / 2 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1958DA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1119U / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cellulitis, Erythema, Injection site erythema, Injection site induration, Injection site mass, Oedema peripheral
SMQs:, Cardiac failure (broad), 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)

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

Write-up: Client''s aunt discovered swollen red arm this morning before bathing child. Egg shaped lump at site of Td, L arm vaccination. Red and firm upon palpation observed by RN at TST skin test reading. Ice applied and client referred to urgent care to treat or r/o cellulitis.


VAERS ID: 301663 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-07-19
Onset:2007-07-19
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:155
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0163U / 1 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0707USA03631

Write-up: Information has been received from a nurse concerning a 7-year-old patient (gender unknown), who on 19-JUL-2007 was vaccinated with Zostavax. The patient was vaccinated due to human error. It was reported that the patient had no symptoms. At the time of the report, the patient''s outcome was unknown. No product quality complaint was involved. Follow-up information received from the registered nurse (R.N.) indicates that the patient is a healthy male with no pre-existing allergies, birth defects or medical conditions who was vaccinated in the right arm with a first subcutaneous dose of Zostavax (lot# 656607/0163U) instead of a dose of Varivax at 11:47 AM. (It was previously reported that he was to receive a dose of Gardasil, which was reported in error). There was no illness at the time of vaccination. There were no concomitant medications given. On 20-Jul-2007, the doctor notified the mother of the error in immunization. The mother reported that the child had no fever or rash. On 26-Jul-2007, the patient came in for a follow-up clinic visit and it was noted that there was no reaction to the Zostavax. There were no laboratory or diagnostic tests performed. It is reported that the patient has never had an adverse event following prior vaccinations. Additional information is not expected.


VAERS ID: 302099 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Indiana  
Vaccinated:2007-09-20
Onset:2007-09-20
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:92
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0462U / UNK LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Wrong vaccine administered~Zoster (Zostavax)~~10.00~In Sibling
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA01697

Write-up: Information has been received from a physician and a medical assistant concerning a 7 year old female who on 20-SEP-2007 was vaccinated subcutaneously in her left arm with a dose of Zostavax (Oka/Merck) (Lot #657559/0462U) instead of Varivax (Oka/Merck). The medical assistant confirmed this was staff error. No product quality complaint was involved. In follow-up, the medical assistant reported the patient did have any side effects from receiving Zostavax (Oka/Merck) and she will not be vaccinated again with Varivax (Oka/Merck). It was also reported that the patient''s brother received a dose of Zostavax (Oka/Merck) (WAES# 0709USA03490) instead of Varivax (Oka/Merck). Additional information is not expected. This is in follow-up to report(s) previously submitted on 12/21/2007. Information has been received from a physician and a medical assistant concerning a 7 year old female who on 20-SEP-2007 was vaccinated subcutaneously in her left arm with a dose of ZOSTAVAX (Lot #657559/0462U) instead of VARIVAX. The medical assistant confirmed this was staff error. No product quality complaint was involved. In follow-up, the medical assistant reported the patient did not have any side effects from receiving ZOSTAVAX and she will not be vaccinated again with VARIVAX. It was also reported that the patient''s brother received a dose of ZOSTAVAX (WAES# 0709USA0349U) instead of VARIVAX. Follow-up information received by the medical assistant providing patient demographics. The patient experienced erythema, induarartion, warmth, and pain at the injection site. The site was greater than 4 inches in diameter. The patient recovered on an unknown date. Additional information is not expected.


VAERS ID: 301762 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2008-01-04
Onset:2008-01-05
   Days after vaccination:1
Submitted: 2008-01-05
   Days after onset:0
Entered: 2008-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 LA / ID

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Injection site erythema, Injection site urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

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

Write-up: Within 12 hours after flu vaccine given my daughter started to vomit and complain of a severe headache. She is still having these symptoms 18 hours later. She has a huge welt and redness where the shot was given on her arm also.


VAERS ID: 301800 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2007-12-03
Onset:2007-12-24
   Days after vaccination:21
Submitted: 2008-01-07
   Days after onset:14
Entered: 2008-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1272U / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood creatine phosphokinase normal, Blood creatinine normal, Blood gases abnormal, Blood glucose increased, Blood potassium increased, Blood sodium decreased, Blood urea normal, Carbon dioxide abnormal, Diabetic ketoacidosis, Fatigue, Polydipsia, Polyuria
SMQs:, Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma in the past
Allergies:
Diagnostic Lab Data: Na 129, K 6.1, CO2 15, BUN 12, Cr 0.5, Gluc 609, VBG pH 7.25 pCO2 46, pO2 38 1/17/08-records received- Glucose 609. Urine positive for ketones, glucose and protein. Sodium 129, potassium 6.06.
CDC Split Type:

Write-up: Patient presented on 12/24/2007 with fatigue, polyuria and polydypsia for 3-4 days. Blood glucose was found to be elevated at 474 mg/dL. He was referred and admitted to Hospital with a diagnosis of new onset diabetic ketoacidosis. He was treated with IV fluid resuscitation and insulin, and he was discharged on 12/27/2007. 1/17/08-records received for DOS 12/24-12/27/07-DC DX: Diabetes. Presented to ED with 5 day history of polydipsia and polyuria and fatigue. Ten pound weight loss.Mild diabetic ketoacidosis.


VAERS ID: 302031 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Arizona  
Vaccinated:2008-01-03
Onset:2008-01-03
   Days after vaccination:0
Submitted: 2008-01-04
   Days after onset:1
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0412U / 1 UN / SC
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0964U / 1 RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Swelling
SMQs:, Cardiac failure (broad), 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)

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

Write-up: Benadryl q 4 hr x 48 hr. Swelling, redness, painful to Rt bicep measurements 5" long 3" wide 7" circ. Reaction to PPV23.


VAERS ID: 302571 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-10-10
Onset:2007-10-14
   Days after vaccination:4
Submitted: 2008-01-04
   Days after onset:82
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0302U / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA03075

Write-up: Information has been received from a physician concerning his 7 year old daughter who on 10-Oct-2007, was vaccinated with PROQUAD (lot #657186/0302U). Concomitant vaccination included PREVNAR (batch 3 B26510D. On 14-Oct-2007, developed a rash all over, low grade fever, and was cranky. It was reported that the vaccinating pediatrician was aware and the patient recovered. A product quality complaint was not reported. Further information was not available. Additional information has been requested.


VAERS ID: 302330 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2001-01-30
Onset:2007-08-02
   Days after vaccination:2375
Submitted: 2008-01-07
   Days after onset:158
Entered: 2008-01-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1093L / 2 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Varicella
SMQs:

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

Write-up: Varicella despite vaccination 1/30/01, 2/13/07.


VAERS ID: 302341 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2008-01-09
Onset:2008-01-10
   Days after vaccination:1
Submitted: 2008-01-10
   Days after onset:0
Entered: 2008-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1495U / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~1~1.00~In Sibling
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt received Varivax 1/10/08. Woke up with swollen red area around injection site 4cm x 4.5 cm.


VAERS ID: 302485 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-12-20
Onset:2007-12-21
   Days after vaccination:1
Submitted: 2008-01-07
   Days after onset:17
Entered: 2008-01-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500489P / 2 NS / IN

Administered by: Private       Purchased by: Unknown
Symptoms: Bronchospasm, Cough
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)

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

Write-up: Bronchospastic cough that persisted for 2 weeks, worse at night. No other symptoms - gave 5 day course of 1mg/kg steroid.


VAERS ID: 302605 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:2008-01-08
Onset:2008-01-11
   Days after vaccination:3
Submitted: 2008-01-14
   Days after onset:3
Entered: 2008-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1217F / 1 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1923HA / 4 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Eye swelling, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 01-11-2008 pm developed fever (low grade most of time except on 01-13-2008 temp. went to 102), complaint of being itchy since 01-11-2008 (no rash), Right eye swollen. Has a bad cough. Has not sought medical treatment.


VAERS ID: 302791 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-09
Entered: 2008-01-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1363U / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: No adverse reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: 4-6 hours after immunization
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events


VAERS ID: 302792 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2008-01-02
Onset:2008-01-02
   Days after vaccination:0
Submitted: 2008-01-02
   Days after onset:0
Entered: 2008-01-15
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB211AA / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1508U / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain, Cough, Flushing, Rash macular, Sneezing, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: flouride varnish applied today
Current Illness:
Preexisting Conditions: Has been on medicines for ADHD, not currently taking
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10-15 minutes after giving vaccines child started to sneeze numerous times, began coughing c/o with throat itching began crying c/o with throat, Benadryl 25 mg liquid given by mouth, skin Blotchy c/o with intermittent abd pain, 30 mins after po Benadryl no coughing or throat itching, skin very flushed advised Dr, advised foster mom to continue with po Benadryl every 4 hours and seek ER if symptoms worsened.


VAERS ID: 302839 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2008-01-14
Onset:2008-01-14
   Days after vaccination:0
Submitted: 2008-01-16
   Days after onset:2
Entered: 2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1759U / 2 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blister, Blood culture, Erythema, Eschar, Full blood count, Induration, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: PMH- Complex including Trisomy 21, Tetralogy of Fallot status post surgical repair, myopia, for which she wears eyeglasses, idiopathic arthritis, and mild intermittent asthma
Allergies:
Diagnostic Lab Data: CBC and blood cx done
CDC Split Type:

Write-up: 3.5 cm x 6 cm area of induration, erythema and warmth w/ numerous clustered vesicles and sm. eschar formation.


VAERS ID: 302980 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Iowa  
Vaccinated:2008-01-15
Onset:2008-01-16
   Days after vaccination:1
Submitted: 2008-01-17
   Days after onset:1
Entered: 2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0442U / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0148F / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH UK244461 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503U / 1 - / -

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

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

Write-up: Mother called to report patient has rash on trunk, arms, complained of itching last evening 1/16/08. Took OTC Benadryl last evening. 1/17/08, still has rash but no itching. Also medicated with Tylenol. Did have residual cough from cold but needed immunizations in order to get into school.


VAERS ID: 303043 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-12-12
Onset:2008-01-10
   Days after vaccination:29
Submitted: 2008-01-11
   Days after onset:1
Entered: 2008-01-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1341U / UNK LA / UN

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

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

Write-up: Received Varivax #1) 1/26/01 #2) 12/12/07 Onset Varicella vesicles-entire body-itchy-afebrile Tx: supportive ie Aveeno baths. Anti-itch topical Benadryl oral prn.


VAERS ID: 303207 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Ohio  
Vaccinated:2008-01-09
Onset:2008-01-10
   Days after vaccination:1
Submitted: 2008-01-22
   Days after onset:12
Entered: 2008-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1494U / 2 RA / SC

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

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

Write-up: Local reaction to varicella vaccine; right posterior arm had a silver dollar sized area of redness at injection site; no pain; afebrile; was seen at PCP on 01/12/08 (3 days after vaccination)-- doctor suggested cool compresses and to watch for infection.


VAERS ID: 303501 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Washington  
Vaccinated:2008-01-22
Onset:2008-01-23
   Days after vaccination:1
Submitted: 2008-01-24
   Days after onset:1
Entered: 2008-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2509AA / UNK - / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB214AA / UNK - / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z1069 / UNK - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1514U / UNK - / SC

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

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

Write-up: Site swelling and redness to the Upper Left Arm (back of arm). Ibuprofen was given to child by his parent along with using cool compresses to injection site. The injection was given at 10:45am.


VAERS ID: 303502 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Washington  
Vaccinated:2008-01-24
Onset:2008-01-24
   Days after vaccination:0
Submitted: 2008-01-24
   Days after onset:0
Entered: 2008-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80822 / 2 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

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

Write-up: Received 2nd flu vaccine dose when already received on 11/01/07. No reaction noted.


VAERS ID: 303652 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:2008-01-17
Onset:2008-01-17
   Days after vaccination:0
Submitted: 2008-01-17
   Days after onset:0
Entered: 2008-01-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1761U / UNK LL / UN

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

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

Write-up: Itching of the hands. Sent to ER.


VAERS ID: 303873 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-11-21
Onset:2008-01-16
   Days after vaccination:56
Submitted: 2008-01-21
   Days after onset:5
Entered: 2008-01-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2527AA / 2 LA / UN

Administered by: Public       Purchased by: Public
Symptoms: Cough, Influenza, Influenza serology positive, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu~Influenza (Seasonal) (no brand name)~4~2.00~In Sibling|flu~Influenza (Seasonal) (no brand name)~2~9.00~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: NP swab for influenza Ag
CDC Split Type:

Write-up: Influenza symptoms (cough, fever) with positive nasopharyngeal test for influenza despite influenza vaccine (inadequate total # of immunizations).


VAERS ID: 303957 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Florida  
Vaccinated:2008-01-03
Onset:2008-01-05
   Days after vaccination:2
Submitted: 2008-01-30
   Days after onset:25
Entered: 2008-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS ATTAVB218BA / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abnormal EEG reading 2 days after.
CDC Split Type:

Write-up: 60 hours after 2nd Hep A vaccine patient had a severe grand mal seizure lasting about 3-4 minutes. No fever, SHe did vomit. Happened about 20 minutes after falling asleep. Rushed to Hospital 911


VAERS ID: 303962 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Washington  
Vaccinated:2008-01-28
Onset:2008-01-29
   Days after vaccination:1
Submitted: 2008-01-30
   Days after onset:1
Entered: 2008-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80956 / 2 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1764U / 2 RL / SC

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

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

Write-up: Pt came home from school on 1/29 c/o pain @ injection site. Pt had swelling, 1" long by 1/2" wide.


VAERS ID: 304023 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2008-01-26
Onset:2008-01-27
   Days after vaccination:1
Submitted: 2008-01-31
   Days after onset:4
Entered: 2008-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1763U / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Cough, Fatigue, Full blood count normal, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC drawn 3 days after vaccine was normal (normal WBC, normal cell counts).
CDC Split Type:

Write-up: Fever of 102 degrees F started 24 hours after administration and continued for 4 days after administration. There was also associated anorexia and fatigue. 48 hours after administration, patient developed a cough that was productive. Examination of pt revealed pyrexia and fatigue but no ENT or Lung abnormalities.


VAERS ID: 304273 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Florida  
Vaccinated:2008-02-01
Onset:2008-02-01
   Days after vaccination:0
Submitted: 2008-02-04
   Days after onset:3
Entered: 2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. MSD1663 / 2 RA / SC

Administered by: Unknown       Purchased by: Military
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)

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

Write-up: CLUSTER OF BLISTERS, NON TENDER, NON ERYTHEMATOUS, NON CELLULITIS FROM RUE.


VAERS ID: 304381 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2008-01-16
Onset:2008-01-17
   Days after vaccination:1
Submitted: 2008-02-01
   Days after onset:15
Entered: 2008-02-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1565U / UNK LA / UN

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

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

Write-up: Within 24 hours positive erythema from insertion down to elbow - warm to touch, hardened area 2cm x 2cm. Lasted 3 days.


VAERS ID: 304399 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Maryland  
Vaccinated:2007-11-03
Onset:2008-01-23
   Days after vaccination:81
Submitted: 2008-02-01
   Days after onset:9
Entered: 2008-02-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2457HA / 7+ LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Influenza, Influenza serology positive, Lacrimation increased, Pharyngolaryngeal pain, Pyrexia, Respiratory tract congestion, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Lacrimal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: The patient had no illnesses at the time of vaccination on 03 November 2007.
Preexisting Conditions: He did however, have a past medical history of allergies and asthma.
Allergies:
Diagnostic Lab Data: 23/Jan/2008: Quick Vue flu test was positive for type A and B influenza.
CDC Split Type: 200800247

Write-up: SERIOUSNESS CRITERIA: OTHER - MEDICALLY SIGNIFICANT. Initial report received on 23 January 2008 from a health care professional. A 7-year-old male patient, with no concurrent illnesses, and a history of allergies (allergies not defined) and asthma, had received a ninth, intramuscular, left arm dose of FLUZONE No Preservative 2007-2008 (lot number U2457HA) on 03 November 2007. Eighty-one days after receiving the Fluzone vaccine, the patient developed a fever of 100.7 degrees Fahrenheit, watery eyes, congestion, cough, and sore throat. A Quick Vue flu test positive for type A and B influenzae. The patient was prescribed Tamiflu as treatment. At the time of this report, the patient had not recovered.


VAERS ID: 304436 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:2008-02-04
Onset:2008-02-04
   Days after vaccination:0
Submitted: 2008-02-06
   Days after onset:2
Entered: 2008-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Body temperature increased, Cellulitis, Injection site infection, Injection site irritation, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Skin tightness
SMQs:, Neuroleptic malignant 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient|NONE~ ()~~0.00~Sibling|NONE~ ()~~0.00~Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: THERE WAS NOT ANY BLOOD TAKEN OR ANY LABS RUN. THE DR. LOOKED AT THE SIGHT AND DIAGNOSED IT AS "CELLULITIS IN CHILDREN"
CDC Split Type:

Write-up: On 02/04/08 my daughter and I arrived at the Health Dept. arrival time around 11am, patient was given a 2nd dose of the Varicella shot in her right arm, due to the mandatory law in the county, to attend her new school. Patient went home and she began to complain around 8pm that night 02/04/2008 about burning and itching and it was a little swollen. Early the next morning 02/05/08 at 6am I woke patient up and her arm was 2x times bigger than the previous night. She was in pain and the site was hot to the touch, and very swollen, I called the health Dept at that time, but the center wasn''t open yet. I took patient on to school for her first day at her new school, as we sat and waited in the school, at 8am, patient kept complaining about the tightness of her skin and the pain, I took patient to class, and told her to call me if the shot sight had gotten any bigger, and if the pain got worse. By 12pm in the afternoon the school nurse called me in a panic, saying that patient needed to be picked up, and taken to the Dr., because the shot sight didnt look good, and it was too swollen, and has gotten bigger. The nurse measured the sight (I think it was 4 inches wide at the time) and put and ice pack on the sight to control the heat and swelling. I called the health dept around 12:30pm, to explain what was happening to my daughter. The female who answered the phone, I told her what happen, and she said oh Lord, let me transfer you. The line kept ringing and the wasn''t any answer at that extension. So I took patient to the nearest ER. Patient was seen by the nurse first, and she was astonished at patient arm. She gave patient a wet towel to compress on the sight for the swelling and heat. At the time 4:30pm patient temp was 100.7 and patient was in horrible pain, the Dr. came in around 5pm and told alot at the sight, he said it wasn''t and allergic reaction, the sight was truly infected, due to the heat and huge swelling of the sight. At that time the Dr. order her to receive one shot of antibiotics in both of her legs the legs. Then she was observed for 20 mins. to make sure she was not allergic, and prescribed and oral dose of Augmentin 1tsp. 2x daily until gone, and ibuprofen for pain. We were release at 6:15pm on 02/5/08, patient was arm was still hot tight huge and swollen. I kept ice packs on it all night. Early 02-6-08 at 6am, patient was woken for school and her arm was smaller than the day before, but still hot and big, she wasn''t able to go to school do to the pain, in her right arm.... her writing hand... still today 2/67/08 she is still trying to recover... I would like for report to be taken serious, and the batch of the varicella shot that my daughter was given to be investigated, and the lady who gave the shot question and investigated, and any reports of shot complaints of the same source investigated...


VAERS ID: 304721 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2008-02-07
Onset:2008-02-08
   Days after vaccination:1
Submitted: 2008-02-11
   Days after onset:3
Entered: 2008-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Oedema peripheral, Pruritus, 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)

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

Write-up: Large swollen, hot arm, itchy, no signs of hypotonic. Seen 2-9-08 by doctor.


VAERS ID: 304842 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Arizona  
Vaccinated:2008-02-11
Onset:2008-02-12
   Days after vaccination:1
Submitted: 2008-02-13
   Days after onset:1
Entered: 2008-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 3 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS ACS2B021BA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 15914 / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site vesicles, Injection site warmth, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CETIRIZINE HCL, ROBITUSSIN DM
Current Illness: SORE THROAT, NO FEVER
Preexisting Conditions: ALLERGIC RHINITIS
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Left arm is red, raised, and warm at injection sites. One site has 2 small blisters at injection site.


VAERS ID: 304928 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2008-02-05
Onset:2008-02-07
   Days after vaccination:2
Submitted: 2008-02-07
   Days after onset:0
Entered: 2008-02-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB225AA / 1 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1654U / 2 UN / IM

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)

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

Write-up: 8x6 cm erythema, swelling, itching (L) deltoid- Inflammatory response? Allergic? R/O early Infections.


VAERS ID: 305084 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Oregon  
Vaccinated:2008-02-12
Onset:2008-02-14
   Days after vaccination:2
Submitted: 2008-02-18
   Days after onset:4
Entered: 2008-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1518U / 2 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Received immunization and had a 5 inch diameter red, warm, hard lump; no fever.


VAERS ID: 305202 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2008-02-11
Onset:2008-02-11
   Days after vaccination:0
Submitted: 2008-02-19
   Days after onset:8
Entered: 2008-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1578U / UNK LA / UN

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

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

Write-up: Hand swelling, rash (whole body), fever, itching. Tx: Benadryl, Solumedrol.


VAERS ID: 305244 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:2008-02-18
Onset:2008-02-18
   Days after vaccination:0
Submitted: 2008-02-20
   Days after onset:2
Entered: 2008-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1355U / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red, warm cellulitis 6X6 inches. Symptoms started by the time patient got home from the office.


VAERS ID: 305395 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2007-12-21
Onset:2007-12-21
   Days after vaccination:0
Submitted: 2008-01-20
   Days after onset:30
Entered: 2008-02-21
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2514AA / 6 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1343U / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives~Measles + Mumps + Rubella (MMR I)~5~4.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Reactive Airway Disease
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Wheezing and redness of face shortly after vaccines given. Treatment - Epi-Pen, Benadryl, Prednisone.


VAERS ID: 305417 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: New York  
Vaccinated:2008-02-13
Onset:2008-02-13
   Days after vaccination:0
Submitted: 2008-02-14
   Days after onset:1
Entered: 2008-02-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0604F / 2 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Local reaction~DTP (no brand name)~5~5.00~In Patient
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Facial swelling, sneezing, generalized urticaria within 5 minutes of Varivax #2. Resolved by 24 hours later.


VAERS ID: 305775 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2008-02-18
Onset:2008-02-18
   Days after vaccination:0
Submitted: 2008-02-21
   Days after onset:3
Entered: 2008-02-26
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 79241 / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0601F / UNK LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Body temperature increased, Chest X-ray normal, Induration, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 10 mg daily; Pulmicort 2 puffs daily
Current Illness: pneumonia 2wks prior
Preexisting Conditions: asthma, allergy- PCN, iodine (shellfish)
Allergies:
Diagnostic Lab Data: 2/20/08 Essentially negative chest
CDC Split Type:

Write-up: Had pneumonia 2 wks prior. Had Pneumovax on 2/18/08. That evening developed fever, arm was hard and swollen. This continued and came to ER on 2/20-temp reported 102.


VAERS ID: 305801 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Ohio  
Vaccinated:2008-02-18
Onset:2008-02-19
   Days after vaccination:1
Submitted: 2008-02-20
   Days after onset:1
Entered: 2008-02-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1781U / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Amoxicillin Allergy; Febrile Seizures 6/05
Allergies:
Diagnostic Lab Data: Watch Closely "site measures" - see above
CDC Split Type:

Write-up: area #redness 5x6 1/2cm; center dark red 2x3cm; early cellulitis - Advised Benadryl/Dad call with update in 24hrs


VAERS ID: 305803 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-02-20
Entered: 2008-02-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB249AA / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1096U / 2 RL / SC

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

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

Write-up: 4x5 cm erythematous patch at site of Varicella vaccine #2.


VAERS ID: 305870 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Missouri  
Vaccinated:2007-02-26
Onset:2007-02-26
   Days after vaccination:0
Submitted: 2008-02-27
   Days after onset:366
Entered: 2008-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0570U / 3 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB181AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Contusion, Fall, Head injury, Pallor, Scratch
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: 02/26/08 Administered Hep. A and Hep. B Child then went to front lobby to wait for his brother to get his immunizations and office staff paged for nurses to come to the front lobby. Upon staff''s arrival chlid laying on floor on his stomach. Another client setting in lobby stated this boy was setting in chair and slid out hitting his head on the floor. Rolled client over he was pale, alert and responding to questions by nodding his head. Gave client a sucker and a bottle of orange pop and cool cloth to head. He then began feeling much better talking, setting up and alert. Mother at childs side, assuring child that he was o.k. and that he must have gotten that fear of shots from her because she had done the same thing her self before. 2/27/08 Called child parent to check on child, mother stated child had a bruise a small scratch to underneath side of rt. eye and is feeling o.k. and denies any further problems.


VAERS ID: 305896 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Maryland  
Vaccinated:2008-02-05
Onset:2008-02-05
   Days after vaccination:0
Submitted: 2008-02-25
   Days after onset:20
Entered: 2008-02-27
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1177U / 2 LL / SC

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

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

Write-up: Severe local reaction about 3" Per mom "baseball size welt," was painful 2/6/08 and on 2/8/08 "itchy"


VAERS ID: 306047 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2008-02-12
Onset:2008-02-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2008-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB242AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1652U / 2 RA / SC

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

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

Write-up: Swelling on the injection site, very tender and red size 4x3 1/2 inch rt arm.


VAERS ID: 306270 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2008-02-27
Onset:2008-02-28
   Days after vaccination:1
Submitted: 2008-03-03
   Days after onset:4
Entered: 2008-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354BA / 3 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80959 / 3 RA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0614R / 4 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z1069 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Father denied allergies at time of vaccine admin, but school nurse says father told her child is allergic to peanuts.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: School nurse called 2 days after shots given to report father taking child to doctor due to covered with hives. Hives first noticed the day after the vaccines were given. Unable to contact father by phone due to incorrect number on our records.


VAERS ID: 306419 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2008-02-26
Onset:2008-02-27
   Days after vaccination:1
Submitted: 2008-02-28
   Days after onset:1
Entered: 2008-03-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0797U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1462U / 2 LA / SC

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

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

Write-up: Area around injection site developed 16x20cm area of erythema and induration. Benadryl and Tylenol, cool compress.


VAERS ID: 306617 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Maryland  
Vaccinated:2008-01-17
Onset:2008-01-17
   Days after vaccination:0
Submitted: 2008-02-29
   Days after onset:43
Entered: 2008-03-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1771U / UNK LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Eye swelling, Swelling face, Swollen tongue, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1020 Mother called from car, just received varicella - throat itching. See attached.


VAERS ID: 306676 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Hawaii  
Vaccinated:2007-11-19
Onset:2008-02-20
   Days after vaccination:93
Submitted: 2008-03-07
   Days after onset:16
Entered: 2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2490AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Blood product transfusion, Hemiparesis, Myelitis transverse, Nuclear magnetic resonance imaging abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: asthma PMH: reactive airway disease
Allergies:
Diagnostic Lab Data: MRI changes in spinal cord from C4 to T 11. Elevated protein, pleocytosis in lumbar puncture. No organisms identified. LABS: CT of spinal cord WNL. MRI of brain & spine abnormal w/swelling secondary to central lesion from C4-T11 c/w transverse myelitis. LP done. CSF: RBC 44, WBC 128, segs 11, lymphs 72, monos 16, eos 1, glucose 62, protein 82 (H). Repeat MRI revealed almost complete resolution. Blood & csf cultures neg. H/H 10.8/31.5 (L) WBC 13.5, plts 380K, neutros 62% (H), lymphs 28 (L), monos 7 & eos 1. Sodium 135. ALT 8. Sed rate 19 (H).
CDC Split Type:

Write-up: Transverse myelitis with hemiparesis truncal weakness, MRI changes in spinal cord from C4 to T 11 Onset of transverse myelitis 2/20/2008 Vaccine given 11/19/2007 IVIG, Steroids given for transverse myelitis given during hospitalization at Hospital. Patient now in Rehab hospital. 3/11/08 Reviewed D/C summary from hospital for 2/23-3/07/2008 admission. FINAL DX: Transverse myelitis. Patient experienced progressive ascending paralysis x 2 days, back pain, balance difficulty w/falls & fever. On admission, was unable to walk, had to crawl. Patient transferred from outlying ER to PICU. Neuro consult done. Tx w/IVIG x 4, IV steroids & pain meds. Transferred to ped floor, improved to be able to walk w/walker & d/c to inpatient rehab on tapering steroids. 3/11/08 Received additional hospital med records which reveal patient also experienced right foot pain & weakness which quickly progressed to paraplegia w/urinary incontinence, areflexia & absence of pain sensation. Optho exam WNL.


VAERS ID: 306797 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2008-03-05
Onset:2008-03-06
   Days after vaccination:1
Submitted: 2008-03-06
   Days after onset:0
Entered: 2008-03-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1663U / 2 LA / SC

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

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

Write-up: Left deltoid 4x2cm erythematous reaction.


VAERS ID: 306875 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2008-03-05
Onset:2008-03-05
   Days after vaccination:0
Submitted: 2008-03-11
   Days after onset:5
Entered: 2008-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0645LS / 2 RA / IM

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

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

Write-up: 6 HOURS AFTER THE VACCINE WAS GIVEN PT GOT REDNESS, PRURITUS, AND SWELLING OF INJECTED RIGHT DELTOID AREA.


VAERS ID: 306950 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2008-03-12
Onset:0000-00-00
Submitted: 2008-03-12
Entered: 2008-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AO127 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 9104510 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1786U / 3 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

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

Write-up: none


VAERS ID: 307110 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:2008-03-14
Onset:2008-03-14
   Days after vaccination:0
Submitted: 2008-03-14
   Days after onset:0
Entered: 2008-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB448AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 3 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1364U / 2 LA / SC

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

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

Write-up: A 7 year old child was inadvertently given an adult Hep B dose. Vital sign remain stable after the injection.


VAERS ID: 307147 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Arizona  
Vaccinated:2008-01-21
Onset:2008-01-21
   Days after vaccination:0
Submitted: 2008-03-15
   Days after onset:53
Entered: 2008-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 15626 / 4 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Body temperature increased, Bronchitis, Convulsion, Dyskinesia, Eosinophil count normal, Feeling hot, Haematocrit normal, Lymphocyte count increased, Malaise, Mean platelet volume decreased, Muscle twitching, Neck pain, Nervous system disorder, Neutrophil percentage decreased, Platelet count increased, Pyrexia, Red cell distribution width decreased, Speech disorder, Staring, Streptococcus identification test positive, Tic, Vomiting, White blood cell count
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~Varicella (Varivax)~2~8.10~Patient|no~ ()~~0.00~Sibling|no~ ()~~0.00~Sibling
Other Medications: None at the time of the shot.
Current Illness: None he did have fever of 100.1
Preexisting Conditions: Allergies but they went away after we had his tonsils removed 3-6-06
Allergies:
Diagnostic Lab Data: ASO was 276 H, WBC 7.5 HCT 38.6 L RDW 10.9 L, PLT 737 H, MPV 6.8 L, SEGS 40 L, LYMPHS 51 H, EOSINS 4 H, I don''t understand the rest of this report. I do have all his medical records.
CDC Split Type:

Write-up: Patient went in for a well-check on 1-21-08, we did not know he had a Temp of 100.1 at the time of the Varicella shot. Facility said his temp was normal. We got the records from the office and that is when we saw he had temp of 100.1. After he got the shot we left and went to get a pair of shoes. He said he did not feel good and did not want to get a movie. So we came home that was around 3:30 he went to his room and laid down. I asked him if he wanted to watch a movie and he said no. He fell asleep and I checked on him he felt warm. I got him up to take his temperature and he threw up and he had a temp of 102.3 so I gave him Tylenol and he fell back to sleep. I checked on him at 8:30 he was burning up his temp was 104.8 I called the ER and she told me to put him in a tepid bath and give him Tylenol and Motrin alternate every 4 hours. I got his Temp down to 102 and it stated at 102 and 101.6 I could not get a an appointment with Dr. he was booked so I took him to the ER on 1-24-08 Dr. saw him, I told her that he had a chickenpox Vaccine on the 1-21-08 she was not concerned about that she said he had Acute Bronchitis. She gave him a Z-Pack 200mg. We gave him the pills crushed up in applesauce. He seemed ok for a few days and then he started jerking his head and he had neck pain. On 2-7-08 he got up around 7:30 and he was jerking out of his skin he could not talk to me and he was staring out into space. I ran him To The ER and Dr. could not find the reason for the Seizure he took a Video of patient, I don''t know what he did with it. I told him patient had a chickenpox shot on 1-21-08 he was concerned about that, and he ran all kinds of tests on him. He finally said patient needed to go to Hospital he was taken by ambulance, Dr. gave him a dose of penicillin before he left. It took 3 1/2 hours to get to hospital in another city when he got there the jerking and twitching had slowed down. The neurologist did no tests no EEG on patient. We were there 22 hours we did not see a Doctor until 8am 2-8-08 when he did come in he looked at patient and said he has a TIC. He gave him Topmaz 25mg and told us to go home and try to live with it. Patient has seen 3 neurologist he has been in 3 hospitals. We found a neurologist in another city he has put patient on Penicillin 250mg and Clonidine 0.1mg. Patient went into Dr. office a happy little boy on 1-21-08 he is now suffering and jerking all over his body he is having severe neurological problems. One 1-20-08 he made the HONOR ROLL at school, that is why he was going to get a new pair of SHOES.


VAERS ID: 307331 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Ohio  
Vaccinated:2008-03-12
Onset:2008-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2008-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1540U / 1 LL / UN

Administered by: Public       Purchased by: Other
Symptoms: Cyanosis, Dyspnoea, Hyperhidrosis, Hypersensitivity
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: PNEUMOVAX given at 10:35, within 60 seconds mom ran out of room stating he was having an allergic reaction to it. Patient found shortness of breath, cyanotic, diaphoretic. Epipen injection given by mom, followed by arapred and Benadryl. Pulse ox 86% - 02 started at 2 for 1 minute. AP 120 R-60. 911 called.


VAERS ID: 307754 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:2008-03-20
Onset:2008-03-20
   Days after vaccination:0
Submitted: 2008-03-21
   Days after onset:1
Entered: 2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1785U / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood pressure, Eye rolling, Muscle rigidity, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of vaccination.
Preexisting Conditions: No pre-existing physician-diagnosed medical condition, but family reported at the end of December pt. had fallen and knocked front teeth out---afterwards pt. had fainted.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came into walk-in child vaccination clinic. Approx. 10:58 am child sat down in chair--mother and uncle beside her. Mother and child--foreign speaking only--uncle was acting as translator. 11:00 am varicella vaccine administered in right arm SQ followed by Hep A vaccine in right deltoid. Pt. tolerated well--appeared to be happy with no SXS of pain, SOA -- child reported no pain at insertion site--no erythema at site seen by RN--covered with band-aid. 11:10am uncle carried patient back into immunization room--stated she had "fainted" in waiting area. Pt. sat down in chair--pt. appeared to be alert, but look extremely pale. Shortly after sat in chair---patient''s arms stiffened up towards chest--body appeared to be rigid and eyes rolled back in head (EMS called)--pt. was lowered onto floor (pt. in supine position)---episode lasted no longer than 20 seconds---ammonia smelling salt placed under nose--pt. able to state name, age and place. Ice pack placed on forehead as well as on abdomen. Vitals were as follows: 11:15 BP (lying down) 92/51 P 57 (EMS arrived) 11:18 BP (lying down) 90/54 P 68 Orthostatic BP started----11:20 BP (lying down) 90/54 P 84 11:23 BP (sitting) 97/63 P 77 11:24 BP (standing) 97/68 P 74. Pt. appeared to be stable. Pt reported no pain, dizziness, or SOA. Pt. alert and oriented--still pale. Asked family if they would like EMS to transport pt. to hospital nearby--declined. Informed pt.''s family if pt. should show any SXS of reaction or anything like previous episode to take pt. to physician or hospital--pt.''s family verbalized understanding.


VAERS ID: 307967 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: West Virginia  
Vaccinated:2007-08-21
Onset:0000-00-00
Submitted: 2008-01-16
Entered: 2008-03-24
   Days after submission:67
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 5 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0527 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0850U / 3 LL / UN

Administered by: Public       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WV0801

Write-up: Pt was inadvertently given DTaP instead of TD. No reaction was reported.


VAERS ID: 308103 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2001-06-26
Onset:2008-03-20
   Days after vaccination:2459
Submitted: 2008-03-21
   Days after onset:1
Entered: 2008-03-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480901 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0233 / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Blister, Convulsion, Dermatitis bullous, Rash papular
SMQs:, Severe cutaneous adverse reactions (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Small V.S.D. and patent foreman orale.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Varicella vaccine breakthrough. Diagnosed with Varicella in our office on 3-21-08. Had 40-50 lesions, papules and vesicles. Afebrile.


VAERS ID: 308137 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Rhode Island  
Vaccinated:2008-03-17
Onset:2008-03-19
   Days after vaccination:2
Submitted: 2008-03-25
   Days after onset:6
Entered: 2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: My son received his ChickenPox Vaccine (booster) on Monday, March 17, 2008 and on Wed., March 19, 2008 what appeared to be a rash broke out on the small of his back. The rash proceeded to get worse so we took him back in to see Dr. on Sat., March 22. Dr. diagnosed patient with Shingles and perscribed: Acyclovir 200mg (2 teaspoonsful 4 times a day) and Hydroxyzine 10 mg (1 teaspoonful every 8 hours as needed for itch). Today is Wednesday, March 25 and the "rash" is still getting worse. I was told by Dr. that it could take upto 3 weeks to see improvement.


VAERS ID: 308138 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: California  
Vaccinated:2008-02-27
Onset:2008-02-29
   Days after vaccination:2
Submitted: 2008-03-25
   Days after onset:24
Entered: 2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568U / 2 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Induration, Pruritus, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: RASH ON RT THIGH- ON 2/29/2008- CAME IN BECAUSE OF ITCHING. ON EXAM PT HAS A 7 CM X 8 CM ERYTHEMATOUS INDURATED AREA ON THE RT. ANTERIOR THIGH. CONSISTENT WITH REACTION TO VARICELLA. - LARGE VARICELLA VACCINE REACTION.- RECOMMEND BENADRYL AND MOTRIN. RTC IF ANY WORSENING.


VAERS ID: 308268 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:2008-03-24
Onset:2008-03-26
   Days after vaccination:2
Submitted: 2008-03-26
   Days after onset:0
Entered: 2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1804U / 2 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Impetigo, Induration, Local reaction, Skin lesion, Stomatitis, Tenderness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received VZV on 3-24-08 into the right upper arm during an office visit for irritation to the right angle of her mouth. Presented in the office 3-26-08 for a local reaction at the injection site. The site was tender, firm to touch, with an erythematous area approximately 12 x 6 cm. The child also presented, 3-26-08, with lesions to the right corner of her mouth, which was diagnosed as Impetigo. Cephalexin oral susp., 250mg/5mL, 2 teaspoons po BID for 10 days was prescribed along with cool compresses to right upper arm and Tylenol. Brother had a very similar VZV local reaction on 2-12-08. See VAERS report # E-21343.


VAERS ID: 308661 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Unknown  
Vaccinated:2007-11-19
Onset:2008-02-01
   Days after vaccination:74
Submitted: 2008-04-01
   Days after onset:59
Entered: 2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Road traffic accident
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA20080504

Write-up: We received on 12 FEB 2008 from a healthcare professional the following information: A 7-year-old male patient, born on 21 JUN 2000 was vaccinated with FLUVIRIN (batch no. unknown) on 19 NOV 2007. The patient was killed in an automobile traffic accident on 01 FEB 2008. The subject had participated in a clinical trial sponsored by MedImmune. FLUVIRIN was used in that trial as a control, and Novartis Vaccine & Diagnostics (NVD) has donated the FLUVIRIN, but other than that has not been involved. Although the event did not occur during the duration of the trial, and the investigator did not see any causal relationship to the vaccination with FLUVIRIN, he reported the event to the IRB and NVD because the child had died.


VAERS ID: 308940 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Virginia  
Vaccinated:2008-04-02
Onset:2008-04-02
   Days after vaccination:0
Submitted: 2008-04-04
   Days after onset:2
Entered: 2008-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 19180 / 2 RA / SC

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

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

Write-up: PERIORBITAL SWELLING (FAMILY HISTORY OF PERIORBITAL SWELLING WITH CERTAIN CERTAIN MEDICATIONS & PRESERVATIVES).


VAERS ID: 308952 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: California  
Vaccinated:2007-08-28
Onset:2008-04-05
   Days after vaccination:221
Submitted: 2008-04-05
   Days after onset:0
Entered: 2008-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1000U / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Varicella
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pulmicort, Xopenex
Current Illness: asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: First dose 2/23/01
CDC Split Type:

Write-up: Pt received varicella vaccine and booster and today presents with chicken pox rash (no fever) with $g50 lesions.


VAERS ID: 309142 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Michigan  
Vaccinated:2008-04-03
Onset:2008-04-03
   Days after vaccination:0
Submitted: 2008-04-13
   Days after onset:10
Entered: 2008-04-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS B256BA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1789U / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient had pain in injection arm then felt nauseous without emesis. Symptoms subsided after 15 minutes of rest.


VAERS ID: 309161 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Unknown  
Location: Pennsylvania  
Vaccinated:2008-03-13
Onset:2008-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1660V / UNK LA / UN

Administered by: Public       Purchased by: Public
Symptoms: Eye swelling, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent 44, Singulair, albuterol, Epi Pen
Current Illness: None
Preexisting Conditions: Asthma, seafood allergy, ADHD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Varicella vaccine was given in left arm between 400-415 pm. Shortly thereafter he began wiping his nose and rubbing his eyes. He said he had a cold. It became apparent it was not a cold and he was given 25 mg Benadryl at 430 pm. His eyes swelled more & he was given 26 mg epi 1:1000 or 440 ppm. Fire rescue was called & he was taken to hospital. He left ER after 9 hrs. He did not need more epi. He was given albuterol via neb after he started wheezing when he fell asleep. He received IV fluids.


VAERS ID: 309545 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-04-15
Entered: 2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARILRIX) / GLAXOSMITHKLINE BIOLOGICALS UNKNOWN / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site pruritus, Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~0.00~Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Both of my children recieved the chicken Pox vaccine. They both had identical reactions. At the site of injection that got a SQUARE rash, larger than a half dollar. It was hot to the touch and extremely itchy. It lasted 3 weeks.


VAERS ID: 309669 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Maine  
Vaccinated:2008-04-16
Onset:2008-04-16
   Days after vaccination:0
Submitted: 2008-04-16
   Days after onset:0
Entered: 2008-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB216AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1918U / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Chest discomfort, Increased upper airway secretion, Injection site induration, Injection site swelling, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: Pt left the office after receiving the vaccines. She & her mom returned approx 30 min later, because she c/o her heart racing - chest discomfort & felt like she also was clearing her throat frequently. She was assessed . Per physician was given Benadryl 25 mg-watched for 30 min. D/C feeling better. Injection site swollen & firm to touch. (Ice pack applied).


VAERS ID: 309673 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Maryland  
Vaccinated:2008-04-16
Onset:0000-00-00
Submitted: 2008-04-16
Entered: 2008-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB223AA / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1762U / UNK LA / IM

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

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

Write-up: Pruritic rash on neck/trunk starting within 30 minutes of Hep A and Varivax. No shortness of breath/wheezing.


VAERS ID: 309735 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Florida  
Vaccinated:2008-04-07
Onset:2008-04-07
   Days after vaccination:0
Submitted: 2008-04-09
   Days after onset:2
Entered: 2008-04-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Injected limb mobility decreased, Injection site induration, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair; Nexium; Replan; Flonase
Current Illness: Afebrile; Nasal congestion
Preexisting Conditions: Asthma; Esophageal reflux; IgG subclass deficiency.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm pain with redness, warmth, induration at injection site. Decreased limb mobility secondary to pain.


VAERS ID: 309756 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-10-10
Onset:2007-10-10
   Days after vaccination:0
Submitted: 2008-03-26
   Days after onset:168
Entered: 2008-04-16
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 04560 / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0712USA01100

Write-up: Information has been received from a registered nurse (R.N.) concerning a 7-year-old female who on 10-OCT-2007 was vaccinated inadvertently with a dose of ZOSTAVAX (Oka/Merck). No adverse symptoms were reported. No outcomes were reported. No product quality complaint involved. Additional information has been received on 06-FEB-2008 via a telephone call with R.N. She explained the reason for product confusion was that they had not received a varicella virus vaccine live (Oka/Merck) shipment but received a ZOSTAVAX (Oka/Merck) shipment instead. The nurse said she did not know that ZOSTAVAX (Oka/Merck) had been ordered and read "varicella zoster" on the vial label and thought it was for chicken pox and administered it to the child. The R.N. explained that it would have helped if the sales rep had done a phone conference prior to them receiving the ZOSTAVAX (Oka/Merck) so that she would have been aware that it was for shingles. She also reported that it "would have helped if the ZOSTAVAX (Oka/Merck) vial indicated shingles. The child is fine and had no adverse experience." Additional information has been requested. Additional information was received from the registered nurse concerning a 7-year-old Female stundent with no pre-existing allergies, birth defects or medical conditions who on 10-OCT-2007 at 07:27 am was vaccinated subcutaneously in the right arm with a first dose of ZOSTAVAX (Merck) (lot# reported as 04560) instead of VARIVAX (Merck). No adverse reactions occurred and no relevant diagnostic tests were performed. No additional information was reported.


VAERS ID: 310027 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-03-26
Entered: 2008-04-16
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0801USA04986

Write-up: Information has been received from a nurse practitioner concerning a 7 year old female who was vaccinated with a dose of Zostavax (Oka/Merck) instead of a dose of Varivax (Oka/Merck). The nurse stated the error as not a product confusion. No adverse event was reported. No medical attention was sought. A product quality complaint was not involved. Additional information has been received from a health professional who stated that the patient was vaccinated with Zostavax (MSD) because that was written on the billing sheet. The person who gave the patient vaccination did what they were told. The patient had no problems after vaccination. The office had called the patient to check up on her. Additional information has been requested.


VAERS ID: 309913 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Arizona  
Vaccinated:2008-04-16
Onset:2008-04-17
   Days after vaccination:1
Submitted: 2008-04-17
   Days after onset:0
Entered: 2008-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1464U / 2 UN / SC

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

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

Write-up: Red and swollen rash. Not painful. Uncomfortable.


VAERS ID: 311386 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-05-22
Entered: 2008-04-23
   Days after submission:337
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Antibody test abnormal, Malaise
SMQs:, Vasculitis (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Antibody test (LLT:Antibody test), 00/00/2007, pneumococcal titer levels all very low except 23F.
CDC Split Type: HQWYE245016

Write-up: Information regarding PREVNAR was received from a healthcare professional regarding a 7-year-old female patient who experienced pneumococcal titer levels all very low except for 23F. The patient received the second dose in 2001. Relevant medical history was not provided. Product was administered in 2001. Dose regimen was 1 dose 1 time per day (intramuscular). Concomitant medications were not reported. On unspecified dates in or around 2001, the patient received a dose of PREVNAR at 13 months and 15 months of age. On an unspecified date in or around 2007, at 7 years of age, the patient''s pnuemococcal titer levels revealed that all but 23F were very low (antibody test abnormal). The reporter noted the patient is ''continually ill'' (malaise). The patient''s outcome is unknown. Antibody test (results: pneumococcal titer levels all very low except 23F) was done in 2007. No additional information was available at the time of this report.


VAERS ID: 310850 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-08-16
Onset:2007-08-16
   Days after vaccination:0
Submitted: 2008-04-24
   Days after onset:252
Entered: 2008-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2605AA / UNK RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Pyrexia, Vomiting, Wrong drug administered
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 4mg. chewable tablet q PM
Current Illness: Acute conjunctivitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 104, joint pain, vomiting. Seen at Medical Care Center, treatment: Ibuprofen, Phenergan. "Parents were told not to have DTaP immunization any further." (She had actually received Tdap.)


VAERS ID: 311113 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Missouri  
Vaccinated:2008-04-16
Onset:0000-00-00
Submitted: 2008-04-17
Entered: 2008-04-28
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2798AA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z1069 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1671U / 2 RA / SC

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

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

Write-up: Child was given DTaP at age 7yrs 8mos - should have received adult Td. CDC: DTAP counts and was not need to be repeated.