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Found 471248 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:332548 (history)  Vaccinated:2008-11-14
Age:11.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-11-14, Days after onset: 0
Location:Illinois  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Peanuts; Shellfish; Insect bites
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR02829AA0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVR319AA2IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.196800IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR02656AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR2863AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1181X4037X1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt rec''d 3 vaccines in R deltoid, MONACTRA. GARDASIL, VARIVAX. Within 3 seconds of given GARDASIL, dime size were formed with reddened swollen area 3" by 2." Dr. evaluated and given BENADRYL 25 MG p.o. per Dr. Called mom @ 5:20 pm. She stated it looked less white in center, still swollen.

VAERS ID:332591 (history)  Vaccinated:2008-11-14
Age:35.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-17, Days after onset: 2
Location:Texas  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: ASTHMA
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS886360IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1381U0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Hyperaesthesia, Lymphadenopathy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: GENERALIZED HYPERSENSITIVITY TO TOUCH LASTING ONE DAY; VOMITING LASTING ONE DAY; FEVER LASTING TWO DAYS; SWOLLEN LYMPH NODES LASTING FOUR DAYS

VAERS ID:332601 (history)  Vaccinated:2008-11-14
Age:63.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-17, Days after onset: 2
Location:Texas  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2761AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Axillary pain, Lymphadenopathy, Pain, Tenderness
SMQs:
Write-up: Patient arrived at the pharmacy 2 days after vaccine administration with swollen lymph nodes in the clavicular area. She described feeling general ache on the night of vaccine administration. The day after, vaccination, she described seeing the enlarged lymph node in the clavicle area. Patient was followed up the day later and also described having tenderness and pain in her axillary area as well.

VAERS ID:332602 (history)  Vaccinated:2008-11-14
Age:3.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-11-17, Days after onset: 3
Location:Indiana  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions: none known
Diagnostic Lab Data: Unknown
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2755AA0IMLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Decreased activity, Pallor, Pharyngeal oedema, Pyrexia
SMQs:, Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Child received influenza vaccine at approximately 1:30 p.m. on 11/14/08, about 1/2 hour after administration, father called to report that child was "out of it", looked pale, doesn''t want to do anything. Nurse advised parent to lay child down, elevate legs/feet and use cold cloth or ice pack. Father advised by nurse that if he continues to have problems to take the child to the ER, since child does not have a primary physician. 11/17/08 Follow-up call to parents by RN, mom reports child was taken to ER, his temperature was 102-103, he very pale and a "swollen throat", Mom states child started to "come around" after ER gave medication (mother unaware what medication was given), and child was sent home. Child today is having no problems. Information given to mom regarding VAERS and vaccine compensation program. Advised mother this would be reported by this office to VAERS.

VAERS ID:332639 (history)  Vaccinated:2008-11-14
Age:3.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-17, Days after onset: 2
Location:Arizona  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B087AA3UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1362X1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Has 7X3 cms Erythema, induration X 2days. No fever. Warm compress, po AUGMENTIN 400 PO BIOX 10

VAERS ID:332740 (history)  Vaccinated:2008-11-14
Age:22.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-11-17, Days after onset: 3
Location:Minnesota  Entered:2008-11-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions:
Diagnostic Lab Data: BP, Pulse, Oxygen
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS0726X IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1291X SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Heart rate, Neck pain, Oxygen saturation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: 9:00am Both vaccines administered, 9:04am c/e (R) side pain in neck, feeling dizzy, 9:08am Assessed by NP - oral liquid BENADRYL 50 mg given, 9:15 No relief from BENADRYL, breathing worse, Epi - Pin injected; 10:00am Symptoms of SOB continue, 25mg injectable BENADRYL given; 10:20am 911 called, patient transported to ER for further eval.

VAERS ID:332768 (history)  Vaccinated:2008-11-14
Age:43.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-19, Days after onset: 4
Location:Michigan  Entered:2008-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies-mold; mildew; cats; dust mites; food preservative.
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89685 IMUN
Administered by: Other     Purchased by: Private
Symptoms: Rash erythematous, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Generalized raised red rash began approx 24hrs after vaccination. Personal physician administrated steroid injections.

VAERS ID:332772 (history)  Vaccinated:2008-11-14
Age:50.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-11-18, Days after onset: 4
Location:New Hampshire  Entered:2008-11-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid; LIPITOR; VALTREX
Current Illness:
Preexisting Conditions: Sulfa; yellow jacket strings; seasonal/ environmental allergies.
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICSE79243IMRA
Administered by: Other     Purchased by: Private
Symptoms: Burning sensation, Eye pruritus, Eye swelling, Lip swelling, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow)
Write-up: 5 1/2 hrs after injection c/o itchy eyes; took BENADRYL .25 mg. Following morning woke with eyes swollen shut. Called MD who advised to take 50 mg BENADRYL @ 9A-1P-6P. AT 6 pm, lips began to swell + burn. Developed rash on face + groin. Went to ER + treated with IV BENADRYL + Steroids. 3 days following vaccine, but (L) eye + cheek still rashy + slightly swollen. NB: Recalls during an environmental site test on 11/13. Friend/calleague has similar symptoms.

VAERS ID:332955 (history)  Vaccinated:2008-11-14
Age:70.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-11-20, Days after onset: 6
Location:Illinois  Entered:2008-11-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2849 IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0554U IMUN
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Local reaction, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient received PNEUMOVAX sub cu in out aspect of (R) upper arm. She experienced local reaction 25x8cm with swelling erythema and tenderness.

VAERS ID:333192 (history)  Vaccinated:2008-11-14
Age:69.0  Onset:2008-11-16, Days after vaccination: 2
Gender:Female  Submitted:2008-11-21, Days after onset: 5
Location:Washington  Entered:2008-11-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899720IMLA
Administered by: Other     Purchased by: Other
Symptoms: Anorexia, Influenza like illness, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 2 days after vaccination patient experienced nausea and developed flu like symptoms. Nausea began to subside 4 days later. She never vomited, but still has no appetite. Her naturopath told her vaccine is live and toxic, and her immune system can''t fight it. Patient''s MD told her it is not a live vaccine. She doesn''t believe him due to statement by naturopath.

VAERS ID:333202 (history)  Vaccinated:2008-11-14
Age:0.3  Onset:2008-11-18, Days after vaccination: 4
Gender:Male  Submitted:2008-11-24, Days after onset: 6
Location:Illinois  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: abd pain
Preexisting Conditions: None. PMH-none
Diagnostic Lab Data: Barium enema. Labs and Diagnsotics: BE WNL.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B201BA IMRL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41FA692A PO 
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Barium enema normal, Crying, Enema administration, Irritability, Opisthotonus
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: Mom reported child crying, aching, acting as if severe abd pain, taken to ER- Barium enema given- infant immed stopped crying per mother. was discharged from ER. 12/23/2008 MR received for ER visit 11/18/2008 with DX: Intermittent irritability w/o evidence for Intussusception. Pt presented with several day hx of intermittent inconsolable crying, back arching and tucking legs into fetal position. Normal feeding and stools. PE WNL. IS r/o via BE. D/C home.

VAERS ID:333295 (history)  Vaccinated:2008-11-14
Age:22.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Male  Submitted:2008-11-25, Days after onset: 10
Location:California  Entered:2008-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: NONE
Diagnostic Lab Data: VESICULAR RASH OF UNKNOWN ETIOLOGY AT THIS TIME. MAY OR MAY NOT BE RELATED TO VACCINE.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1492SCRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site rash, Injection site vesicles, Rash pruritic, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: DEVELOPED A RASH SURROUNDING INJECTION SITE. APPROXIMATELY 3" IN DIAMETER. RASH HAS MULTIPLE LESIONS VESICULAR IN NATURE. MEMBER STATES RASH ITCHES. NO FEVER OR OTHER C/O AT THIS TIME BUT MEMBER IS RECOVERING FROM ANOTHER RASH ON HIS LEG THAT DEVELOPED PRIOR TO HAVING ANY ANTHRAX VACCINATIONS.

VAERS ID:333661 (history)  Vaccinated:2008-11-14
Age:0.2  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-12-02, Days after onset: 18
Location:Washington  Entered:2008-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: n/a
Preexisting Conditions: n/a
Diagnostic Lab Data: n a
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC2922AA0IMLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2786990IMRL
HEP: HEP B (FOREIGN)MERCK & CO. INC.1106F0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC277010IMRL
Administered by: Private     Purchased by: Military
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: N/A

VAERS ID:333715 (history)  Vaccinated:2008-11-14
Age:16.0  Onset:2008-11-21, Days after vaccination: 7
Gender:Male  Submitted:2008-11-28, Days after onset: 7
Location:Ohio  Entered:2008-12-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy; BIAXIN; CEFTIN; LORABID
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2768BA5IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: TDAP given 11/19/2008. 11/21/2008 general achiness all over arms, legs muscles hurt to take MOTRIN.

VAERS ID:333726 (history)  Vaccinated:2008-11-14
Age:3.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Male  Submitted:2008-12-03, Days after onset: 18
Location:South Carolina  Entered:2008-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Flovent, Aquaphor
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.US493AA0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Rhinorrhoea
SMQs:
Write-up: Patient was 3 year old male with known history of asthma. Parent provided documentation to day care informing them not to allow him to receive the intranasal flu vaccine due to contraindications and guidance from child''s pediatrician. During the schools annul flu vaccine program, the patient was given the intranasal vaccine. As a result, the patient''s mother has self reported moderate subsequent symptoms of headache and runny nose. At this time, the patent has not sought medical care to address the symptoms noted above.

VAERS ID:333743 (history)  Vaccinated:2008-11-14
Age:0.2  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-12-03, Days after onset: 19
Location:Oklahoma  Entered:2008-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE AT THE TIME
Current Illness: HYDROCELE, REFLUX
Preexisting Conditions: REFLUX, FEEDING INTOLERANCE 12/15/08-records received-PMH: reflux.
Diagnostic Lab Data: SEE MEDICAL RECORDS AT HOSPITAL. HAD SEVERAL TESTS 12/15/08-records received-EEG showed abnormal movements and seizures. CT normal.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3200AA0IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0601X1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD031250IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0690X0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Computerised tomogram normal, Convulsion, Depressed level of consciousness, Dyskinesia, Electroencephalogram abnormal, Laboratory test, Tardive dyskinesia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: HAD SEIZURE APPROX 4 HOURS AFTER IMMUNIZATIONS. QUESTIONABLE HISTORY OF SEIZURE THE DAY BEFORE SHOTS AS PER HISTORY GIVEN BY PARENTS 12/15/08-records received for DOS 11/15-11/20/08. DC DX:Abnormal movements, seizure disorder, reflux. Presented to ED with epsiodes consistent with changing sensorium, smacking of lips and generalized movements of arms and legs. Occurred day prior to admission. Video pH probe and pneumogram showed significant reflux.

VAERS ID:334115 (history)  Vaccinated:2008-11-14
Age:17.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-12-05, Days after onset: 20
Location:California  Entered:2008-12-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergies; Penicillin, AUGMENTIN, sulfa and ERYTHROMYCIN
Diagnostic Lab Data: CBC w/auto diff; Sed rate; Blood culture; comprehensive metabolic
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2768AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1076X0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Blood culture, Erythema, Full blood count, Headache, Injection site cellulitis, Injection site erythema, Injection site swelling, Injection site warmth, Metabolic function test, Pain, Pyrexia, Red blood cell sedimentation rate, Skin lesion, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (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), Hypersensitivity (broad)
Write-up: Patient was seen on 11.17.08 and noted: lesion on upper extremity: arm, on the right for 2 days, which has been painful and red. It has been swollen, and has not been draining pus/fluid. Started Sat am after receiving PNEUMOVAX on Friday, low grade fever up to 100 degrees, vomited once, and has a headache. Patient was seen on 11.18.08 and Dr noted: this is a 17 year old female patient who comes in to the clinic in follow up after yesterday''s visit. Yesterday we treated her for a cellulitis at the site of injection that had occurred on 11/14/08. The area was red, warm and swollen. I had started her on CLINDAMYCIN orally and that area had actually improved. It is much lighter red, the swelling is better and the warmth is better but overnight she has developed a new area about 2 inches below the site of injection that looks very similar and has been growing bigger. It is very red, warm and swollen as well. They had been putting compresses on the area. She has had three doses of CLINDAMYCIN. Patient was seen on 11.20.08 and Dr noted: 17 year old female here for a follow up reaction to PNEUMOVAX received 11.14.08 However, the injection site for the flu shot has remained uneventful. She was seen at ER for IV antibiotic therapy and is finally responding. She is taking CLEOCIN and DOXYCYCLINE. Patient was seen on 11.21.08 and Dr noted: resolving cellulitis. There is little to no heat or induration of distal aspect of upper arm but small amount of induration remains at injection site.

VAERS ID:334516 (history)  Vaccinated:2008-11-14
Age:39.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-17, Days after onset: 2
Location:Michigan  Entered:2008-12-09, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma, hx Ovarian cancer.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2739AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1381U0SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2998BA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site cellulitis, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt has an area of cellulitis to medial aspect of left upper arm- 8 cm X 16 cm. with axillary adenopathy. (+) fevers (101.6) and pain.

VAERS ID:334520 (history)  Vaccinated:2008-11-14
Age:1.0  Onset:2008-11-18, Days after vaccination: 4
Gender:Male  Submitted:2008-11-20, Days after onset: 2
Location:New York  Entered:2008-12-09, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None had recovered from gastroenteritis (10/30/08)
Preexisting Conditions: Down''s syndrome
Diagnostic Lab Data: Ultrasound as above
CDC 'Split Type':
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1250X0SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1009X0SCUN
Administered by: Private     Purchased by: Private
Symptoms: Irritability, Orchitis, Pyrexia, Testicular swelling, Ultrasound scan abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient received MMR & VARIVAX on 11/14/08. 2 days later was fussy, cranky. On 11/18 developed fever than a small area of reddness on testicles on 11/19 left tests became tense and swollen, a febrile was referred to surgeon. Ultrasound showed blood flow to testicle & no hernia. Diagnosed with viral orchitis.

VAERS ID:334539 (history)  Vaccinated:2008-11-14
Age:0.4  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-19, Days after onset: 4
Location:Missouri  Entered:2008-12-09, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC 'Split Type':
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DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC2900AA1UNRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD031251UNLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0594X1PO 
Administered by: Private     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting with every bottle starting on 11-15-08, within 24 hours of getting vaccine.

VAERS ID:334557 (history)  Vaccinated:2008-11-14
Age:61.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-11-17, Days after onset: 3
Location:Illinois  Entered:2008-12-09, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, 81 mg q d
Current Illness: None
Preexisting Conditions: Iodine dye; ZYBAN
Diagnostic Lab Data: CBC; BMP; Cardiac Enzymes; CXR; EKG; Blood cultures - essentially normal (WBC - 1200)
CDC 'Split Type':
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2740AA1UNLL
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Blood culture, Cardiac enzymes, Chest X-ray, Chills, Cough, Dizziness, Dyspnoea, Electrocardiogram, Eye burns, Full blood count, Headache, Hyperaesthesia, Metabolic function test, Nasal congestion, Ocular hyperaemia, Pyrexia, White blood cell count decreased
SMQs:, Anaphylactic reaction (narrow), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Vestibular disorders (broad)
Write-up: ER @ 10:30, 11/14 - IV, TYLENOL. Chills, fever (101.9), eye red and burning. H/A, dizziness, SOB, sensitivity to touch ("pin-prickly" feeling), mild cough, nasal congestion, weakness. H/A and weakness diminishing, but still present on 11/17/08.

VAERS ID:334558 (history)  Vaccinated:2008-11-14
Age:53.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-11-18, Days after onset: 3
Location:Minnesota  Entered:2008-12-09, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3028BA UNRA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Chills, Joint stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: Employee received Tdap vaccine at approximately 1:30pm on 11-14-08. At approximately 10am on the following day started having symptoms of joint pain/stiffness, chills with fever over 100. Symptoms lasted until the morning of 11/17/08.

VAERS ID:334606 (history)  Vaccinated:2008-11-14
Age:77.0  Onset:2008-11-20, Days after vaccination: 6
Gender:Male  Submitted:2008-12-09, Days after onset: 19
Location:South Carolina  Entered:2008-12-09
Life Threatening? No
Died? Yes
   Date died: 2008-12-03
   Days after onset: 13
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Also see #7 1.Hypertension. 2. Diabetes mellitus type 2. 3. Diverticulosis with hemorrhage. 4. Hyperlipidemia. 5. Bright red blood per rectum. 6. DVT in July 2004.FL 5 def
Preexisting Conditions: also see #7 ALL: NKDA 12/3/09 records received-PMH:DVT/PE,DM, HTN, factor V Leiden.
Diagnostic Lab Data: Yellow fever serum RT PCR: negative,LEPTOSPIRA ANTIBOD. neg, HSV 1/2 QUALITATIVE, PCR- neg,CMV DNA- neg, ehrlichia- neg, Blood cultures neg, CT head, abd, pelvis, brain - negative 2/3/09-records received-MRI brain no evidence of acute intracranial lesions. MRI spine multi level degenerative disease. 2/11/09-laboratory reports received-YF IgM antigen positive. YF arboviral nucloic acid negative.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2768AA IMLA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF307AB SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acidosis, Antibody test negative, Asthenia, Blood culture negative, Blood immunoglobulin M, Computerised tomogram normal, Confusional state, Cytomegalovirus test negative, Death, Dyspnoea, Ehrlichia serology, Encephalopathy, Endotracheal intubation, Fatigue, Haemodynamic instability, Herpes simplex serology negative, Hypotension, Intensive care, Intervertebral disc degeneration, Malaise, Mechanical ventilation, Multi-organ failure, Nausea, Nuclear magnetic resonance imaging brain normal, Polymerase chain reaction, Pyrexia, Renal failure, Respiratory failure, Sepsis syndrome, Septic shock, Tachycardia, Tachypnoea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow)
Write-up: Patient is a 77-year-old male with a history of factor V Leiden, hyperlipidemia, prior history of DVTs, and diabetes mellitus type 2, who presented to the hospital on 11/21/2008 complaining of 2 days of fever, nausea, and generalized weakness and malaise. Pt had Yellow Fever vaccination on 11/14/08 prior to his planned trip abroad. Pt has been otherwise in good health prior to admission. Influenza vaccine was given on 10/30/08. HOSPITAL COURSE: The patient quickly progressed to hemodynamic instability and sepsis syndrome exhibited by tachypnea, tachycardia, hypotension and confusion. Therefore, he was transferred to the MICU on 11/22/2008. The patient was intubated for airway protection at that time and increased work of breathing. The patient required vasopressor support for his blood pressure and was started on broad-spectrum antibiotics. The patient subsequently developed multiorgan system failure, including respiratory failure requiring ventilator support, and oliguric renal failure requiring hemodialysis support. Multiple cultures were sent to try and determine the etiology of the patient''s symptoms and reason for septic shock. It was noted the patient was on broad-spectrum antibiotic, antiviral and antifungal coverage. No specific infection inciting these symptoms was ever identified. The only cultures that were positive were drawn from the patient''s access lines, which grew out Candida albicans. Infectious Disease was following along with the patient the entire time of his stay in the MICU. Over the ensuing days, the patient failed to progress and actually worsened from 12/02 and 12/03 as exhibited by increased tachypnea and work of breathing, hypotension with continued pressor support, and oozing from some of his lines and orifices. At this time, the patient''s family requested that the patient be made DNR and that supportive measures be withdrawn. Therefore, these steps were undertaken on the afternoon of 12/03/2008. The patient passed away officially at 1425 on 12/03/2008. Physical exam was performed to confirm the patient''s death. The family was offered autopsy and declined. 2/3/09-records received for DOS 11/21-12/03/08-C/O Presented to ED with C/O malaise, weakness, nausea, fever and fatigue. Mechanical ventilation. Sepsis. Metabolic acidosis. Septic encephalopathy. 3/30/09-COD multi-organ failure. Septic shock.

VAERS ID:334691 (history)  Vaccinated:2008-11-14
Age:57.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-11-25, Days after onset: 11
Location:Wisconsin  Entered:2008-12-09, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Psoriasis
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Other     Purchased by: Other
Symptoms: Dysphonia
SMQs:, Parkinson-like events (broad)
Write-up: Received vaccine at about 11:00am. At 6:00pm, I began getting hoarse which cleared up about 12:30 or sometime after midnight.

VAERS ID:334699 (history)  Vaccinated:2008-11-14
Age:4.0  Onset:2008-11-16, Days after vaccination: 2
Gender:Female  Submitted:2008-11-17, Days after onset: 1
Location:North Carolina  Entered:2008-12-09, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None aware of
Preexisting Conditions: All year long sinus problems
Diagnostic Lab Data: Pt to doctor client has strep thoart possible mono no side effect from shots.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU24700A4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA106023SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0890X1SCRA
Administered by: Public     Purchased by: Other
Symptoms: Dysphonia, Lymphadenopathy, Oropharyngeal pain, Pharyngitis streptococcal
SMQs:, Agranulocytosis (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Shot given on 11-14-08. Mother states on 11-16-08 client woke up sore throat with knots under chin (lymph nodes swollen). Child''s voice hoarse, mother instructed to take child to doctor & call PHN waer

VAERS ID:334725 (history)  Vaccinated:2008-11-14
Age:71.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-12-02, Days after onset: 18
Location:California  Entered:2008-12-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asprin; Acyclovir; Vitamin D; Lisinorpril; Esterified Estrogens HS
Current Illness: None
Preexisting Conditions: Allergy to Ibuprofen
Diagnostic Lab Data: None
CDC 'Split Type':
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Dose
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1163X IM 
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Shot in upper right arm near shoulder. 3 hrs later, 12:30 or so, arm " hurt" when I move. Swollen and bright red color, and put cold compress and later heat till about 6:00 pm. Sat. and Sun. still hurt, and Mon. better and light red.

VAERS ID:335420 (history)  Vaccinated:2008-11-14
Age:58.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2008-12-09, Days after onset: 25
Location:Minnesota  Entered:2008-12-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Betadine. PMH: Hyperlipidemia. Reflux
Diagnostic Lab Data: MRI at hospital. Labs and Diagnostics: Echo (-). Carotid US (-) for stenosis, (+) for minimal plaque. Head CT (-). ECG WNL.
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2831AA UNLA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Computerised tomogram normal, Echocardiogram normal, Hypoaesthesia, Iron deficiency, Neurological examination abnormal, Nuclear magnetic resonance imaging abnormal, Pain, Paraesthesia, Tinnitus, Transient ischaemic attack, Ultrasound Doppler
SMQs:, Peripheral neuropathy (broad), Ischaemic cerebrovascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow)
Write-up: Within 2 hrs. after I had the shot, I had tingling on my left side. I thought it would go away. I went to the hospital the next morning & the MRI showed I had a stroke. 12/26/2008 MR received for DOS 11/15-16/2008 with D/C DX: Partially reversible ischemic neurologic deficit. Esophageal reflux. Iron deficiency anemia. Hyperlipidemia. Pt presented to ER with c/o numbness and tingling on the L side of body which began several hours after receiving flu shot. Neuro exam (+) for L sided paresthesia of arm, leg, face. Started on Plavix and ASA to be f/u as outpt. 02/01/2010 Follow-up: I have neuropathy (numbness) in the left hand and foot. Also some weakness in left arm and sometimes a fuzzy slight numbness in left chest area. The neuropathy causes me pain. Also I have loud ringing in my ears constantly.

VAERS ID:335751 (history)  Vaccinated:2008-11-14
Age:49.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-12-01, Days after onset: 17
Location:Washington  Entered:2008-12-19, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: nerve damage~Influenza (no brand name)~0~48~In Sibling
Other Medications: Allergy med- CLARITEN
Current Illness: None
Preexisting Conditions: Seasonal allergy
Diagnostic Lab Data: None
CDC 'Split Type':
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Manufacturer
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Dose
Route
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS87684 UNLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site rash, Rash papular, Rash pruritic, Scar
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The evening of the flu shot, noticed raised lesions that resemble hives, vesicle fluid filled, itched-broke out on arms, chest- injection site- no lesions noted- no fever noted - lesion scarred in two days.

VAERS ID:335752 (history)  Vaccinated:2008-11-14
Age:38.0  Onset:2008-11-18, Days after vaccination: 4
Gender:Female  Submitted:2008-12-03, Days after onset: 15
Location:Washington  Entered:2008-12-19, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC;YAZ
Current Illness: None
Preexisting Conditions: hay fever; pollen; dust.
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS87882020UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 4 days after FLUVIRIN vaccine notice bump ? chickenpox on lower leg (2), trunk (cluster of 3), and arm, very itchy, no temperature - lesion went away in a day.

VAERS ID:335826 (history)  Vaccinated:2008-11-14
Age:67.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-12-18, Days after onset: 34
Location:Kentucky  Entered:2008-12-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no illness at the time of vaccination and he had not been taking any concomitant medications. Past medical history included allergies to grass, mold and shellfish.
Diagnostic Lab Data: None
CDC 'Split Type': 200803658
Vaccination
Manufacturer
Lot
Dose
Route
Site
BCG: BCG (MYCOBAX)SANOFI PASTEURU2849AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Disorientation, Nausea, Rash, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Initial report was received on 18 November 2008 from a health care professional. A 67-year-old male patient with a history of grass, mold and shellfish allergies, had received an intramuscular left deltoid injection of FLUZONE SV 2008-2009, lot number U2849AC on 14 November 2008 and 30 minutes later, he developed weakness, nausea and vomiting which persisted at the time of the report. The patient was scheduled to be evaluated by their physician on 18 November 2008. At the time of the report, the patient had not recovered from the event. Follow-up information received on 08 December 2008 from a nurse. Per the reporter, their staff spoke with the patient on 24 November 2008 and he was continuing to feel disoriented. The patient went to the emergency room (date not provided) and reported "no organ damage." The patient reported he had lost 25 pounds since 14 November 2008. He also reported a rash on his elbow below the injection site. The patient is currently on a bland diet and at home. The reporter stated "contact patient for additional information." Per this new information, this case was upgraded to serious. The reporter for this case is the same as case number 2008-03659. Documents held by sender: None.

VAERS ID:336156 (history)  Vaccinated:2008-11-14
Age:15.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2008-12-12, Days after onset: 28
Location:Unknown  Entered:2008-12-29, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500557P0IN 
Administered by: Military     Purchased by: Military
Symptoms: Epistaxis, Immediate post-injection reaction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: Nosebleed immediately after FLUMIST for 3-5 minutes, resolved spontaneously.

VAERS ID:338570 (history)  Vaccinated:2008-11-14
Age:73.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Wyoming  Entered:2009-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Voltaren, Hydrocodone, Niacin, Synthroid, Norvasc, Citalopram
Current Illness: 3 WKS Post-op R knee Arthroscopy
Preexisting Conditions: High Bp, High Chol, Hypothyroid
Diagnostic Lab Data: Unknown
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0870X UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Injected limb mobility decreased, Laboratory test, Musculoskeletal pain, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Left arm Pneumonia Vaccine R arm Flu vaccine and 7 hours later, L arm pain so severe + decreased mobility, went to the ER. ER Dr. was "uncaring + wouldn''t listen to symptoms so discourage + left ER, Pt has had severe muscle, joint pain to knees, thigh that hasn''t resolved/ patient is undergoing multiple X-rays, tests, MRI for diagnosis.

VAERS ID:340840 (history)  Vaccinated:2008-11-14
Age:21.0  Onset:0000-00-00
Gender:Female  Submitted:2009-02-26
Location:Illinois  Entered:2009-02-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0902USA04035
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Myelitis transverse
SMQs:, Demyelination (narrow)
Write-up: Information has been received from a physician concerning a 21 year old female who on 05-SEP-2008 was vaccinated with a first dose of GARDASIL and on 14-NOV-2008 was vaccinated with a second dose of GARDASIL. Then the patient was diagnosed with transverse myelitis, which the physician stated it mimics multiple sclerosis. The patient saw a neurologist. At the time of reporting, the outcome was unknown. Upon internal review, transverse myelitis was determined to be an other important medical event. Additional information has been requested.

VAERS ID:340877 (history)  Vaccinated:2008-11-14
Age:60.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-02-27, Days after onset: 105
Location:Florida  Entered:2009-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA178AA IMLA
Administered by: Military     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Influenza like illness, Musculoskeletal pain, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Generalized joint/body ache, weakness, fever (flu-like symptoms). The following day, patient reported pain (10/10) in left shoulder and left leg, brought down to 7/10 after administration of ketorolac 30 mg I.V. once.

VAERS ID:340887 (history)  Vaccinated:2008-11-14
Age:13.0  Onset:2008-12-04, Days after vaccination: 20
Gender:Male  Submitted:2009-03-02, Days after onset: 88
Location:Washington  Entered:2009-03-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ASTHMA, epistaxis. NKDA, eczema, family h/o CA. Allergies: dust, pollens
Diagnostic Lab Data: Labs and Diagnostics: MRI (+) optic neuritis. CSF with 10 WBCs, glucose 111, normal protein 28. CSF cx (-). 1,25-OH vit D (H) 75. Labs & Diags: CSF glucose 111 (H), T bili 0.1 (L), MRI Brain - Appearance of optic neuritis involving the proximal aspect of the optic nerves extending to the chiasm. CT Head/brain- Incidentally noted 5mm widening of L vestibular aqueduct, otherwise normal. CXR WNL. CMV neg. Lyme neg. Bergdorfori neg.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P3IN 
Administered by: Military     Purchased by: Military
Symptoms: Asthma, Astigmatism, Blindness, Blood 1,25-dihydroxycholecalciferol increased, CSF culture negative, CSF glucose increased, CSF protein normal, CSF white blood cell count, Chest X-ray normal, Cough, Cytomegalovirus antibody negative, Hypertension, Lumbar puncture normal, Myopia, Nuclear magnetic resonance imaging abnormal, Obesity, Optic neuritis, Rhinorrhoea, Vision blurred, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Ocular infections (broad), Hypersensitivity (broad)
Write-up: Loss of eyesight starting at about two weeks after immunization. "Optic neuritis". 3/3/09 MR received for DOS 12/4-8/2008 with D/C DX: Optic Neuritis. Pt presented with c/o worsening vision x 6 days. Initially L eye went blurry and several days later R eye. Started on prednisone with improvement noted by day 4. D/C on oral pred. 10/30/09 Medical record received for DOS 12/04/08- 10/15/2009 Adolescent c/o decreasing vision bilat 13 days s/p vaccine. Unable to read. MRI positive for optic neuritis. Admit for IV steroid therapy. Sight returning by day 4 w/ improvement of light sensitivity and object recognition. Oral steroids upon d/c. All lab work normal. LP WNL except for elevated glucose. All titers neg. Discharge to home. Planned optho follow-up. Continuous improvement over time. Last eye exam showed refractive error-myopia, astigmatism. Also documented were obesity and pre-hypertension concerns. Nutritional/dietary consult. ED visit on 2/25/08 also noted for bilat wheeze, cough, post nasal drip and nasal itching. Exacerbation of childhood asthma.

VAERS ID:346903 (history)  Vaccinated:2008-11-14
Age:14.0  Onset:2008-12-05, Days after vaccination: 21
Gender:Female  Submitted:2009-05-14, Days after onset: 159
Location:Unknown  Entered:2009-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: diagnostic laboratory, 01/09/09, 3.2, Lymphatic number. Was High; diagnostic laboratory, 01/09/09, 47.2%, Lymphatic percentage. Was High; hemoglobin, 01/09/09, 11.7, low; complete blood cell, 01/09/09, result not showed
CDC 'Split Type': WAES0904USA02916
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERU2791DA UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.0187U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Fatigue, Full blood count, Haemoglobin decreased, Headache, Lymphocyte count increased, Lymphocyte percentage increased
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Dementia (broad)
Write-up: Information has been received from a Allergy Technician concerning a 14 year old female patient with no pertinent medical history and no drug reactions or allergies who on 14-NOV-2008 was vaccinated with a first dose of GARDASIL (Lot # 656049/0187U) 0.5ml, intramuscularly. Concomitant therapy included influenza virus vaccine (unspecified). On approximately 05-DEC-2008 the patient experienced fatigue and headaches. The patient was a basketball player and she could not participate in some recent drills. The patient had a schedule appointment to see a cardiologist on 06-MAY-2009. On 09-JAN-2009 the following diagnostics laboratory test were performed: Completed blood cell count (CBC), blood hemoglobin test (HGB): 11.7 was low, Lymphatic percentage: 47.2 was high and lymphatic number: 3.2 was high. At the time on the report on 17-APR-2009 the patient had not recovered. The patient sought medical attention was at office. Additional information has been requested.

VAERS ID:351264 (history)  Vaccinated:2008-11-14
Age:86.0  Onset:0000-00-00
Gender:Male  Submitted:2009-06-24
Location:Unknown  Entered:2009-07-13, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Diabetes; Hypertension
Preexisting Conditions: Brain neoplasm; Shingles
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0903USA00899
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Burning sensation, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a consumer concerning her 86 year old husband with diabetes and hypertension and a history of brain tumor. No known drug allergies/drug reactions, who on 14-NOV-2008 was vaccinated with a 0.65 ml dose of ZOSTAVAX (Merck) (Lot # not reported). It was reported that the patient had shingles four months prior to the vaccination. It was reported that the patient was still having pain, tingling and burning where the shingles were following vaccination. A laboratory work was performed (results not provided). It was reported that the patient had not recovered at the time of the report. The patient sought unspecified medical attention. No further information is available.

VAERS ID:354015 (history)  Vaccinated:2008-11-14
Age:30.0  Onset:2008-11-17, Days after vaccination: 3
Gender:Female  Submitted:2009-07-30, Days after onset: 254
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL; PULMICORT; SINGULAIR; MAXALT
Current Illness: Asthma; Seasonal allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0811USA02643
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lethargy, Malaise
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a consumer concerning his 30 year old wife with asthma and seasonal allergies who on 14-NOV-2008 was vaccinated with PNEUMOVAX (lot# not provided). Concomitant therapy included montelukast sodium (MSD), rizatriptan benzoate (MSD), influenza virus vaccine (unspecified) at the same time, PULMICORT. On 17-NOV-2008 the patient became lethargic and experienced malaise. The injection site was red, warm to touch, extremely sore, raised, and swollen. The patient''s symptoms persisted. The patient did not seek medical attention. Additional information has been requested.

VAERS ID:354173 (history)  Vaccinated:2008-11-14
Age:70.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2009-07-30, Days after onset: 256
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0812USA01792
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: Information has been received from a Registered Nurse concerning a female patient in her 70''s who on approximately 14-NOV-2008 was vaccinated iwth PNEUMOVAX 23 (Lot # was not available), 0.5ml. On approximately 15-NOV-2008 the patient experienced cellulitis on her forearm. After 3 days the patient had the symptom she recovered on approximately 18-NOV-2008. The patient sought medical attention with the physician and nurse. No further information is available.

VAERS ID:355559 (history)  Vaccinated:2008-11-14
Age:39.0  Onset:2008-11-16, Days after vaccination: 2
Gender:Female  Submitted:2008-12-09, Days after onset: 23
Location:California  Entered:2009-08-13, Days after submission: 246
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type': MEDI0007541
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Other     Purchased by: Private
Symptoms: Anosmia, Malaise, Nasal congestion, Nasopharyngitis, Productive cough, Pyrexia, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: A non-serious spontaneous report of lost sense of smell, feeling rundown, fever, sneezing, nasal congestion and productive cough was received from a consumer concerning a 39 year-old female that occurred two days after receiving FLUMIST. No medical history or concomitant medications were reported. The patient received FLUMIST on 14-Nov-2008. On the 16-Nov-2008, the reporter indicated that she lost her sense of smell and had a mild fever, nasal congestion, productive cough, feeling rundown and sneezing since receiving FLUMIST. Some of the symptoms resolved in 1 to 3 days others are almost resolved. The events of fever, loss of smell and productive cough resolved; sneezing, feels rundown and nasal congestion were almost resolved as of 26-Nov-2008. The reporter states that she has acquaintances who experienced similar symptoms around the same time period of her symptoms; she thinks she had a cold.

VAERS ID:355560 (history)  Vaccinated:2008-11-14
Age:6.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2009-04-09, Days after onset: 145
Location:Virginia  Entered:2009-08-13, Days after submission: 126
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug (s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MEDI0007531
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500540P IN 
Administered by: Public     Purchased by: Public
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious spontaneous report of expired FLUMIST administered was received from a nurse concerning a six-year-old female. No medical history was provided. A nurse gave the patient FLUMIST that expired on 12-Nov-2008. There was no adverse event associated with this medication error therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Follow up received on 02-Dec-2008 includes: patient was not re-dosed and no adverse events occurred. Additional information was received on 09-Apr-2009: Based on the results for the investigation, the root cause for the medication errors were caused by 1)customers not discarding product from the previous season and 2) product expiring during the peak of the flu season resulting in some medication errors that occurred shortly after the product expired.

VAERS ID:364273 (history)  Vaccinated:2008-11-14
Age:4.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Male  Submitted:2009-11-02, Days after onset: 352
Location:Texas  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TX090035PR
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B084AB0IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1362X1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1283X1SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eye swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: CHILD HAD SWEELING ON AREA AROUND EYES AND POSSIBLE FACIAL SWELLING

VAERS ID:364283 (history)  Vaccinated:2008-11-14
Age:0.4  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-11-02, Days after onset: 353
Location:Texas  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TX090037
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC1B156DA1IMLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT27836A0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF497AA1IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC631161IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0014X1PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: PATIENT''S MOTHER STATED CHILD RAN A LOW GRADE FEVER FOR A SHORT TIME AFTER SHOTS. NEXT DAY NO FEVER AND CHILD WAS FINE. PATIENT DID NOT HAVE AN ADVERSE REACTION. RECEIVED FLU VACCINE TOO EARLY.

VAERS ID:364975 (history)  Vaccinated:2008-11-14
Age:4.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Male  Submitted:2009-11-04, Days after onset: 354
Location:Texas  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TX090068PR
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2788DA4IMLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eye swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: FLU SHOT ADMINISTERED FRIDAY AFTERNOON. SATURDAY MORNING DEVELOPED EYE SWELLING AND IN AFTERNOON DEVELOPED RASH AND ICTHING CHEST AND KNEE

VAERS ID:364977 (history)  Vaccinated:2008-11-14
Age:14.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-11-04, Days after onset: 355
Location:Texas  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TX090069
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2790BA UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2561AA UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abasia, Asthenia, Chest pain, Condition aggravated, Crying, Dyskinesia, Dyspnoea, Emotional distress, Hypoaesthesia, Paraesthesia, Pleurisy, Rash
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: APPROXIMATELY 20 MINUTES AFTER RECEIVING VACCINE PATIENT COMPLAINING OF CHEST PAIN WITH DIFFICULTY BREATHING V/S 148-96 R20 P82 CLEAR BREATH SOUNDS ON AUSCULTATION ANTERIOR AND POSTERIOR AND RASH COMPLAINED OF TINGLING TO BOTH HANDS. HAD PATIENT BREATHE IN PAPER BAG WITHOUT RELIEF. CLIENT STATES CP TOO BAD TO AMBULATE. EMS CALLED AND PATIENT TRANSFERRED TO LOCAL HOSPITAL. PATIENT RELEASED SAME DAY FROM ER DX: PLEURISY. 11/4/08 PUBLIC HEALTH OFFICE HAD FLU CLINIC ON THIS DATE. INFLUENZA AND MCV4 WAS PROVIDED. PATIENT 14/8 RECEIVED INFLUENZA INJECTION TO L DELTOID AND MCV4 TO R DELTOID. HE THEN WENT BACK TO HIS CLASSROOM. APPROX. 20-30 MIN LATER HE CAME BACK TO C/O BURNING SUBSTERNAL CHEST PAIN AND DIFFICULTY BREATHING. VS: 148-96 P82 R20, CLEAR BREATH SOUNDS ANTERIORLY/POSTERIORLY NO RALES, WHEEZING, RHONCHI, NO RASH. DURING ASSESSMENT CLIENT BEGAN COMPLAINING OF NUMBNESS/TINGLING TO BOTH HAND AND FINGER. TRIED TO GET CLIENT TO BREATHE IN BROWN PAPER BAG. HE BEGAN TO CRY SAYING CP WAS INCREASING. A MALE EMPLOYEE AND I TRIED TO HELP HIM TO A VEHICLE TO BE TRANSPORTED FOR EXAM BUT CLIENT STATED HE WAS TOO WEAK TO WALK SO EMS WAS NOTIFIED. WHILE WAITING FOR EMS ARRIVAL, V/S RETAKEN BP 152/92 P90 R20 BREATHING SOUNDS REMAINED CLEAR, NO RASH NOTED TO INCREASE ABD/BACK, NOTED R HAND BEGAN TO CONTRACT AND CLIENT CONTINED TO CRY. STAFF UNABLE TO COMFORT CLIENT. EMS ARRIVED AT SCENE, CLIENT WAS TRANSPORTED TO ER FOR ASSESSMENT. RECEIVED REPORT AT APPROXIMATELY 4 PM THAT CLIENT WAS RELEASED WITH WITHOUT MEDS AND DX: PLEURISY.

VAERS ID:365093 (history)  Vaccinated:2008-11-14
Age:16.0  Onset:2008-11-14, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 355
Location:Texas  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: DEPRESSION, ANXIETY
Diagnostic Lab Data: NONE
CDC 'Split Type': TX090070PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER0667X1SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2770AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 9:40 AM TDAP, MMR ADM. FEW SECONDS LATER CLIENT HAD FAINTING EPISODE MILD SEIZURE LIKE ACTIVITY LASTING 20 SECONDS. NO INJURY OCCURRED. JUST LEANED AGAINST MOTHER AFTERWARDS WAS ORIENTED TO DOB, TIME AND PLACE. REFERRED TO PHYSICIAN DID NOT GO, MONITORED 30 MINUTES. PHONE AT 1:30PM AT HOME. EATING AND DOING WELL. NO FURTHER PROBLEMS

VAERS ID:332599 (history)  Vaccinated:2008-11-15
Age:81.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Male  Submitted:2008-11-17, Days after onset: 2
Location:Colorado  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone, hydromorphone, pantoprazole, synthroid, warfarin, phenytoin, ondansetron, fentanyl, acetaminophen, fentanyl
Current Illness: Intractable HA
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0743X IMRA
Administered by: Public     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)
Write-up: Large amount of swelling and redness at site of injection, lasting several hours after administration. No treatment.

VAERS ID:332604 (history)  Vaccinated:2008-11-15
Age:43.0  Onset:2008-11-17, Days after vaccination: 2
Gender:Female  Submitted:2008-11-17, Days after onset: 0
Location:Texas  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNKNOWN~ ()~NULL~~In Patient
Other Medications: NONE
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2741AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Receive vaccination in left deltoid on Saturday 11/15/08. Began having redness and swelling early Monday morning, 11/17/08. Went to doctor that afternoon to get it checked.

VAERS ID:332643 (history)  Vaccinated:2008-11-15
Age:63.0  Onset:2008-11-17, Days after vaccination: 2
Gender:Female  Submitted:2008-11-17, Days after onset: 0
Location:Virgin Islands  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: HTN, N100M, Hypercholesterol.
Diagnostic Lab Data:
CDC 'Split Type':
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TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2346EA1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Muscle swelling, Pain, Pyrexia, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Fever to 101.2. deltoid muscle swollen, hot to touch and painful.

VAERS ID:332672 (history)  Vaccinated:2008-11-15
Age:36.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-11-17, Days after onset: 2
Location:Tennessee  Entered:2008-11-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPOROL (u) for BP vitamins
Current Illness: None
Preexisting Conditions: High BP
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA151AA UNLA
Administered by: Other     Purchased by: Other
Symptoms: Lip swelling, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Patient had vaccine at approximately 1:00pm and at 6:00pm began having top lip swelling and sore throat. Not witnessed. Patient had eaten lean Quisine for lunch around noon.

VAERS ID:332711 (history)  Vaccinated:2008-11-15
Age:17.0  Onset:2008-11-16, Days after vaccination: 1
Gender:Female  Submitted:2008-11-18, Days after onset: 2
Location:Pennsylvania  Entered:2008-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: None
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS0758F2IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04900SCLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B011AA IMLA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD30014000PO 
Administered by: Public     Purchased by: Private
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient started taking oral Typhoid Vaccine 11/5/08 and started experiencing abdominal pain 11/16/08. She has taken 2 capsules. Last night she also experienced abdominal pain.

VAERS ID:332733 (history)  Vaccinated:2008-11-15
Age:31.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-18
Location:Colorado  Entered:2008-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vicodin
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89882 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Arthralgia, Musculoskeletal pain, Toothache
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: On 11/18/2008 patient called and stated she was having tooth, stomach, shoulder and elbow pain, she was concerned that this was related to her vaccination. We have tried to contact her again but have not gotten a response.

VAERS ID:332729 (history)  Vaccinated:2008-11-15
Age:35.0  Onset:2008-11-17, Days after vaccination: 2
Gender:Female  Submitted:2008-11-19, Days after onset: 2
Location:California  Entered:2008-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Kariva, Bupropion, Amitriptilne
Current Illness: No
Preexisting Conditions: I am allergic to nickel. I am also allergic to the drugs Cipro, Keflex and Toradol.
Diagnostic Lab Data: I am going to the doctor to receive a shot to counteract the rashes. For the first day I took Benadryl to reduce the itching.
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR49281-0382-15 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Pruritus, Rash, Rash pustular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Two days after my flu shot I broke out in a severe rash on my legs. It is raised red bumps that itch severely. I also broke out with pustules (pencil eraser to dime-sized) on my back and stomach. Other than the flu shot there were no changes to my diet or medication during this time, so I drew the conclusion that it must be an adverse reaction to the vaccination.

VAERS ID:332761 (history)  Vaccinated:2008-11-15
Age:53.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Male  Submitted:2008-11-17, Days after onset: 2
Location:Unknown  Entered:2008-11-19, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER88637 UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: Previously healthy 53 y/o received influenza vaccine at work around Nov. 5, 2008. This individual has no medical problems and takes no meds. Manufacturer was Novartis, Lot number 88637. 10 days later, the patient developed Shingles - Herpes Zoster - involving the C8 dermatome on the left arm/hand. The Zoster appears to be mild in intensity. Placed on Valtrex 1 gm tid x 7 days on 11/16/2008.

VAERS ID:332780 (history)  Vaccinated:2008-11-15
Age:18.0  Onset:2008-11-17, Days after vaccination: 2
Gender:Female  Submitted:2008-11-18, Days after onset: 1
Location:Ohio  Entered:2008-11-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0507X SCUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Rash macular, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt. given VARIVAX 11-15-08. Per pt., on 11-17-08, 8A pt. developed pruritic rash with red, blotchy spots over shoulder-neck area. Pt. was seen by Dr. 11-18-08. Slight blotchy erythema on cheeks other wise most hives have resolved (PRN BENADRYL/hydrocortisone cream)

VAERS ID:332914 (history)  Vaccinated:2008-11-15
Age:30.0  Onset:0000-00-00
Gender:Female  Submitted:2008-11-20
Location:Pennsylvania  Entered:2008-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Percocet, albuterol, Advair, docusate, and ibuprofen
Current Illness: S/P C Section
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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TDAP: TDAP (ADACEL)SANOFI PASTEURC2865AA IMGM
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site reaction
SMQs:
Write-up: Patient reported having a local reaction at the site of injection. No medical attention requested.

VAERS ID:333060 (history)  Vaccinated:2008-11-15
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-18
Location:Maryland  Entered:2008-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA209AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Incorrect dose administered
SMQs:
Write-up: Drive thru flu clinic - 14 y/o child received adult formulation. No phone number provided, mailed letter to notify.

VAERS ID:333061 (history)  Vaccinated:2008-11-15
Age:8.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-18
Location:Maryland  Entered:2008-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA209AA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Incorrect dose administered
SMQs:
Write-up: Drive thru flu clinic, 8 year old child received adult formulation. No phone number provided, mailed letter for patient to call our office to notify.

VAERS ID:333062 (history)  Vaccinated:2008-11-15
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-18
Location:Maryland  Entered:2008-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA209AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Incorrect dose administered
SMQs:
Write-up: Drive thru flu clinic -14 y/o child received adult formulation. No phone number provided. Mailed letter to pt to call our office to notify

VAERS ID:333734 (history)  Vaccinated:2008-11-15
Age:37.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-12-03, Days after onset: 18
Location:Louisiana  Entered:2008-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABA008A IMUN
Administered by: Public     Purchased by: Private
Symptoms: Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site became raised & hot after vaccine administration.

VAERS ID:333907 (history)  Vaccinated:2008-11-15
Age:45.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Male  Submitted:2008-12-04, Days after onset: 19
Location:Wisconsin  Entered:2008-12-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNKNOWN
Preexisting Conditions: NONE
Diagnostic Lab Data: N/A
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSUNKNOWN IMUN
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: PATIENT RECEIVED FLU-VACCINE AND DEVELOPED A RASH // MD TREATED PATIENT WITH CLARITIN DAILY FOR 5 DAYS

VAERS ID:334459 (history)  Vaccinated:2008-11-15
Age:74.0  Onset:2008-11-18, Days after vaccination: 3
Gender:Female  Submitted:2008-11-24, Days after onset: 6
Location:Ohio  Entered:2008-12-09, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: dizzy~Influenza (no brand name)~1~71~In Patient
Other Medications: Blood pressure medicine
Current Illness: None-Healthy
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2751AA UNUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Diarrhoea, Nausea, Neck pain, Oropharyngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: 3 to 4 days after shot. Chills, fever, neck aches, sore throat, nausea, diarrhea. 11-29- still lingering with MR.

VAERS ID:334532 (history)  Vaccinated:2008-11-15
Age:10.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-11-15, Days after onset: 0
Location:Massachusetts  Entered:2008-12-09, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: F/U call to mom @ 3:30. Pt. fine, eating/drinking. No headache/dizziness.
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2831AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Head injury, Hypotonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Fainted, hit head - call to 911 - out for approx. 10 sec. Was limp - came to good color. Alert x 3, pulse 80. Sat on floor - applied ice pack to forehead - small bump. No bleeding. Paramedics came checked her out - refused to go to hospital - Mom took home.

VAERS ID:334682 (history)  Vaccinated:2008-11-15
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2008-11-15
Location:Illinois  Entered:2008-12-09, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 81 mg ASPRINE/VITAMINS
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERU28811AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: "None stated"

VAERS ID:334697 (history)  Vaccinated:2008-11-15
Age:3.0  Onset:2008-11-16, Days after vaccination: 1
Gender:Female  Submitted:2008-11-17, Days after onset: 1
Location:Ohio  Entered:2008-12-09, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERC2999AA3UNLL
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.50G555P0IN 
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER0062X2UNLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.1259U0UNRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site vesicles, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 10 cm wide x 8 cm long area of redness, induration and warmth with a few vesicles (which began today).

VAERS ID:334740 (history)  Vaccinated:2008-11-15
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2008-11-18
Location:Michigan  Entered:2008-12-09, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None needed
CDC 'Split Type':
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DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2955 UNLA
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: Dtap administered to pt, should have been Tdap.

VAERS ID:335390 (history)  Vaccinated:2008-11-15
Age:36.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-12-16, Days after onset: 31
Location:Pennsylvania  Entered:2008-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Sulfa drugs, lanolin (contact dermatitis)
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS  IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Asthma, Chills, Conjunctivitis, Eye discharge, Malaise, Photophobia, Pyrexia, Wheezing
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: Malaise, fever, chills followed by slow onset of asthma (with wheezes), photophobia, conjunctivitis (with thick yellow discharge). treated with Albuterol inhaler & Advair (spaced 3 hours apart), 2 tabs of benadryl and another 2 puffs of albuterol before bed (12am). Symptoms resolved completely by the 8am. Considered visiting the emergency room, but symptoms improved by the evening. I am a medical professional- if I wasn''t I would have definitely gone to the ER.

VAERS ID:335630 (history)  Vaccinated:2008-11-15
Age:39.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-18
Location:Texas  Entered:2008-12-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS88363 IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthropathy, Bursa disorder, Pain, Tenderness
SMQs:, Arthritis (broad)
Write-up: ADMINISTERED INJECTION ON 11/15/08. PT CALLED ON 11/30 SAYING BOTH HE & HIS WIFE HAVE EXPERIENCED SEVERE PAIN/SORENESS IN RIGHT UPPER ARM. HE FEARS THAT THE SHOT WAS GIVEN IN WRONG PLACE (HIGH-TOP OF SHOULDER)& THAT THE PAIN CONTINUES TO WORSEN. PT STATED THAT IBUPROFEN & SPORTS CREAM ARE NOT HELPING. ON 12/1/08, I RETURNED HIS CALL & TOLD HIM TO SEE A DOCTOR. ON 12/2, PT TOLD ME HE HAD SEEN HIS DOCTOR & WAS GIVEN AN ORAL CORTICOSTEROID FOR 1 WEEK. DOCTOR SPECULATED THAT THE JOINT OR BURSA SACK MAY HAVE BEEN HIT. (HIS WIFE DID NOT SEE A DOCTOR. HE STATED THAT SHE CANNOT TAKE A CORTICOSTEROID BECAUSE OF A CURRENT HEALTH CONDITION). ON 12/17, PATIENT SAYS HE HAD COMPLETED THE CORTICOSTEROID. PAIN SUBSIDED WHILE ON MED,BUT NOW HAS RETURNED. HIS WIFE IS SOMEWHAT BETTER. THE DOCTOR HAS TOLD PATIENT THAT HE SHOULD HAVE AN MRI. PATIENT SAYS HE WILL DO THIS AFTER THE HOLIDAYS ARE OVER.

VAERS ID:336003 (history)  Vaccinated:2008-11-15
Age:24.0  Onset:2008-11-17, Days after vaccination: 2
Gender:Female  Submitted:2008-12-13, Days after onset: 26
Location:Georga  Entered:2008-12-23, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500557P OTUN
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVBN7AB IMUN
Administered by: Military     Purchased by: Military
Symptoms: Rash, Rash erythematous, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Had hives around TB test site after 2 days, and at 3 days had red bumps on forehead and across nose and cheeks. No swelling or raised areas.

VAERS ID:336094 (history)  Vaccinated:2008-11-15
Age:16.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-12-28, Days after onset: 43
Location:Arizona  Entered:2008-12-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Ashma
Diagnostic Lab Data: Xrays, MRI, Dr. visits
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Loss of consciousness, Nuclear magnetic resonance imaging, X-ray
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), Arthritis (broad)
Write-up: She was given the HPV Vaccine and passed out. She never fell or hit anything. she came to and had sever pain in her ankle. she has had xrays and a MRI and they show nothing wrong BUT she still has the pain.

VAERS ID:337114 (history)  Vaccinated:2008-11-15
Age:85.0  Onset:2008-11-21, Days after vaccination: 6
Gender:Female  Submitted:2008-12-23, Days after onset: 32
Location:Iowa  Entered:2008-12-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cancer; Drug hypersensitivity; Osteoporosis; Gastric disorder
Preexisting Conditions: Scarlet fever; Pneumonia
Diagnostic Lab Data: None
CDC 'Split Type': WAES0811USA03837
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC. 0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Feeling cold
SMQs:
Write-up: This is in follow-up to report(s) previously submitted on 12/23/2008. Initial and follow-up information have been received from a registered pharmacist and an 84 year old retired female with gastric side effects to salicylate and NSAIDS, osteoporosis, diagnosed with unspecified cancer in 1985 and received "flu shot" on 14-OCT-2008 and a history of a history of scarlet fever when she was 11 years old, pneumonia as a child, who on 15-NOV-2008 was vaccinated with the first dose of ZOSTAVAX (Merck) SC 0.65 ml (lot # not reported) at 11:00. Concomitant therapy included PROTONIX, FORTICAL, enteric coated aspirin and loperamide HCl. On 21-NOV-2008 (also reported as "approximately 1-2 weeks after vaccination) the patient started to experience being "ice cold" and chilly that lasted for 2 days. The patient recovered from cold and chilly on 23-NOV-2008. The patient sought medical attention and spoke to the registered pharmacist. Follow-up information was received. The patient''s feeling of being extremely cold lasted for approximately 2 days. No other symptoms were noted. The patient recovered on 23-NOV-2008. Additional information is not expected.

VAERS ID:336714 (history)  Vaccinated:2008-11-15
Age:14.0  Onset:2009-01-02, Days after vaccination: 48
Gender:Female  Submitted:2009-01-07, Days after onset: 5
Location:Georga  Entered:2009-01-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Muscle spasms, Pain, Vaginal discharge
SMQs:, Dystonia (broad)
Write-up: Patient had Gardasil shot and then Depo-Provera about 1 week later. 2 months later, this past Friday she passed a mass of tissue vaginally that was approximately 5" X 2" and was in pain similar to labor. This child is not sexually active, has experience severe cramping. Concerned may have caused permanent damage to her uterus. Ultrasound today, gyn in the next few.

VAERS ID:338529 (history)  Vaccinated:2008-11-15
Age:4.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Male  Submitted:2008-12-10, Days after onset: 25
Location:California  Entered:2009-01-16, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MEDI0007614
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500540P IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious report of administration of expired product has been received from a registered nurse concerning a four-year-old male who received FLUMIST on 15-Nov-2008. FLUMIST expired on 12-Nov-2008. Medical history and concomitant medications were not reported. There was no adverse event reported with this medication error; therefore, treatment and reporter/sponsor causality assessment''s are not applicable, and the event is considered resolved. This case is submitted in accordance with a post-marketing commitment on accelerated reporting for the newly indicated population of 2 years to 59 months of age for FLUMIST. 01/05/09 On 05-Jan-2009, the reporting nurse confirmed that there were no late-occurring adverse events reported. 01/05/09 Based on the results of the investigation, the root cause for the medication errors were caused by 1) customers not discarding product from previous season and 2) product expiring during the peak of flu season resulting in some medication errors that occurred shortly after the product expired. Follow-up information received on 20-Mar-2009 included Product Complaint Investigation results.

VAERS ID:340670 (history)  Vaccinated:2008-11-15
Age:23.0  Onset:2008-11-16, Days after vaccination: 1
Gender:Male  Submitted:2009-02-25, Days after onset: 101
Location:Texas  Entered:2009-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER 3IMUN
Administered by: Military     Purchased by: Military
Symptoms: Dyspnoea, Nausea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: within 24 hours, urticarial rash on chest, shortness of breath, and nausea

VAERS ID:344754 (history)  Vaccinated:2008-11-15
Age:63.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Male  Submitted:2009-06-24, Days after onset: 220
Location:Pennsylvania  Entered:2009-04-08, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions:
Diagnostic Lab Data: complete blood cell - normal; rapid Streptococcus - negative
CDC 'Split Type': WAES0902USA00857
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1418X SCUN
Administered by: Other     Purchased by: Other
Symptoms: Aphthous stomatitis, Fatigue, Full blood count normal, Lymphadenopathy, Mouth ulceration, Pain, Pyrexia, Streptococcus identification test, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a medical assistant concerning a 63 year old male with diabetes and no drug allergies who on 15-NOV-2008 was vaccinated SQ into the left arm with a dose of ZOSTAVAX (Oka/Merck) (663197/1418X). It was reported that the patient was on a diabetic diet. On 30-JAN-2009 the patient experienced fever of 104.2 F, fatigue, body aches, swollen cervical lymph nodes and oral ulceration''s. The patient sought medical attention at physician''s office. The patient was examined and prescribed AUGMENTIN. A rapid strep test was negative and a complete blood count was normal. The patient was examined again on 04-FEB-2009 and the symptoms were improved. As of 05-FEB-2009, the patient was recovering. Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/27/2009. Follow-up information was received from the medical assistant. It was reported that the 63 year old white male patient developed a viral syndrome including severe aphthous ulcers in the mouth not long after the vaccination OF zoster vaccine live (Oka/Merck). The reporter stated that "there is no connection between the two". At the time of the report, the patient recovered. No further information is available.

VAERS ID:355586 (history)  Vaccinated:2008-11-15
Age:7.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Male  Submitted:2009-01-05, Days after onset: 51
Location:California  Entered:2009-08-13, Days after submission: 219
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MEDI0007615
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500540P IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious spontaneous report of administration of expired product has been received from a Registered Nurse concerning a seven-year-old male who received FLUMIST on 15-Nov-2008. FLUMIST expired on 12-Nov-2008. Medical history and concomitant medications were not reported. There was no adverse event reported with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause for the medication errors were caused by 1) customers not discarding product from the previous season and 2) product expiring during the peak of the flu season resulting in some medication errors that occurred shortly after the product expired. On 05-Jan-2009, the reporting nurse confirmed that there were no late-occurring adverse events reported.

VAERS ID:392178 (history)  Vaccinated:2008-11-15
Age:57.0  Onset:2008-11-16, Days after vaccination: 1
Gender:Female  Submitted:2010-06-14, Days after onset: 574
Location:Virginia  Entered:2010-07-02, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Allergy to gentamycin; allergy to neomycin; tinnitus. The subject had previously received influenza vaccinations and "no problems with flu vaccines in the past". No adverse events were reported following receipt of prior immunizations.
Diagnostic Lab Data: UNK
CDC 'Split Type': A0758215A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA388AA UNUN
Administered by: Public     Purchased by: Private
Symptoms: Condition aggravated, No reaction on previous exposure to drug, Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: This case was reported by a pharmacist and described the occurrence of exacerbation of tinnitus in a 57-year-old female subject who was vaccinated with FLUARIX (GlaxoSmithKline). The subject''s medical history included allergy to gentamycin, allergy to neomycin and tinnitus. Concurrent medications included KLONOPIN. On 15 November 2008 at 10:11, the subject received unspecified dose of FLUARIX (.5 ml, unknown, left arm). On 16 November 2008, 1 day after vaccination with FLUARIX, the subject experienced exacerbation of tinnitus. The pharmacist reported that the subject experienced a worsening in her tinnitus after received FLUARIX. FLUARIX was administered at the pharmacy on Saturday, and then on Sunday she noticed the worsening of her tinnitus. The time of day for the onset is unknown. The worsened tinnitus was bothersome to the subject but has not required medical treatment at this time. Of note, the subject has a history of an allergy to neomycin and gentamycin but she has had flu vaccines in the past and never had a problem, thus the decision was made to use FLUARIX even though it contains a small amount of gentamycin. At the time of reporting the event was unresolved. The pharmacist considered the event was possibly related to vaccination with FLUARIX.

VAERS ID:406888 (history)  Vaccinated:2008-11-15
Age:40.0  Onset:2008-11-20, Days after vaccination: 5
Gender:Female  Submitted:2010-11-04, Days after onset: 713
Location:Arizona  Entered:2010-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: Spinal Tap, MRI on brain, cervical & thoracic spine, Evoke Response tests indicate Multiple Sclerosis
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Brain stem auditory evoked response abnormal, Demyelination, Hypoaesthesia, Lumbar puncture, Migraine with aura, Multiple sclerosis, Nuclear magnetic resonance imaging, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging thoracic
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Demyelination (narrow)
Write-up: Within 5 days of getting a flu shot, numbness began in torso, spread to arms, legs, and optic migranes. Continued for 2 months until treated with high-dose steroids. Tests indicate demylenation in brain and thoracic spinal cord. MS-like attack.

VAERS ID:335273 (history)  Vaccinated:2008-11-15
Age:66.0  Onset:2008-11-16, Days after vaccination: 1
Gender:Female  Submitted:2008-12-12, Days after onset: 26
Location:Foreign  Entered:2008-12-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Epilepsy; Hemiparesis; Psychomotor development impaired
Preexisting Conditions: Meningoencephalitis
Diagnostic Lab Data: X-ray, did not indicate any secure infiltrate; diagnostic laboratory test, "LPK"; serum C-reactive protein, 183; urinalysis, negative
CDC 'Split Type': WAES0812USA02111
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERD9737 IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0291X IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Application site reaction, C-reactive protein increased, Convulsion, Laboratory test, Pain in extremity, Pyrexia, Urine analysis normal, X-ray normal
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Initial case was reported as serious on 05-DEC-2008 by Health Authority. Information has been received from a Health Authority concerning a 66 year old female patient who was vaccinated with PNEUMOVAX 23 vaccine (Batch # NH55920, Lot # 661742/0291X), intramuscularly in arm and with VAXIGRIP (Batch # D9737) (manufacturer unknown) intramuscularly in arm on 15-NOV-2008. Health Authority reported convulsions (twice), fever and an application site reaction with pain in the arm started on 16-NOV-2008. The patient was referred to the hospital by ambulance. The conditions were evaluated as adverse events of the vaccinations. Other infection focuses could be excluded. An X-ray of the lungs did not indicate any secure infiltrate and a urine stick was negative. CRP was 183 (no unit reported) and LPK was 12 (no unit reported). The patient received HERACILLIN for suspected injection abscess (a local infection around the injection site could not be excluded). The patient had a medical history of meningoencephalitis in the childhood, remaining hemiparesis, psychomotor development disorder and epilepsy, but no attacks in one year. The outcome was unknown. The case was closed. Other business partner numbers include E2008-11348. No further information is available.

VAERS ID:338263 (history)  Vaccinated:2008-11-15
Age:2.0  Onset:2008-11-16, Days after vaccination: 1
Gender:Male  Submitted:2009-01-26, Days after onset: 71
Location:Foreign  Entered:2009-01-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No known past medical history of allergy or repetitive infections.
Diagnostic Lab Data: Body temperature, 16Nov2008, 38.7 Cels. degrees; C-reactive protein, 16Nov2008, 25
CDC 'Split Type': B0555088A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, C-reactive protein increased, Injection site erythema, Injection site induration, Injection site oedema, Injection site warmth, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case was reported by a foreign regulatory authority (#DJ20081122 and 1527-2008) and described the occurrence of injection site edema in a 26 month-old male subject who was vaccinated with INFANRIX TETRA (GlaxoSmithKline). The subject had no relevant past medical history (including no known allergy and no repetitive infections) and had no concurrent medication. On 15 November 2008, the subject received an unspecified dose of INFANRIX TETRA (batch unknown, right thigh). On 16 November 2008, one day after vaccination with INFANRIX TETRA, the subject was hospitalized for a hard, red and hot edema at injection site, not much painful. Edema, localized on lateral anterior face of right thigh, was 15 cm diameter around injection site. No discharge was observed. The subject presented with fever at 38.7 Celsius degrees at admission and right inguinal adenopathies. His general statement was good and he did not seem septic. C reactive protein level was at 25. On 18 November 2008, the subject was discharged from hospital after two days of apyrexia. He was under CLAMOXYL (100mg/kg/day) for a period of 10 days, including the two first days given intravenously. At the time of reporting, injection site reaction and fever were resolved. Outcome of adenopathies was unspecified. The agency reported that injection site reaction was probably related to vaccination with INFANRIX TETRA, according to the foreign method of imputability. Causality was not assessed for fever and adenopathies. This case has been closed; no more information will be available.

VAERS ID:340918 (history)  Vaccinated:2008-11-15
Age:13.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2009-03-02, Days after onset: 107
Location:Foreign  Entered:2009-03-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0561857A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS  IMUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.NH46170 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Fall, Skull fracture, Subarachnoid haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic cerebrovascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: This case was reported by a regulatory authority (2009-00650) and described the occurrence of syncope in a 13-year-old female subject who was vaccinated with ENGERIX B (GlaxoSmithKline), GARDASIL (non-GSK). On 15 November 2008, the subject received unspecified dose of ENGERIX B (intramuscular, unknown injection site, lot number not provided), unspecified dose of GARDASIL (intramuscular, unknown injection site). On 15 November 2008, 5 minutes after vaccination with ENGERIX B and GARDASIL, the subject experienced syncope with a convulsion; then she fell on the floor and experienced skull fracture with a slight subarachnoid hemorrhage. The subject was hospitalized for 1 week. During the hospitalization no diagnostic or therapy documented regarding epileptic events, so that the convulsion has to be seen in the context of the syncope. At the time of reporting the events were resolved. The regulatory authority reported that the events were possibly related to vaccination with ENGERIX B and GARDASIL. Due to close temporal connection between the two vaccine administrations and the occurrence of the adverse events, it was not possible to identify one of the two vaccines rather their injection as cause. A non-medicamentous cause seemed to be however improbable. This was all the information available from the Regulatory Authority. If they receive additional information, they will report it as soon as they get it. Therefore this case has been closed.

VAERS ID:347572 (history)  Vaccinated:2008-11-15
Age:29.0  Onset:2008-11-17, Days after vaccination: 2
Gender:Male  Submitted:2009-05-27, Days after onset: 190
Location:Foreign  Entered:2009-05-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0574589A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTIPV: DT + IPV (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS  IMUN
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was reported by a regulatory authority (# GB-MHRA-ADR 20427267) and described the occurrence of nausea in a 29-year-old male subject who was vaccinated with HEPATYRIX, yellow fever vaccine and (non-gsk) REVAXIS. On 15 November 2008 the subject received unspecified dose of HEPATYRIX (1 ml, intramuscular), unspecified dose of Yellow fever vaccine (.5 ml, subcutaneous), unspecified dose of REVAXIS (.5 ml). On 17 November 2008, 2 days after vaccination with HEPATYRIX, REVAXIS and Yellow fever vaccine, the subject experienced nausea, vomiting and weight loss. The regulatory authority reported that the events were clinically significant (or requiring intervention). On 17 April 2009, the events were resolved. MHRA Verbatim Text: Patient experienced prolonged nausea and vomiting leading to 20 percent weight loss.

VAERS ID:350378 (history)  Vaccinated:2008-11-15
Age:48.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2009-06-29, Days after onset: 225
Location:Foreign  Entered:2009-06-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0792670A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLL204AA0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Conjunctivitis, Cough, Periorbital oedema, Pyrexia, Stridor
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Periorbital and eyelid disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: This case was reported by a regulatory authority (#V0809438) and described the occurrence of stridor in a 48-year-old female subject who was vaccinated with FLUVIRAL, GlaxoSmithKline. On 15 November 2008 the subject received 1st dose of FLUVIRAL (unknown). On 15 November 2008, 5 hours after vaccination with FLUVIRAL, the subject experienced Stridor, fever, cough, conjunctivitis and periorbital edema. The duration of these events was 5 days. This case was assessed as medically serious by GSK. At the time of reporting the events were resolved.

VAERS ID:376734 (history)  Vaccinated:2008-11-15
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2010-01-12
Location:Foreign  Entered:2010-01-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Magnetic resonance imaging, suggestive of a malignant lesion
CDC 'Split Type': WAES1001USA00416
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal distension, Nuclear magnetic resonance imaging abnormal, Ovarian cancer, Ovarian cyst, Surgery
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Malignant tumours (narrow), Ovarian malignant tumours (narrow)
Write-up: Information has been received from a general practitioner concerning a 17 year old female patient with no family history of ovarian cancer who on 15-NOV-2008 and on 06-FEB-2009 was vaccinated with the first and second doses of GARDASIL (batch number, lot number not provided). The patient was not on contraceptives at time of reporting. On an unspecified date, the patient experienced significant abdominal distension. MRI was very suggestive of a malignant lesion. Ovarian cancer was consequently suspected. The patient underwent surgical operation in December 2009: genital organs were preserved and the surgeon specified that it was probably a non-malignant cyst. Anatomopathological results were awaited. The outcome was not reported at the time of reporting. The patient''s ovarian cancer, abdominal distension, and ovarian cyst were considered other important medical events. Other business partner number included: E200911947. Additional information has been requested.

VAERS ID:334337 (history)  Vaccinated:2008-11-16
Age:24.0  Onset:2008-11-17, Days after vaccination: 1
Gender:Female  Submitted:2008-11-20, Days after onset: 3
Location:Nebraska  Entered:2008-12-09, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89994 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on forearms- both arms - worse on arm vaccinated.

VAERS ID:334344 (history)  Vaccinated:2008-11-16
Age:41.0  Onset:2008-11-16, Days after vaccination: 0
Gender:Male  Submitted:2008-11-16, Days after onset: 0
Location:Minnesota  Entered:2008-12-09, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Physical exam only
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500563P0IN 
Administered by: Military     Purchased by: Military
Symptoms: Dyspnoea, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Urticaria pruritis and shortness of breath.

VAERS ID:335781 (history)  Vaccinated:2008-11-16
Age:32.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335782 (history)  Vaccinated:2008-11-16
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335783 (history)  Vaccinated:2008-11-16
Age:48.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335784 (history)  Vaccinated:2008-11-16
Age:54.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335786 (history)  Vaccinated:2008-11-16
Age:39.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335787 (history)  Vaccinated:2008-11-16
Age:42.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335788 (history)  Vaccinated:2008-11-16
Age:31.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:335789 (history)  Vaccinated:2008-11-16
Age:26.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-19
Location:Virginia  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111 IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:336210 (history)  Vaccinated:2008-11-16
Age:20.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-29
Location:Virginia  Entered:2008-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:336212 (history)  Vaccinated:2008-11-16
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-29
Location:Virginia  Entered:2008-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:336221 (history)  Vaccinated:2008-11-16
Age:23.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-29
Location:Virginia  Entered:2008-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:336626 (history)  Vaccinated:2008-11-16
Age:0.6  Onset:2008-12-19, Days after vaccination: 33
Gender:Male  Submitted:0000-00-00
Location:Maine  Entered:2009-01-06
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 1/6/09-records received-two week history of rhinorrhea and cough and 3 day histoy of fever to 103. Bilateral otitis media
Preexisting Conditions: Crytorehism (rt)
Diagnostic Lab Data: 1/9/09-records received-Urine culture negative. Lumbar puncture increased protein of 317, increased opening pressure, WBC 741 with 71 polys and normal glucose. CSF gram positive cocci in pair. Blood culture streptococcus pneumoniae. WBC 20.
CDC 'Split Type': ME00109
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2957AA2UNLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2792EA0UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA106022UN 
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC529972UNRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0280X2PO 
Administered by: Private     Purchased by: Public
Symptoms: Bacteraemia, Blood culture positive, CSF glucose normal, CSF pressure increased, CSF protein increased, CSF white blood cell count increased, Computerised tomogram abnormal, Culture urine negative, Fontanelle bulging, Gram stain positive, Intracranial pressure increased, Irritability, Lumbar puncture abnormal, Meningitis pneumococcal, Pyrexia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow)
Write-up: This is a previously health 8-month-old boy with a 2-week history of runny nose and cough without fever. Three days prior to admission he developed a fever which has been a T-max of 103. He was seen in the emergency department at his referring hospital two days prior to this admission at which point he was diagnosed with bilateral otitis media. Labs were not drawn at that time. He was started on azithromycin orally for which he had received two doses when he returned to the emergency department last night due to persistent fever and irritability. At that point his bulging fontanelle was noticed and he was empirically given a dose of IM ceftriaxone 100 mg hg. Note that a lumbar puncture was attempted and yielded only a few drops of apparently bloody CSF. It is unclear to me in talking with the lab whether this was actually received by the lab. A blood culture was obtained and that is pending. Finally a urine culture was obtained, but the lab also does not have this specimen. The patient was then transported by a team originating from that hospital. He had an 10 in place as both peripheral and central access were unsuccessful. 1/6/09-records received for DOS 11/22/08-12/29/08-DC DX: Streptococcus meningitis. Streptococcus Bacteremia.admitted with C/O two week history of rhinorrhea and cough and 3 day histoy of fever to 103. Bilateral otitis media 2 days prior to admission. Irritability. Bulging fontanelles.

VAERS ID:336913 (history)  Vaccinated:2008-11-16
Age:28.0  Onset:0000-00-00
Gender:Male  Submitted:2009-01-09
Location:Virginia  Entered:2009-01-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: SM RECEIVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE

VAERS ID:336925 (history)  Vaccinated:2008-11-16
Age:29.0  Onset:0000-00-00
Gender:Male  Submitted:2009-01-09
Location:Virginia  Entered:2009-01-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: SM RECEIVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE

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