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Case Details (Sorted by Vaccination Date)

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VAERS ID:333007 (history)  Vaccinated:2008-11-21
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-21
Location:Connecticut  Entered:2008-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B024BA1IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: None Noted

VAERS ID:333044 (history)  Vaccinated:2008-11-21
Age:4.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-11-21, Days after onset: 0
Location:Washington  Entered:2008-11-21
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) (FLUZONE)SANOFI PASTEURU2806AA2UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Gave flu shot in left deltoid and child had local reaction to injection. Swelling was 2" from point of entry and redness 9" toward elbow from point of entry. 1 ml PO of Benadryl given and father was instructed to ice and give Tylenol if needed. Discussed with MD. Patient is to return to clinic if symptoms worsen.

VAERS ID:333045 (history)  Vaccinated:2008-11-21
Age:1.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-21, Days after onset: 0
Location:California  Entered:2008-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Slight nasal secretions; no fever
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0988X0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0531X0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Immediate post-injection reaction, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Given MMR and Varicella SQ. Rt thigh had immediate swelling and redness. Ice pack applied. BENADRYL 25 ml given swelling did not persist. Discharged home with instructions.

VAERS ID:333049 (history)  Vaccinated:2008-11-21
Age:18.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2008-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None mentioned
Preexisting Conditions:
Diagnostic Lab Data: Not available
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS881131P IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling abnormal, Feeling hot, Hypoacusis, Immediate post-injection reaction, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypersensitivity (narrow)
Write-up: 3:15 pm injection. Five minutes later reported blurred vision and feeling strange. Had patient sit down, reported feeling warm and nauseous. She asked for some water, gave a bottle, drank a little but did not feel any better. Did not have breathing difficulty or swallowing. 3:30 pm reported that she was having hearing difficulty.

VAERS ID:333115 (history)  Vaccinated:2008-11-21
Age:48.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 3
Location:Nebraska  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED02649111A IMUN
Administered by: Public     Purchased by: Private
Symptoms: Chest pain, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Had shortness of breath and cough 3 hours after flu shot given, then chest pain for about for about an hour later that night.

VAERS ID:333149 (history)  Vaccinated:2008-11-21
Age:36.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 3
Location:Texas  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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1494SCRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB04244IMRA
Administered by: Military     Purchased by: Military
Symptoms: Anxiety, Dyspnoea, Oropharyngeal pain, Palpitations, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)
Write-up: Patient received anthrax and typhoid in the Rt deltoid. Patient has a really bad anxiety of receiving shots but tolerated them well. Had nurse in the room in case of vasovagel reaction. During her 20 minute wait time patient was talking with me and was doing fine. Patient started to complain of a sore throat. Started to call nurse back into the office when the patient started to say her tongue felt funny and she was having difficulty breathing. Applied O2 at 6L with NC and hit code blue alarm. Received provider''s order to administer Epi Pen, administered Epi Pen in Rt thigh. Patient asked if her heart was supposed to be racing after that and was reassured that it was a side effect of the Epi Pen. Her symptoms started to go away shortly after receiving the Epi Pen. Monitored patient for 1 hour after event and the provider sent her home on quarter for the rest of the day.

VAERS ID:333167 (history)  Vaccinated:2008-11-21
Age:0.5  Onset:0000-00-00
Gender:Female  Submitted:2008-11-24
Location:Michigan  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None so far~ ()~NULL~~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0062X IM 
HIBV: HIB (ACTHIB)SANOFI PASTEURUF441AA IM 
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC71571 IM 
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0595X PO 
TDAP: TDAP (ADACEL)SANOFI PASTEURC2844AA IM 
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Patient was given Tdap instead of DTaP

VAERS ID:333176 (history)  Vaccinated:2008-11-21
Age:4.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-11-24, Days after onset: 2
Location:California  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2956BA4IMLA
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899854IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA10603SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1210X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1187X1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt presented to clinic 11/24/08 at 9am with c/o swelling, pruritis, erythema, and pain to L upper arm. Pt received DTap and IPV at that site on 11/21/2008 @ this clinic. Per pt''s mother, symptoms are improving. No erythema appreciated. No current c/o itching. No fever, no streaking. Pt has been icing the site and taking tylenol for pain.

VAERS ID:333183 (history)  Vaccinated:2008-11-21
Age:72.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 3
Location:Virginia  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR2L06AA IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1076X1IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site mass, Oedema peripheral, Pyrexia, Rash, Rash papular, Skin discolouration
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Arm swollen till elbow, rash on upper body, lump on the site. High fever 101.7 ok on 11/24/2008 arm yellow. Taking NAPROXEN and BENADRYL, for PNEUMOVAX.

VAERS ID:333262 (history)  Vaccinated:2008-11-21
Age:35.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-21, Days after onset: 0
Location:Minnesota  Entered:2008-11-25, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Whole food multivitamin capsule; none
Current Illness: None
Preexisting Conditions: (PMH non-Hodgkin lymphoma 2004 -$g remission since 2005); allergies to all narcotics; Iodine-Hive
Diagnostic Lab Data: Vital signs stable: 114/74, 107/70, 103/73 HR 74; 100% PO2 sat
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899940UNRA
Administered by: Public     Purchased by: Other
Symptoms: Blood pressure normal, Dizziness, Ear, nose and throat examination normal, Heart rate normal, Neurological examination normal, No reaction on previous exposure to drug, Oxygen saturation normal, Pharyngeal oedema
SMQs:, Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Patient presented to clinic about 20 minutes after receiving FLUVIRIN c/o throat swelling (mild) described as "cotton throat" no shortness of breath, no facial, tongue, or lip swelling, c/o mild dizziness. No prior reaction to FLUVIRIN. VSS IM Benadryl 50mg. given with significant improvement of symptoms, improved throat. Within 30-40 minutes after receiving Benadryl 50mg x 1 dose, patient reported significant improvement of throat swelling about 75% improvement. Dizziness improved after ate a nutrition/ energy bar and water. Vital signs stable. Ortho-static BPS/HR stable. HEENT/Respirtory/Cardiac and Neuo exam all stable/ normal. Alert and oriented x3 patient discharged in stable condition and advised to call 911 if symptoms recurred or worsened. Patient expressed understanding of plan. Advised to discuss future eligibility for FLUVIRIN vaccine with her primary care provider and inside under allergy skin testing.

VAERS ID:333274 (history)  Vaccinated:2008-11-21
Age:49.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-11-25, Days after onset: 4
Location:Massachusetts  Entered:2008-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA191AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Fatigue, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: At 8pm 11hours after vaccine administration experienced muscle aches all over At 9pm experienced chills and shivering At 10pm high fever The next day felt okay but just tired and sore At time of report, feeling fine

VAERS ID:333329 (history)  Vaccinated:2008-11-21
Age:0.2  Onset:0000-00-00
Gender:Male  Submitted:2008-11-21
Location:New Hampshire  Entered:2008-11-26, 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: Trivisol
Current Illness: None
Preexisting Conditions: Preterm 35 wk infant
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3177AA0IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC400310IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0595X0PO 
Administered by: Private     Purchased by: Public
Symptoms: Incorrect drug dosage form administered
SMQs:
Write-up: None. Pt. was given HIB component of PENTACEL mixed w/ sterile water and no DTaP/IPV component. No adverse effects. Will require repeat vaccination.

VAERS ID:333359 (history)  Vaccinated:2008-11-21
Age:53.0  Onset:2008-11-23, Days after vaccination: 2
Gender:Female  Submitted:2008-11-26, Days after onset: 3
Location:Nebraska  Entered:2008-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2749AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Pruritus, Skin warm, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: redness, swelling- induration of 5 cm x 6 cm. Warm to touch, severe itching tenderness

VAERS ID:333436 (history)  Vaccinated:2008-11-21
Age:1.3  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-11-26, Days after onset: 5
Location:California  Entered:2008-11-26
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: FTT
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUTZ782CA0IMRL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever 104. ER trip.

VAERS ID:333398 (history)  Vaccinated:2008-11-21
Age:24.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-11-27, Days after onset: 5
Location:Wisconsin  Entered:2008-11-27
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: exercise-induced asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Abdominal discomfort, Chest discomfort, Cough, Diarrhoea, Dyspepsia, Haemoptysis, Headache, Malaise, Nausea, Oropharyngeal pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Fever 100.4 11/22, cough from 11/24 till present, brown sputum with streaks of blood for four a.m.''s following vaccine, severe sore throat upon a.m. awakening from time of vaccine till present, upper abdominal discomfort on right and left sides on 11/22, diarrhea on 11/22, runny nose from 11/24 till present, severe nausea on 11/22, headache on 11/22, feeling of mailaise on 11/22, chest tightness, heartburn.

VAERS ID:333430 (history)  Vaccinated:2008-11-21
Age:61.0  Onset:2008-11-24, Days after vaccination: 3
Gender:Female  Submitted:2008-11-27, Days after onset: 3
Location:Maryland  Entered:2008-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin; BP Med
Current Illness: Wound to leg (cellulitis)
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3030AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient describes that 3 days after receiving vaccine that her arm near injection site became hard and red. It has progressively gotten worse and is now itchy. Pt. applying ice and will start BENADRYL 25 mg po q 6 hours.

VAERS ID:333484 (history)  Vaccinated:2008-11-21
Age:25.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-12-01, Days after onset: 9
Location:New York  Entered:2008-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.09084 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Hypoaesthesia, Palpitations, Panic disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)
Write-up: Patient experienced shortness of breath beginning one day after her MMR vaccine. Patient was hospitalized due to sypmtoms. 12/2/08-records received for DOS 11/21/08-ED visit for C/O palpitations, numbness in hands sense of impending doom. DX: Panic disorder without agoraphobia. Observed and discharged home.

VAERS ID:333649 (history)  Vaccinated:2008-11-21
Age:51.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-12-02, Days after onset: 11
Location:Pennsylvania  Entered:2008-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diovan, Vesicare, Femtrace, Effexor
Current Illness: None
Preexisting Conditions: High BP, Allergies to Penicillin, Tetracycline, codeine
Diagnostic Lab Data: None known
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2806AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0989U0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Hyperhidrosis, Inflammation, Oedema peripheral, Pain in extremity, Pyrexia, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: PPV administered @ 3 PM. By 6 PM pt. reports arm swollen and very painful. By 9 PM pt. reports she felt feverish, chills, vomited, diaphoretic. Seen by PCP 11/24/08. Prescribed 6 day course of steroids to reduce inflammation and swelling. Pt. reports each day the arm is improving. Last conversation with patient 11/26/08.

VAERS ID:333689 (history)  Vaccinated:2008-11-21
Age:0.3  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-12-02, Days after onset: 11
Location:New York  Entered:2008-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Seen in ER. Possible ALTE. Transferred to another hospital. Observed and released.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSB149AA1IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUF445AA1IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD010751IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0899X1PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Livedo reticularis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Healthy 3 1/2 month female infant received immunization PEDIARIX, ACTHIB, PREVNAR and ROTATEQ and dev. low grade fever with mottling of extremities and problems breathing 12 hrs later.

VAERS ID:333693 (history)  Vaccinated:2008-11-21
Age:51.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-12-02, Days after onset: 11
Location:Nebraska  Entered:2008-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1076X2IMRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Oedema peripheral, Pain, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 11/21/08-"Pain began evening of 11/21/08 (several hours after receiving injection). Swelling, reddness warmth began 11/22/08 above & below elbow on right arm. Saw primary MD 11/24/08. Symptoms subsided that evening. No antibiotics needed".

VAERS ID:333723 (history)  Vaccinated:2008-11-21
Age:49.0  Onset:2008-11-29, Days after vaccination: 8
Gender:Male  Submitted:2008-12-03, Days after onset: 4
Location:Virginia  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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER    
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Military     Purchased by: Unknown
Symptoms: Cellulitis, Eschar, Induration, Lymphadenopathy, Lymphangitis, Paronychia, Post vaccination autoinoculation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt received smallpox vaccine in L deltoid. He reports scratching the vaccination site with his R hand and developed induration with eschar formation on his R thumb. Eschar similar in appearance to L detoid innoculation site eschar. Pt reports biting his fingernails. He has a R thumb paronychia with cellulitis and lymphatic streaking proximally to R forearm and B/L axillary and inguinal LAD. Clinical diagnosis of R thumb autoinoculation with paronychia/cellulitis presumed to be GAS. Treated with IM ceftriaxone and PO clindamycin.

VAERS ID:333725 (history)  Vaccinated:2008-11-21
Age:32.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-12-03, Days after onset: 12
Location:New York  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: latex, prednisone, asthma,IC, acid reflux, environmental allergies, animal dander allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2849AC2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthma, Cough, Dysphagia, Eye discharge, Eye swelling, Ocular hyperaemia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Extreme bilat eye redness and swelling with purulent drainage. Asthma attack, coughing, trouble swallowing.

VAERS ID:333759 (history)  Vaccinated:2008-11-21
Age:0.6  Onset:2008-11-26, Days after vaccination: 5
Gender:Male  Submitted:2008-11-28, Days after onset: 2
Location:Pennsylvania  Entered:2008-12-03, Days after submission: 5
Life Threatening? No
Died? Yes
   Date died: 2008-11-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac
Current Illness: Minimal URI
Preexisting Conditions: "Snoring" per ENT; No sleep apnea; GERD 3/9/09-records received-per parent patient suffered from sleep apnea from birth and sometimes snore when sleeping. Antibiotic therapy for recent throat problem. Born 4 weeks premature.
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B198AA2UNLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU22787CA0UNRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD031252UNRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.096882PO 
Administered by: Private     Purchased by: Private
Symptoms: Apnoea, Death, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow)
Write-up: 5 days after vaccines administered pt was found face-down in crib not breathing. Resuscitation not successful. No other signs of illness. Presumed SIDS vs suffocation. 3/9/09-autopsy report received-COD Sudden Infant Death Syndrome.

VAERS ID:333904 (history)  Vaccinated:2008-11-21
Age:9.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-12-04, Days after onset: 13
Location:Colorado  Entered:2008-12-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2800CA4IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swelled from elbow to above shoulder 2 to 3 times normal. Was hot, red, itchy and painful lasting 7 days. Was given claritin daily for one week to help with itching. Cold packs applied for several days. Onset was several hours after injection.

VAERS ID:334026 (history)  Vaccinated:2008-11-21
Age:45.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-12-04, Days after onset: 13
Location:Wisconsin  Entered:2008-12-05, 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: [therapy unspecified]; LESCOL XL
Current Illness: Asthma; Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: diagnostic laboratory, 11/24/08, blood work - could not test him for any allergies regarding PNEUMOVAX 23
CDC 'Split Type': WAES0812USA00340
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: Anaphylactic shock, Blood pressure decreased, Blood test, Dyspnoea, Erythema, Pulse absent, Swelling face, Tremor
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a consumer concerning her 45 year old husband with asthma and penicillin allergy who on 21-NOV-2008 was vaccinated with PNEUMOVAX 23 and influenza virus vaccine (unspecified) in the physician''s office. Concomitant therapy included "SIMBACOURT" and LESCOL XL. On the same day, "about a minute after receiving PNEUMOVAX 23 vaccine", the patient went into full blown anaphylactic shock. The patient''s blood pressure went to 40/0, he did not have a pulse, his face was swollen and red, he had shortness of breath and had the shakes. Since this happened at the physician''s office, the patient was kept on IV drips for 3.5 hours, given epinephrine (manufacturer unspecified), BENADRYL (manufacturer unspecified) and another steroid (name and manufacturer unspecified). Once the office gave the patient these medications, the patient''s carotid pulse was good and his blood pressure came back up. The patient did not have to be hospitalized and he did not go to the hospital, but he was monitored at the physician''s office and went home later that day. The physician''s office gave the patient an EPI pen to take home with him. The consumer reported that the patient recovered on 22-NOV-2008. The patient went to see an allergist on 24-NOV-2008 who did some blood work. But the allergist stated that they could not test him for any allergies regarding PNEUMOVAX 23 vaccine. Upon internal review, anaphylactic shock was considered to be other important medical event. Additional information has been requested.

VAERS ID:334325 (history)  Vaccinated:2008-11-21
Age:51.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-12-02, Days after onset: 10
Location:Nebraska  Entered:2008-12-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 10mg g D
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: To Dr- got kennalog inject ordered PT with electrical stem
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR42849AC0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Burning sensation, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Achy on day of injection then noted tingling burning from lateral aspect of scapula thru shoulder down (L) arm thru lateral aspect of elbow joint continuing down arm thru to pulmar side of hand- numbness and tingling- tried hot/cold compresses, Tylenol, aleu, Ibuprofen Repostan no relief.

VAERS ID:334329 (history)  Vaccinated:2008-11-21
Age:54.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-12-04, Days after onset: 13
Location:North Carolina  Entered:2008-12-09, 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: DIOVAN; OMOPRAZOLE; VIT; MG; FE; FLOMAX; Fish Oil; VICODIN
Current Illness: No
Preexisting Conditions: Allergies, TETRACYCLINE; PMH, HTN, BPH
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89999 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt received vaccine on 11/4 & called on 12/3 to report that his arm was continuing to feel tender & appeared to be swollen. His MD has been notified.

VAERS ID:334367 (history)  Vaccinated:2008-11-21
Age:41.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-23, Days after onset: 2
Location:Maryland  Entered:2008-12-09, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2753AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Aphonia, Cough, Dyspnoea, Eye swelling, Nasal congestion, Oropharyngeal pain, Pain, Pallor, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Started w/ coughing to clear throat losing voice some trouble getting a full breath. About an hour later started w/ body aches, sore throat fever, stuffed nose. Pale and swelling under eyes. Took Benadryl and Ibuprofen. Felt mostly better the next day.

VAERS ID:334404 (history)  Vaccinated:2008-11-21
Age:36.0  Onset:2008-11-23, Days after vaccination: 2
Gender:Female  Submitted:2008-11-25, Days after onset: 2
Location:Connecticut  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: Lisinopril; LOVAZA; ZANTAC; ZORCOR
Current Illness:
Preexisting Conditions: HTN; high cholesterol; thickened LV
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site warmth, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 11/21/08, ADACEL given 3:45 pm. 11/23/08, 11:50 AM, pt. called, (L) axillary lymph node area red and very sore where injection given. Negative fever, positive erythema, warmth, tenderness.

VAERS ID:334428 (history)  Vaccinated:2008-11-21
Age:49.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 3
Location:Washington  Entered:2008-12-09, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2831AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Conjunctivitis, Cough, Pyrexia, Wheezing
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: Conjunctivitis, fever, rigors, cough, wheezing.

VAERS ID:334463 (history)  Vaccinated:2008-11-21
Age:6.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Male  Submitted:2008-11-24, Days after onset: 2
Location:Colorado  Entered:2008-12-09, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2761AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Local reaction
SMQs:
Write-up: Local site reaction - no treatment.

VAERS ID:334549 (history)  Vaccinated:2008-11-21
Age:37.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 3
Location:Maine  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:
Other Medications:
Current Illness: None
Preexisting Conditions: Seasonal Unknown
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3030AA IMRA
Administered by: Public     Purchased by: Other
Symptoms: Burning sensation, Erythema, Oedema peripheral, Pruritus, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right deltoid 4.5 inch annular area, warm, raised. Uniform in color, reddened. Complain of tenderness, itching and burning. Over the counter Ibuprofen and Ice.

VAERS ID:334625 (history)  Vaccinated:2008-11-21
Age:62.0  Onset:2008-12-01, Days after vaccination: 10
Gender:Female  Submitted:2008-12-09, Days after onset: 8
Location:Nevada  Entered:2008-12-09
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: Confirmed shingles by PMD
CDC 'Split Type':
Vaccination
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VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1415X0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: Ct. received shingles vaccine on 11/21/08. Outbreak of shingles on 12/1/08. MD visit on 12/5/08 and was informed by MD to call to report to manufacturer.

VAERS ID:334664 (history)  Vaccinated:2008-11-21
Age:45.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-29, Days after onset: 8
Location:Montana  Entered:2008-12-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899980IMRA
Administered by: Other     Purchased by: Private
Symptoms: Activities of daily living impaired, Headache, Injection site induration, Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: 2 day duration localized, moderate induration and swelling at injection site; followed by approx 5 days moderate, generalized body myalgia negatively affecting daily activities. Associated HA throughout duration of symptoms.

VAERS ID:334666 (history)  Vaccinated:2008-11-21
Age:19.0  Onset:2008-11-26, Days after vaccination: 5
Gender:Male  Submitted:2008-12-04, Days after onset: 8
Location:North Carolina  Entered:2008-12-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No known drug,food,medication or latex allergies. No active medical illnesses, no birth defects
Diagnostic Lab Data: Troponin, negative; CPK, normal; CPK-MB, negative; CBC, normal
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB195AB IMUN
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER  OTUN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB03472 IMUN
Administered by: Military     Purchased by: Military
Symptoms: Axillary pain, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal, Chest pain, Erythema, Full blood count normal, Influenza like illness, Injection site reaction, Pain, Pruritus, Troponin
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 19 year old male, ADSM, is referred by primary care physician to FBVHC for evaluation of smallpox vaccine inoculation site concerns and left axillary pain. Symptoms: flu-like symptoms <96 hours, chest pain, pain, erythema, pruritus

VAERS ID:334686 (history)  Vaccinated:2008-11-21
Age:0.6  Onset:2008-11-23, Days after vaccination: 2
Gender:Female  Submitted:2008-11-26, Days after onset: 3
Location:Missouri  Entered:2008-12-09, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUT2782FA0IMLL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Mom states patient developed fevers Sunday night & continues to run 99-101 degree F. No other symptom. States has been giving TYLENOL. Instructed to notify physician.

VAERS ID:334760 (history)  Vaccinated:2008-11-21
Age:45.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 3
Location:Alaska  Entered:2008-12-09, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
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ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV1496SCLA
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURERB03470IMLA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Erythema, Joint stiffness, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad)
Write-up: Anthrax vaccine 11/21/08. Swelling, redness, itching of bicep. Progressed to shoulder and elbow joint stiffness/pain. Visit MD 11/24/08.

VAERS ID:335043 (history)  Vaccinated:2008-11-21
Age:53.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Male  Submitted:2008-12-11, Days after onset: 19
Location:Washington  Entered:2008-12-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Physician stated probably a reaction to the shot as he exibited flu like symptoms, however probably not allergy to shot as no hives.
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA183AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Anorexia, Arthralgia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Approx 16 hours after vaccination patient began experiencing aching joints and muscle pain approx 20 hours after vaccination he began getting a fever - fever reached 102.7. Approx 40 hours after vaccination fever would not go down took him to minor emergency where they kept him for 4 hours giving him an iv to re-hydrate him and got fever down to 100.3 and sent us home. Upon arriving home fever increased again to 102.4. At approx 52 hours after vaccination fever began to break. Patient spent 5 days in bed, missing 3 days of work. Could not eat for 4 1/2 days of this.

VAERS ID:335162 (history)  Vaccinated:2008-11-21
Age:34.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-12-11, Days after onset: 19
Location:New York  Entered:2008-12-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol; ZYRTEC; KLONOPIN; FLONASE; ADVAIR; ZADITOR; minerals (unspecified) (+) vitamins; PATANASE
Current Illness: anxiety; asthma; Drug hypersensitivity; Environmental allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0812USA01585
Vaccination
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0868X0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Chills, Injection site swelling, Pyrexia, Sepsis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a nurse concerning a female with prednisone, antidepressants, environmental items allergies, anxiety and asthma who on 21-NOV-2008 was vaccinated with the first dose of PNEUMOVAX 23. Concomitant therapy included KLONOPIN, minerals (unspecified) (+) vitamins (unspecified), FLONASE, ADVAIR, albuterol, ZYRTEC, ZADITOR and PATANASE NASAL SPRAY. The patient developed sepsis and cellulitis after her first vaccination with PNEUMOVAX 23. On 22-NOV-2008 the day after vaccination, the patient developed chills and fever and her arm swelled from elbow to deltoid. The patient went to emergency room and was admitted to hospital for three days. While hospitalized she received oxacillin. On unspecified date, the patient recovered from sepsis, cellulitis and chills. Additional information has been requested.

VAERS ID:335258 (history)  Vaccinated:2008-11-21
Age:36.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-12-12, Days after onset: 20
Location:Texas  Entered:2008-12-12
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
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVBGX0BA0IMUN
Administered by: Public     Purchased by: Unknown
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash all over body- No treatment

VAERS ID:335311 (history)  Vaccinated:2008-11-21
Age:39.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:2008-12-15
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: Morphine allergy
Diagnostic Lab Data: Chest X-rays
CDC 'Split Type':
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1481IMRA
Administered by: Military     Purchased by: Military
Symptoms: Chest X-ray, Chest discomfort, Cough, Pain, Rash, Respiratory tract congestion
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (narrow)
Write-up: 1 day after 2nd ANTRAX had severe body aches. 4 days after developed rah on arm where shot was given as well as chest tightness, congestion and cough. Took BENADRYL and prescription cough medicine.

VAERS ID:335333 (history)  Vaccinated:2008-11-21
Age:68.0  Onset:2008-12-05, Days after vaccination: 14
Gender:Female  Submitted:2008-12-15, Days after onset: 10
Location:Wisconsin  Entered:2008-12-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Artificial tear Ointment (Lacri-Lube), Calcium, Cod Liver Oil, Vitamin B-12, Docusate Sodium, Doneprezil, Levothyroxine, Oxybutynin Chloride, Pseudoephedrine prn, Psyllium powder.
Current Illness: none
Preexisting Conditions: No known drug allergies, no known birth defects.
Diagnostic Lab Data: Varicella Zoster Antigen VZ-Ag - Positive (Lesion on R foot) HSV Antigen was negative on R foot.
CDC 'Split Type':
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VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1416X0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Herpes simplex serology negative, Rash pruritic, Rash vesicular, Varicella zoster virus serology positive
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient developed vesicular clusters with about 10 vesicles over about a 3 centimeter diameter on the inside of her right arch and then has a similar cluster up on the outside of her right thigh. No other rash is noted around her right leg. Has no apparent pain in her back or buttock. This began on 12/5/08, just 14 days after receiving Zostravax. Patient stated that this rash itches but no significant pain associated with it. Patient was started on Prednisone 20 mg. 2 tabs (40 mg.) x 4 days, then 1 tab for 4 days. Valacyclovir 1 G tabs, 1 tab 3 times a day x 7 days.

VAERS ID:336567 (history)  Vaccinated:2008-11-21
Age:  Onset:0000-00-00
Gender:Female  Submitted:2008-12-12
Location:Unknown  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:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0811USA03660
Vaccination
Manufacturer
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HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Mass
SMQs:
Write-up: Information has been received from a physician concerning a female who on 21-NOV-2008 was vaccinated with a second dose of GARDASIL. The patient experienced a lump in right arm after second dose of GARDASIL. The patient sought unspecified medical attention. At the time of reporting, the patient''s outcome was unknown. Additional information has been requested.

VAERS ID:335653 (history)  Vaccinated:2008-11-21
Age:38.0  Onset:2008-12-15, Days after vaccination: 24
Gender:Female  Submitted:2008-12-18, Days after onset: 3
Location:Kentucky  Entered:2008-12-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No: Pt. stated well
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899720IMLA
Administered by: Other     Purchased by: Private
Symptoms: Bursitis, Vaccination complication
SMQs:
Write-up: Pt. diagnosed with bursitis due to flu vaccine. Going into joint spur and not muscle. Required multiple MD visits and physical therapy due to illness.

VAERS ID:335658 (history)  Vaccinated:2008-11-21
Age:1.3  Onset:2008-12-03, Days after vaccination: 12
Gender:Female  Submitted:2008-12-18, Days after onset: 15
Location:California  Entered:2008-12-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: X-ray (-)
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2785CA0IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1291X0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1192X0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Weight bearing difficulty, X-ray normal
SMQs:, Arthritis (broad)
Write-up: Vaccine received 11/21/08. Pt presented 12/3/08 with inability to bear weight on (L) leg - no trauma, no recent illness, no fever, (-) X-ray, on 12/8 had wrist pain post MMR Arthralgia.

VAERS ID:335749 (history)  Vaccinated:2008-11-21
Age:13.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2008-12-17, Days after onset: 26
Location:Missouri  Entered:2008-12-19, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2815AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Received MENACTRA vaccine 11/21/08. On same evening fever 104, general aching all over and nausea. Last approximately 24-48 hours.

VAERS ID:335777 (history)  Vaccinated:2008-11-21
Age:24.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-12-19, Days after onset: 28
Location:Florida  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: None
Current Illness: None
Preexisting Conditions: Aspirin allergy.
Diagnostic Lab Data: N/A
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.1522U0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3027AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Cold sweat, Dizziness, Injection site erythema, Injection site pruritus, Pallor
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Gardasil administered to left deltoid IM. Client complained of feeling dizzy approx. 15 - 25 seconds later. Slight paleness to skin and hands clammy. 2nd nurse called to assist. Feet were propped up, cold compresses applied, client stated approx 5 - 7 minutes later that she was feeling better. Client left office on own accord, with mother, after approx. 10 minutes of observation. When client presented to another clinic in health department she refused 2nd Gardasil shot with complaints of feeling weak for 2 days post vaccine. Further stated that injection site was itching and red.

VAERS ID:335807 (history)  Vaccinated:2008-11-21
Age:27.0  Onset:2008-12-15, Days after vaccination: 24
Gender:Female  Submitted:2008-12-19, Days after onset: 4
Location:Illinois  Entered:2008-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR, 40mg; CLOBETASOL, 0.05
Current Illness:
Preexisting Conditions: KNA or medical conditions
Diagnostic Lab Data: Neurology exam, negative per patient
CDC 'Split Type':
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HPV4: HPV (GARDASIL)MERCK & CO. INC.0737U1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Laboratory test, Neurological examination normal, Pain in extremity
SMQs:
Write-up: Her whole arm hurts. Hurts most on her deltoid and travels down her arm. Has seen MD to get labs done and neurology exam.

VAERS ID:336397 (history)  Vaccinated:2008-11-21
Age:63  Onset:2008-11-24, Days after vaccination: 3
Gender:Female  Submitted:2009-01-03, Days after onset: 40
Location:Alaska  Entered:2009-01-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Visual verification of Shingles lession. Shingles started on side and went around the torso following a typical patern.
CDC 'Split Type':
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VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1415X0SCRA
Administered by: Unknown     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: Patient developed Shingles 3 days after vaccination. Patient had no prior history of Shingles, was not ill, had not been ill for atleast 3 months prior to vaccination and did not have a history or reason for a low WBC or other immunilogical problems.

VAERS ID:336510 (history)  Vaccinated:2008-11-21
Age:57  Onset:2008-11-22, Days after vaccination: 1
Gender:Male  Submitted:2009-01-05, Days after onset: 44
Location:Massachusetts  Entered:2009-01-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None now
Diagnostic Lab Data: X-ray of shoulder; MRI
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA191AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, Mobility decreased, Pain, Sleep disorder
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain at injection site x 2 days. On 3rd day radiated to L shoulder at deltoid. Constant throbbing pain, restricts mobility. Severe enough to wake from sleep. On going problem.

VAERS ID:337115 (history)  Vaccinated:2008-11-21
Age:26  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-12-23, Days after onset: 32
Location:Missouri  Entered:2009-01-13, 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: Ankylosing spondylitis
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0811USA03927
Vaccination
Manufacturer
Lot
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Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a female registered with ankylosing spondylitis. Who on 21-Nov-2008 was vaccinated with a dose of ZOSTER vaccine (lot # not provided). After vaccination, nurse developed a very large welt, about 3-4 inches in diameter on her left arm. The nurse also experienced swelling, warmth and soreness at the site. The nurse reported that she used cold compresses to reduce swelling of the welt. The area was still red and sore 24-Nov-2008. At the time of reporting (24-Nov-2008) the outcome of the very large welt, swelling and warmth was not reported. Additional information has been requested. Follow-up information has been received from a registered nurse a 46 year old female with ankylosing spondylitis. Who on 21-Nov-2008 was vaccinated with a dose of ZOSTER vaccine (lot #658205/1085U) subsequently. On 10-OCT-2008 the reporter was vaccinated with FLUZONE and pneumococcal vaccine, polyval (MSD). On 22 NOV-2008 the patient developed red, warm at the site, hard induration starting at approximately 3x5 cm increasing to approximately 8x12 cm. painful and itching and had a patch of shingles down the center of the induration. The patient was prescribed with (MEDROL DOSE PACK). On 28-NOV-2008 the patient recovered. Additional information is not expected.

VAERS ID:337194 (history)  Vaccinated:2008-11-21
Age:18  Onset:2008-11-22, Days after vaccination: 1
Gender:Male  Submitted:2009-01-13, Days after onset: 52
Location:New York  Entered:2009-01-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB555AA4IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURV2727AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2937BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1010X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Night of vaccines pt broke out in hives, lg itchy red welts --$g both arm, back and chest. Benadryl given and change to Zyrtec.

VAERS ID:337195 (history)  Vaccinated:2008-11-21
Age:16  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2009-01-13, Days after onset: 53
Location:New York  Entered:2009-01-13
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: Controlled asthma
Diagnostic Lab Data: None
CDC 'Split Type':
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500561P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Cough, Fatigue, Hyperhidrosis, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad)
Write-up: Mom stated child had congestion, sweats, tiredness and cough since given FLUMIST. Advised to use asthma meds and follow up w/ MD if symptoms worsen.

VAERS ID:338577 (history)  Vaccinated:2008-11-21
Age:  Onset:2008-12-12, Days after vaccination: 21
Gender:Female  Submitted:2009-01-16, Days after onset: 35
Location:Illinois  Entered:2009-01-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hyperlipidaemia
Preexisting Conditions:
Diagnostic Lab Data: Neruological examination, negative
CDC 'Split Type': WAES0812USA03225
Vaccination
Manufacturer
Lot
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Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0137U1IMUN
Administered by: Other     Purchased by: Private
Symptoms: Neurological examination normal, Pain in extremity
SMQs:
Write-up: This is in follow-up to report (s) previously submitted on 1/16/2009. Information has been received from a pharmacist, concerning a female patient with hyperlipidaemia and no known drug reactions or allergies, who on 11-SEP-2008 was vaccinated with the first dose of GARDASIL, 0.5ml, intramuscularly and on 21-NOV-2008 was vaccinated with the second dose of the HPV vaccine (Lot # 655165/0137U), 0.5ml, intramuscularly. Concomitant therapy included LIPITOR and clobetasol propionate cream. The pharmacist reported the patient developed arm apin 3 weeks after the second dose of vaccination date. At the time of ther report, the pain has not resolved. Follow-up information received from pharmacist indicated that the patient had no known drug reaction/allergies or any medical condition, who on 21-NOV-2000 at 15:30 pm, the patient was vaccinated with the second dose of GARDASIL in the left deltoid. On 15-DEC-2008, the patient developed arm pain, most on deltoid area and traveled down her arm. A neurology exam was performed resulting negative per patient. At the time of the report, the patient had recovered. No further information is available.

VAERS ID:338663 (history)  Vaccinated:2008-11-21
Age:25  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2009-01-16, Days after onset: 56
Location:Illinois  Entered:2009-01-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0812USA04143
Vaccination
Manufacturer
Lot
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Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X2IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site induration, Injection site pain, Nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a physician concerning a 25 year old female with no pertinent medical history or allergies who on 21-NOV-2008 was vaccinated intramuscularly in her right deltoid with 0.5 ml third dose of GARDASIL (lot # 660557/0072X). Concomitant therapy included an unspecified birth control medication. On 21-NOV-2008 the patient developed an induration "about the size of a dime" at the injection site of the right deltoid muscle. The area was painful to touch, The physician added that the patient had a similar knot near her vagina. The patient contacted the office via phone. No laboratory or diagnostics test were performed. At the time of this report, as 18-DEC-2008, the events persisted. Additional information has been requested.

VAERS ID:338064 (history)  Vaccinated:2008-11-21
Age:4  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-21, Days after onset: 0
Location:Idaho  Entered:2009-01-23, Days after submission: 63
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: None~ ()~~0~Patient
Other Medications:
Current Illness:
Preexisting Conditions: Hx milk prior-allergy as infant resolved. Lx ALTR cano w/residual HSE
Diagnostic Lab Data: Epinephrine given IM @ 1615
CDC 'Split Type': ID08048
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B087CA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA02983IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1079X1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Angioedema, Drooling, Injection site urticaria, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Developed angio edema of face, large wheal @ inj site of MMR @ 10 minutes. Uricaria over truck & limbs by 20 minutes & some drooling -$g im epinephrine given

VAERS ID:338920 (history)  Vaccinated:2008-11-21
Age:0.2  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2009-01-27, Days after onset: 67
Location:North Carolina  Entered:2009-02-03, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type': NC09009
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3180AA0IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0062X0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC400710IMRL
Administered by: Private     Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: High pitch screaming x 48 hrs.

VAERS ID:340355 (history)  Vaccinated:2008-11-21
Age:23  Onset:0000-00-00
Gender:Female  Submitted:2009-02-12
Location:Unknown  Entered:2009-02-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No Relevant Data~ ()~~0~In Patient
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0901USA03940
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0575X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Furuncle, Injection site pustule, Purulence
SMQs:
Write-up: Information has been received from a nurse practitioner concerning a 23 year old female patient with no pertinent medical history and no known drug allergies, who on 21-NOV-2008 was vaccinated with the first dose of GARDASIL vaccine (lot # 661530/0575X) 0.5 ml intramuscularly. There was no concomitant medication. The patient experienced puss-filled boils around the site of injection (2008). The boils "come and go" for the last eight weeks. She had had a total of 8-10 boils so far. The patient had a tattoo on her left arm (around the deltoid area) which she had had for years prior to receiving the vaccine. The patient''s puss-filled boils around the site of injection persisted. The patient sought medical attention. Additional information has been requested.

VAERS ID:340251 (history)  Vaccinated:2008-11-21
Age:21  Onset:2008-11-23, Days after vaccination: 2
Gender:Female  Submitted:2009-02-20, Days after onset: 89
Location:New York  Entered:2009-02-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none PMH: migraine HA x 3 yrs. Vertigo. Factor V Leiden WNL. Family hx: endometrial ca, CVA. 9/19/08 HPV#1, no lot # available.
Diagnostic Lab Data: Brain CT scan, brain MRI, Factor 5 blood test, FISH blood test, lyme disease, CBC, Evoked potential test. LABS: PAP smear neg. CBC, BMP & CT of brain WNL.MRI brain & evoked potentials WNL. Chromosome tests WNL. Antithrombin III & anti
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0752X1 UN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arterial insufficiency, Ataxia, Balance disorder, Blindness unilateral, Borrelia burgdorferi serology, Brain stem auditory evoked response normal, Cardiolipin antibody negative, Chromosome analysis normal, Computerised tomogram normal, Condition aggravated, Diplopia, Dizziness, Fluorescent in situ hybridisation, Headache, Hypoaesthesia, IVth nerve paralysis, Injection site mass, Metabolic function test normal, Migraine, Nausea, Nuclear magnetic resonance imaging brain normal, Platelet count increased, Scan brain, Smear cervix normal, Somatosensory evoked potentials, Thrombin-antithrombin III complex normal, Thrombocythaemia, Thrombosis, Tinnitus, Transient ischaemic attack, Vision blurred, Visual evoked potentials normal
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic cerebrovascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow)
Write-up: Loss of balance, double vision, dizziness, nausea, abnormally high blood platelet count. 3/12/09 Received ER medical records of 11/28/2008. FINAL DX: migraine HA; dizziness Records reveal patient experienced dizziness & blurred vision right eye, nausea x 3 days. Seen by neuro, dx w/migraine & scheduled for ophtho eval all as outpatient. PCP requested CT scan. Remained stable in ER & d/c to home w/PCP & neuro f/u. 4/16/09 Received vaccine & PCP medical records of 6/21/07-3/12/09. FINAL DX: likely TIA due to thrombocytosis Records reveal patient experienced good general health on 9/19/07 for HPV #1 & tol well. RTC 11/20 only for HPV #2. RTC 12/11/08 for Heme consult & dx w/thrombocytosis & on baby ASA; had lump left arm x 1 mo. RTC 12/30 w/ double vision. Neuro consult done 1/8/09 reveals pt w/dizziness & double vision & seen in ER. Previous optometry exam revealed stroke/clot right eye. Now w/double vision intermittently. Tx w/meds. RTC 3/12/09 meds changed. RTC 3/19/09 states 2 days s/p HPV#2, lost balance, lost vision right eye x 3 days & nauseated. 6/16/09 Received Neuro-Ophtho medical records of 6/4/09. FINAL DX: episode of sudden vision loss on 11/23/08; episodic diplopial blurriness; ataxia & imbalance; episodic numbness, tinnitus; daily migraines; r/o vertebral/basilar insufficiency; questionable right 4th nerve palsy. 6/17//09 Medical and neurology records received DOS 9/29/03 to 4/23/09. Assessment: Dizziness, migraine, diplopia. Patient c/o dizziness, migraine, diplopia, lightheaded, headache.

VAERS ID:341251 (history)  Vaccinated:2008-11-21
Age:7  Onset:2008-11-23, Days after vaccination: 2
Gender:Male  Submitted:2009-01-30, Days after onset: 68
Location:Wisconsin  Entered:2009-03-06, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling red hot left arm pain Tylenol and ice

VAERS ID:341284 (history)  Vaccinated:2008-11-21
Age:32  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2009-03-06, Days after onset: 104
Location:California  Entered:2009-03-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Migraine headaches controlled on topamax
Preexisting Conditions: none
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA178AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3028AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pain in jaw
SMQs:, Osteonecrosis (broad)
Write-up: The morning after receiving the Tdap, along with a trivalent flu shot, the patient reported jaw pain on the left side that "hurt like hell" and persisted for several days.

VAERS ID:343449 (history)  Vaccinated:2008-11-21
Age:6  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2009-03-04, Days after onset: 103
Location:South Dakota  Entered:2009-03-18, Days after submission: 13
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 concomitant mediations or relevant medical history. No adverse events were reported with previous vaccinations.
Diagnostic Lab Data: UNK
CDC 'Split Type': A0758584A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS 1UNLA
Administered by: Private     Purchased by: Other
Symptoms: Vaccination complication, Wrong technique in drug usage process
SMQs:
Write-up: This case was reported by a healthcare professional and described the occurrence of vaccination complication in a 6-year-old female subject who was vaccinated with HAVRIX for prophylaxis. Previous and/or concurrent vaccination included FLUMIST; manufacturer unspecified given on 21 November 2008. On 21 November 2008 at 15:45, the subject received 2nd dose of HAVRIX (.5 ml, unknown, left arm). On 21 November 2008, at the time of vaccination with HAVRIX, the subject experienced vaccination complication and accidental blood exposure. The reported noticed when the administering nurse drew back the syringe prior to injecting HAVRIX there was blood in the vaccine (vaccine complication). The vaccine was given in this manner and no adverse events have been experienced. At the time of reporting the outcome of the events were unspecified.

VAERS ID:342254 (history)  Vaccinated:2008-11-21
Age:23  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2009-03-13, Days after onset: 110
Location:Minnesota  Entered:2009-03-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': WAES0902USA03560
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site erythema
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Information has been received form a nurse concerning a 23 year old female who on 21-NOV-2008 was vaccinated injection with the first dose of GARDASIL (lot # not reported). After received the first dose of GARDASIL, on 22-NOV-2008 the patient''s face was red and she had redness at the site of where the band aid was. The patient recovered from adverse events after some time. The nurse reported that on 23-JAN-2009 they decided they were going to wait to give the second dose of GARDASIL. It was reported that the patient did not seek medical attention. Additional information has been requested.

VAERS ID:343582 (history)  Vaccinated:2008-11-21
Age:19  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2009-04-06, Days after onset: 134
Location:Minnesota  Entered:2009-04-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Private
Symptoms: Activities of daily living impaired, Chest pain, Walking disability
SMQs:, Dementia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Approximately 24 hours after the vaccine was received the patient had severe chest pain. The chest pain began evening and lasted for over an hour. The pain began mildly and was intermittent then increased in severity so that it was difficult for the patient to function normally, such as walking etc. The patient considered going to the emergency room of the local hospital, but the pain began to slowly subside and the patient did not go in. Temperature was not taken

VAERS ID:347270 (history)  Vaccinated:2008-11-21
Age:18  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2009-05-26, Days after onset: 185
Location:Indiana  Entered:2009-05-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SINGULAIR DAILY
Current Illness: none known
Preexisting Conditions: Allergic to dust,cats,horses and pollen/Asthma
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB280AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: tingling of lips and tongue 30 min after injection lasting 30 min

VAERS ID:350570 (history)  Vaccinated:2008-11-21
Age:4  Onset:2009-06-27, Days after vaccination: 218
Gender:Male  Submitted:2009-06-30, Days after onset: 3
Location:Nevada  Entered:2009-06-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B064AA2IMLL
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU2808AA0IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB243AA1IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA099622SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0667X1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1006X1SCRL
Administered by: Public     Purchased by: Public
Symptoms: Rash, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Child was evaluated on 6/30/09 and noted to have confirmed case of diffuse varicella. Child''s rash involved dozens of varicella lesions on trunk, back, abdomen, arms and legs, only a few on face. He appeared otherwise well without fever or other symptoms. Mild case.

VAERS ID:354156 (history)  Vaccinated:2008-11-21
Age:50  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:New Jersey  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FIORICET with Codeine; atenolol; desipramine hydrochloride; LEVOXYL
Current Illness: Drug hypersensitivity
Preexisting Conditions: Graves'' disease
Diagnostic Lab Data: None
CDC 'Split Type': WAES0811USA03950
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Erythema, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a licensed practical nurse concerning an approximately 50 year old female with drug hypersensitivity to thimerosal and a history of Graves'' disease who on 21-NOV-2008 was vaccinated IM with PNEUMOVAX 0.5ml (LOT# not reported). Concomitant therapy included atenolol, LEVOXYL, FIORICET with Codeine and desipramine. Subsequently, the patient experienced painful, red, and swollen from deltoid to elbow after administration of PNEUMOVAX. The patient experienced fever and chills. The patient was recovering from the adverse events. No lab or diagnosis studies were performed. It was reported that the patient sought medical attention: office visit. Additional information has been requested.

VAERS ID:354174 (history)  Vaccinated:2008-11-21
Age:17  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 250
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:
CDC 'Split Type': WAES0812USA01793
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1076X UNUN
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: Information has been received from a pharm D that a medical assistant stated that a 17 year old female patient who on 21-NOV-2008 was vaccinated with PNEUMOVAX. On 21-NOV-2008 the patient developed "serious cellulitis" and was treated with IV antibiotics in the Emergency room. The patient was completely symptom free as of 25-NOV-2008. This is one of several reports from the same reporter. Additional information has been requested.

VAERS ID:354189 (history)  Vaccinated:2008-11-21
Age:71  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2009-07-30, Days after onset: 250
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type': WAES0812USA02135
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1076X UNUN
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a pharm D that a medical assistant stated that a 71 year old male patient who on 21-NOV-2008 was vaccinated with PNEUMOVAX. On 21-NOV-2008 the patient developed "serious cellulitis" and presented with redness and swelling of upper arm along aspect extending downward elbow. Initially redness at injection site but this had resolved leaving mid and distal area of arm with local oedema. The patient had sought medical attention. The outcome of "serious cellulitis" was not reported. This is one of several reports by the same reporter. Additional information has been requested. Additional information has been requested.

VAERS ID:354635 (history)  Vaccinated:2008-11-21
Age:66  Onset:2009-08-14, Days after vaccination: 266
Gender:Male  Submitted:2009-08-19, Days after onset: 5
Location:Florida  Entered:2009-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin, Niaspan, Flonase Nasal Spray
Current Illness: None
Preexisting Conditions: Hyperlipidemia, Obesity
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1417X SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Herpes zoster, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: The patient came in to see the doctor with a case of the shingles. Patient was advised to apply cold compresses 4 times a day for 20 minutes to relieve pain or itching. Good handwashing to prevent the spread of germs. Acyclovir 800mg tablets twice daily. Gabapentin 300mg capsule at bedtime. Zovirax 5% external ointment applied three times a day.

VAERS ID:367177 (history)  Vaccinated:2008-11-21
Age:  Onset:2008-11-23, Days after vaccination: 2
Gender:Female  Submitted:2008-11-27, Days after onset: 4
Location:Florida  Entered:2009-11-12, Days after submission: 350
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical history, concomitant medications and illness at time of vaccination were not reported.
Diagnostic Lab Data:
CDC 'Split Type': 200803708
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Back pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: A female whose age and medical history were not reported, received an injection of Fluzone (lot number, dosage, route and site not reported) on 21 November 2008. Two hours after vaccination, the patient was brought to the reporter''s office with leg, back and abdominal pain. There was no vomiting or diarrhea. Corrective treatment was Benadryl. The outcome was not reported. The reporter would not give further information.

VAERS ID:375723 (history)  Vaccinated:2008-11-21
Age:69.0  Onset:2010-01-04, Days after vaccination: 409
Gender:Female  Submitted:2010-01-04, Days after onset: 0
Location:Kansas  Entered:2010-01-04
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: Penicillin; HTN; hyperlipidemia; Polymyalgia
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1418X0SCUN
Administered by: Private     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: Herpes Zoster after ZOSTAVAX 11/21/2008.

VAERS ID:384433 (history)  Vaccinated:2008-11-21
Age:0.0  Onset:2008-12-08, Days after vaccination: 17
Gender:Male  Submitted:2010-03-05, Days after onset: 452
Location:Unknown  Entered:2010-04-06, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Serotonin syndrome; Jaundice neonatal
Diagnostic Lab Data: rapid Streptococcus, 02/11/09, No group A beta-hemolytic strep species isolated
CDC 'Split Type': WAES0906USA01134
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Breath sounds abnormal, Cough, Crying, Decreased appetite, Irritability, Nasal congestion, Nasopharyngitis, Otitis media acute, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Streptococcus test, Streptococcus test negative, Tympanic membrane disorder, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow)
Write-up: Information has been received from medical records concerning a 3 weeks old male with a history of serotonin syndrome (SSRI) and jaundice neonatal who on 21-NOV-2008 was vaccinated with a first dose of hepatitis B virus vaccine(manufacturer unknown). On approximately 08-DEC-2008 the patient was taken to the clinic by parents for evaluation because of a 12-24 hour history of slight cough and runny nose. They reported that he had been a little fussy, but feeding. The physician''s physical exam showed that the lung was clear to auscultation without rales, rhonchi, or wheeze. Respiratory rate was 40-50 and unlabored. Impression was a 3-week newborn with an upper respiratory infection. Recommendation was bulb syringe for removing secretions and to follow up if symptoms did not improve in 3-5 days or if fever developed. On 02-JAN-2009, the baby was brought in by the mother to see the physician with primary complaints about a bad cough, rattling in his chest that started 3-4 days prior. He might have had a slight fever initially but none for the past 3-4 days. She reported that his appetite might have been a little decreased. The physicians'' examination showed clear tympanic membranes, nares slightly congested, oropharynx with good moist mucus membranes, lungs clear to auscultation without rales, rhonchi or wheeze. Respiratory rate was 40-50 and unlabored. Impression was upper respiratory infection and cough in a 6-week old infant. Recommendation was that parent was to continue to monitor him and could use TYLENOL for comfort. Also discussed use of a humidifier or a vicks vaporizer and to follow up if no improvement in 1-2 weeks. On 15-JAN-2009, the baby was vaccinated with a first dose of ROTATEQ PO, PEDIARIX in left thigh, PREVNAR IM in right thigh and ACTHIB IM in right thigh. On 11-FEB-2009 the baby was brought to clinic by father who said the baby had red cheeks, crying and had a temperature of 100 axillary. Physical exam was normal. Impression was acute fever, and rule out strep infection. A rapid Streptococcus group A test was done and was negative. Plan was to continue checks, TYLENOL BID, observe behavior and call for temp$g101, dry diaper for 6 hrs, vomiting or respiratory distress. On 17-APR-2009 the patient was brought in for a clinic visit with complaints of cold. He was pulling his right ear and had no fever. He was congested for 4 days. On examination his ears and tympanic membranes were abnormal. The abnormal findings were that his tympanic membranes was dull and bulging. The physicians'' impression was right otitis media. The plan was to put the baby on AMOXIL 125/5 and to use humidifier. Additional information is not expected. Medical records will be provided upon request.

VAERS ID:412969 (history)  Vaccinated:2008-11-21
Age:49.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2010-12-16, Days after onset: 755
Location:Ohio  Entered:2010-12-16
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: Migraines
Diagnostic Lab Data: MRI''s, X-rays, blood work.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2790BA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Asthenia, Blood test, Hypoaesthesia, Joint range of motion decreased, Muscle spasms, Musculoskeletal pain, Nuclear magnetic resonance imaging, Paraesthesia, Periarthritis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Arthritis (narrow)
Write-up: Shoulder sore and over a period of a few weeks had progressed to frozen shoulder with muscle spasms and loss of ability to raise left arm to side and behind back. Numbness and tingling to left thumb and index finger. Unable to use left arm for lifting more than 5# for 10 months then was very weak. Went thru several months of physical therapy and one shoulder manipulation procedure along with numerous anti-inflammatory drugs. Over the course of 2 years the shoulder pain has progressed to other joints and I am now seeing a rheumatologist for this. I am still unable to use my left arm to its full potential due to the limited range of motion which has resulted from the flu shot.

VAERS ID:414316 (history)  Vaccinated:2008-11-21
Age:0.2  Onset:2010-01-05, Days after vaccination: 410
Gender:Male  Submitted:2011-01-08, Days after onset: 368
Location:Massachusetts  Entered:2011-01-08
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no known
Preexisting Conditions: possible kidney blockage was treated with antibiotics from birth-3weeks of age. Child developed c diff
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B139AA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF254AC0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC990800IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1192U0PO 
Administered by: Private     Purchased by: Other
Symptoms: Food allergy, Hypersensitivity, Immunodeficiency, Injection site eczema, Milk allergy
SMQs:, Angioedema (broad), Hypersensitivity (narrow)
Write-up: Eczema at injection sites on both legs. Now has Immunological Hypersensitivity reactivity to milk, eggs & possibly more.

VAERS ID:341189 (history)  Vaccinated:2008-11-21
Age:3.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Male  Submitted:2009-03-05, Days after onset: 104
Location:Foreign  Entered:2009-03-05
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': B0562310A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B101AC4IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERAC20B101AC4IMLA
Administered by: Other     Purchased by: Other
Symptoms: Cold sweat, Crying, Dizziness, Fatigue, Gaze palsy, Hyperhidrosis, Hypotonia, Injection site pain, Injection site swelling, Malaise, Nausea, Pallor, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad)
Write-up: This case was reported by a regulatory authority (# NL-LRB-84474) and described the occurrence of fainting in a 3-year-old male subject who was vaccinated with INFANRIX-IPV (GlaxoSmithKline). The subject had no relevant medical history and no concomitant medication. On 21 November 2008, the subject received 5th dose of INFANRIX-IPV (intramuscular, unknown injection site). On 21 November 2008, 3 minutes after vaccination with INFANRIX-IPV, the subject experienced fainting, eyeballs raise upward, skin cold clammy, paleness of skin, dizziness, sweating and hypotonia. The following days, the patient experienced feeling unwell, fatigue, nausea, swelling injection site, injection site pain, fever and crying. The regulatory authority reported that the events were clinically significant (or requiring intervention). At the time of reporting the events were resolved. The regulatory authority reported that the events were probably related to vaccination with INFANRIX-IPV. No further information could be obtained from the regulatory authority: therefore the case has been closed.

VAERS ID:351138 (history)  Vaccinated:2008-11-21
Age:3.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2009-07-10, Days after onset: 230
Location:Foreign  Entered:2009-07-10
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: Acute nasopharyngitis
Diagnostic Lab Data: C-reactive protein, 111
CDC 'Split Type': B0573261A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B101AC4IMUN
Administered by: Other     Purchased by: Other
Symptoms: C-reactive protein increased, Clumsiness, Convulsion, Crying, Delirium, Encephalitis, Fall, Incontinence, Loss of consciousness, Mechanical ventilation, Pain, Peripheral coldness, Pyrexia, Status epilepticus, Stridor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad)
Write-up: This case was reported by a regulatory authority (# NL-LRB-87080) and described the occurrence of encephalitis in a 3-year-old female subject who was vaccinated with INFANRIX-IPV (GlaxoSmithKline). No concomitant medication. No relevant medical history. On 21 November 2008 the subject received 5th dose of INFANRIX-IPV (intramuscular). At an unspecified time after vaccination with INFANRIX-IPV, the subject experienced convulsion. Latency, duration and other symptoms were unknown. The subject was hospitalized. At the time of reporting the event was resolved. No further information was available as this was all the information that regulatory authorities had. Follow up received on 03 July 2009: The subject''s medical history included acute nasopharyngitis. On 21 November 2008, less than one day after vaccination with INFANRIX-IPV the subject experienced localized pain. Six weeks after vaccination the subject presented slight fever, crying, status epilepticus and encephalitis. Other reporter reactions were childhood incontinence, unconsciousness, coldness of skin and increased C-reactive protein (111). The parents found the girl in bed and could not make contact. A few hours later she suffered from status epilepticus which lasted approximately 17 hours (coming and going) despite of the treatment. The subject was hospitalized and she was treated with CEFTRIAXONE. There was no evidence for mitochondrial disturbance. One week after phasing out the artificial respiration she got inspiration stridor for which DEXAMETHASON was given. Due to deliria complication the treatment was stopped. The subject improved slowly. Five and a half months after the subject recovered with clumsy movements and a lot of tumbling as sequels. The regulatory authorities considered the events were unlikely related to vaccination with INFANRIX IPV. No further information was available as this was all the information that regulatory authorities had.

VAERS ID:333154 (history)  Vaccinated:2008-11-22
Age:7.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 2
Location:California  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2833AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1190X1SCLA
Administered by: Public     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: GAVE PATIENT SECOND FLU SHOT WHEN NOT NEEDED

VAERS ID:333196 (history)  Vaccinated:2008-11-22
Age:8.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 2
Location:California  Entered:2008-11-24
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
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500583P0IN 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1219X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 8cm X 10cm induration/erythema.

VAERS ID:333267 (history)  Vaccinated:2008-11-22
Age:4.0  Onset:2008-11-24, Days after vaccination: 2
Gender:Female  Submitted:2008-11-25, Days after onset: 1
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: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B087BA4IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB319AA1IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA110923IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0748U1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1219X1SCRL
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Children received DTaP and HEP A (L) thigh, IPV, Varicella (R) thigh and MMR (L) deltoid. Came back 2 days later with redness, swelling and blisters surrounding injection site. Received Abx.

VAERS ID:333321 (history)  Vaccinated:2008-11-22
Age:80.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2008-11-22, Days after onset: 0
Location:Colorado  Entered:2008-11-25, 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:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2757AA IJLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0990U IJRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Local swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Localized swelling 6cm right deltoid area warm to touch slight redness surrounding swollen area. PNEUMOVAX given. Pharmacist suggested cold compress to area and Benadryl 50mg at 4-6 hours. If becomes worse to go to ER.

VAERS ID:333577 (history)  Vaccinated:2008-11-22
Age:9.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 2
Location:Massachusetts  Entered:2008-12-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ?Allergy to red food dye.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89972 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Pt. had a flu shot then complained of pressure in his throat, evaluated by EMT''S, BP 100/70, S/S resolved on their own quickly.

VAERS ID:333578 (history)  Vaccinated:2008-11-22
Age:66.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 2
Location:Massachusetts  Entered:2008-12-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
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 DIAGNOSTICS89972 IMRA
Administered by: Public     Purchased by: Other
Symptoms: Blood pressure increased, Chest discomfort, Feeling hot, Paraesthesia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow)
Write-up: pt. "felt heat and warmth throughout body. Settled in chest, BP increase and tingling in fingers funny feeling in throat.

VAERS ID:333579 (history)  Vaccinated:2008-11-22
Age:67.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 2
Location:Massachusetts  Entered:2008-12-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes
Diagnostic Lab Data: Unknown
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89972 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Pt. c/o tremors and shaking uncontrollably, and was monitored by adverse effects monitoring coordinator, and EMTs. Paramedics arrived, and pt. was transport to ER.

VAERS ID:333576 (history)  Vaccinated:2008-11-22
Age:60.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 2
Location:Massachusetts  Entered:2008-12-02, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2760AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Felt faint, was diaphoretic, pale. Pt refused transport to hospital. Sat in chair after having flu shot, EMTS on scene. Generalized pallor and diaphoresis. Pt was conscious and alert and oriented.

VAERS ID:334395 (history)  Vaccinated:2008-11-22
Age:2.0  Onset:2008-11-23, Days after vaccination: 1
Gender:Male  Submitted:2008-11-24, Days after onset: 1
Location:Virginia  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:
Other Medications:
Current Illness: None
Preexisting Conditions: RAD
Diagnostic Lab Data: CRP; RAST; EGGS
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2772AA3UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Food allergy, Injection site erythema, Injection site oedema, Injection site warmth, Radioallergosorbent test
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm at site of immunization edema, erythema, warmth area 16X11.5 cm, no pain, no pruritus.

VAERS ID:334408 (history)  Vaccinated:2008-11-22
Age:38.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2008-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA168AA IMRA
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURERAH8V86408A IMRA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURERUHAVB2518A IMLA
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURERU2294CA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Cold sweat, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Service member became lightheaded, clammy and nauseated. Within 10 mins, he was feeling better.

VAERS ID:334724 (history)  Vaccinated:2008-11-22
Age:6.0  Onset:2008-11-24, Days after vaccination: 2
Gender:Unknown  Submitted:0000-00-00
Location:California  Entered:2008-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B065AA4UNRA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 2 days later, presents with erythema and wells over (R) deltoid.

VAERS ID:334728 (history)  Vaccinated:2008-11-22
Age:72.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2008-12-03, Days after onset: 11
Location:Missouri  Entered:2008-12-09, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bee stings; OXYCONTIN; FOSOMAX
Diagnostic Lab Data: Lasted from about 3pm to 7-8 pm
CDC 'Split Type':
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Eye burns, Eye disorder, Eye pain, Lacrimation increased, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Lacrimal disorders (narrow)
Write-up: Affected my eyes. They felt gainy, watering, red, sore, burning. This happened one other time about ? 7-8-9 years ago. I have Fuchs Dystery.

VAERS ID:334729 (history)  Vaccinated:2008-11-22
Age:2.0  Onset:2008-11-30, Days after vaccination: 8
Gender:Male  Submitted:2008-12-02, Days after onset: 2
Location:Illinois  Entered:2008-12-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: H/o (+) RSV; Eczema; Rash & swelling with vaccine (1st set) 10-30-06; Rash with DTaP 6 mo.
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1186X UNUN
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Pyrexia, Rash generalised
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 12/1/08 Pt presented in pediatric clinic with a rash "all over his body" with fever for 3 days. Provider assessed rash to be allergic response to a vaccine (also by history). Prescribed Benadryl 25mg po TID.

VAERS ID:334775 (history)  Vaccinated:2008-11-22
Age:1.4  Onset:2008-11-23, Days after vaccination: 1
Gender:Male  Submitted:2008-11-26, Days after onset: 3
Location:California  Entered:2008-12-09, Days after submission: 13
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: Cellulitis
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B085BA IMLL
Administered by: Other     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and edema surrounding vaccination site. On day 2-3 after vaccination.

VAERS ID:335057 (history)  Vaccinated:2008-11-22
Age:4.0  Onset:2008-11-22, Days after vaccination: 0
Gender:Male  Submitted:2008-12-11, Days after onset: 19
Location:New Jersey  Entered:2008-12-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~NULL~~In Patient
Other Medications: claritian
Current Illness: None
Preexisting Conditions: 2/14/06-B/L tubes -hx of recurrent otitis media
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA11093IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.2550X2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1183X1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: We had a 4 year old boy come into the office for Polio and Varicella vaccinations, prior to this appointment,he was in our office to get MMR , Flu and DTP vaccinations. By mistake he was administered another MMR. No adverse reaction at this time.

VAERS ID:336101 (history)  Vaccinated:2008-11-22
Age:7.0  Onset:2008-11-23, Days after vaccination: 1
Gender:Female  Submitted:2008-12-19, Days after onset: 26
Location:Ohio  Entered:2008-12-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALSU2770AA1IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.119HX1UNUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Next morning arm swollen, red and hard. Very tender.

VAERS ID:350091 (history)  Vaccinated:2008-11-22
Age:5  Onset:2008-11-26, Days after vaccination: 4
Gender:Female  Submitted:2009-05-29, Days after onset: 183
Location:New York  Entered:2009-06-17, Days after submission: 19
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: Injection site irritation
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0812USA03515
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1247X1UNUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local reaction, Oedema peripheral, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 5 year old "healthy" female with a history of skin irritation at injection site (onset 24-OCT-2008, after administration in the left deltoid with the fifth dose of FLUZONE (Lot #U2786aa) at 5:30 p.m. of 15-OCT-2008) who on 22-NOV-2008, at 10:30 a.m., was vaccinated with a second dose of MMR II (Lot #661679/1247X). On 26-NOV-2008, "3 days post injection", the patient developed mild localized swelling, redness and itchiness in the left arm which was "persisting onto the 9th day". The patient had a doctor visit and was diagnosed with urticaria. Additional information is not expected.

VAERS ID:355611 (history)  Vaccinated:2008-11-22
Age:52  Onset:2008-11-22, Days after vaccination: 0
Gender:Female  Submitted:2009-04-09, Days after onset: 137
Location:Kentucky  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': MEDI0007661
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500557P IN 
Administered by: Private     Purchased by: Private
Symptoms: Expired drug administered, Inappropriate schedule of drug administration
SMQs:
Write-up: A non-serious spontaneous report of administration of expired product to a 52-year-old was received from a Nurse concerning a 52-year-old female. The patient''s medical history and concomitant medications were not reported. On 22-Dec-2008, the patient received expired FLUMIST (expiration date 21-Dec-2008). The reporter inquired about dosing with expired product and information in patient over 49 years of age. 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. 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. Follow-up information was received on 09-Apr-2009: Product Complaint Investigation results.

VAERS ID:368648 (history)  Vaccinated:2008-11-22
Age:55  Onset:2008-11-23, Days after vaccination: 1
Gender:Male  Submitted:2009-11-17, Days after onset: 359
Location:Missouri  Entered:2009-11-19, Days after submission: 2
Life Threatening? No
Died? Yes
   Date died: 2008-11-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Immunoglobulin human antirabies
Current Illness:
Preexisting Conditions: The patient had been bitten by a bat on the left ear four to six weeks prior to symptom onset. The patient had a history of chronic neck and back pain that occasionally featured numbness. Three days prior to the event, the patient had a history of pruritus on his left ear, face and arm (19/nov/2008), mild chest pain (21/Nov/2008), and panic attacks and anxiety associated with swall
Diagnostic Lab Data: 21/Nov/2008: Electrocardiogram and cardiac enzymes (negative for myocardial infarction); 24/Nov/2008: Lumbar puncture (CSF) - glucose 78 mg/dL, protein 39 mg dL, six red blood cells/mm3, and one white blood cell/mm3; differential showed lym
CDC 'Split Type': 200904838
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
RAB: RABIES (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Antibody test negative, Anxiety, Autopsy, Biopsy skin abnormal, Bradycardia, Brain herniation, CSF glucose increased, CSF lymphocyte count normal, CSF monocyte count negative, CSF neutrophil count negative, CSF protein normal, CSF test abnormal, CSF white blood cell count negative, Cardiac enzymes normal, Chest pain, Computerised tomogram normal, Condition aggravated, Death, Dehydration, Differential white blood cell count abnormal, Drug screen negative, Dysphagia, Electrocardiogram normal, Encephalitis, Full blood count normal, Histology abnormal, Hypoaesthesia facial, Hypotension, Intracranial pressure increased, Lactic acidosis, Lumbar puncture, Meningitis, Metabolic function test, Metabolic function test normal, Oliguria, Panic attack, Polymerase chain reaction, Pruritus, Rabies, Red blood cells CSF positive, Renal failure acute, Saliva analysis abnormal, Virus serology test positive, Withdrawal of life support
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Haematopoietic leukopenia (broad), Lactic acidosis (narrow), Peripheral neuropathy (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 (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Skin tumours of unspecified malignancy (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad)
Write-up: Initial report received 09 November 2009 from a literature citation which involves a case of misuse (i.e., inappropriate schedule of drug administration). On 24 November 2008, the Centers for Disease Control and Prevention was notified about suspected rabies in a 55-year-old male patient who had been bitten by a bat four to six weeks prior to symptoms onset. Family members reported that they saw a bat in the rafters of the front porch for several days before it flew into the house. The patient caught the bat and allowed it to crawl up his arm and neck and was bitten on the left ear. The patient did not report the incident to public health authorities or seek medical evaluation. The patient left the bat unrestrained in the house for two days, and when the bat appeared to be well after that period, he released it outside. On 26 November 2008, infection with rabies virus variant associated with silver-haired bats was confirmed and the patient subsequently died on 30 November 2008. The following report summarizes the patient''s treatments and clinical course. A 55-year-old male patient developed pruritus on 19 November 2008 on his left ear that spread to his left face and arm. Two days later on 21 November 2008, he began experiencing mild chest pain and reported to the emergency department. Testing included an electrocardiogram and cardiac enzymes which were negative for acute myocardial infarction and the patient was discharged with instructions to return if symptoms worsened. On 22 November 2008, the patient returned to the emergency department with panic attacks and anxiety associated with swallowing water. At that time, the patient reported that he had been bitten by a bat on the left ear lobe four to six weeks earlier. He received corrective treatment with rabies post-exposure prophylaxis consisting of 15.4 mL of rabies immune globulin (manufacturer, lot number not reported) and 1 mL of rabies human diploid vaccine (manufacturer and lot number not reported), and a tetanus-diphtheria vaccine booster (manufacturer

VAERS ID:333912 (history)  Vaccinated:2008-11-22
Age:0.2  Onset:0000-00-00
Gender:Male  Submitted:2008-12-04
Location:Foreign  Entered:2008-12-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0548114A
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALS  PO 
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: This case was reported by a physician via a sales representative and described the occurrence of seizure in a 2-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). Previous and/or concurrent vaccination included Hib; GlaxoSmithKline; given on an unspecified date; PREVNAR, unspecified; Wyeth Labs; given on an unspecified date. On 22 November 2008, the subject received unspecified dose of ROTARIX (oral), lot number not provided. In November 2008, less than one week after vaccination with ROTARIX, the subject experienced mild seizure, rash on skin and vomiting. The subject was hospitalised at emergency ward. At the time of reporting the events were resolved.

VAERS ID:414944 (history)  Vaccinated:2008-11-22
Age:27.0  Onset:2009-11-01, Days after vaccination: 344
Gender:Female  Submitted:2011-01-18, Days after onset: 443
Location:Foreign  Entered:2011-01-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Familial risk factor
Preexisting Conditions:
Diagnostic Lab Data: Diagnostic laboratory test, full blood exam (FBE: normal; diagnostic laboratory test, proluchin: normal; serum electrolytes test, normal; hepatic function tests, normal; serum prolactin test, normal; serum free androgen index, normal; thyroid function test, normal; total serum lipids test, normal
CDC 'Split Type': WAES1011USA03634
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alopecia areata, Androgens normal, Blood electrolytes normal, Blood prolactin normal, Full blood count normal, Lipids normal, Liver function test normal, Thyroid function test normal
SMQs:
Write-up: Information has been received from a physician via CSL (manufacturer control # 20101119GC1) concerning a 27 year old female who on an unspecified date was vaccinated with GARDASIL (therapy dose, route and site unknown). Subsequently the patient experienced alopecia areata after the vaccination. Dexamethasone-Cyclophoshamide pulse (DCP) immunotherapy and extra injectable corticosteroids were given for the treatment of alopecia. The patient had a family history. Her aunt and cousin had alopecia areata. At the time of this report, the patient was getting worse. This is one of several reports received from the same source. Follow up information has been received from the physician. The physician reported that the patient''s hair started falling out in mid September 2009. In November 2009, widespread alopecia areata was noted. The full blood exam, electrolytes, liver function tests, androgen, prolactin, thyroid function tests and lipids were all normal. The patient had required treatment with oral steroids for 6 weeks and multiple intralesional steroid injection with slow but incomplete improvement. At the time of this report, the patient had not recovered. The physician considered that widespread alopecia areata was related to therapy with GARDASIL. The reporting physician considered this adverse event to be an other important medical event. No further information is available.

VAERS ID:333426 (history)  Vaccinated:2008-11-23
Age:37.0  Onset:2008-11-24, Days after vaccination: 1
Gender:Male  Submitted:2008-11-27, Days after onset: 3
Location:Maryland  Entered:2008-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Laceration
Preexisting Conditions: Hay fever; pollen; mold
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3030AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Axillary mass, Musculoskeletal stiffness, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Patient states that the day after receiving DAPTACEL vaccine, his arm was stiff. Gradually there become a lump in his axillae area, and today there is swelling to his chest area (same sided of injection).

VAERS ID:335998 (history)  Vaccinated:2008-11-23
Age:60.0  Onset:2008-11-24, Days after vaccination: 1
Gender:Male  Submitted:2008-12-17, Days after onset: 23
Location:Indiana  Entered:2008-12-23, 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: LISINORPIL 20 mg
Current Illness: No
Preexisting Conditions: High Blood Pressure
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA198BA0IMUN
Administered by: Other     Purchased by: Private
Symptoms: Injected limb mobility decreased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: muscle soreness in rotator cuff area. Inability to life arm to full extension.

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