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Case Details (Sorted by Vaccination Date)

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VAERS ID:331028 (history)  Vaccinated:2008-10-31
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2008-10-31
Location:Massachusetts  Entered:2008-10-31
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: Amixicillian
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0331X2UNLA
Administered by: Private     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: None. Please note pt got VARIVAX # 3 today. Had proquad last year and VARIVAX #1 11/12/2003

VAERS ID:330955 (history)  Vaccinated:2008-10-31
Age:5.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-01, Days after onset: 0
Location:Unknown  Entered:2008-11-01
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: allergic reaction
CDC 'Split Type':
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2506AA1IMLA
Administered by: Military     Purchased by: Unknown
Symptoms: Hypersensitivity, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pain and itching at injection site followed by severe swelling. ER doctors prescribed antihistimines and Motrin.

VAERS ID:331117 (history)  Vaccinated:2008-10-31
Age:1.7  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 3
Location:Georga  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 4mg (once per day)
Current Illness: None. Child healthy.
Preexisting Conditions: Child takes singulair for asthma/allergy type symptoms.
Diagnostic Lab Data: N/A
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1IMLL
Administered by: Private     Purchased by: Public
Symptoms: Decreased activity, Diarrhoea, Hypophagia, Lethargy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Vomiting, Diarrhea, high fever 103.5, lethargic, not eating, drinking very little. Not playful.

VAERS ID:331118 (history)  Vaccinated:2008-10-31
Age:2.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-03, Days after onset: 3
Location:Iowa  Entered:2008-11-03
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: Daily multivitamin
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: digital thermometer, axillary temp of 100 deg.
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Got shot at 1:15pm, threw up at 4:30pm, 5pm, 5:45pm, 6:45pm, and 7:45pm. Also had low grade fever for about 24 hrs.

VAERS ID:331133 (history)  Vaccinated:2008-10-31
Age:61.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 3
Location:Kentucky  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Estradiol, Hydrochlorothiazide, Meloxicam, Gabapentin, Actonel
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED02349111A IM 
Administered by: Unknown     Purchased by: Private
Symptoms: Back pain, Chills, Dizziness, Headache, Influenza like illness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt reported flu like symptoms, chills, dizziness, nausea, headache and back ache within 4 hours of receiving the vaccination. Pt called pharmacy and was told to get some tylenol for the bach aches and the headache. Pt called the pharmacy the second time and was told to contact her physician. Pt did go to ER the night of the vaccination for the symptoms previously reported.

VAERS ID:331144 (history)  Vaccinated:2008-10-31
Age:55.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-03, Days after onset: 2
Location:Minnesota  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2770AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pain, Periarthritis
SMQs:, Arthritis (narrow)
Write-up: Left shuolder frozen shoulder, throbbing when laying down at night. Flu vaccination on Friday & Saturday evening shoulder became sore.

VAERS ID:331153 (history)  Vaccinated:2008-10-31
Age:4.0  Onset:2008-11-02, Days after vaccination: 2
Gender:Female  Submitted:2008-11-03, Days after onset: 1
Location:California  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.50055OP0IN 
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURAO8053IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1926U1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1904U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Rash generalised, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The child developed a generalized, itching rash on 11/2/08 at night. Vaccines given on 10/31/08.

VAERS ID:331171 (history)  Vaccinated:2008-10-31
Age:0.6  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-03, Days after onset: 3
Location:New Jersey  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC2B198BA2IMUN
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2794GA0IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUF562AA2IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC990792IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0903X2PO 
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever to 104 degree x 72hr

VAERS ID:331218 (history)  Vaccinated:2008-10-31
Age:0.5  Onset:0000-00-00
Gender:Male  Submitted:2008-11-04
Location:North Carolina  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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HIBV: HIB (ACTHIB)SANOFI PASTEURUF503AA1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC790800IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0595X1PO 
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B030AA0IMLL
Administered by: Private     Purchased by: Unknown
Symptoms: Wrong drug administered
SMQs:
Write-up: Tdap given instead of Pediarix.

VAERS ID:331230 (history)  Vaccinated:2008-10-31
Age:19.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-09, Days after onset: 9
Location:Indiana  Entered:2008-11-04, 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: Albuterol
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS8811004 UNLA
Administered by: Private     Purchased by: Public
Symptoms: Cough, Influenza like illness, Myalgia, Oropharyngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad)
Write-up: Shot - 10/30. Sore throat 10/31. Diffuse myalgias with fever to 100.1, cough and flu like symptoms - 11/1 - present.

VAERS ID:331250 (history)  Vaccinated:2008-10-31
Age:29.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-04, Days after onset: 3
Location:Pennsylvania  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Loestrin
Current Illness: N/A
Preexisting Conditions: Tetricyclin allergy, seasonal
Diagnostic Lab Data: N/A
CDC 'Split Type':
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2817AA SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Injection site erythema, Injection site swelling, Joint stiffness, Myalgia, Palpitations, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: High Fever, Chills, Racing Heartbeat, Aching muscles, Stiffness in joints, swelling and redness in arm at site of vaccine

VAERS ID:331273 (history)  Vaccinated:2008-10-31
Age:21.0  Onset:0000-00-00
Gender:Female  Submitted:2008-11-04
Location:California  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: pregnancy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500560P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Pregnant patient was given Flumist. She did not have nay symptoms after the administration. Incidetn reported to patient''s OB GYN.

VAERS ID:331274 (history)  Vaccinated:2008-10-31
Age:4.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2008-11-04, Days after onset: 3
Location:California  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same rxn~Influenza (Fluzone)~UN~3~In Patient|none~ ()~NULL~~In Sibling1
Other Medications: none known
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2755AA3IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left Deltoid warm, hard, painful and swollen down to elbow, left arm 3/4 " larger than Right, follow up call on 11/3 and 11/4 improvement in painfulness and other symptoms less each day

VAERS ID:331360 (history)  Vaccinated:2008-10-31
Age:94.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-10-31, Days after onset: 0
Location:Missouri  Entered:2008-11-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89994 IDRA
Administered by: Other     Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Raised lump several minutes after injection. Cold pack to area.

VAERS ID:331371 (history)  Vaccinated:2008-10-31
Age:2.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 3
Location:Maryland  Entered:2008-11-05, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: //// congestion, / epistaxis either nostril /// ////
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.560558P1IN 
Administered by: Public     Purchased by: Public
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Epistaxis L nostril

VAERS ID:331411 (history)  Vaccinated:2008-10-31
Age:56.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2008-11-05, Days after onset: 4
Location:Nebraska  Entered:2008-11-05
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 at this time.
CDC 'Split Type':
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3028BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache
SMQs:
Write-up: Headache since 11-1-08; headache is occipital radiating to frontal, bilateral; rates pain 4-5/10; is somewhat relieved with Ibuprofen; less relief from Tylenol.

VAERS ID:331418 (history)  Vaccinated:2008-10-31
Age:55.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 5
Location:New Hampshire  Entered:2008-11-05
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: Patient did not seek medical treatment.
CDC 'Split Type': NH0814
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01849111A0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Diarrhoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: Patient c/o wheezing and coughinin that started within three hours after the immunization. She also states that she had mild diarrhea for the following two days.

VAERS ID:331424 (history)  Vaccinated:2008-10-31
Age:0.3  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-05, Days after onset: 4
Location:Pennsylvania  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted
Preexisting Conditions: Healthy 4 month old
Diagnostic Lab Data:
CDC 'Split Type':
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Manufacturer
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DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B064AA1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF504AA1IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0342-21IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC683121IMRL
Administered by: Private     Purchased by: Private
Symptoms: Crying, Hyperhidrosis, Musculoskeletal stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad)
Write-up: Patient received vaccines noted below on Oct 31st 2008. No complications noted at time of administration. Father called office on 11/1/08 at 12:10pm to report ? atypical febrile seizure through the night of 11/1/08. Temperature reported to be 99.8 rectally. Father stated child''s extremities were stiff,was crying, sweating and had a bowel movement at approx 3am and lasting 30 seconds. Episode witnessed by father who also is a adult neurologist.

VAERS ID:331575 (history)  Vaccinated:2008-10-31
Age:57.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-06, Days after onset: 6
Location:California  Entered:2008-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899770IMLA
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Herpes zoster, Immune system disorder, Lymph node pain, Lymphadenopathy, Malaise, Nausea, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 10/31 3pm malaise, lo graade fever, nausea, fatique 11/2 AM rash on left side of back spreading to side to groin, lymph nodes swelling and pain. 11/3 Dr visit dx with shingles due to immune supression effect of flu vaccine, at which time I was prescribed Acyclovir.

VAERS ID:331601 (history)  Vaccinated:2008-10-31
Age:49.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 5
Location:Indiana  Entered:2008-11-06, 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: CLARITAN
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899734IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Pallor, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pale, Tremors, SOB

VAERS ID:331663 (history)  Vaccinated:2008-10-31
Age:0.7  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-03, Days after onset: 3
Location:North Carolina  Entered:2008-11-07, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2797FA0IMRL
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Child presented to clinic 4 days after getting flu vaccine with hives 4 hours after vaccine was administered. Nurse practitioner gave child Zyrtec and Zantac and told to take until hives go away.

VAERS ID:331747 (history)  Vaccinated:2008-10-31
Age:  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-07, Days after onset: 7
Location:Colorado  Entered:2008-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject had no relevant medical history. The subject has previously received flu shots with no reported adverse reactions. Just last year she received the flu vaccine without problems. There was no reported history of adverse events following previous vaccinations. The subject reported no allergy to eggs or thimerosal.
Diagnostic Lab Data: Unk
CDC 'Split Type': A0755441A
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA356BA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Hypertension, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad)
Write-up: This case was reported by a pharmacist and described the occurrence of hypertension in an adult female subject who was vaccinated with FLUARIX (GlaxoSmithKline). There were no concurrent medications. On 31 October 2008 the subject received a dose of FLUARIX at 0.5 ml. On 31 October 2008, less than one day after vaccination with FLUARIX, the subject experienced hypertension, trouble breathing and tachycardia. She was seen in the emergency room and was treated and released. The pharmacist considered the events were clinically significant (or requiring intervention). On 1 November 2008, the events were resolved. The pharmacist considered the events were possibly related to vaccination with FLUARIX.

VAERS ID:331757 (history)  Vaccinated:2008-10-31
Age:1.3  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-07, Days after onset: 7
Location:Illinois  Entered:2008-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: recent gastroenteritis
Preexisting Conditions: gastroesophageal reflux PMH: Sinus infection & URI w/prolonged antibiotic use which delayed immunizations.
Diagnostic Lab Data: CT brain - normal; MRI brain/cervical spine normal; CSF normal protein, glucose LABS: CSF tests & EEG WNL. Blood, urine & CSF culture neg. Viral c/s neg. CT head & MRI brain & c-spine WNL. CXR diffuse peribronchial thickening w/o focal airspace disease.
CDC 'Split Type':
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Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2951BA3IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08362IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0482X0SCRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC659333IMLL
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Body temperature increased, CSF culture negative, CSF glucose normal, CSF protein normal, Cerebellar ataxia, Chest X-ray abnormal, Computerised tomogram normal, Crying, Culture urine negative, Diarrhoea, Dysstasia, Electroencephalogram normal, Fall, Fatigue, Gait disturbance, Irritability, Lethargy, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Scan brain, Screaming, Sick relative, Virus culture negative, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow)
Write-up: Temp 103 within 6 hours, vomiting next day, ataxia on second day after vaccines. 12/5/08 Reviewed hospital medical records of 11/2-11/5/2008. FINAL DX: fever & acute cerebellar ataxia on admit. No d/c summary available Records reveal patient experienced fever, diarrhea & abnormal gait on day of vaccination after nap. Seen in urgent care center & released. Seen in ER same day & released. Fever continued & began vomiting, lethargic, tiredness. Returned to ER, tx w/IVF & meds & released. Irritable & weak. Then developed difficulty standing & falling w/walking, crawling & sitting w/intermittent screaming & inconsolable crying, diarrhea. Multiple people in family sick w/URI symptoms.

VAERS ID:331776 (history)  Vaccinated:2008-10-31
Age:65.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-07, Days after onset: 7
Location:Florida  Entered:2008-11-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: HTN
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2771AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Client received Influenza Virus vaccine at 12:00 pm 10/31/2008. Client returned to clinic-12:20pm 10/31/08 with c/o throat tightness and enlarged tongue upon exam, noted enlarged tongue. Pharynx open. Lungs CTA bilaterally no wheezing. Epipen 1:1000 .3mg given in L anterolateral thigh at 12:23 p.m.... Paramedics arrived at 12:25 p.m client reported felt better after Epipen. Client sent to ER via ambulance for further evaluation at 12:30 pm 10/31/2008.

VAERS ID:331839 (history)  Vaccinated:2008-10-31
Age:4.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-04
Location:Louisiana  Entered:2008-11-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Tinea Capitis
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500553P0IN 
Administered by: Private     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Broke out in welps. Friday evening 10-31-08 after receiving FLUMIST that day BENADRYL given welps continues X days. Now better. Notified office 11-3-08

VAERS ID:331844 (history)  Vaccinated:2008-10-31
Age:25.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-04, Days after onset: 4
Location:North Carolina  Entered:2008-11-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Cats
Diagnostic Lab Data: N/A
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA372AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Axillary pain, Diarrhoea, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Diarrhea X 3. Took Imodium 10-31-08. Swollen, tender lymph node under left arm. Going down now. No fever. Mild nausea on 11/3/08.

VAERS ID:331861 (history)  Vaccinated:2008-10-31
Age:70.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-10-31, Days after onset: 0
Location:Pennsylvania  Entered:2008-11-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: penicillin; codeine; IV dye
Diagnostic Lab Data:
CDC 'Split Type':
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt had swelling and urticaria of (R) arm.

VAERS ID:331988 (history)  Vaccinated:2008-10-31
Age:1.1  Onset:2008-11-02, Days after vaccination: 2
Gender:Male  Submitted:2008-11-11, Days after onset: 9
Location:Massachusetts  Entered:2008-11-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Optic Nerve hypoplasia
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB246AA0UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC400333UNLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0513X0UNRL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis
SMQs:
Write-up: Cellulitis left thigh treated with Augmentin.

VAERS ID:331957 (history)  Vaccinated:2008-10-31
Age:7.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-12, Days after onset: 11
Location:Unknown  Entered:2008-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2506AA IMLA
Administered by: Military     Purchased by: Military
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Caused severe asthmatic attack. O2 level of 92. Required emergency treatment sopportive therapy and steriods. One week recovery.

VAERS ID:332036 (history)  Vaccinated:2008-10-31
Age:54.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-04, Days after onset: 4
Location:Oklahoma  Entered:2008-11-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Idiopathic Thrombocytopenic Purpura
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2811AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Dizziness, Hallucination, Hyperhidrosis, Injection site erythema, Injection site pain, Oedema peripheral, Pain, Pyrexia, Tinnitus
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: 10/31/2008 8pm -soreness in right deltoid. Dizzy & lightheaded. 8:30 pm- chills-fever 9pm- temp 102.3 degrees, Tylenol 9:30 PM Temp 103.1 degrees. 10pm- Fever broke, chills, sweating then fever back up again. 11 pm- More Tylenol 11:50 pm until 48 hrs later continued to have high fever. Sweating, achiness, ringing in ears & one episode of hallucination. Continued to alternate Tylenol & Motrin. Arm & hand swollen. 11-1-08 Benadryl. Fever over. Deltoid red/painful. Arm swollen. 11-3-08- swelling & redness reduced. 11-5-08- resolved.

VAERS ID:332066 (history)  Vaccinated:2008-10-31
Age:57.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-04, Days after onset: 4
Location:California  Entered:2008-11-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies in the distant past
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2748AA IMUN
Administered by: Other     Purchased by: Private
Symptoms: Dysphagia, Dyspnoea, Ocular hyperaemia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Throat constricted, red eyes, difficulty breathing and swallowing.

VAERS ID:332085 (history)  Vaccinated:2008-10-31
Age:0.5  Onset:0000-00-00
Gender:Male  Submitted:2008-11-03
Location:Colorado  Entered:2008-11-12, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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Manufacturer
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DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B143AA UNRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF498AA UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA11092 UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC27729 UNLL
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Pt received extra dose of IPV no adverse reaction.

VAERS ID:332149 (history)  Vaccinated:2008-10-31
Age:51.0  Onset:2008-11-08, Days after vaccination: 8
Gender:Male  Submitted:2008-11-12, Days after onset: 4
Location:Missouri  Entered:2008-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none~ ()~NULL~~In Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: T and L spine MRI, Nerve conduction velocity testing to R/O GBS. Exam by neurologist and neurosurgeon consistent with myelitis syndrome
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU27518AA10IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Muscular weakness, Myelitis, Nerve conduction studies abnormal, Neurological examination abnormal, Nuclear magnetic resonance imaging abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: myelitis, left leg numbness and weakness, started 9 days after influenza vaccination. Syndrome confirmed by neurologist and neurosurgeon. Treatment: Steroids

VAERS ID:332200 (history)  Vaccinated:2008-10-31
Age:42.0  Onset:2008-11-04, Days after vaccination: 4
Gender:Female  Submitted:2008-11-17, Days after onset: 13
Location:West Virginia  Entered:2008-11-12, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WV0838
Vaccination
Manufacturer
Lot
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0907X1SCUN
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Induration, Pyrexia, Swelling
SMQs:, 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), Hypersensitivity (broad)
Write-up: Red swollen; fever; and hard caked area. Stated Tuesday 11/4/2008, went to Caplin Clinic for treatment. Was given PREDNISONE and CLARITIN. Also advised to use the ice packs 20 min 4 times a day. Measured hard caked area at 6 cm by 5 cm.

VAERS ID:332262 (history)  Vaccinated:2008-10-31
Age:53.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-12, Days after onset: 12
Location:North Carolina  Entered:2008-11-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
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Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89738 UNLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient describes sharp pains at vaccine admin site - has persisted for approx 2 wks.

VAERS ID:332285 (history)  Vaccinated:2008-10-31
Age:37.0  Onset:2008-11-11, Days after vaccination: 11
Gender:Male  Submitted:2008-11-13, Days after onset: 2
Location:Wisconsin  Entered:2008-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: 3/18/09-records received-Wound staphylococcus coagulase negative.
CDC 'Split Type':
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Culture, Eschar, Fatigue, Injection site cellulitis, Injection site pain, Injection site vesicles, Injection site warmth, Lymphadenopathy, Musculoskeletal pain, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Muscle aches, joint aches, fatigue, low grade fever, severe pain and swelling in Left shoulder and arm. Multiple sites of blistering aside from the inoculation site in left shoulder. 3/18/09-records received-seen for C/O sick with fevers and chills, myalgias and sleepiness times 1 week. Symptoms resolved now with constellation of sores in deltoid region. Painful lymphadenopathy in axillary area. Arm is numb. PE: warmth and cellulitis emanating around periphery of constellation of sores. Neurovascularly intact about left hand and arm. Assessment:cellulitis of left arm likely due to small pox vaccination. 3/23/09-records received for DOS 11/12/08-Since vaccines on 10/31/08 C/O left arm muscle aches, joint aches, fatigue, low grade fevers and severe pain and swelling in left shoulder and arm. Treated day before in ED for infection of left arm. Multiple blisters aside the site. Left shoulder redness, swelling tenderness and 5-6 blisters primary inoculation site forming eschar. Assessment: cellulitis due to vaccine. Likely adverse reaction to smallpox vaccination

VAERS ID:332288 (history)  Vaccinated:2008-10-31
Age:12.0  Onset:2008-11-06, Days after vaccination: 6
Gender:Male  Submitted:2008-11-13, Days after onset: 7
Location:Alabama  Entered:2008-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inhaler PRN
Current Illness: viral URI/sore throat without fever
Preexisting Conditions: asthma. PMH: none noted
Diagnostic Lab Data: None
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2759AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Facial palsy, Facial paresis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Left-sided facial weakness starting within 1 week after influenza vaccine administered (left arm). 12/15/2008 MR received from PCP for DOS 10/31/08. Pt seen by PCP for c/o sore throat/ body aches/ runny nose. DX: URI. Flu shot given. Seen again 11/12/08 with L sided facial weakness x 1 week. Dx: Bell''s Palsy.

VAERS ID:332301 (history)  Vaccinated:2008-10-31
Age:18.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2008-11-13, Days after onset: 12
Location:North Carolina  Entered:2008-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2790AA7IDLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0432X0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site swelling, Injection site warmth, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right arm began swelling at site of injection 11-02-08 2 days after injection. On 11-03-08 right arm swollen, red and warm to touch with area beginning at injection site ending at the elbow in large oval area.

VAERS ID:332335 (history)  Vaccinated:2008-10-31
Age:10.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-04, Days after onset: 3
Location:Texas  Entered:2008-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB239AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1144X SCLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site cellulitis, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: ER visit for swollen arm 11/1. Diagnosed with Cellulitis (injection site) and given clindamycin.

VAERS ID:332383 (history)  Vaccinated:2008-10-31
Age:61.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-12
Location:D.C.  Entered:2008-11-14, 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: LIPITOR; ALTACE; LOPRESSOR; PLAVAX
Current Illness: None
Preexisting Conditions: shellfish all; Non dx strep infec
Diagnostic Lab Data: None
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA316BA UNRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The day after receiving flu shot had tenderness at site which progressed to upper (waste to head) Rt delt to lt side. All upper body aches to point where home sick for a couple days and saw PCP. No fever or other sx just upper bodyaches

VAERS ID:332475 (history)  Vaccinated:2008-10-31
Age:59.0  Onset:2008-11-03, Days after vaccination: 3
Gender:Female  Submitted:2008-11-11, Days after onset: 8
Location:New York  Entered:2008-11-14, 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: Beef, shellfish, eggs, pineapples, streptomycin
Diagnostic Lab Data:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR 0SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Incorrect route of drug administration, Lymph node palpable, Pyrexia, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt seen here on 11/03/2008. Received a MENACTRA injection last week by another MD. Was given SC on (L) forearm. Pt presented with redness, swelling area hot to touch, Pt febrile, (R) (L) axillary node. Dx with cellulitis. Rx ed with vom, IV ROCEPHIN X 3 QD and Keflex PO x 10 days.

VAERS ID:332453 (history)  Vaccinated:2008-10-31
Age:37.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-15, Days after onset: 15
Location:Michigan  Entered:2008-11-15
Life Threatening? Yes
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: PCN allergy, fam hx of CAD, otherwise (-).
Diagnostic Lab Data: ECHOCARDIOGRAM, XRAYS, BLOODWORK. Labs and diagnostics: CXR WNL. head CT WNL. EKG WNL. Echo WNL. Troponins (-)x3. Stress test (-). CK WNL 32.
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS88117391UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood creatine phosphokinase normal, Blood test, Cardiac enzymes normal, Cardiac stress test normal, Chest X-ray normal, Chest pain, Computerised tomogram normal, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Headache, Heart rate increased, Nausea, Palpitations, Troponin
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: SHORTNESS OF BREATH, CHEST PAIN, RAPID HEART BEAT. 12/15/08 MR received for DOS 11/13-14/2008 with DX: Chest pain. Pt presented with several week hx of dizziness and h/a, now with substernal chest pain which radiates into the neck, associated with palpitations, SOB and nausea. VS, EKG, O2 sats, and cardiac enzymes all WNL. Sx improved with nitro. Admitted for further w/u which was (-). 1/28/2010 Intermitten episodes of rapid heart beat.

VAERS ID:332511 (history)  Vaccinated:2008-10-31
Age:27.0  Onset:2008-11-09, Days after vaccination: 9
Gender:Female  Submitted:2008-11-17, Days after onset: 8
Location:Kentucky  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0503X SCUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC2966AA IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0135X SCUN
Administered by: Other     Purchased by: Unknown
Symptoms: Pruritus, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Dr saw at medical center on 11-14-08 with itching on scalp and noticed bump. Dev. bumps on ears-behind, on the forehead, chest, abd, back and today on legs and arms. Plan-Acyclovir 800mg one tablet po qid x 5 days. Do not get 2nd vaccine.

VAERS ID:332512 (history)  Vaccinated:2008-10-31
Age:53.0  Onset:2008-11-02, Days after vaccination: 2
Gender:Female  Submitted:2008-11-10, Days after onset: 8
Location:Florida  Entered:2008-11-17, 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: IMITREX; XANAX; FIORCET; TYLENOL #3
Current Illness: None
Preexisting Conditions: allergic to DARVON; Hx Migraines
Diagnostic Lab Data:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2847AA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Adverse reaction, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 2 days after received the vaccines, She expressed (high fever, 102, 103 F, then slightly lower the next week. She was unable to get out of bed without, feeling terribly nauseated. She was continued to her bed all week. She was urged to go to the ER but she did not, saw her PCP next day who affirmed adverse reaction.

VAERS ID:332523 (history)  Vaccinated:2008-10-31
Age:17.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2008-11-07, Days after onset: 6
Location:Washington  Entered:2008-11-17, Days after submission: 10
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: Amoxicillin allergy
Diagnostic Lab Data: None
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.   UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Pain, Pain in extremity
SMQs:
Write-up: FLUMISt and MENACTRA administered 10/31/08. Sore arm 11/1, mild body aches 11/2, in bed with severe body aches 11/3 -11/6. No fever/UBI/GI Sx normal exam 11/7/08

VAERS ID:332582 (history)  Vaccinated:2008-10-31
Age:45.0  Onset:2008-11-03, Days after vaccination: 3
Gender:Female  Submitted:2008-11-17, Days after onset: 14
Location:California  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Shingles 20 years ago
Diagnostic Lab Data:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899775IMLA
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: Developed facial shingles three days after flu shot and primary physician requested reporting via the VAERS.

VAERS ID:332701 (history)  Vaccinated:2008-10-31
Age:21.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-18, Days after onset: 18
Location:Illinois  Entered:2008-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dicyclomine, Toprol XL, Dessogen, Pepcid AC, Tramadol
Current Illness: none
Preexisting Conditions: Supraventricular Tachycardia, Acid Reflux, pain in Right side that the physicians do not know what causes it but I have had it for about 5 years
Diagnostic Lab Data: Still nauseous & vomiting.
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01849111A3IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: For the last 4 years that I have gotten the flu shot which was required for nursing school, I have gotten very ill. I have not had an anaphylaxis action yet, but I have had severe nausea & vomiting that lasted for several weeks after the vaccine was given. The public health nurse asked if I wore contacts because she knew thimerosal was an ingredient in both and I am allergic to all contact solutions except one that does not contain that ingredient so she believes i have an allergy to the thimerosal in the flu shot. This has caused me to miss class for several weeks each year after receiving the flu shot so because of all of this I was told to fill out this report. My nausea & vomiting is not just like the normal aches and feeling a little nauseous right after the shot which most people can have. This is more severe and lasts alot longer

VAERS ID:332773 (history)  Vaccinated:2008-10-31
Age:41.0  Onset:2008-11-11, Days after vaccination: 11
Gender:Male  Submitted:2008-11-18, Days after onset: 7
Location:New Jersey  Entered:2008-11-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PRAVASTATIN 40 mg
Current Illness:
Preexisting Conditions: HYPER CHOLESTEREMIA
Diagnostic Lab Data: Blood work done by PMD on 11/16/08
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89973 UNLA
Administered by: Other     Purchased by: Private
Symptoms: Blood test, Chills, Muscular weakness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad)
Write-up: 10/31/08 Received FLUVIRUS on 11/11/08 noticed bilateral lower extremity muscle pain. 11/12/08 additional muscle pain in upper left extremities. 11/13/08 felt feverish, chills, muscle pain continue. 11/14/08 no fever/chills but had significant muscle pain in arms and legs, called PMD, Doctor instructed to discontinue PRAVASTATIN 40mg and take 2 ALEVE every 12 hrs. 11/15/08 muscle pain decreased with ALEVE but developed severe weakness hands/finger. Seen by PMD 11/16/08.

VAERS ID:333036 (history)  Vaccinated:2008-10-31
Age:59.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2008-11-18, Days after onset: 17
Location:Washington  Entered:2008-11-21, 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: No illness
Preexisting Conditions: Diabetes - (L) shoulder has metal prosthesis since 2003 PMH: Type 2 DM, CAD, CHF, EF 30%, HTN, hyperlipidemia, paroxysmal atrial fib, anemia secondary to chronic disease, chronic renal failure, hypocalcemia, hyperphosphatemia, obesity, PVD w/bilateral LE amputations, malnutrition, hyperuricemia. Allergy: PCN, hives.
Diagnostic Lab Data: In patient testing. GRAM Stain Final, moderate to many polys, many RBCS, no organism seen, 11/07/08 - 1136; ANAEROBE Culture Final, no anaerobes isolated in 5 days, 11/11/08-0816; GRAM Stain Final, test not performed, 11/07/08-1136; Wound C
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA15BA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0989U1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Abscess, Blood culture negative, Culture wound negative, Gram stain negative, Injected limb mobility decreased, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Surgery, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 11-01-08 Hot red spot 2" with improvement. 11-06-08 NP attempted with success IV antibiotics; sent to doctor/orthopedic doctor then admit to hospital (11-06 - 11-13). Surgery/sterile abscess. Currently wound care and antibiotics. 12/2/08 Reviewed hospital medical records of 11/6-11/11/2008. FINAL DX: left deltoid abscess after pneumovax, s/p I&D. Records reveal patient experienced injection site swelling, erythema, induration & decreased mobility of left arm where he received pneumovax. Seen in clinic & sent to surgeon for aspiration of area. Admitted for I&D, IV antibiotics. D/C to home on continued oral antibiotics, insulin & wound clinic f/u for wound vacuum treatment.

VAERS ID:333065 (history)  Vaccinated:2008-10-31
Age:69.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-11-19, Days after onset: 18
Location:Connecticut  Entered:2008-11-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: H/o mitral valve prolapse
Diagnostic Lab Data:
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1541U0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Cellulitis, Cough, Injection site erythema, Injection site warmth, Pain in extremity, Pyrexia, Sinus headache
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt c/o fever 102 degrees, H/A, cough, sinus pressure (R) arm sore, red warm to touch over area of injection site- came to office on Monday morning 11/3/08. Evaluated by Doctor - started on course of KEFLEX. Diagnosed with cellulitis.

VAERS ID:333071 (history)  Vaccinated:2008-10-31
Age:82.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-18, Days after onset: 18
Location:Wisconsin  Entered:2008-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Piroxicam, codeine, DARVON, propoxyphene
Diagnostic Lab Data: None
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2755AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Chills, Diarrhoea, Dizziness, Dysphonia, Feeling hot, Headache, Hyperhidrosis, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: Hot, sweating, vomiting - diarrhea, chills, crushing pain, fever, dizzy, headache. It lasted three days. Very weak and dizzy for several days. Hoarseness.

VAERS ID:333076 (history)  Vaccinated:2008-10-31
Age:37.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-04, Days after onset: 4
Location:Pennsylvania  Entered:2008-11-24, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Valve replacement, Hypothyroidism, arrythmias. Allergies: IV dye; VICODIN; codeine, Iodine.
Diagnostic Lab Data: EKG rhythm strip/pulse oximeter
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2753AA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Dyspnoea, Electrocardiogram, Oxygen saturation, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Received flu shot 10/31/08 at 13:18 hrs. Developed symptoms of throat swelling and difficulty breathing. Treated with ALBUTEROL Nebulizer 2.5 mg in 3 mlns, BENADRYL, 25 mg IVP.

VAERS ID:333113 (history)  Vaccinated:2008-10-31
Age:51.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-23, Days after onset: 23
Location:Texas  Entered:2008-11-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS881131P0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad)
Write-up: The patient states that she has had continued soreness and aching in the shoulder where she received the flu vaccine.

VAERS ID:333152 (history)  Vaccinated:2008-10-31
Age:60.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 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:
Other Medications:
Current Illness:
Preexisting Conditions: Fibromyalgia. Allergy to PCN and Sulfa.
Diagnostic Lab Data:
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA3888AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2689AA0IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Headache, Pain in extremity
SMQs:
Write-up: Headache intermittant for a week after. Sore right arm (arm that received flu vaccine is the right). Tdap went in the left arm.

VAERS ID:333440 (history)  Vaccinated:2008-10-31
Age:36.0  Onset:2008-11-11, Days after vaccination: 11
Gender:Male  Submitted:2008-11-26, Days after onset: 15
Location:New Jersey  Entered:2008-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hx of heart murmur PMH: Osgood-Schlatter disease. Heart murmur. Smoker. Allergy: iodine, anaphylaxis, percocet, stomach upset. Family hx: premature CAD, MI, Marfan''s.
Diagnostic Lab Data: 11/14/08, CRP u/s 27.0; Chol, 127; Trig 103; HDL, 35; LDL, 77; Creatine Kinase MB, 0%; Creatine Kinase, 87 U/L; Troponin I Cardiac, 0.97 (H*) ng/mL; 11/14/08, Reported normal ECG; 11/19/08, TTE: EF 55%, Normal; GXT - NL GXT exercise echo w/o exercised induced segmental wall motion abnormalities to suggest stress induced myocardial ischemia at 94% of predicted MHR for age. Note: Post exercise images are suboptimal secondary to pt imaging characteristics. 11/26/08, ECHO - showed normal LV function with no e/o pericardial effusion LABS: cardiac enzymes neg, troponin 0.03. CBC, chemistry, EKG, CXR, echocardiogram, stress test WNL.
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ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P IN 
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSA14ABB103A UNUN
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEUR   UN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA09233 IMUN
Administered by: Military     Purchased by: Military
Symptoms: Asthma, Blood cholesterol normal, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal, Blood pressure increased, Blood triglycerides normal, C-reactive protein increased, Cardiac enzymes normal, Chest X-ray normal, Chest pain, Cough, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Exercise test normal, Full blood count normal, Headache, High density lipoprotein normal, Hyperhidrosis, Laboratory test normal, Low density lipoprotein normal, Nasopharyngitis, Non-cardiac chest pain, Rhinorrhoea, Tobacco user, Troponin I increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Clinic visit on 11/14/08 - Left sided chest pain since 11/11 with some radiation to left arm associated with diaphoresis and elevated BP, light headache and difficulty taking deep breath. Chest pain worse on morning of 11/13/08. Pain was worse when lying flat, cough, or deep breath. Not associated with exertion. Nonprandial. Given MOTRIN at local clinic with little relief. After enzymes (+) on 11/14/08, pt referred on 11/18/08 to hospital and admitted overnight. Discharged the following day. Since this episode, he has developed cold-like symptoms (runny nose, cough), but his chest pain has been absent. Performs ADLs w/o development of chest pain, sob, or tightness. 12/5/08 Reviewed hospital medical records of 11/18-11/19/2008. FINAL DX:noncardiac chest pain; asthma; tobacco use disorder. Records reveal patient experienced left side chest pain w/radiation down left arm x 1 week, constant x 3 days then intermittent. Evaluated at outside clinic where troponin reported to be 0.97(H). Cardiac w/u neg. D/C to home w/PCP f/u.

VAERS ID:333415 (history)  Vaccinated:2008-10-31
Age:46.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-28, Days after onset: 28
Location:Texas  Entered:2008-11-28
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:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS8999Y1IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Pain in extremity
SMQs:
Write-up: Patient called 11-28-08 and said her arm was still sore from vaccine. Pain is like that of a sore muscle.

VAERS ID:333739 (history)  Vaccinated:2008-10-31
Age:56.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-12-03, Days after onset: 32
Location:Illinois  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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFFLA185AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Induration, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Patient received flu vaccination in left arm. Patient says she started to get a red knot the size of a baseball , hot and itching. She didn''t experience problems until day after flu shot. She didn''t seek medical attention, she called the Director and called healthcare center. We advised her to contact the physician if further problems.

VAERS ID:333757 (history)  Vaccinated:2008-10-31
Age:16.0  Onset:2008-11-07, Days after vaccination: 7
Gender:Female  Submitted:2008-11-21, Days after onset: 14
Location:New Hampshire  Entered:2008-12-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MEDI0007542
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  OTUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Fatigue, Feeling cold, Headache, Heart rate increased, Lethargy, Loss of consciousness, Nausea, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: A serious spontaneous report of passed out, increased heart rate, shaking, feeling tired, lethargy, headache, feels cold, chills, and nausea has been received from a consumer concerning a 17-year-old female subsequent to FLUMIST. Neither past medical history nor concomitant medications have been reported. The patient received FLUMIST on 31-Oct-2008. One week after receiving FLUMIST, the patient started feeling tired and having headaches. On 09-NOV-2008, the patient passed out while at work and paramedics transported her to the hospital. She had symptoms of increased heart rate and lethargy. While at the ER, all tests were normal and the patient was released. The following week, the patient still felt tired, reported feeling cold, had chills with shaking and nausea. The patient was taken back to the physician on 20-Nov-2008 who indicated that the patient could be experiencing stress and gave her something for her stomach. The outcome was not reported.

VAERS ID:334279 (history)  Vaccinated:2008-10-31
Age:  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-07, Days after onset: 7
Location:Montana  Entered:2008-12-09, Days after submission: 32
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: Per pt. report: seafood; bees; nutmeg; some medications
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA375AA UNLA
Administered by: Public     Purchased by: Other
Symptoms: Chest discomfort, Erythema, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt. reports- "tightness of chest", palm sized area of slight, diffuse swelling, reddened. Pt. took self admin. with BENADRYL. No medical treatment or dx tests required. Fever 101.

VAERS ID:334282 (history)  Vaccinated:2008-10-31
Age:21.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 3
Location:Missouri  Entered:2008-12-09, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO KLONOPIN DEPAKOTE
Current Illness: Denies
Preexisting Conditions: Bipolar; allergy to ABISIFY
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0575X0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Oropharyngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Approximately 4 hours after receiving HPV vaccine developed fever and sore throat and nausea. Did not take temperature-no vomiting. Did not take any OTC medicine (TYLENOL, PEPTO-BISMAL, etc.). Symptoms lasted about 24 hours.

VAERS ID:334290 (history)  Vaccinated:2008-10-31
Age:47.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-10
Location:Indiana  Entered:2008-12-09, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2746AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cognitive disorder, Cough, Myalgia, Oropharyngeal pain, Sinus disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad)
Write-up: Less than 1/2 hour after injection loss of cognitive ability slept 4 hours better next day. After 1 week sore throat and sore muscles, cough, sinus problem 3 days still having symptoms.

VAERS ID:334292 (history)  Vaccinated:2008-10-31
Age:8.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-11, Days after onset: 11
Location:New York  Entered:2008-12-09, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well child
Preexisting Conditions: ADHD per mother of child. No meds. 1/15/09-records received-PMH: asthma, ADHD, febrile seizures at age of 1, 3, and 5.
Diagnostic Lab Data: Abnormal EEG @ hospital per mother of PT. Diagnosis of Epilepsy per mother. 1/15/09-records received-CBC, chemistry, chest x-ray, heat CT all negative. EEG: abnormal temporal slowing suggestive of seizure disorder. Blood and urine cultur
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500548P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Blood culture negative, Blood pressure increased, Computerised tomogram normal, Convulsion, Culture urine negative, Dyskinesia, Eczema, Electroencephalogram abnormal, Fatigue, Full blood count normal, Gaze palsy, Heart rate increased, Incontinence, Laboratory test normal, Lethargy, Loss of consciousness, Pyrexia, Somnolence, Stupor, Tremor, Viral infection, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Seizure lasting more than 5 min. with incontinence & loss of consciousness. Stupor with return of consciousness. Transported by ambulance to hospital, then to other hospital. 1/15/09-records received for DOS 11/1-11/3/08- DC DX: Seizure-like activity; viral infection with fever. Presented with seizure-like activities. Jerking movements, shaking all over, head jerking backwards, eyes rolled toward back of head. Urinated on self. Unresponsive throughout the 5 minute activity. Lethargic. Blood pressure increased, heart rate increased, temperature elevated. Vomited, drowsy and tired. PE: eczema.

VAERS ID:334320 (history)  Vaccinated:2008-10-31
Age:1.6  Onset:2008-11-03, Days after vaccination: 3
Gender:Female  Submitted:2008-11-17, Days after onset: 14
Location:Michigan  Entered:2008-12-09, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Stomatitis 11 days prev./resolved
Preexisting Conditions: PMH: recent Hand, Foot & Mouth disease. Febrile seizure. Ear tubes
Diagnostic Lab Data: Viral culture negative; MRI brain positive ADEM; spine negative. Labs and Diagnostics:MRI Lumbar spine WNL. MRI thoracic spine with abnormal signal T2. MRI cervical spine (+) for abnormal signal C7. MRI brain c/w ADEM. Abd X-ray c/w constipation. Head CT (+) for maxillary sinus thickening. LP with CSF protein 82, CSF glucose 70, CSF IgG 15.1, CSF albumin 90.5. CSF WBCs 25-100% monos. CSF cx (-). Blood cx (-). Wound cx (+) for staph.RBC(+). No oligoclonal bands. SGOT 57, SGPT 94. CBC with WBCs WNL on admission-up to 26.8 on 11/12/08. EBV, CMV, Flu, Mycoplasma, Entervirus (-).
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2792CU2IMRL
Administered by: Private     Purchased by: Public
Symptoms: Abasia, Abdominal X-ray, Acute disseminated encephalomyelitis, Alanine aminotransferase increased, Albumin CSF increased, Aspartate aminotransferase increased, Ataxia, Blood culture negative, CSF culture negative, CSF glucose normal, CSF immunoglobulin increased, CSF monocyte count increased, CSF oligoclonal band absent, CSF protein increased, CSF white blood cell count increased, Computerised tomogram abnormal, Culture wound positive, Decreased appetite, Dehydration, Extensor plantar response, Facial palsy, Full blood count, Hyperreflexia, Irritability, Lumbar puncture, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Nuclear magnetic resonance imaging normal, Pyrexia, Rash pustular, Red blood cells CSF positive, Somnolence, Spinal X-ray normal, Staphylococcus identification test positive, Viral test negative, Virus culture negative, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow)
Write-up: Stomatitis, posterior lesion seen 10-20-08 in office. Symptomatic Rxment improved. Came in 10-31-08 for scheduled Flu immunization seen by nurse, well -$g gave immunization: 3 days later ataxia, seen at ER. Admitted-MRI +ve ADEM, hospitalized 11 days. I.V. steroid, acyclovir. 12/16/08 MR received for DOS 11/4-15/2008 with DX: ADEM. Pt presented with fever, decreased appetite, and ataxia. PE (+) for a fussy, sick looking irritable pt. Mild dehydration and refusal to walk. Pustule noted on L buttock. No ataxia reported in initial H&P. Admitted to r/o encephalitis. Neuro consult with Dx: ADEM presents with ataxia, somnolence, irritability, R facial palsy, Babinski''s sign and brisk DTRs. Tx with abx, steroids, IVIG with improvement.

VAERS ID:334431 (history)  Vaccinated:2008-10-31
Age:0.4  Onset:0000-00-00
Gender:Female  Submitted:2008-11-11
Location:Iowa  Entered:2008-12-09, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2792DA IMRL
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Non given

VAERS ID:334489 (history)  Vaccinated:2008-10-31
Age:21.0  Onset:2008-11-10, Days after vaccination: 10
Gender:Female  Submitted:2008-11-14, Days after onset: 4
Location:Minnesota  Entered:2008-12-09, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Negative strep test 11/12/08
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA173AA IMUN
Administered by: Public     Purchased by: Other
Symptoms: Fatigue, Lymphadenopathy, Musculoskeletal stiffness, Nausea, Pharyngitis, Streptococcus identification test negative
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: 11-12-08 DX with pharyngitis, strep test negative. Reported enlarged lymph nodes, extreme fatigue, stiff neck. Symptoms onset on or around 11-10-08. Improved energy by 11-13-08. Return to on 11/14/08. On 10-31-08 c/o nausea 20 minutes after shot, went away.

VAERS ID:334525 (history)  Vaccinated:2008-10-31
Age:54.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Male  Submitted:2008-11-18, Days after onset: 18
Location:Idaho  Entered:2008-12-09, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL, 10mg
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSFLLA192880IMLA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Joint swelling, Periorbital oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Severe generalized pruritic urticarial reaction with periorbital edema. Just swelling & pain.

VAERS ID:334621 (history)  Vaccinated:2008-10-31
Age:18.0  Onset:2008-11-29, Days after vaccination: 29
Gender:Male  Submitted:2008-12-04, Days after onset: 5
Location:Georga  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, medication, food, or latex allergy.
Diagnostic Lab Data: The patient was hospitalized at a hospital therefore there are no records of laboratory and x-ray results available for review. Phone consultation with the Infectious Diseases physician providing patient care yields the following verbal laboratory results: 1. Abnormal echocardiogram with 40-45% ejection fraction. 2. Abnormal EKG with ST-T wave changes. 3. Elevated Troponin with a peak measurement of 34. The health center is in process of requesting medical records to corroborate the verbal reporting. 12/26/08-records received- EKG abnormal and cardiac enzymes abnormal.
CDC 'Split Type':
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Manufacturer
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Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500549P IN 
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER  IDUN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB03472 IMUN
Administered by: Military     Purchased by: Military
Symptoms: Cardiac enzymes increased, Chest pain, Cough, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram, Electrocardiogram ST-T change, Headache, Influenza like illness, Myocarditis, Myopericarditis, Nausea, Oropharyngeal pain, Pain, Troponin increased, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow)
Write-up: The Chief at facility called to report a case of Myopericarditis. The patient is an 18 y/o male who received primary SPV, AVA #1, Typhoid IM, and FLUMIST on 31 Oct 2008. He developed Flu like symptoms and chest pain requiring hospitalization on 11/29/08. Symptoms: Nausea w/ vomiting. 12/26/08-records received-chest pain. 3-3 days after vaccine C/O flu-like illness, mild headache, cough sore throat, general body achiness then would feel well and symptoms returned and included chest pain on 11/26/08. Diagnosis myocarditis, acute.

VAERS ID:336526 (history)  Vaccinated:2008-10-31
Age:20.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-12-12, Days after onset: 42
Location:New Jersey  Entered:2008-12-15, 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: Diabetes; Hypothyroidism; Coeliac disease
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0812USA00025
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0548X1IMUN
Administered by: Private     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a medical assistant concerning a 20 year old female patient with diabetes and hypothyroidism who on 05-AUG-2008 was vaccinated with the first dose of GARDASIL, lot # 660620/0571X, 0.5 mL, intramuscularly; and on 31-OCT-2008 was vaccinated with the second dose of GARDASIL, lot # 661044/054f8X, 0.5 mL, intramuscularly. Concomitant therapy included insulin Novolog and insulin Levemir. It was reported that the patient on 31-OCT-2008 experienced pain and redness at the injection site of the left upper arm after receiving her second dose of HPV vaccine. The pain was increased and the area formed a large, firm lump surrounded by a red ring. The patient had difficulty lifting the left arm. Patient not recovered. She was scheduled for an office evaluation on 28-NOV-2008. Additional information has been requested. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information from her physician indicated that the patient was a female student (152 pounds, 67.5 inches) with diabetes, hypothyroidism and celiac disorder who reported redness, swelling and decrease of mobility in arm after being vaccinated. The patient was seen on 29-NOV-2008 with erythema (2 cm thick) at site of injection, mobility within normal limits. Therapy with nonsteroidal anti-inflammatory drug (unspecified) was prescribed. Patient recovered on 19-JAN-2009. Additional information is not expected.

VAERS ID:335744 (history)  Vaccinated:2008-10-31
Age:10.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-09
Location:Wisconsin  Entered:2008-12-19, Days after submission: 10
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 BIOLOGICALSAC14B064AA IMUN
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2828AA IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1221X SCUN
Administered by: Public     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: Based on lot # recording- appears that DTap was administered instead of Hep A. Unable to confirm if DTap was actually given instead of Hep. A. Recommended re start Hep A series. Mother stated there were no adverse side effects following vaccines, told to wait minimum 6 mos after any Td/Tdap dose.

VAERS ID:336012 (history)  Vaccinated:2008-10-31
Age:35.0  Onset:2008-11-14, Days after vaccination: 14
Gender:Female  Submitted:2008-12-18, Days after onset: 34
Location:California  Entered:2008-12-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Ciprofloxacin Allergy
Diagnostic Lab Data: Viral Culture (11/21/2008)
CDC 'Split Type':
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Blister, Rash erythematous, Rash maculo-papular, Virus culture
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Erythematous,small maculopapular rash, with one vesicle. Symptomatic treatment (Benadryl by mouth as needed).

VAERS ID:337218 (history)  Vaccinated:2008-10-31
Age:73.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2008-12-23, Days after onset: 52
Location:Georga  Entered:2008-12-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type': WAES0811USA00206
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1416X UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site swelling, Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a pharmacist concerning a 73 year old female who on 31-OCT-2008 was vaccinated with one dose of ZOSTAVAX, Lot number 663195/1416X. On 01-OCT-2008, the patient was vaccinated with influenza virus vaccine (unspecified) and it was unspecified if the patient was on other medications. It was reported that "over the weekend" on approximately 01-NOV-2008 the patient developed swelling at the injection site and rash on her left breast. Also, her lymph nodes were swollen. The pharmacist had not seen the patient. At the time of the report the patient had not contacted her physician yet. At the time of the report the patient was recovering. The patient sought medical attention, called pharmacist. Additional information has been requested.

VAERS ID:336512 (history)  Vaccinated:2008-10-31
Age:14.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2008-11-06, Days after onset: 5
Location:Georga  Entered:2009-01-05, Days after submission: 60
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': GA08088
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2829AA UNRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB291BA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1002X1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: Pt received vaccine on Friday. Saturday night pt noticed site where he received the vaccine was itching and he had developed a rash that was about 5 in X 2 in with a darker red raised rash in the center that was about one inch in diameter. Pt. noticed no other signs or symptoms other than itching and rash on back of (R) upper arm.

VAERS ID:336838 (history)  Vaccinated:2008-10-31
Age:64.0  Onset:2009-01-01, Days after vaccination: 62
Gender:Female  Submitted:2009-01-08, Days after onset: 7
Location:Connecticut  Entered:2009-01-08
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none 2/25/09-records received- Viral gastroenteritis with abdominal discomfort and diarrhea approximately 2 weeks prior to admission on 1/3/09.
Preexisting Conditions: 2/25/09-records received-PMH:Coronary artery disease. hyperlipidemia, hypothyroidism, depression. Slight elevated c reactive protein, hypothyroid, hypotension, poss rheumatoid arthritis and coronary artery disease - being treated successfully by cardiologist.
Diagnostic Lab Data: 2/25/09-records received- Lumbar puncture elevated protein 76, normal glucose 77, 29 red blood cells, 75,000 white blood cells, no oligoclonal bands, IgG normal, no PCRss detected. ANA titer normal, negative anti-Rho antibody, ESR 8. Rheumatoid factor elevated at 48.MRI brain T2 abnormality in white matter and subsequent MRIs demonstrated stable extensive areas of restricted effusion within bilateral parietocciptal regions.. CTA vessel irregularity. EKG sinus tachycardia. Troponin increased 0.11. Liver function tests elevated. Elevated WBC 13, urine culture negative, blood culture positive for coag-negative Staphylcoccus. Chest x-ray consistent with aspiration pneumonia. LABS and DIAGNOSTICS: CBC - WBC 11.0 x1000/uL (H) Neutophils 85% (
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89973 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Angiopathy, Antinuclear antibody negative, Areflexia, Ataxia, Autonomic nervous system imbalance, Back pain, Bacteria urine identified, Bilirubin conjugated increased, Blood albumin increased, Blood bilirubin increased, Blood chloride decreased, Blood cortisol increased, Blood culture positive, Blood glucose increased, Blood product transfusion, Blood sodium decreased, Blood urine present, CSF glucose normal, CSF oligoclonal band absent, CSF protein increased, Cerebellar syndrome, Cerebrovascular accident, Cerebrovascular disorder, Chest X-ray abnormal, Computerised tomogram head, Culture urine negative, Electrocardiogram abnormal, Endotracheal intubation, Epstein-Barr virus antibody positive, Extensor plantar response, Facial palsy, Gait disturbance, Gastroenteritis viral, Gastrostomy tube insertion, Glucose urine present, Guillain-Barre syndrome, Haematoma, Hypertensive crisis, Hyporeflexia, Hypothyroidism, Intensive care, Ischaemic stroke, Liver function test abnormal, Lumbar puncture, Lymphocyte percentage decreased, Malaise, Mechanical ventilation, Mental status changes, Miller Fisher syndrome, Nausea, Neutrophil percentage increased, Nuclear magnetic resonance imaging brain abnormal, Pain, Pneumonia aspiration, Polymerase chain reaction, Protein urine present, Red blood cell sedimentation rate increased, Red blood cells urine positive, Rheumatoid factor increased, Staphylococcus identification test positive, Tracheostomy, Troponin increased, Urinary sediment present, Urine analysis, Urine analysis abnormal, Urine ketone body present, Vasculitis, Vomiting, White blood cell count increased, White blood cells urine positive
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Angioedema (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic cerebrovascular conditions (narrow), Haemorrhagic cerebrovascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hypertension (narrow), Cardiomyopathy (broad), Demyelination (narrow), Hypothyroidism (narrow), Vasculitis (narrow), Ocular motility disorders (narrow), Chronic kidney disease (broad), Hypersensitivity (broad)
Write-up: GUILLIAN BARRE Syndrome after receiving the flu shot. Very severe case, currently in intensive care at Hospital 2/25/09-records received for DOS 1/5-2/9/09-DC DX:Central Nervous System Vasculopoathy due to Primary versus Secondary Central Nervous System Vasculitis. Bilateral parietoccipital ischemic strokes. GUILLIAN-BARRE syndrome MILLDER FISHER variant. Presented with uncontrollable back pain and body aches, general malaise, nausea and vomiting.PE: Gait instability, ataxia, dysmetria. Altered mental status and hypertensive crisis and autonomic instability. Patellar reflexes absent, mild left facial palsy. IVIG treatment. Mechanical ventilation and intubation with tracheostomy. 2/25/09 Hospital records, DC summary received. Service dates 1/5/09 too 2/9/09. Assessment: Principle Diagnosis - Central Nervous System Vasculopathy due to Primary vs Secondary Central Nervous System Vasculitis. Other Diagnoses - Bilateral Parietooccipial Ischemic Strokes, Guillain-Barre Syndrome, Coronary Artery Disease, Hyperlipidemia, Hypothyroidism, Depression. Viral gastroenteritis with abdominal discomfort and diarrhea 2 weeks prior. Patient presented with uncontrollable back pain and body aches. General malaise, nausea and vomiting. Difficulty with balance. Gait instability, ataxia, dysmetria. Altered mental status, hypertensive crisis, admitted to ICU. Patellar reflexes initially present, later patellar and Achilles reflexes absent. 1+ reflexes biceps / triceps. Mild left facial palsy. IVIG administration. Mental status worsened. Acute bilateral strokes. Babinski present. Right thigh hematoma. Mechanical ventilation. Gastrostomy tube. Aspiration pneumonia. Follow-up: Serious vision impairment Started with flu-like symptoms about a week or two after receiving shot. Seemed to recover but still weak, stomach pain. Jan 1, 2009 - intense stomach pain, nausea, weakness, inability to walk, shoulder and back pain, dizziness. Admitted to hospital Jan 5, 2009. Flu vaccine 10/31/08, possibly also shingles vaccine.

VAERS ID:337424 (history)  Vaccinated:2008-10-31
Age:52.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2009-01-11, Days after onset: 71
Location:Washington  Entered:2009-01-15, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01049211A IMRA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Injection site pain, Sleep disorder
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Flu Shot was fine at first but overtime developed aching where vaccine was deposited inside arm to point of interfering with sleep. Also general arm weakness and sharper pain at vaccine site with use. Clinic visit ruled out infection. Tried RX 6-day decreasing course of methylprednisolone. With Rx applied heat. Symptoms decreased with meds and heat but still had some pain with use and general weakness into December. By end of Dec was symptom free.

VAERS ID:338674 (history)  Vaccinated:2008-10-31
Age:12.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2009-01-16, Days after onset: 76
Location:Pennsylvania  Entered:2009-01-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type': WAES0812USA05232
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Headache
SMQs:
Write-up: Information has been received from a physician concerning a 12 year old female patient with no pertinent medical history who in the end of October 2008 was vaccinated with the second dose of GARDASIL vaccine. There was no concomitant medication. The physician reported that patient has been having temporal headaches on right side of her head since 3 days after receiving the HPV vaccine. A computed axial tomography or magnetic resonance

VAERS ID:339118 (history)  Vaccinated:2008-10-31
Age:30.0  Onset:2008-12-18, Days after vaccination: 48
Gender:Male  Submitted:2009-02-06, Days after onset: 50
Location:Unknown  Entered:2009-02-06
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: 2/17/09-records received-Negative tests except for mild hypokalemia.
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500562P1IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diagnostic procedure, Facial palsy, Hypokalaemia, Laboratory test normal
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Bell''s Palsy developed 17 DEC 08. 2/17/09-records received for DOs 12/22/08-Released form hospital after exhaustive investigation into sudden left facial palsy.

VAERS ID:339774 (history)  Vaccinated:2008-10-31
Age:59.0  Onset:2008-11-12, Days after vaccination: 12
Gender:Female  Submitted:2009-02-03, Days after onset: 83
Location:Colorado  Entered:2009-02-18, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Penicillin; Low thyroid; Elevated cholesterol 2/26/09-records received-PMH:low back pain. neck pain. hypothyroidism.
Diagnostic Lab Data: MRI; EMG; Blood tests 2/20/09-records received-EKG normal, CAT scan of head no evidence of intracranial hemorrhage, possible chronic small vessel ischemia. Chest x-ray normal.CBC and CMP WNL. Glucose 128, D-dimer less than 400. 2/26/09-records received-EMG/NCV demonstrated demyelinating polyradiculoneuropathy most likely chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). CPK increased 204.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA350BA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood glucose normal, Blood test, Blood test normal, Chest X-ray normal, Chronic inflammatory demyelinating polyradiculoneuropathy, Computerised tomogram head, Computerised tomogram normal, Decreased activity, Electrocardiogram normal, Electromyogram abnormal, Fatigue, Fibrin D dimer normal, Foreign travel, Full blood count normal, Hyperglycaemia, Hypertension, Hypoaesthesia, Immunoglobulin therapy, Metabolic function test, Nausea, Nerve conduction studies abnormal, Neuralgia, Nuclear magnetic resonance imaging, Pain in extremity, Paraesthesia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Demyelination (narrow)
Write-up: Hospitalization for numbness, pain, in hands and feet. IVIG, Narotin. 2/20/09-records received for DOS 11/28/08-presented to ED with C/O hands and feet hurt and tingling and numbness of hands and feet. Symptoms began couple of weeks ago when travelling out of country. DX:Bilateral hand and foot pain, etiology undetermined. Mild Hyperglycemia. 2/26/09-records received for DOS 12/4-12/9/08-DC DX: Post-vaccination demyelinating polyradiculoneuropathy. Presented with numbness and pain in extremities. Treated with IVIG. Nausea vomiting. Follow-up: Continued nerve pain in hands, feet, continued fatigue. Unable to do physical activity at previous level. Plan to retire earlier due to fatigue. Blood pressure high. Doctor hopes I will continue w/ remyelinization of nerve endings. Doesn''t know if I will achieve 100%.

VAERS ID:341154 (history)  Vaccinated:2008-10-31
Age:41.0  Onset:2008-11-03, Days after vaccination: 3
Gender:Female  Submitted:2009-02-01, Days after onset: 90
Location:Ohio  Entered:2009-03-05, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500541P0IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Chest X-ray normal, Influenza like illness, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 3 days post immunization pt. c/o wheezing with exhalation. The Monday following 11/10 she came down with flu-like symptoms + fever 101 degrees. She saw her personal physician given Z Pack. 2 additional episodes in December + January treated with Z-Pack + OTC cold med CXR-negative in February.

VAERS ID:341731 (history)  Vaccinated:2008-10-31
Age:55.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2009-03-13, Days after onset: 133
Location:Alaska  Entered:2009-03-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2807AA9IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1383U0SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3027AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Axillary pain, Chills, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 10/31/08 5pm c/o sore right armpit, took ibuprofen 800mg,11/1/08 3pm injection site size of a quarter, fever & chills, temp 101 degree: 11/2/08 injection site size of palm of hand taking ibuprofen q 4 hr; 11/3/08 injection site measured by PHN 18.5cm wide, 15 cm long, temp 98.7; resolved by 11/10/08

VAERS ID:343677 (history)  Vaccinated:2008-10-31
Age:54.0  Onset:2008-11-04, Days after vaccination: 4
Gender:Female  Submitted:2009-04-07, Days after onset: 153
Location:North Carolina  Entered:2009-04-07
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Anxiety/depression Medical records state PMH: allergic rhinitis; heartburn; menopause; tinnitus; acute bronchitis, anemia, epistaxis & OM resolved; appendectmy.
Diagnostic Lab Data: 5/11/09 Received OPH office records DOS 11/4/08-12/1/09. LABS: Temporal artery biopsy WNL. MRI brain WNL. Elevated C-reactive protein. Negative Lyme disease titer. LABS: WBC 17.2(H), neutros 87.5%(H), lymphs 5.6%(L), BUN 27(H). ESR 9(N).CRP <0.3(N). HgbA1C 6.2(N). Lipid panel(H). MRI 11/8 neg for MS. Right shoulder & CXR WNL.
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSU2828AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Biopsy artery normal, Blindness, Blindness unilateral, Blood urea increased, Borrelia burgdorferi serology negative, Bursitis, C-reactive protein increased, Chest X-ray normal, Eye pain, Fall, Fundoscopy abnormal, Lipids increased, Lymphocyte percentage decreased, Musculoskeletal pain, Neutrophil percentage increased, Nuclear magnetic resonance imaging normal, Optic ischaemic neuropathy, Optic neuritis, Red blood cell sedimentation rate normal, Rotator cuff syndrome, Visual impairment, White blood cell count increased, X-ray limb normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Glaucoma (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (narrow), Ocular infections (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad)
Write-up: 11/4/08 Optic Neuropathy leading to severe loss of vision right eye. Treated with high dose IV steroids with no benefit. 5/4/09 Received Optho Clinic consult of 12/30/2008. FINAL DX: AION right eye(anterior ischemis optic neuritis) Records reveal patient experienced sudden painless vision loss right eye on 11/2. Exam revealed disc edema. 5/11/09 Received OPH office records DOS 11/4/08-12/1/09. FINAL DX: Anterior Ischemic Optic Neuropathy - Right Eye Patient noticed spot and pain in right eye. Central vision loss. Right eye fundus elevation with telangiectatic vessels. 4/28/09 Received PCP medical records of 11/17/08-4/6/09. FINAL DX: ischemic optic neuropathy Records reveal patient experienced unilateral vision loss. Had been diagnosed by outside MD & had PICC line placed for high dose steroids x 5 days. Unilateral blindness remained despite steroids & was continued on oral antibiotics & steroids w/o resolution. 1/2/09 tripped & fell w/pain on right shoulder & ribs. Dx w/rotator cuff bursitis & tx w/PT & meds. 5/12/10 Monocular blindness.

VAERS ID:344241 (history)  Vaccinated:2008-10-31
Age:6.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Male  Submitted:2009-04-14, Days after onset: 164
Location:Virginia  Entered:2009-04-15, 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: VYVANSE
Current Illness: No
Preexisting Conditions: ADHD; Allergies (Environmental)
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2797DA IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB319AA1IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0622X0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis
SMQs:
Write-up: R upper arm cellulitis at injection site.

VAERS ID:346241 (history)  Vaccinated:2008-10-31
Age:77.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2009-05-11, Days after onset: 192
Location:Minnesota  Entered:2009-05-12, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2760AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0551X IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Erythema, Heart rate increased, Increased upper airway secretion, Limb discomfort, Pruritus, Skin warm, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Pt walked into clinic at 10:00 am on 11-3-08. She reported 4-5 hrs after getting vaccines pt noted redness, warmth, soreness and itching on upper left arm and pulse went to 1:15 & returned to normal w/5 min after doing valsalua movement - hx of evt. The next day 11-1-08, the redness had spread to up her neck to the side of her face & was warm/itchy. At night 11-1-09 pt had constant cough, phlegm production, wheezing when she layed down . The redness is now decreased to 6" & 0 soreness and itching 0 cough. Pt did not seek medical care with acute sx.

VAERS ID:347367 (history)  Vaccinated:2008-10-31
Age:1.1  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2009-05-15, Days after onset: 195
Location:California  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: Eczema
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0811USA02212
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT278CA0IMUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.662437/1251X0SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.661649/1156X0SCUN
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site mass, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse (RN) concerning a 13 month old female with eczema who on 31-Oct-2008 was vaccinated subcutaneously in the left triceps with a 0.5ml dose of VARIVAX (Oka/Merck) (Lot#661649/1156X). Concomitant therapy included acetaminophen (Tylenol). On 10-Nov-2008 the patient developed a red nodule at injection site that was warm to touch. On 13-Nov-2008 the patient had an office visit and was examined by physician. On that day the patient had a non-tender by 1 cm erythematous patch with a 1cm induration at the injection site. The patient was treated with Hydrocortisone cream. At the time of the report, 13-Nov-2008, the patient had not recovered from the events. Follow-up information was received from the R.N. on 08-Jan-2009 concerning a 13 month old white female with eczema. On 31-Oct-2008, at 9:00 a.m. the patient was vaccinated subcutaneously in the left tricep with a first dose of VARIVAX (Oka/Merck) (Lot#561649/1156X). On the same day, at 9:00am, the patient also received a first dose of MMR II (Lot # 662437/1251X) subcutaneously in the right tricep and a first dose of FLUZONE (lot#UT2782CA) intramuscularly in the left deltoid. There was no illness at the time of vaccination. On 10-Nov-2008, the patient developed bump at the left tricep area. On 13-Nov-2008 the patient came into the office for observation. She had a 2cm by 1cm area pink patch with induration (1cm). The area had no apparent tenderness and was not warm. It was reported that the area "was warm prior and also was more red" and the "site was improving". The patient was not afebrile. Topical hydrocortisone acetate cream was placed to the area. The patient recovered on an unspecified date. Information / Follow-up information received on 08-Jan-2009 contained the following adverse experiences: hives with eggs (November 2008). Additional information is not expected.

VAERS ID:350181 (history)  Vaccinated:2008-10-31
Age:18.0  Onset:0000-00-00
Gender:Female  Submitted:2009-05-29
Location:Unknown  Entered:2009-06-17, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0901USA04183
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Measles antibody negative
SMQs:
Write-up: Information has been received from a medical assistant concerning an 18 year old female who in approximately 1991, "when she was 1 year of age" was vaccinated with MMR II. On 31-OCT-2008 the patient was vaccinated with MMR II. The medical assistant states the patient still has low titer for measles. The patient''s titers are not low for mumps or rubella. No further information is available.

VAERS ID:353980 (history)  Vaccinated:2008-10-31
Age:52.0  Onset:2008-11-01, Days after vaccination: 1
Gender:Female  Submitted:2009-07-30, Days after onset: 271
Location:Texas  Entered:2009-08-06, 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: albuterol
Current Illness: Drug hypersensitivity; Sulfonamide allergy; Allergic reaction to antibiotics; Food allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0811USA00510
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0224X0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Oral pruritus, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a healthcare worker concerning a 52 year old female with allergy to soy products, sulfa, BACTRIM, CIPRO and LEVAQUIN and no illness at the time of vaccination who on 31-OCT-2008 was vaccinated with the first dose of PNEUMOVAX 23 (lot#: 660717/0224X) 0.5ml IM into the left deltoid. Concomitant therapy included flu vaccine and albuterol inhaler. After receiving the vaccination the patient experienced itching on her legs and mouth. Subsequently, the patient recovered from itching on her legs and mouth. Follow-up information was received from the healthcare worker. The healthcare worker indicated that the patient called on 03-NOV-2008 and stated she felt itching and wanted to know if the vaccine contained soy. the patient took BENADRYL to treat itching. The patient''s itching lasted 1 day and recovered at the time reporting. Additional information is not expected.

VAERS ID:353997 (history)  Vaccinated:2008-10-31
Age:46.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:New York  Entered:2009-08-06, 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: Unknown
CDC 'Split Type': WAES0811USA01735
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0380U IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Initial information has been received from a healthcare worker and follow-up information was received from a physician concerning a 46 year old female who on 31-OCT-2008 was vaccinated with a dose of PNEUMOVAX (lot # 657143/0380U) intramuscularly. The patient had skin reactions after administration of PNEUMOVAX. The patient developed redness and pain in the injection arm. She had sore area a few inches across. On 17-NOV-2008, the patient was in the office and had recovered. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:354018 (history)  Vaccinated:2008-10-31
Age:84.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:New York  Entered:2009-08-06, 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: Unknown
CDC 'Split Type': WAES0811USA02784
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0380U IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Initial information has been received from a healthcare worker and follow-up information was received from a physician concerning a 84 year old female who on 31-OCT-2008 was vaccinated with a dose of PNEUMOVAX (lot # 657143/0380U) intramuscularly. The patient had skin reactions after administration of PNEUMOVAX. The patient developed redness and pain in the injection arm. She had a sore area a few inches across. On 17-NOV-2008, the patient was in the office and had recovered. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:354162 (history)  Vaccinated:2008-10-31
Age:42.0  Onset:0000-00-00
Gender:Male  Submitted:2009-07-30
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0811USA04098
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0978X0IMUN
Administered by: Private     Purchased by: Other
Symptoms: Body temperature increased, Erythema
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad)
Write-up: Information has been received from a registered pharmacist concerning a 42 year old male who on 31-OCT-2008 (also reported as "31-DEC-2008") was vaccinated with PNEUMOVAX (Lot # 662661/0978X) intramuscularly (total daily dose not reported). Subsequently the patient developed 13x17cm red area and running 102 temp and the patient went to ER and started on BIAXIN. At the time of the report the patient recovered from 13x17cm red area and running 102 temp. This is one of several reports received from the same source. No further information is available.

VAERS ID:355351 (history)  Vaccinated:2008-10-31
Age:  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-10-31, Days after onset: 0
Location:California  Entered:2009-08-13, Days after submission: 286
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': MEDI0007362
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500560P   
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: A non-serious spontaneous report of administration to pregnant female was received from a Registered Nurse concerning an adult female. The patient''s medical and obstetrical history was not reported. On 31-Oct-2008, FLUMIST was "mistakenly given" to a pregnant female. There was no adverse event associated with this pregnancy. Treatment and reporter/sponsor causality assessments are not applicable.

VAERS ID:355450 (history)  Vaccinated:2008-10-31
Age:  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 5
Location:Unknown  Entered:2009-08-13, Days after submission: 280
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': MEDI0007464
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.    
Administered by: Public     Purchased by: Unknown
Symptoms: Malaise, Oral herpes, Rhinorrhoea
SMQs:, Oropharyngeal infections (narrow)
Write-up: A non-serious, spontaneous report of fever blister on the lip, "felt bad" and runny nose was received from a nurse concerning an adult female, subsequent to FLUMIST. Neither medical history nor concomitant medications have been reported. The patient received FLUMIST vaccine on 31-Oct-2008. Immediately after receiving FLUMIST, the patient began having a runny nose and just "felt bad". Two days later she woke up with a large fever blister on she lip and felt terrible. The following day, she was seen by a doctor, who agreed that her symptoms were caused by FLUMIST. The outcome of the events was not reported.

VAERS ID:358085 (history)  Vaccinated:2008-10-31
Age:23.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2009-09-22, Days after onset: 326
Location:Kansas  Entered:2009-09-23, 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: DIFLUCAN; omeprazole
Current Illness: Pregnancy NOS (LMP = Unknown)
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0909USA02430
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1448U1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Premature labour
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a office manager, for GARDASIL, a Pregnancy Registry Product, concerning a 23 year old female who on 11-SEP-2008 was vaccinated with the first dose of GARDASIL (0.5ml, IM). On 31-OCT-2008 the patient received the second dose of GARDASIL (0.5ml, IM, lot# 659653/1448U). Concomitant therapy included omeprazole and DIFLUCAN. Subsequently the patient got pregnant on an unspecified date. In April 2009, the baby girl was born prematurely and was on an incubator. The patient had a 2 month postpartum visit on 30-JUN-2009. A physician had a note in a chart saying the third dose of GARDASIL would hold off since the patient was breastfeeding. At the reporting time the outcome was unknown. Additional information has been requested.

VAERS ID:367173 (history)  Vaccinated:2008-10-31
Age:1.7  Onset:2008-11-16, Days after vaccination: 16
Gender:Female  Submitted:2009-02-24, Days after onset: 100
Location:Montana  Entered:2009-11-12, Days after submission: 261
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: The patient had no pre-existing allergies or medical conditions, no illnesses at the time of vaccination and was not taking any concomitant medications. The patient had not experienced any adverse events following prior vaccinations. It was unknown if the patient had received any other vaccinations within four weeks of 31 October 2008.
Diagnostic Lab Data:
CDC 'Split Type': 200803656
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU02808A1IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHHAVB289AA IMUN
Administered by: Private     Purchased by: Other
Symptoms: Ataxia, Clumsiness, Coordination abnormal
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Ataxia, clumsiness, lack of coordination, Initial report received on 17 November 2008 from a patient''s parent, who is a physician. A 23 month old female patient experienced mild ataxia 16 days after she had received left thigh intramuscular injection of FLUZONE SV 2008-2009 (lot number U2808AA) and a dose of Hepatitis A vaccine (trade name, manufacturer, lot number, route/site of administration not reported). The patient experienced clumsy behavior and was not able to grasp things when she reached out for hem. There were no other symptoms. At this time of the report, the symptoms persisted. Patient outcome unknown. Follow-up information was received on 19 February 2009 from patient''s parent. The patient received HAVRIX, hepatitis A vaccine (manufacturer GSK, lot number AHAVB289AA) intramuscularly. The patient did not require treatment, laboratory or diagnostic tests. The patient''s symptoms resolved within two and three days from the date of onset.

VAERS ID:384390 (history)  Vaccinated:2008-10-31
Age:38.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2010-03-05, Days after onset: 490
Location:Missouri  Entered:2010-04-06, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy NOS (LMP = 4/1/2008); Drug hypersensitivity; Skin injury
Preexisting Conditions: Gastric bypass
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0812USA04106
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2882FA IMUN
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0401X1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Amniocentesis, Drug exposure during pregnancy, Incorrect dose administered, No adverse event, Ultrasound scan, Wrong drug administered
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a nurse practitioner concerning a 38 year old pregnant female with allergy to DEMEROL and a history of gastric bypass in 1996 who on 31-OCT-2008 at 08:40 was vaccinated IM into deltoid with the second dose of RECOMBIVAX HB (lot# 660461/0401X). There was no concomitant medication. Dose 1 was administered at a different facility and the date that dose 1 was administered was unspecified. Dose 2 was given as 2 combined pediatric doses of RECOMBIVAX HB. As of 18-DEC-2008, the patient was 7 and 1/2 months pregnant (estimated LMP was 18-MAY-2008 and EDD was 22-FEB-2009). No symptoms reported. The patient sought medical attention in the office. Follow-up information received from a licensed practical nurse indicated that the patient was a female with sun damaged skin who received her first dose of (previously reported by the nurse practitioner as second dose) of RECOMIVAX HB (lot# 66041/0401X) IM into the left deltoid on 31-OCT-2008. Concomitant vaccine included FLUZONE, (lot # UT2882FA) IM into the right deltoid as 2 combined pediatric doses during the same visit. The patient did not seek medical attention (previously reported by the nurse practitioner as sought medical attention). The nurse practitioner''s office had not seen patient since injection given on 31-OCT-2008 and could not provide any information regarding the outcome of the pregnancy. Follow-up information has been received from a healthcare professional who reported that the patient had 2 previous pregnancies and 1 live birth. No birth defect but a miscarriage or stillbirth occurred 5-6 weeks from last menstrual period during previous pregnancies. It was reported that the date of LMP was 01-APR-2008. On 31-OCT-2008, 30 weeks after the LMP, the patient went to her primary care physician (PCP) for a flu shot and was given the RECOMIVAX HB instead in error (patient was pregnant at that time). During pregnancy, the patient took FLINSTONES MULTIVITAMINS and 2 doses of injection RHOGAM. No prescription drug was taken. The patient had no infections/illnesses during pregnancy. Ultrasounds were performed (results unknown) on 11-MAY-2008 (5 weeks 5 days from LMP), 27-JUN-2008 (12 weeks 3 days from LMP), 27-AUG-2008 (21 weeks 1 day from LMP) and 10-DEC-2008 (36 weeks 1 day from LMP). A nuchal translucency (results unknown) was performed on 27-JUN-2008 (12 weeks 3 days from LMP). An amniocentesis (results unknown) was performed on 26-AUG-2008 (21 weeks from LMP). On 30-DEC-2008, 39 weeks after the LMP, the patient delivered a normal, healthy female baby weighing 8 pounds 7 ounces with no congenital anomalies. Additional information is not expected.

VAERS ID:384508 (history)  Vaccinated:2008-10-31
Age:36.0  Onset:2008-12-20, Days after vaccination: 50
Gender:Female  Submitted:2010-04-07, Days after onset: 472
Location:Washington  Entered:2010-04-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR    
Administered by: Public     Purchased by: Public
Symptoms: Abortion spontaneous, Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: Miscarriage

VAERS ID:392197 (history)  Vaccinated:2008-10-31
Age:42.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2010-06-14, Days after onset: 591
Location:Massachusetts  Entered:2010-07-02, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Degenerative Arthritis; Multiple Sclerosis
Preexisting Conditions: The subject has multiple sclerosis and degenerative arthritis. She has never had a multiple sclerosis attack except for optic neuritis several years ago. In the past, the subject has had injections in the knee and experienced similar reactions to those experienced following FLUARIX, but she has never had reactions to this extent after a flu vaccination. The subject received three FLUZONE Vaccines at this facility in the past and developed a little swelling after they were given. The subject has no history of adverse events following previous vaccinations other than those noted for flu vaccines. The subject did not use alcohol or tobacco.
Diagnostic Lab Data: Upon examination on 30 December 2008, it was found that the injection site area was mildly swollen, the subjects reflexes and strength were normal, but when a little pressure was put on the arm, the subject resisted. There was no numbness or tingling. Deep touch was normal and deep tendon reflexes were normal. The reporter suspected that the injection may have been given too deep in the muscle and therefore, performed an ultrasound that was found to be normal. Ultrasound of left upper arm: Negative for hematoma.
CDC 'Split Type': A0762376A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA358AA IJUN
Administered by: Public     Purchased by: Private
Symptoms: Activities of daily living impaired, Hyperaesthesia, Injection site erythema, Injection site pain, Injection site swelling, Musculoskeletal pain, Neck pain, Pain, Pain in extremity, Reflex test normal, Sleep disorder, Ultrasound scan normal
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: This case was reported by a physician and described the occurrence of swelling at the injection site in a 42-year-old female subject who was vaccinated with FLUARIX (GlaxoSmithKline). Concurrent medical conditions included degenerative arthritis and multiple sclerosis. Concurrent medications included Gabapentin, Glucosamine, Baclofen, Arthrotec, COPAXONE and PROVIGIL. On 31 October 2008 the subject received a dose of FLUARIX at 1.0 ml in the left arm. On 1 November 2008, 1 day after vaccination with FLUARIX, the subject developed a swollen red area on her left upper arm about the size of a small lemon. The area was tender to touch and she put ice on it and used NSAIDs. Within two to three weeks it was better, but her left arm did continue to hurt. Three weeks prior to reporting, the pain began to intensify. The subject experienced tremendous aching pain in the lateral part of her upper arm, neck and shoulder, radiating down her arm. She wakes up at night due to the pain. The reporter stated that the subject holds her arm on her upper abdomen because it hurts for her arm to hang down. The subject stopped climbing stairs and cannot pick up her child due to the pain, but she still continues to work. She sought medical attention on the day of reporting and the following was noted: The injection site area was mildly swollen, the subjects reflexes and strength were normal, but when a little pressure was put on the arm, the subject resisted. There was no numbness or tingling. Deep touch was normal and deep tendon reflexes were normal. The reporter suspected that the injection may have been given too deep in the muscle and therefore, performed an ultrasound that was found to be normal. It was specifically noted that the events of swelling, redness, tenderness and pain were worse at the time of reporting and probably related to treatment with FLUARIX. The outcomes and relationships of the other events to FLUARIX were not specifically stated. Follow-up information was received on 23 January 2009: The diagnosis was reported as arm pain at injection site. Onset date of earliest sign or symptoms was 31 October 2008. Outcome of the events was reported as unresolved and worse. The reporter considered the events were possibly related to FLUARIX. Ultrasound of the left upper arm was negative for hematoma. A biopsy was not performed. The subject did not use alcohol or tobacco. The subject has received flu shots "yearly".

VAERS ID:392347 (history)  Vaccinated:2008-10-31
Age:  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2010-06-14, Days after onset: 591
Location:Colorado  Entered:2010-07-02, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject had no relevant medical history. The subject has previously received flu shots with no reported adverse reactions. There was no reported history of adverse events following previous vaccinations.
Diagnostic Lab Data: UNK
CDC 'Split Type': A0755443A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA356BA0UNUN
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: This case was reported by a pharmacist and described the occurrence of swelling in the feet in an adult female subject who was vaccinated with FLUARIX, (GlaxoSmithKline). There were no concurrent medications. On 31 October 2008, at 09:00, the subject received a dose of FLUARIX at 0.5 ml. On 31 October 2008, at 17:00 (8 hours after FLUARIX administration), the subject experienced swelling in the feet and hives on the trunk. The subject was seen by an internal physician at the hospital and was treated with unknown medications. The events resolved. The pharmacist considered the events possibly related to vaccination with FLUARIX.

VAERS ID:399289 (history)  Vaccinated:2008-10-31
Age:26.0  Onset:2008-10-31, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 642
Location:California  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0912USA00842
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0652X0UNGM
Administered by: Private     Purchased by: Other
Symptoms: Vaccine positive rechallenge, Vaginal discharge
SMQs:
Write-up: Information has been received from a physician concerning a 26 year old female patient with no illness at the time of vaccination and no pre-existing allergies who on 31-OCT-2008 and 31-DEC-2008 was vaccinated with the first and second dose of GARDASIL (lot # 661766/0652X) in her buttock. On 29-APR-2009, the patient was vaccinated with the third dose of GARDASIL (lot# 0294Y) in her buttock. There was no concomitant medication. On 31-OCT-2008, after the first dose of vaccination, the patient experienced vaginal watery discharge. On 06-NOV-2008, the patient recovered. On 31-DEC-2008, after the second dose of vaccination, the patient experienced vaginal watery discharge. Medical attention was not sought. There were no laboratory diagnostic studies performed. On 06-JAN-2009, the patient recovered. Follow-up information has been received from a physician who reported that all three doses of GARDASIL administered to the patient were 0.5mL. There was no adverse event following prior vaccination. Additional information is not expected.

VAERS ID:414177 (history)  Vaccinated:2008-10-31
Age:45.0  Onset:2008-11-18, Days after vaccination: 18
Gender:Male  Submitted:2011-01-06, Days after onset: 779
Location:Maine  Entered:2011-01-06
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU2840AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)
Write-up: fell to floor and went to hospital

VAERS ID:419452 (history)  Vaccinated:2008-11-01
Age:75.0  Onset:2011-03-11, Days after vaccination: 860
Gender:Male  Submitted:2011-03-24, Days after onset: 12
Location:Unknown  Entered:2011-03-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions:
Diagnostic Lab Data: body temp, 03/11/11, 102.5 F
CDC 'Split Type': WAES1103USA02590
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood culture, Dysphonia, Feeling jittery, Oedema peripheral, Pyrexia, Weight increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a 78 year old male with bronchitis and no drug reaction/allergies who in November 2008, was vaccinated with a dose of ZOSTAVAX (Merck) and in November 2010, was vaccinated with a dose of "pneumonia vaccine" (manufacturer unknown) (duration and dose not reported) and a dose of "flu vaccine" (manufacturer unknown) (duration and dose not reported). There was no concomitant medication. On 11-MAR-2011, the patient went to the emergency room and he was hospitalized for a fever of 102.5F and complaints of feeling jittery. Antibiotics were given for the events. "Blood cultures" was performed and the result was unknown. He was hospitalized from 11-MAR-2011 to 13-MAR-2011, and he was not fully recovered and he still had a hoarse voice. Consumer mentioned that he received an unspecified number of doses of LEVAQUIN (manufacturer unspecified and dose unspecified) during his hospitalization on 11-MAR-2011 to 13-MAR-2011, and he experienced swelling in his legs and a 10 pound weight gain. Consumer mentioned that the leg swelling had resolved and that he had lost the 10 pounds that he had gained. Additional information is not expected.

VAERS ID:443859 (history)  Vaccinated:2008-11-01
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-28
Location:Unknown  Entered:2011-11-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1111USA02284
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Asthenia, Convulsion, Headache, Pain
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a newspaper which indicated that a mother reported that her 16 year old daughter who 3 years ago (in November 2008), was vaccinated with GARDASIL vaccine (dose and lot # not reported). Subsequently the patient had been debilitated by headache, pains and seizure brought on by the vaccine and could no longer attend school.

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