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Case Details (Sorted by Vaccination Date)

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VAERS ID:312013 (history)  Vaccinated:2008-05-09
Age:82.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Male  Submitted:2008-05-10, Days after onset: 1
Location:Texas  Entered:2008-05-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Syncope
Preexisting Conditions: Penicillin allergy
Diagnostic Lab Data: Blood cultures. Labs and Diagnostics: Blood cx (-).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.97221061IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood culture negative, Chills, Leukopenia, Local reaction, Oedema peripheral, Pain in extremity, Pyrexia, Thrombocytopenia
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Shaking chills with fever. Pain swelling rt arm. 5/19/2008 MR received for DOS 5/9-11/2008. Pt admitted for syncopal episodes given Pneumovax in hospital. Pt developed a local reaction of pain and swelling of the R thumb with low grade fever. Pt had brief leukopenia and thrombocytopenia ? rxn to Pneumovax. DX: Local reaction to Pneumovax on R upper arm. Low Grade fever. Thrombocytopenia. R arm pain. Tx with Levaquin.

VAERS ID:312113 (history)  Vaccinated:2008-05-09
Age:29.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-12, Days after onset: 2
Location:Virginia  Entered:2008-05-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1634SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Fever 102.2 within 24 hours after receiving anthrax vaccine dose #5. Some erythema noted and referred for evaluation.

VAERS ID:312118 (history)  Vaccinated:2008-05-09
Age:67.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2008-05-12, Days after onset: 2
Location:Texas  Entered:2008-05-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor, fossamax, prozac
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0203X0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Chest discomfort, Chest pain, Headache, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Got shot on Friday about 9:30 am and symptoms began Saturday around noon on Saturday. Pt. had been shoveling dirt and cleaning house Friday night and Saturday morning. Headache, back above shoulder blades hurt very bad. Site was red, swollen and tender to the touch. Chest is hurting a bit, tightness. Did not feel as if needed to see an MD about it. Monday morning redness and heat has gone down but swelling is still present.

VAERS ID:312120 (history)  Vaccinated:2008-05-09
Age:0.3  Onset:0000-00-00
Gender:Female  Submitted:2008-05-12
Location:North Carolina  Entered:2008-05-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B139AA1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC458911IMRL
Administered by: Public     Purchased by: Public
Symptoms: Medication error
SMQs:
Write-up: Administered HIb vaccine diluted with sterile water diluent instead of diluent that came with vaccine. No adverse Sxs. reported. Informed DON. Mother was notified to repeat vaccination in one month.

VAERS ID:312124 (history)  Vaccinated:2008-05-09
Age:9.0  Onset:0000-00-00
Gender:Female  Submitted:2008-05-12
Location:North Carolina  Entered:2008-05-12
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1669U2SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: patient was given third varivax, booster had already been given

VAERS ID:312129 (history)  Vaccinated:2008-05-09
Age:24.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Female  Submitted:2008-05-12, Days after onset: 3
Location:Nebraska  Entered:2008-05-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None listed
Current Illness: No
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0147X3SCLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Went to Employee Health for MMR shot around 1015, Hives started that evening around 2100.

VAERS ID:312136 (history)  Vaccinated:2008-05-09
Age:14.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Female  Submitted:2008-05-09, Days after onset: 0
Location:North Carolina  Entered:2008-05-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1448U0SCLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1963CA2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1977U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Incorrect route of drug administration
SMQs:
Write-up: No adverse event - vaccine given SC instead of IM (HPV - Gardasil). When the nurse gave the vaccine- she drew back blood after hitting a vein. No treatment needed- Nurse placed needle in sharps box & administered a new vaccine.

VAERS ID:312140 (history)  Vaccinated:2008-05-09
Age:20.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2008-05-12
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: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2965AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Full blood count, Similar reaction on previous exposure to drug, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad)
Write-up: Tdap booster. T=101 Tachycardia last booster $g10 yrs

VAERS ID:312198 (history)  Vaccinated:2008-05-09
Age:13.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Female  Submitted:2008-05-09, Days after onset: 0
Location:Massachusetts  Entered:2008-05-13, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2550AA UNUN
Administered by: Unknown     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Pt. given MENACTRA (meningitis) vaccine today by error had received this on 9/7/07.

VAERS ID:312264 (history)  Vaccinated:2008-05-09
Age:0.2  Onset:2008-05-09, Days after vaccination: 0
Gender:Male  Submitted:2008-05-13, Days after onset: 4
Location:North Carolina  Entered:2008-05-13
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: BMP and CBCD were normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B142AA0IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF348AA0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC499190IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1732U0PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Full blood count normal, Gaze palsy, Metabolic function test normal, Moaning, Pyrexia, Staring, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient received 2 month vaccines (Pediarix, HIB, Prevnar, Rotateq) on 5/9/08. That evening, he developed fever up to 101.6, had emesis x 1, had eye deviation and became unresponsive with fixed gaze and moaning for 30 min- 1 hr. Parents brought patient to ED, where patient was responsive and exam was normal.

VAERS ID:312280 (history)  Vaccinated:2008-05-09
Age:14.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2008-05-13, Days after onset: 3
Location:California  Entered:2008-05-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2553AA1IMUN
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU21210BA IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1858U2SCUN
Administered by: Private     Purchased by: Private
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Both arms where injections were given are hot to touch, raised, rash-like. Pt was scratching injections.

VAERS ID:312281 (history)  Vaccinated:2008-05-09
Age:68.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-13, Days after onset: 3
Location:Illinois  Entered:2008-05-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1382U0IMUN
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0293X0SCUN
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site infection
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness at site of injection appeared to be infected.

VAERS ID:312314 (history)  Vaccinated:2008-05-09
Age:0.5  Onset:2008-05-12, Days after vaccination: 3
Gender:Male  Submitted:2008-05-14, Days after onset: 2
Location:Unknown  Entered:2008-05-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B145AA2IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC547632IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1832U2PO 
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt received routine 6-month vaccinations on 09 May 08. Mom states all associated redness, swelling had resolved before appearance of rash on 12 May 08. Rash was raised, red and localized around each injection site; has persisted x 3 days but has improved. No fever or other symptoms per mother, no s/s of infection. No previous symptoms with same vaccines, no known sensitivities to latex, aluminum or adhesives.

VAERS ID:312323 (history)  Vaccinated:2008-05-09
Age:13.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-14, Days after onset: 4
Location:Georgia  Entered:2008-05-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: swelling of arm~Meningococcal (Menactra)~1~13~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: overweight; elevated cholesterol level
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB217BA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1360U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt. developed redness and swelling at site of varicella injection

VAERS ID:312362 (history)  Vaccinated:2008-05-09
Age:11.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-14, Days after onset: 4
Location:New Hampshire  Entered:2008-05-15, 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: Obesity
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1669U1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1784U1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Large red rash at vaccine site 5 cm in diameter.

VAERS ID:312372 (history)  Vaccinated:2008-05-09
Age:4.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Male  Submitted:2008-05-09, Days after onset: 0
Location:Georgia  Entered:2008-05-15, 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: Rash, swollen tongue, coughing
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2951BA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04903SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0147X1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1850U1SCLL
Administered by: Private     Purchased by: Other
Symptoms: Cough, Rash, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: 5 minutes after getting MMR, IPOL, DTAP, Varicella patient started coughing and tongue began swelling and also has a rash. Patient returned to office got 1 1/2 tsp of BENADRYL at 11:35 AM. O2 stat was 98%. Patient was given ORAPRED and was observed for 1 hour. Patient was prescribed an Epi Pen to take home for emergency/anaphylaxis.

VAERS ID:312384 (history)  Vaccinated:2008-05-09
Age:  Onset:2008-05-13, Days after vaccination: 4
Gender:Male  Submitted:2008-05-15, Days after onset: 2
Location:New York  Entered:2008-05-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DILTAZEN ,ASA, MULTI VIT, ANTIHISTAMIN
Current Illness: OME
Preexisting Conditions: MITRAL VALZE PROLAPSE, ALLERGIC RHINITIS
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2863AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site infection
SMQs:
Write-up: TDAT GIVEN 5/9/08. INFECTION AT SITE ON 5/13/08

VAERS ID:312396 (history)  Vaccinated:2008-05-09
Age:17.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Female  Submitted:2008-05-15, Days after onset: 6
Location:South Dakota  Entered:2008-05-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid and Metformin
Current Illness: none
Preexisting Conditions: Prediabetic and hypothyroidism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1740U1IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0749U2SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2543AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Blood pressure, Confusional state, Dizziness, Dysarthria, Fatigue, Feeling abnormal, Heart rate, Hypoaesthesia, Limb discomfort, Malaise, Nausea, Pain, Tremor, Vision blurred
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad)
Write-up: Patient presented to office at 0830 for vaccines. MMR, Menactra, and HPV administered by nurse at approximately 0845. Patient went to waiting room after vaccinations for approximately 10-15 minutes. At about 0900, Patient presents back to nurse''s office and reports that she felt "funny" after first vaccine, but did not think much of it. Dizziness and shaking worsened while waiting in waiting room and difficult to focus while trying to read her book. Blood pressure at that time noted to be 110/78 and pulse 84. Client states she ate breakfast, does not feel faint, just dizzy. Sprite provided for client and offered to let her lie down. Client states she feels fine in chair. 0915: Client states dizziness and shaking remian the same. Client is conversing with nurse. Conversation appropriate and alert and oriented X 3. 0930: patient''s mother was present to sign for vaccines and ask questions, but left before vaccine was given. Mother of child called at 0930 to inform her of situation. Blood pressure 108/74. Mother of child came to the office to get child. 0945: Client states dizziness/shaking the same. Conversing with nurse appropriately. 1005: Dr''s office notified regarding patient''s condition. Physician not in office at this time, but clerical staff planned to relay message and return call to client for further recommendations or advice. Client discharged to home with mom and sister. States still has shaking feeling, but no worse than it was at 0900. Patient has a history of hypothyroidism and is considered prediabetic. She is on Synthroid and Metformin. Was also diagnosed with pancreatitis in 11-07 with unknown cause. Patient''s approximate weight is 225 pounds. 1615: Telephone call to patient to follow up on condition. Child not home, mother reports that she slept for about 4 hours after leaving office and now feeling a little better. Still a little dizzy and nauseated, but did go to work at Firesteel. Dr. returned call to family and was not concerned at this time. Stated that client could take

VAERS ID:312411 (history)  Vaccinated:2008-05-09
Age:38.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2008-05-15, Days after onset: 5
Location:Unknown  Entered:2008-05-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB452AA UNRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR40289 SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0807U SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC286AA UNLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA0446 UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 5/12/08 Pt. called to report "bump" w/redness & itching approx size of a quarter at site of Tdap inj. L deltoid given on 5/9/08. Pt. used LIDEX cream with relief.

VAERS ID:312559 (history)  Vaccinated:2008-05-09
Age:11.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-13, Days after onset: 3
Location:Washington  Entered:2008-05-19, 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: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB222AA1IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B06BA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1799U1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Red, swollen, itchy and warm seen 5-10-08 given KEFLEX.

VAERS ID:312687 (history)  Vaccinated:2008-05-09
Age:57.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-15, Days after onset: 5
Location:North Carolina  Entered:2008-05-20, 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: CAD, NKDA
Diagnostic Lab Data:
CDC Split Type:
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1132U0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Local reaction, Pain, 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: Administer vaccine on 05/09/08 - patient being having symptoms on 05/10/08 around 2:00pm. Had fever, body aches and local reaction at injection site. Red and swelling at injection site and painful. 9 1/2 cm x 10 cm.

VAERS ID:313129 (history)  Vaccinated:2008-05-09
Age:13.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Female  Submitted:2008-05-16, Days after onset: 7
Location:Illinois  Entered:2008-05-23, 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: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Went to ER for IV fluids.
CDC Split Type:
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MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2617AA IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU2610AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure decreased, Feeling abnormal, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 10 hours after vaccine when walking out, fainted, hit head on carpet - was dazed for 10 minutes. Decreased BP, glucose was ok.

VAERS ID:313174 (history)  Vaccinated:2008-05-09
Age:1.0  Onset:2008-05-20, Days after vaccination: 11
Gender:Female  Submitted:2008-05-22, Days after onset: 2
Location:Massachusetts  Entered:2008-05-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Motor weakness upper body
Diagnostic Lab Data: CBC, Pb, RAST: Egg yolk, egg white, gelatin
CDC Split Type:
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB216AA0IMUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1485U0SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1975U0SCUN
Administered by: Private     Purchased by: Unknown
Symptoms: Blood lead, Erythema, Erythema multiforme, Full blood count, Radioallergosorbent test, Skin warm
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Confluent red, warm, irregularly shaped areas on all 4 extremities. Initially seen on evening of 5/20/08 as just a few spots. More formed in AM of 5/21/08. More like erythema multiforme on 5/22/08.

VAERS ID:313441 (history)  Vaccinated:2008-05-09
Age:36.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2008-05-14, Days after onset: 4
Location:Massachusetts  Entered:2008-05-27, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma, hypothyroidism, right elbow tendon repair 2006 8VT
Diagnostic Lab Data: None
CDC Split Type:
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TDAP: TDAP (ADACEL)SANOFI PASTEURC2862AA UNLA
Administered by: Other     Purchased by: Other
Symptoms: Discomfort, Injected limb mobility decreased, Mobility decreased, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Reports received vaccine 730AM 5/9/08. On 5/10/08 at 8AM felt discomfort with swelling and limited range of motion. Used heat and gentle stretches. Resolved.

VAERS ID:313784 (history)  Vaccinated:2008-05-09
Age:45.0  Onset:2008-05-12, Days after vaccination: 3
Gender:Male  Submitted:2008-05-19, Days after onset: 7
Location:Minnesota  Entered:2008-05-28, 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: none
Current Illness: none
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
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RAB: RABIES (IMOVAX)SANOFI PASTEURA025722IMLA
Administered by: Other     Purchased by: Private
Symptoms: Body temperature increased, Injection site erythema, Injection site pruritus, Injection site rash, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Patient came in to donate plasma on 5-16-08 and reported having possible reaction from his rabies immunization on 5-9-08. He stated on 5-12-08, he noticed a 2-inch red itchy rash on his left upper arm. Tues. 5-13-08, the rash disappeared, but he had a temp. and felt nauseated.

VAERS ID:313841 (history)  Vaccinated:2008-05-09
Age:74.0  Onset:2008-05-22, Days after vaccination: 13
Gender:Female  Submitted:2008-05-22, Days after onset: 0
Location:Wisconsin  Entered:2008-05-28, 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: ferrous sulfate, demerol, peanuts
Diagnostic Lab Data:
CDC Split Type:
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VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0158X0SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pruritus, Skin swelling, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Area approximately 30mm in size - red and warm to touch. Area has 4-5 raised areas approximately 5mm in size. Complained of tenderness and itching. Seen by MD and placed on ACYCLOVIR 800mg 5x/d x 7d.

VAERS ID:314101 (history)  Vaccinated:2008-05-09
Age:50.0  Onset:2008-05-23, Days after vaccination: 14
Gender:Male  Submitted:2008-05-29, Days after onset: 6
Location:Wisconsin  Entered:2008-05-29
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: lymes titer essentially neg, wbc neg, R knee x-ray showed joint effusion
CDC Split Type:
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1610U IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0868U IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Borrelia burgdorferi serology negative, Joint swelling, Oedema peripheral, White blood cell count normal, X-ray limb abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Developed swelling of right knee on 5/23, to urgent care on 5/24, then on 5/25 left knee and hands also swollen. Swelling subsided on 5/26. Swelling resolved on 5/29.

VAERS ID:314363 (history)  Vaccinated:2008-05-09
Age:35.0  Onset:2008-05-17, Days after vaccination: 8
Gender:Male  Submitted:2008-05-21, Days after onset: 4
Location:Wisconsin  Entered:2008-05-30, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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SMALL: SMALLPOX (ACAM2000)ACAMBIS, INC.  IDUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Possible cellulitis; Probable aggressive immune reaction (Redness/swelling of left shoulder)

VAERS ID:314445 (history)  Vaccinated:2008-05-09
Age:63.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-05-27, Days after onset: 17
Location:Florida  Entered:2008-06-02, 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:
Current Illness: Diabetes; Neuropathy; High BP
Preexisting Conditions: Diabetes; Neuropathy; High BP
Diagnostic Lab Data: Hospital ER 5-18-08
CDC Split Type:
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TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Ear pain, Impaired work ability, Local swelling, Lymph node pain, Lymphadenopathy, Oral intake reduced, Oral pain, Pain, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: On Friday May 9th I received a combination shot of TDAP. Saturday May 10th I woke up with right lymph gland swollen larger than a lemon. Did not hurt for a few days. Then about the third day it swelled even worse. I started to experience a terrible pain that wouldn''t let up. Pain that ran all the way under my ear. The whole side of my head swelled, even the back of my neck. I ached all over. I have never had worse pain - ever. Could not open my mouth to eat for several days. Could not work and stayed in bed for most of those days. Today is the 27th May and today is the first time I''ve been out of the house except to go to the ER. I finally went to the ER on 05-18-08. Dr didn''t know for sure the cause but I do. Nothing had changed, nothing out of the ordinary. Nothing new except the shot. Dr put me or LORTAB 5/500 mg and AUGMENTIN 875 mg. Tried to use warm moist heat. 9 days after my visit to the ER, I''m better, but still not completely over it.

VAERS ID:314797 (history)  Vaccinated:2008-05-09
Age:45.0  Onset:2008-05-11, Days after vaccination: 2
Gender:Female  Submitted:2008-05-02, Days after onset: 9
Location:Hawaii  Entered:2008-06-03, Days after submission: 32
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: Per EE was told in the past "sensitive" to NEOMYCIN
Diagnostic Lab Data: none
CDC Split Type:
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)MERCK & CO. INC.1470F UNUN
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 2 days post vaccine, EE had hard, warm area at injection site-did not report 5/20/08. Referred to occmed MD for F/U. Tx with BENADRYL & LIDEX cream. Off work x 1 day to take meds. MD thinks Rx secondary to NEOMYCIN sensitivity. *EE did not reveal this at time of vaccine.

VAERS ID:314814 (history)  Vaccinated:2008-05-09
Age:8.0  Onset:2008-05-09, Days after vaccination: 0
Gender:Male  Submitted:2008-05-09, Days after onset: 0
Location:Wisconsin  Entered:2008-06-03, Days after submission: 25
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: Allergy: Fish
Diagnostic Lab Data:
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1916U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: SOB, cough, hives; Treatment: Epi-Pen, Benadryl

VAERS ID:315275 (history)  Vaccinated:2008-05-09
Age:  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2008-06-06, Days after onset: 27
Location:Georgia  Entered:2008-06-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: zoloft 100mg protonix40mgsingulair 10mgnasonex 50mcg,depakote er 500mg, glucophage 850 mg
Current Illness: none
Preexisting Conditions: Depression, prolonged, asthma, seizure disorder, polycystic ovaries/stein-leventhal syndrome, over weight status,allergic arthritis, GERD esophageal reflux
Diagnostic Lab Data:
CDC Split Type:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0871U SCLA
Administered by: Public     Purchased by: Private
Symptoms: Feeling hot, Lymphadenopathy, Malaise, Pyrexia, Rash, Tenderness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Patient got sick the night of MMR administration. States just did not feel well, nonspecific. She had a fever, did not take temperature, states felt warm. She then developed a rash with swollen lymph nodes, some tenderness. No fever or chills or other problems. This is documented by physician on 05-21-08.

VAERS ID:317262 (history)  Vaccinated:2008-05-09
Age:22.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2008-06-24, Days after onset: 45
Location:Michigan  Entered:2008-06-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to PCN
Diagnostic Lab Data:
CDC Split Type:
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TDAP: TDAP (ADACEL)SANOFI PASTEURC2927AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Cold sweat, Gait disturbance, Injection site erythema, Injection site mass, Injection site pruritus, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)
Write-up: -Weakness(barely able to walk) - pain in arm so severe it cause nausea - fever - bump, redness and itching at injection site - fever like symptoms x4days - cold sweats in sleep;(took 2 Aleve every 12 hours x 4days); -$g when I stopped symptoms returned.

VAERS ID:317639 (history)  Vaccinated:2008-05-09
Age:11.0  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:2008-06-26, Days after onset: 47
Location:Maryland  Entered:2008-06-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fever, vomiting, Diarrhea
Preexisting Conditions: motor tics(approx. 3.5 years previous)
Diagnostic Lab Data: Seen by Dr.
CDC Split Type:
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TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Tic
SMQs:, Dyskinesia (broad), Dystonia (broad)
Write-up: Verbal Tics and Motor Tics

VAERS ID:318581 (history)  Vaccinated:2008-05-09
Age:19.0  Onset:2008-05-16, Days after vaccination: 7
Gender:Male  Submitted:2008-07-09, Days after onset: 54
Location:Florida  Entered:2008-07-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0043X0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Anorexia, Epstein-Barr virus test negative, Lethargy, Lymphadenopathy, Pharyngolaryngeal pain, Pyrexia, Rash, Streptococcus identification test negative, Urticaria, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: The patient developed a fever ranging from 100-102 for 7 days, severe swelling of the lymph glands bilatterally in the neck, sore throat, lethargy, vomiting on the 5th day a rash occurring on the trunk on the 8th day after onset of symptoms, hives on the trunk on the 9th day, loss of appetite, weight loss of 11 lbs. in one week. The patient tested negative for strep and monnonucleosis

VAERS ID:318721 (history)  Vaccinated:2008-05-09
Age:69.0  Onset:2008-05-13, Days after vaccination: 4
Gender:Male  Submitted:2008-07-11, Days after onset: 59
Location:Kansas  Entered:2008-07-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone 25 mg po every other day (for myasthenia gravis)
Current Illness:
Preexisting Conditions: Myasthenia gravis 7/28/08-records received-PMH:Myasthenia gravis. Dyslipidemia. Myocardial infarction 10 years ago. Osteoporosis. Gastroesophageal reflux disease. Psoriasis. Paroxysmal atrial flutter. Allergic rhinitis. Allergies to penicillin, aspirin and coumadin cause burning in gastrointestinal tract.
Diagnostic Lab Data: CSF 7/28/08-records received-Labs: WBC increased 13.4, seg increased 95, lymph % low at 3, mono% low at 2, granulocytes increased 12.7, CSF WBC increased 29, protein increased 56 and glucose increased 71, BNP increased 398, CSF culture no growth, blood culture no growth, MRI brain negative. CT head no intracranial abnormality. 8/13/08 Yellow Fever Lab Results from CDC lab:Day 10 serum positive for YF IgM Ab, PRNT 1:1280; Day 10 CSF positive for YF IgM Ab, PRNT 1:4
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YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF303AA0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Brain natriuretic peptide increased, CSF culture negative, CSF glucose increased, CSF protein increased, CSF white blood cell count increased, Computerised tomogram normal, Confusional state, Decreased appetite, Diarrhoea, Encephalitis post immunisation, Fall, Granulocyte count increased, Immunosuppression, Lymphocyte percentage decreased, Monocyte percentage decreased, Myasthenia gravis, Nervous system disorder, Neutrophil percentage increased, Nuclear magnetic resonance imaging brain normal, Pyrexia, Serology positive, White blood cell count increased
SMQs:, Cardiac failure (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt with a pertinent medical history of myasthenia gravis which was being treated with 25 mg of prednisone every other day. Received YF vax on 5/9/2008, and on 5/13/08 developed fevers of 102F to 103F that persisted for three days. On 5/17/08 the patient defervesced, but became febrile on 5/20/08 (again 102F to 103F). The patient developed confusion on 5/22/08 and was admitted to hospital on 5/23. This is a case of suspected YF vax assocated neurotropic disease. CSF and serum samples were sent to CDC lab for Yellow fever testing. 7/28/08-records received for DOS 5/22-5/28/08-DC DX: Post yellow fever vaccine encephalitis. Fever, resolved. On admission temperature of 101.8. Received yellow fever vaccination while chronically immunosuppressed. Decreased strength weakness of lower extremities. Fell, confused, diarrhea and decreased appetite. Follow-up Information 12-SEP-2008: Encephalitis due to YF vaccine

VAERS ID:320716 (history)  Vaccinated:2008-05-09
Age:0.2  Onset:2008-05-10, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2008-07-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZITHROMAX started same day
Current Illness: L otitis media, URI
Preexisting Conditions: None
Diagnostic Lab Data: CBC showed white cell count of 12,700 with 49% segs, 43% lymphs, 8% monos, H&H is 10.3 and 29.7, platelet count is 423,000. C-reactive protein is slightly elevated at 6.35. Urinalysis was unremarkable. RSV nasal was negative. CSF was cl
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Route
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DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B139AA0IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF253AB0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC631110IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0208X0PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Blood bicarbonate increased, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, CSF cell count normal, CSF white blood cell count negative, Chest X-ray, Choking, Conjunctivitis, Convulsion, Cough, Diarrhoea, Dyspnoea, Full blood count, Gaze palsy, Haematocrit decreased, Haemoglobin normal, Hypotonia, Lymphocyte percentage increased, Monocyte percentage, Mucous stools, Neutrophil percentage decreased, Otitis media acute, Platelet count normal, Respiration abnormal, Respiratory arrest, Respiratory syncytial virus serology negative, Tympanic membrane hyperaemia, Unresponsive to stimuli, Urine analysis normal, Virus culture negative, Vomiting, White blood cell count normal
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conjunctival disorders (narrow), Ocular infections (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow)
Write-up: Infant had a choking episode, vomited suddenly went limp and eyes rolled in back in head. He was "breathing funny" with rare gasping breaths and long pauses for 2 min, then stayed limp and unresponsive for about 5 min until paramedics arrived. 7/31/2008 VAERS report submitted with MR attached for DOS 5/10-11/2008 with D/C DX: Choking episode vs seizure resolved. Left acute otitis media, conjunctivitis and cough resolving. Pt with recent hx of otitis media and conjunctivitis received vax at PCP''s office 5/9/08. Presented to ER 5/10/08 after an episode of limpness, eyes rolling back, breathing difficulty and arrested breathing following a choking episode with coughing and vomiting. Pt was limp and unresponsive for ~5 minutes. Had been having loose, mucusy stools. Upon arrival in the ER temp was 99.2''F and pt had a red, dull L TM and a harsh cough. Slight color change noted after blood draw. Pt tx''s with IV abx and had no further episodes.

VAERS ID:324684 (history)  Vaccinated:2008-05-09
Age:18.0  Onset:2008-05-26, Days after vaccination: 17
Gender:Female  Submitted:2008-09-08, Days after onset: 105
Location:New York  Entered:2008-09-09, 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: See attached: Physical Exam: General Appearance: alert, NAD
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0067X1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache
SMQs:
Write-up: See attached does; The patient presents with headache. These symptoms began 2 months ago. Other comments Include: seen here for headaches about 6 weeks ago was referred to Dr at that time mother has been unable to get through to the neurology department though (and Dr now on maternity leave); bad headaches twice a day now has been able to continue her job went to ER last month for a headache, there head CT normal. Comments: patient said that she has been getting headaches on and off since June she would like some bloodwork done.

VAERS ID:387970 (history)  Vaccinated:2008-05-09
Age:1.0  Onset:2008-05-28, Days after vaccination: 19
Gender:Unknown  Submitted:2010-05-14, Days after onset: 716
Location:Texas  Entered:2010-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0908USA00992
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Skin lesion
SMQs:
Write-up: Information has been received from a health professional concerning a 12 month old patient who on 09-MAY-2008 was vaccinated with a dose of VARIVAX (Merck) (lot #, route and site of administration not reported). On approximately 28-MAY-2008 the patient developed 20-50 lesions. At the time of the reporting, the patient''s outcome was unknown. This is one of several reports from the same source. No further information is available.

VAERS ID:498539 (history)  Vaccinated:2008-05-09
Age:0.5  Onset:2008-05-10, Days after vaccination: 1
Gender:Female  Submitted:2013-07-30, Days after onset: 1907
Location:New Hampshire  Entered:2013-08-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Fever~DTaP + IPV + Hib (Pentacel)~2~0.30~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Bl cx (-); urine 20-40 WBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B149AA2IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF329AC2IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC391862IMRL
Administered by: Private     Purchased by: Public
Symptoms: Blood culture negative, Body temperature increased, Culture urine negative, Full blood count normal, White blood cells urine positive
SMQs:, Neuroleptic malignant syndrome (broad), Chronic kidney disease (broad)
Write-up: 5/9/08 6 m WCE and vaccine. 5/10/08 urgent care w/ 100-102 bl cx and CBC - nl. 5/11/08 urgent care 104 -$g ROCEPHIN IM. 5/12/08 urine 20-40 WBC cx neg -$g KEFLEX due to ROCEPHIN IM.

VAERS ID:486665 (history)  Vaccinated:2008-05-09
Age:5.0  Onset:2012-12-11, Days after vaccination: 1677
Gender:Male  Submitted:2013-03-12, Days after onset: 90
Location:Foreign  Entered:2013-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1303PRT005152
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Mumps, Pyrexia, Salivary gland enlargement, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Case of vaccination failure received from the Health Authorities on 27-Feb-2013 under the reference number C201302-122 via the local site Sanofi Pasteur MSD. The primary reporter was a physician. Case medically confirmed. A 10-year-old male patient received a dose of measles, mumps and rubella vaccine (manufacturer unknown, batch number NF51210) subcutaneously on 09-May-2008. He had previously received a dose of M-M-R II (batch number HT06830) subcutaneously on 20-Jan-2004. On 11-Dec-2012 he experienced mumps with fever and swelling of the salivary glands which lasted 7 days. The reporter stated that this case may be due to a probable vaccination failure. The patient was administered corrective treatment with unspecified anti-inflammatory therapy and he recovered on 18-Dec-2012. The patient had no relevant clinical or pharmacological history and no known previous adverse event to other drugs.

VAERS ID:312458 (history)  Vaccinated:2008-05-10
Age:43.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-05-12, Days after onset: 2
Location:South Carolina  Entered:2008-05-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CRESTOR, KEFLEX 500mg
Current Illness: L 3rd digit laceration
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2864AA0UNRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site nodule, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, severe pain tender nodule under site of injection R deltoid.

VAERS ID:312520 (history)  Vaccinated:2008-05-10
Age:1.3  Onset:2008-05-11, Days after vaccination: 1
Gender:Male  Submitted:2008-05-16, Days after onset: 5
Location:California  Entered:2008-05-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic sinusitis, nasal lacrimal duct obstruction
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER14B0603UNRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature, Injection site erythema, Injection site swelling, Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt received DTaP #4 5/10/08 -$g 5/11/08 with swelling & redness at vaccine site -$g 5/12/08 with rash all over. No subjective fever per mom. Pt brought into clinic 5/16/08: Temp=99.6, on exam with diffuse urticaria. Rx''d BENADRYL 12.5/5 ml 1 tspn Q6 hours PRN & hydrocortisone cream. Will follow up in clinic 5/20/08.

VAERS ID:312921 (history)  Vaccinated:2008-05-10
Age:44.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-05-21, Days after onset: 11
Location:California  Entered:2008-05-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2888AA UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypersensitivity, Induration, Skin warm, Tenderness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Allergic reaction. Patient given T.Dap. Subsequently, large wheal and flare the length of the upper arm developed; also was warm, tender, and firum to touch. Treatment: benadryl 25 mg Q6H PRN and Ibuprofen 400 mg TID, PRN.

VAERS ID:312932 (history)  Vaccinated:2008-05-10
Age:20.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Male  Submitted:2008-05-21, Days after onset: 11
Location:Texas  Entered:2008-05-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unusual movement of legs at night after one round of vaccines as infant. No serious reaction. Do not recall which vaccines were
Other Medications: Had previously taken medication for Seborrheic Dermatitis. But uncertain if he took it recently. He is overseas now, so do not have this information.
Current Illness: Healthy, athletic, 20-year old university student. Though had just finished final exams and drove home night before vaccines, so
Preexisting Conditions: April 2001 Concussion/brief loss of consciousness after hard fall while playing soccer-Kicked in the head when or as he fell. While unconscious, had similar symptoms as reaction to vaccines-with frothy sputum, pale, seizure like movements. Normal EEG & CT Head post injury. October 2001 struck by a car, while riding his bicycle. Never lost consciousness, but had a questionable concu
Diagnostic Lab Data: No studies performed.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURA03015  
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2566AA0  
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA05220  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1805U0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure, Convulsion, Dissociation, Foaming at mouth, Gaze palsy, Heart rate decreased, Hyperhidrosis, Hypersomnia, Immediate post-injection reaction, Loss of consciousness, Muscle contractions involuntary, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Almost immediately after 4th vaccine injection (sitting in a chair): eyes rolled back, passed out, copious frothy sputum pouring from mouth, arms and hands contracted up to chest in seizure like movements, pale & diaphoretic. Nurse snapped what appeared to be an ammonia cap under his nose, and patted face and arms, calling his name. She said he was having a severe vasovagal response and would "come back." I could not feel a radial pulse and was ready to dial 911 and access need for CPR. I pulled out my EpiPen, but did not use-no wheezing or signs of anaphylaxis. He regained consciousness after approximately 1 minute, asking how long he was out and reported feeling "detached." Nursed called doctor on call and reported reaction. Blood Pressure 98/60 and pulse 56 at 11:01 a.m. approximately 4-5 minutes after he regained consciousness. He slept most of the day and said he felt fine the next morning. I do not know which vaccines were injected into right arm and which were injected into left arm.

VAERS ID:312970 (history)  Vaccinated:2008-05-10
Age:67.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-05-21, Days after onset: 11
Location:Unknown  Entered:2008-05-22, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0805USA02849
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMUN
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a registered pharmacist concerning a 67 year old female with concomitant medications, drug allergies and pertinent medical history not specified, who on 10-MAY-2008 was vaccinated with a dose of PNEUMOVAX 23, IM, (Lot# not specified), while hospitalised for an unspecified condition. Subsequently in MAY-2008 the patient developed a severe localised reaction and the injection site was red and hot. The patient also developed edema. At the time of reporting, the outcome of the events was that the patient was "home and stable." It was noted by the reporter that the patient''s experiences caused a prolonged hospitalization. No product quality complaint was involved. Additional information has been requested.

VAERS ID:313234 (history)  Vaccinated:2008-05-10
Age:24.0  Onset:2008-05-16, Days after vaccination: 6
Gender:Female  Submitted:2008-05-20, Days after onset: 4
Location:Minnesota  Entered:2008-05-23, 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: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD30013393PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Pain in jaw
SMQs:, Osteonecrosis (broad)
Write-up: Headache while taking pills on Friday 5/16/08 lower jaw pain both sides to ear.

VAERS ID:315277 (history)  Vaccinated:2008-05-10
Age:27.0  Onset:2008-05-11, Days after vaccination: 1
Gender:Male  Submitted:2008-06-06, Days after onset: 26
Location:Wisconsin  Entered:2008-06-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 5IMRA
Administered by: Military     Purchased by: Unknown
Symptoms: Arthralgia, Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: SEVERE MUSCLE AND JOINT SORENESS/WEAKNESS IN THE RIGHT ARM AND SHOULDER THAT LASTED FOR 3+ WEEKS.

VAERS ID:318593 (history)  Vaccinated:2008-05-10
Age:13.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-07-09, Days after onset: 60
Location:Illinois  Entered:2008-07-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: previous report John~DTaP+IPV+HepB+Hib (no brand name)~1~0~In Sibling1|previous report John~Pneumo (no brand name)~0~0~In Siblin
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.UNKNOWN1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Influenza like illness, Injection site erythema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Injections were extremely painful. Second injection caused flu like symptons associated with fever. Site at injections were extremely painful, sore and red for several days. Guardisil was the injections given.

VAERS ID:320007 (history)  Vaccinated:2008-05-10
Age:15.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-07-15, Days after onset: 66
Location:Illinois  Entered:2008-07-17, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0806USA08095
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a physician concerning a 16 year old female patient who on 10-MAY-2008 was vaccinated with the first dose of GARDASIL vaccine (yeast). On 10-MAY-2008 the patient had an injection site reaction (local reaction with erythema) for a few days. Subsequently, the patient recovered from local reaction with erythema for a few days. Additional information has been requested.

VAERS ID:320988 (history)  Vaccinated:2008-05-10
Age:17.0  Onset:2008-05-20, Days after vaccination: 10
Gender:Female  Submitted:2008-07-31, Days after onset: 72
Location:Michigan  Entered:2008-07-31
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: acne and seasonal asthma 8/18/08-records received-PMH: Asthma.
Diagnostic Lab Data: 5/22 weak positive strep test, 5/25 increased wbc count, negative mono test, negative chest xray, 7/25 workup for syncope - all labs normal, eeg normal. Completing EKG at a future date. 8/18/08-records received-CBC normal, WBC 12.8, chemistries normal. CXR. pectus excavatum, no acute changes since 2/17/05.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1757U0IMLA
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anxiety, Chest X-ray normal, Chills, Cough, Decreased appetite, Dizziness, Electroencephalogram normal, Fatigue, Full blood count normal, Headache, Influenza, Laboratory test normal, Mononucleosis heterophile test negative, Myalgia, Pharyngitis streptococcal, Pharyngolaryngeal pain, Pyrexia, Rhinorrhoea, Streptococcus identification test positive, Syncope, Viral infection, Vitreous floaters, Vomiting, Weight decreased, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: 5/20/08 - fever 103 and vomiting, 5/22/08 weak strep response and antibiotic given and got better, 5/25 101 fever and ER visit, high wbc count dx acute viral syndrome. After this extreme fatigue, anxiety, syncope (x2)in June and July, lightheadedness, weight loss (10 #), decreased appetite and floater in vision. 8/18/08-records received for DOS 5/25/08-presented to ED with C/O cough, sore throat, fever, chills, muscle aches and "flu" started 5 days agao. Diagnosed with Strep 4 days ago. Today developed fever. Nasal discharge. Moderate frontal headache. Impression:Acute viral syndrome.

VAERS ID:334983 (history)  Vaccinated:2008-05-10
Age:13.0  Onset:2008-06-10, Days after vaccination: 31
Gender:Female  Submitted:2008-11-14, Days after onset: 157
Location:Unknown  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0811USA00057
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1758U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Full blood count, Headache, Ophthalmological examination abnormal, Visual acuity reduced, X-ray
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Arthritis (broad)
Write-up: Information has been received from a physician''s nurse concerning a 13 year old female, who on 10-MAY-2008, received the first dose of GARDASIL (lot # 659180/17580), 0.5 ml, intramuscularly. Concomitant therapy included meningitis vaccine (manufacturer unspecified, lot # U2492AA). On 10-JUN-2008, the patient experienced joint pains, headache and decreased visual acuity. The patient returned for the second dose of GARDASIL (lot # 660393/0067X) on 21-JUL-2008. The patient was sent to an ophthalmologist, who diagnosed the decreased in visual acuity. The patient had a complete blood cell count (CBC) and x-ray test (results not provided). The patient would not be getting the third dose. It was not known if the adverse events had improved between the first and second dose of GARDASIL. At the time of the report, on 31-OCT-2008, the outcome of the patient was unknown. Additional information has been requested.

VAERS ID:313377 (history)  Vaccinated:2008-05-10
Age:1.8  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-05-23, Days after onset: 13
Location:Foreign  Entered:2008-05-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: X-ray, Comment: showed broken part of needle intramuscular inside thigh
CDC Split Type: WAES0805USA04586
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.NH031201IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Foreign body trauma, Surgery, Underdose, Vaccination complication, X-ray abnormal
SMQs:
Write-up: Information has been received from a physician concerning a 20 month old female patient with no relevant medical history, who on 10-MAY-2008 received the second dose of MMR II (batch # NH03120) via the intramuscular route in the thigh. While the physician was performing vaccination the child was crying and moving a lot. When the physician pricked across the skin, she felt as if there was something hard. She did not push yet the liquid inside and then the vaccine came off with a very tiny remaining piece of the needle which measured between 1 and 2 mm. Only very little liquid could be injected. The physician could not find the missing part of the broken needle neither on the floor nor in the patient''s thigh on palpation. The patient was then referred to the hospital for X-ray which showed the broken part of the needle intramuscularly inside the thigh. The patient underwent surgical operation under general anesthetic and the broken piece of the needle was removed. The outcome was not reported. Upon internal review it was determined that vaccination complication and underdose were serious as an other important medical event. Other business partner numbers included: E200804351. No further information is available.

VAERS ID:318630 (history)  Vaccinated:2008-05-10
Age:21.0  Onset:2008-05-10, Days after vaccination: 0
Gender:Female  Submitted:2008-07-09, Days after onset: 60
Location:Foreign  Entered:2008-07-10, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807PHL00006
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning his 21 year old female niece who on 10-MAY-2008 was vaccinated with her first dose of GARDASIL. Patient had no history of allergies and had no concomitant medications at the time of the vaccination. On 11:00 am of 10-MAY-2008, immediately after the vaccination was completely given, the patient experienced seizure and fainting which lasted for approximately 30 seconds. The reporting physician mentioned that the patient did not have breakfast yet when she received the vaccination. Subsequently, the patient recovered from seizure and fainting. The physician mentioned that after the event, the patient was monitored for other similar episodes. At the time of reporting, patient did not have any similar experience yet. The reporter felt that seizures and fainting were related to therapy with GARDASIL. Upon internal medical review, seizure is considered as an other important medical event. Additional information is not expected.

VAERS ID:318655 (history)  Vaccinated:2008-05-10
Age:0.2  Onset:2008-05-11, Days after vaccination: 1
Gender:Female  Submitted:2008-07-10, Days after onset: 60
Location:Foreign  Entered:2008-07-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0527640A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS  UNUN
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41CA502A PO 
Administered by: Other     Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal distension, Abdominal pain, Crying, Oral intake reduced
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)
Write-up: This case was reported by a physician and described the occurrence of abdominal discomfort in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). On an unspecified date, the subject received unspecified dose of ROTARIX. On an unspecified date, at an unspecified time after vaccination with ROTARIX, the subject experienced severe abdominal pain. At the time of reporting the outcome of the event was unspecified. Follow up information received on 02 July 2008: On 10 May 2008, the subject received unspecified dose of ROTARIX (oral). On 11 May 2008, 1 day after vaccination with ROTARIX, the subject experienced persistent abdominal discomfort, colicky pattern and leg pulling. The subject started crying from abdominal discomfort and had inconsolable crying for 2 days that resolved at treatment with infant drops. The subject experienced persistent colicky spell for 4-5 days that required intervention, investigations were done but no underlying cause was found. The physician considered the events were clinically significant (or requiring intervention). At the time of reporting the outcome of the events was unspecified. Follow up information received on 03 July 2008: Concurrent vaccination included ENGERIX B (GlaxoSmithKline, unknown route) given on 10 May 2008. On 10 May 2008, the subject received unspecified dose of ROTARIX (oral). On 11 May 2008, 12-18 hours after vaccination with ROTARIX, the subject experienced abdominal discomfort and inconsolable crying. Problem was intense in first 48 hours. She settled but had 1-2 spell/day of inconsolable crying, reduced feeding and tense abdomen that relaxed by gentle massaging. Investigated but no cause found. At the time of reporting inconsolable crying improved. The physician considered the inconsolable crying possibly related to vaccination with ROTARIX.

VAERS ID:321024 (history)  Vaccinated:2008-05-10
Age:  Onset:0000-00-00
Gender:Female  Submitted:2008-07-31
Location:Foreign  Entered:2008-08-01, 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: Medical history, concomitant medications and illness at the time of vaccination were not reported.
Diagnostic Lab Data:
CDC Split Type: 200802266
Vaccination
Manufacturer
Lot
Dose
Route
Site
CHOL: CHOLERA (NO BRAND NAME)UNKNOWN MANUFACTURER 0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Arthralgia, Gait disturbance, Headache, Impaired work ability, Malaise, Paraesthesia, Sensation of heaviness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Initial report received on 15 July 2008 from a consumer, who is also the patient. A female patient, whose age and medical history were not reported, took a first dose of DUKORAL (lot # not reported) on the first Saturday in may (03 May 2008) and a second dose on the second Saturday in May (10 May 2008), for an upcoming cruise. After an unspecified amount of time, the patient reported that she "suffered neurological problems" which included tingling in her legs, electrical currents pulsating in the muscles of her legs, "terrible" joint pain, "headaches that made migraines look mild in comparison" and general malaise. She was off work for two weeks at the beginning of June 2008. The patient reported that her legs "at one point shut down" and she could barely walk. She used to run about 5 miles at a time on a treadmill; now when able to get on a treadmill, she can only walk. According to the patient, she consulted several physicians, but a naturopath was the only one who was able to help. She had seen a neurologist, and at the time of the report was waiting for an MRI and consultations with an infectious disease doctor and possibly a rheumatologist. At the time of the report (15 July 2008), the patient had not recovered; she continued to have electrical currents pulsating in her leg muscles and joint pain; she still could not run or workout as she had in the past. Follow-up information received on 23-Jul-2008 from the patient. On 02 May 2008, the patient had received "typhoid and hepatitis A vaccine". It was not specified if this was one vaccine or two separate vaccines. The manufacturer and lot number(s) were not reported. About one week later, on a Saturday, the patient took the first dose of DUKORAL (lot # not reported) and subsequently developed headache and malaise. She told her physician, who apparently told her that there would be no protection from one dose. As she was "not feeling too badly" by the next Saturday, she took the second dose of DUKORAL (lot number not reported). Three days later, she had tingli

VAERS ID:326087 (history)  Vaccinated:2008-05-11
Age:14.0  Onset:2008-05-11, Days after vaccination: 0
Gender:Female  Submitted:2008-08-14, Days after onset: 95
Location:California  Entered:2008-08-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA02233
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Blood pressure increased, Dizziness, Syncope, Urinary retention
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician concerning a "14 year old" female who on approximately 11-MAY-2008 was vaccinated with her first dose of GARDASIL vaccine (yeast) (lot# not reported). Concomitant therapy included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid and meningococcal ACYW conj vaccine (dip toxoid) (MENACTRA). On approximately 11-MAY-2008 the patient felt dizzy, agitated, had elevated blood pressure, was holding in urine and fainted. Subsequently, the patient recovered from feeling dizzy, agitated, elevated blood pressure, holding in urine and fainting. The patient sought unspecified medical attention on an unspecified date. Additional information has been requested.

VAERS ID:344753 (history)  Vaccinated:2008-05-11
Age:65.0  Onset:2008-08-01, Days after vaccination: 82
Gender:Female  Submitted:2009-03-27, Days after onset: 238
Location:Maryland  Entered:2009-04-08, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Breast cancer
Preexisting Conditions: Arm discomfort; Swelling arm; Pustule
Diagnostic Lab Data: diagnostic laboratory - came back fine; biopsy - negative
CDC Split Type: WAES0902USA00594
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Biopsy site unspecified normal, Hypersensitivity, Laboratory test, Pain, Proctalgia, Rash pustular, Stomatitis, Vulvovaginal pain
SMQs:, Severe cutaneous adverse reactions (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a 66 year old female consumer with no known drug reactions/allergies and breast cancer since January 2007, who on 11-MAY-2008 was vaccinated with a dose of ZOSTER vaccine live (Oka/Merck). Concomitant medication included thyroid medication. In August 2008, the patient started to have a rash with "fluid filled pustules from head to toe that burn and feel like someone was stabbing me with a needle". The patient stated that she had sores in her mouth and had burning pain in her vaginal and rectal area. The patient reported that so far she had gone to see four dermatologists and a gynecologist regarding the rash. The firs dermatologist gave her PREDNISONE (manufacturer unspecified) for three weeks and the second dermatologist put her on Z pack (manufacturer unspecified). The other prescription creams (names and manufacturers unspecified). The patient went to see her gynecologist for the burning pain she was having in her rectal and vaginal area and was given more topical creams (names and manufacturers unspecified). The patient stated that her oncologist the referred her to two other dermatologists. The dermatologists did some blood test, which all came back fine, and a biopsy with was negative. The patient stated that all the physicians were stating that she appeared to be having an allergic reaction to the vaccine. The patient still had the rash, she was homebound and in constant pain. The patient received a small pox vaccine (name and manufacturer unspecified may) many years ago and her arm blew up to the size of a thigh and she had weeping pustules on her arms that lasted for the summer through the winter. The specific date this happened was not mentioned. In follow-up the patient''s husband stated that his wife had a history of cancer. And that it had been over a year since she had had any cancer treatments. At the time of reporting the patient was not recovered. Additional information has been requested.

VAERS ID:312255 (history)  Vaccinated:2008-05-12
Age:13.0  Onset:2008-05-13, Days after vaccination: 1
Gender:Male  Submitted:2008-05-13, Days after onset: 0
Location:Florida  Entered:2008-05-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~0~In Patient|NA~ ()~~0~In Sibling|NA~ ()~~0~In Sibling
Other Medications: NONE PER MOM
Current Illness: NONE
Preexisting Conditions: NONE PER MOM
Diagnostic Lab Data: None at present time.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2558AA IM 
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2027AA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature increased, Headache, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Received call from School Nurse @ 8:30 a.m. on 5/13/08 stating Mom called her this morning that child was ill had Headache, Emesis and Temperature. Reviewed shot records and contacted Mom @ approximately 9:00 a.m on 5/13/08 and questioned how son was feeling. Mom was at work and stated that he called her complaining he didn''t feel good, had headache all night, and vomited this morning. Mom asked him to take his temperature with a digital thermometer and he told her it was 101.0 degrees. She told him to take Ibuprofen and go back to bed. I asked her if he had any stiffness in the neck, how many times he vomited and if he normally runs temperatures easily? She stated he was sick with a stomach virus on 5/8/08 and 5/09/08 but seemed to be fine on 5/10/08 and 5/11/08. She stated he did have a temperature of approx. 100.0 degrees during the stomach virus. He had one emesis in the am per Mom. She was not there with the child and he reported it to her over the phone. I asked Mom if he was home alone and she said yes, " I think he will be fine and I am not sure this is even related to the vaccines". I requested she continue to check on him hourly, contact her physician and to contact me with updates regularly. Advised to go to ER if symptoms get worse. I contacted Mom @ noon to get update. She stated his temperature was 100.0 degrees, no further emesis, slight headache but feeling much better. She is going to make him a doctors appt. if he continues to feel ill. She will leave work in the afternoon and take him to the doctor if she feels it is necessary. I requested she contact me with update at end of day.

VAERS ID:312262 (history)  Vaccinated:2008-05-12
Age:32.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2008-05-13, Days after onset: 1
Location:Virginia  Entered:2008-05-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cipro - dizziness, nausea.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1634SCLA
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA312BA3IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA02212IMRA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt reports symptoms began 10 min after vaccines given of headache, dizziness, nausea. Pt was seen at clinic at 1400 pm on 5/12/08 and given Motrin. Pt states no relief from Motrin. Pt returned to clinic Immunizations today c/o of worsening of headache, dizziness, nausea.

VAERS ID:312315 (history)  Vaccinated:2008-05-12
Age:1.6  Onset:2008-05-13, Days after vaccination: 1
Gender:Male  Submitted:2008-05-14, Days after onset: 1
Location:Connecticut  Entered:2008-05-14
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: possible language delay
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14BO56DA3IMLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.1259U1IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: swollen L leg - same leg as DTaP vaccine administered

VAERS ID:312316 (history)  Vaccinated:2008-05-12
Age:5.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2008-05-14, Days after onset: 2
Location:Indiana  Entered:2008-05-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B069AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0805-23SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0425U1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1776U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Mother states child with "stomach ache'' and diarrhea at intervals since Monday PM. Denies elevated temperature, vomiting. Recommended that physician be notified if no improvement by 05/15/08.

VAERS ID:312452 (history)  Vaccinated:2008-05-12
Age:17.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2008-05-12, Days after onset: 0
Location:New York  Entered:2008-05-16, 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: ADVAIR 250/50, PROVENTIL HFA q 46 prn
Current Illness: None
Preexisting Conditions: asthma, allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2559AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1382U0IDLA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Pt. c/o nausea shortly after vaccine administration then c/o difficulty breathing.

VAERS ID:312454 (history)  Vaccinated:2008-05-12
Age:29.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-05-13, Days after onset: 1
Location:Georgia  Entered:2008-05-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2937BA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Received vaccine at 5:20 p.m. At 7 p.m. left arm began throbbing and became painful. Associated redness. She took ibuprofen and applied ice. This a.m. 9:10 a.m. 5/13/08 - pain improved but still present.

VAERS ID:312474 (history)  Vaccinated:2008-05-12
Age:0.3  Onset:2008-05-13, Days after vaccination: 1
Gender:Male  Submitted:2008-05-16, Days after onset: 3
Location:Massachusetts  Entered:2008-05-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B128AB1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF218A71IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB70145B1IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1619U PO 
Administered by: Private     Purchased by: Public
Symptoms: Crying, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: 2 DAYS OF FUSSYNESS, IRRITABILITY, CRYING, AND LOW GRADE FEVER. STARTED 2-3HR AFTER ADMINISTRATION OF VACCINES.

VAERS ID:312509 (history)  Vaccinated:2008-05-12
Age:19.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-05-16, Days after onset: 4
Location:Louisiana  Entered:2008-05-16
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2351AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Erythema, Fatigue, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Right upper arm redness, fever, headache, loss of appetite, fatigue.

VAERS ID:312579 (history)  Vaccinated:2008-05-12
Age:23.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-05-14, Days after onset: 2
Location:Rhode Island  Entered:2008-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2017BA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt c/o pain in L delt (site of admin) also tenderness, redness - onset eve of injection.

VAERS ID:312601 (history)  Vaccinated:2008-05-12
Age:24.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-05-19, Days after onset: 7
Location:Minnesota  Entered:2008-05-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Penicillin
Diagnostic Lab Data: pt did not come to us for care after reaction, she telephoned us the next day and reported that she had gone to urgent care
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.C2775AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Lip swelling, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: lightheaded, puffy lips, throat tightness

VAERS ID:312617 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-14, Days after vaccination: 2
Gender:Female  Submitted:2008-05-16, Days after onset: 2
Location:Virginia  Entered:2008-05-19, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pink-eye
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B084BA0IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0075U0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH0958P0IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1388U0PO 
Administered by: Military     Purchased by: Military
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: 24-48 hours of vaccination child had diarrhea and fever with vomiting starting in the evening after shots.

VAERS ID:312688 (history)  Vaccinated:2008-05-12
Age:5.0  Onset:2008-05-13, Days after vaccination: 1
Gender:Female  Submitted:2008-05-14, Days after onset: 1
Location:Missouri  Entered:2008-05-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSU2354BA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08733IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.148441SCRA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Itching, swelling (50 cent size) left arm.

VAERS ID:312972 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-05-15, Days after onset: 3
Location:Florida  Entered:2008-05-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac
Current Illness: None
Preexisting Conditions: None PMH: GERD. Egg donor, 36 wk c-section secondary to low amniotic fluid & gestational diabetes. Mom w/asthma, allergies & hypothyroid.
Diagnostic Lab Data: EEG prolonged - normal. LABS: CBC & chemistry WNL. Plts 619 (H)UA (+) leukocyte & blood. CT brain, CXR & EEG WNL. Urine, blood, viral & stool c/s all neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1610U0UNLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF363AA0UNRL
Administered by: Private     Purchased by: Private
Symptoms: Blood culture negative, Chest X-ray normal, Computerised tomogram normal, Convulsion, Crying, Culture stool negative, Culture urine negative, Depressed level of consciousness, Electroencephalogram normal, Eye discharge, Eyelid oedema, Flushing, Full blood count normal, Gaze palsy, Hypersomnia, Insomnia, Irritability, Laboratory test normal, Lethargy, Pallor, Platelet count increased, Pyrexia, Rash, Scan brain, Screaming, Urine analysis abnormal, Urticaria, Virus culture negative
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad)
Write-up: Crying, decreased sleep followed by seizure like episode upward gaze, unable to arouse hyporesponsive. 6/24/08 Reviewed hospital medical records of 5/14-5/16/2008. FINAL DX: possible seizure Records reveal patient experienced fever, flushing, fine diffuse rash & left arm welt like rash, irritability, screaming x 2 days. Left eyelid red, swollen w/drainage. On day of admission eyes rolled back, deep sleep, pale, difficult to arouse then very lethargic after awakened. Neuro consult done.

VAERS ID:312973 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-14, Days after vaccination: 2
Gender:Male  Submitted:2008-05-19, Days after onset: 5
Location:Texas  Entered:2008-05-22, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None Family Hx: mom ill w/respiratory infection
Diagnostic Lab Data: Stool C and S negative in hospital; Rotavirus test positive in hospital. LABS: Blood, urine c/s neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2935AA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF348AA0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC631150IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1888U0PO 
Administered by: Private     Purchased by: Public
Symptoms: Blood culture negative, Culture stool negative, Culture urine negative, Diarrhoea, Gastroenteritis, Oral intake reduced, Pyrexia, Rotavirus test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Vomited x1, 2 loose stools, temp 101.6. Onset 36 hours post vaccination. 6/20/08 Reviewed hospital medical records of 5/15-5/16/2008. FINAL DX: gastroenteritis Records reveal patient had markedly decreased oral intake, vomiting, diarhea, fever x approx 12 hrs. Tx w/IVF. No further vomiting, diarrhea or fever & improved oral intake. D/C to home.

VAERS ID:312976 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2008-05-14, Days after onset: 2
Location:Georgia  Entered:2008-05-22, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: 1. Ex 30 week preemie, 2. Anemia, 3. IVH-grade I & II. PMH: 30 wk premie twin. Anemia of prematurity. Apnea of prematurity. Grade I-II IVH. Immature retina
Diagnostic Lab Data: WBC 3.3 5/14/08. HCT 25 5/14/08. Labs and Diagnostics: Ammonia 113. 4+ Glucose on UA. Echo (+) for PFO otherwise WNL. EEG abnormal. Head CT WNL. Brain MRI WNL. Aldosterone low. HCT 22. CRP 3.4. Blood, urine and CSF cx all (-). HSV
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B1441BA0IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUF240AB0IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHB54013F0IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0143X0PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Adrenal insufficiency, Ammonia increased, Anaemia, Apnoea, Atelectasis, Blood aldosterone decreased, Blood culture negative, Bradycardia, C-reactive protein increased, CSF glucose increased, Cardio-respiratory distress, Chest X-ray abnormal, Convulsion, Culture urine negative, Dyskinesia, Dysphagia, Echocardiogram abnormal, Electroencephalogram abnormal, Endotracheal intubation, Gastrointestinal tube insertion, Glucose urine, Haematocrit decreased, Herpes simplex serology negative, Hypotension, Hypothermia, Hypotonia, Mechanical ventilation, Muscle twitching, Nuclear magnetic resonance imaging brain normal, Oxygen saturation decreased, Packed red blood cell transfusion, Parachute mitral valve, Parainfluenzae virus infection, Polymerase chain reaction, Respiratory failure, Scan brain, Sepsis, Tongue disorder, Unresponsive to stimuli, Vaccination complication, Virus serology test positive, White blood cell count decreased
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Dyskinesia (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Respiratory failure (narrow)
Write-up: Severe apnea/bradycardia/desaturation events-12 hours after vaccines requiring intubation. Seizure-like activity began ~14 hours after vaccinations. Clinical sepsis with hypotension requiring pressors, hypothermia, and anemia ensued. in 20 hours after admission. Brother (twin) received same vaccines from same lot number and asymptomatic. Prognosis is unclear at this time. 06/17/2008 MR received for DOS 5/13-30/2008 with D/C DX; Respiratory Failure. Prematurity. Apnea of Prematurity. Sepsis-clinical. Infant presented after being found by mom to be unresponsive. Found to be bradycardic, with apnea and O2 desaturations in the ER. Pt was intubated and placed on a vent. Devceloped RUL atelectasis which resolved. Hypotension was initially unresponsive to fluid and required Dopamine.Pt tx with cortisone for absolute adrenal deficiency. Neurologically pt developed jerking, twitching, tongue thrusting felt to be seizures. Pt somnolent with poor tone 2'' to phenobarb. + dysphagia so NG tube placed for nutritional supplementation. Given PRBC for low Hct. Tx with abx and antivirals for clinical sepsis. ID consult with Impression adverse cardiorespiratory event following immunizations.

VAERS ID:312991 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:0000-00-00
Gender:Female  Submitted:2008-05-14
Location:Pennsylvania  Entered:2008-05-22, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B127AA0IMLL
HEP: HEP B (FOREIGN)MERCK & CO. INC.1246F0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC650490IMLL
Administered by: Private     Purchased by: Private
Symptoms: Overdose, Wrong drug administered
SMQs:, Drug abuse and dependence (broad)
Write-up: Patient was incorrectly given hepatitis B instead of Hib in addition to PEDIARIX and PREVNAR.

VAERS ID:313008 (history)  Vaccinated:2008-05-12
Age:45.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-05-15, Days after onset: 3
Location:Colorado  Entered:2008-05-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2766AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Myalgia, Nausea, Nervousness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: 5/12/08 RCD vacc. than pm. Developed fever 102 degrees, severe myalgia, abd pain nausea. Seen 5/13/08 at OV. Still muscle pain & shakes. No fever. S/w pt 5/15/08 100% recovered.

VAERS ID:313020 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-19, Days after vaccination: 7
Gender:Female  Submitted:2008-05-22, Days after onset: 3
Location:Florida  Entered:2008-05-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: COLIC
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B156CA0IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.173440PO 
Administered by: Private     Purchased by: Private
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)
Write-up: Hematachezia

VAERS ID:313124 (history)  Vaccinated:2008-05-12
Age:11.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2008-05-15, Days after onset: 3
Location:Michigan  Entered:2008-05-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SINGULAIR, FLONASE, MUCINEX, amox., CLARITIN
Current Illness: Sinusitis/allergic rhinitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2937BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1658U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pain, 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: Fever x3d, pain x3d, erythema x2d, swelling x2d, warm at site x2d, 45mm x 80mm erythema & edema.

VAERS ID:313798 (history)  Vaccinated:2008-05-12
Age:1.0  Onset:2008-05-14, Days after vaccination: 2
Gender:Male  Submitted:2008-05-23, Days after onset: 9
Location:Ohio  Entered:2008-05-28, 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: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0039X0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 2 days after MMR vaccine was given patient lost consciousness and, possibly had a mild seizure.

VAERS ID:313820 (history)  Vaccinated:2008-05-12
Age:35.0  Onset:2008-05-28, Days after vaccination: 16
Gender:Male  Submitted:2008-05-28, Days after onset: 0
Location:Unknown  Entered:2008-05-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURW04003A  LA
Administered by: Military     Purchased by: Military
Symptoms: Infection, Injection site infection
SMQs:
Write-up: Secondary infection of smallpox vaccination site.

VAERS ID:313825 (history)  Vaccinated:2008-05-12
Age:20.0  Onset:2008-05-20, Days after vaccination: 8
Gender:Female  Submitted:2008-05-23, Days after onset: 3
Location:Virginia  Entered:2008-05-28, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LO ESTRIN 24 FE
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0151X0IMGM
Administered by: Private     Purchased by: Private
Symptoms: Drug administered at inappropriate site, Injection site erythema, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: C/o soreness, redness at inj. site. C/o tingling both R & L buttock 1 wk after Inj.

VAERS ID:313829 (history)  Vaccinated:2008-05-12
Age:0.5  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Colorado  Entered:2008-05-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2951BA2IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF269AA2IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04742IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH0631122IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0209X2PO 
Administered by: Private     Purchased by: Private
Symptoms: Cyanosis, Hypokinesia
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Approximately six hours after vaccines given, patient awoke from nap with decreased activity and episode of cyanosis. No WOB, respiratory distress, activity, etc. Full sepsis work up with treatment possible UTI (uncircumcised male).

VAERS ID:314110 (history)  Vaccinated:2008-05-12
Age:4.0  Onset:2008-05-13, Days after vaccination: 1
Gender:Male  Submitted:2008-05-29, Days after onset: 16
Location:Michigan  Entered:2008-05-29
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 needed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2933AB3IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR131403IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.A02731IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Induration, Oedema peripheral, Skin warm, Weight bearing difficulty
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: The day after immunization, patients leg swelled up two times the size of the other leg.The area was very warm to the touch and very red. The area was also hard as a rock. As the day went on the swelling did continue to worsen moving from the thigh area down below the knee area. The patient could not walk on his leg. Treatment for this was Motrin and also Benadryl, along with warm compress. The reaction did last for 2 days after this and then finally went down to normal size.

VAERS ID:314440 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2008-06-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: CBC normal; urine normal; Lactic acid 1-8; BC NG-ST; Chemistry normal; CRP<0.1 (normal)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2951AA0IMRL
HEP: HEP B (FOREIGN)MERCK & CO. INC.1610U1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF356AB0IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04900IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC631100IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0019X0PO 
Administered by: Private     Purchased by: Private
Symptoms: Apparent life threatening event, Blood culture negative, Blood lactic acid decreased, C-reactive protein normal, Full blood count normal, Heart rate decreased, Hypotonia, Immediate post-injection reaction, Irritability, Laboratory test normal, Pallor, Urine analysis normal
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Patient became limp, pale, decreased hear rate within minutes of vaccinations. Given O2; transferred to ER -$g hospitalized overnight for observation 7/11/08 Reviewed hospital medical records of 5/12-5/13/2008. FINAL DX: ALTE Records reveal patient experienced limpness, decreased responsiveness & pallor immediately s/p vaccinations & lasting approx 5 min. In ER, fully awake, irritable but w/neg exam. Admitted for overnight observation. No further episodes & d/c to home next day.

VAERS ID:314808 (history)  Vaccinated:2008-05-12
Age:5.0  Onset:2008-05-13, Days after vaccination: 1
Gender:Female  Submitted:2008-05-21, Days after onset: 8
Location:Wisconsin  Entered:2008-06-03, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA02984IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling entire upper arm, with redness and tenderness - Prescribed Benadryl, Prednisolone for 3 days, Augmentin for 5 days.

VAERS ID:315296 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2008-06-07, Days after onset: 26
Location:California  Entered:2008-06-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B145AA0IMLL
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURERUF264AA0IMRL
PPV: PNEUMO (PNU-IMUNE)PFIZER/WYETHB54015K0IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0015X0PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Cold sweat, Crying, Discomfort, Hypotonia, Inappropriate schedule of drug administration, Lethargy, Pallor, Screaming
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Gave Tylenol about 1 hour after the shots because he seemed a little uncomfortable. However, these reactions came about 3 hours after the shots. 1) ear piercing screams and crying, 2) whimpering, and 3) pale, clammy and limp. They lastest about 4 hours until he fell asleep. We continued giving Tylenol.

VAERS ID:316848 (history)  Vaccinated:2008-05-12
Age:15.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-06-13, Days after onset: 32
Location:Georgia  Entered:2008-06-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0805USA02871
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0152X2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Medical device complication, Pharmaceutical product complaint, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a healthcare worker concerning a 15 year old female who on 07-NOV-2007 was vaccinated with a first dose of GARDASIL (lot # not reported). On 10-JAN-2008 the patient was vaccinated with a second dose of GARDASIL (lot # not reported). On 12-MAY-2008 the patient was vaccinated with a third dose of GARDASIL (lot # 0152X). It was reported that "when attempting to administer the GARDASIL syringe, the plunger would not depress. According to the medical assistant, the white plastic tray was crushed at the end. The plastic seal was loose and up at the damaged end. The carton was not damaged. The syringe was removed from the package and the needle was placed on the syringe. The needle was in the patient''s arm and the plunger would not depress. When the needle was removed from the arm, the safety device activated. The syringe was discarded because the patient fainted and the medical assistant needed to put the syringe in a safe place." It was also reported that "they have been using the syringe for a while and are familiar with its use. The product was ordered directly from Merck. This was a product quality complaint. The patient was vaccinated successfully with another prefilled syringe. There were no problems reported. The SR# is 13050492422. Additional information has been requested.

VAERS ID:316879 (history)  Vaccinated:2008-05-12
Age:23.0  Onset:2008-05-15, Days after vaccination: 3
Gender:Female  Submitted:2008-06-13, Days after onset: 29
Location:Massachusetts  Entered:2008-06-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREMPRO; LUPRON; ATIVAN
Current Illness: Dysmenorrhea; Penicillin allergy; Sulfonamide allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0805USA03585
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1522U IMUN
Administered by: Other     Purchased by: Other
Symptoms: Axillary pain
SMQs:
Write-up: Information has been received from a Medical Assistant (MA) concerning a 23 year old female patient with dysmenorrhoea, penicillin allergy and sulfonamide allergy who on 12-MAY-2008 was vaccinated IM into left deltoid muscle with 0.5 mL of GARDASIL (lot # 659055/1522U). Concomitant therapy included ATIVAN, LUPRON and ESTROGENS, PREMPRO. The MA reported that on 12-MAY-2008 the patient developed a "deep soreness" of the left axilla. There was no redness or swelling. No further information available. The patient had not recovered as of this report date. Additional information has been requested.

VAERS ID:317381 (history)  Vaccinated:2008-05-12
Age:59.0  Onset:2008-05-14, Days after vaccination: 2
Gender:Female  Submitted:2008-06-17, Days after onset: 34
Location:Iowa  Entered:2008-06-25, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0347X0SCRA
Administered by: Public     Purchased by: Other
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Sore from elbow to shoulder. Takes 400mg Motrin after morning- both arms, right hurts more than left.

VAERS ID:317603 (history)  Vaccinated:2008-05-12
Age:3.0  Onset:2008-05-14, Days after vaccination: 2
Gender:Female  Submitted:2008-06-17, Days after onset: 34
Location:New Jersey  Entered:2008-06-26, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2607AA3IMLA
HIBV: HIB (ACTHIB)SANOFI PASTEURUF241AC3IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC575383IMRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Feeling hot, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Red, swollen and warm to touch.

VAERS ID:318942 (history)  Vaccinated:2008-05-12
Age:22.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2008-07-08, Days after onset: 57
Location:Unknown  Entered:2008-07-11, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0806USA00370
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a nurse concerning a 22 year old female who on 12-MAY-2008 was vaccinated with the first dose of GARDASIL 0.5 ml intramuscularly. The nurse stated that on 02-JUN-2008, the patient called the office stating that her arm had been painful at the injection site for the past 3 weeks. At the time of the report the patient was not recovered. Additional information has been requested.

VAERS ID:329095 (history)  Vaccinated:2008-05-12
Age:0.2  Onset:2008-05-13, Days after vaccination: 1
Gender:Female  Submitted:2008-10-13, Days after onset: 153
Location:Unknown  Entered:2008-10-16, 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: None
Diagnostic Lab Data:
CDC Split Type: WAES0809USA03489
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1388U0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Information has been received from a healthcare professional concerning a 9 week old female with no medical history who on 12-MAY-2008 was vaccinated with ROTATEQ. Concomitant therapy included diphtheria toxoid (+) hepatitis B virus vaccine rHBsAg (yeast) (+) pertussis acellular 3-component vaccine (+) poliovirus vaccine inactivated (Vero) (+) tetanus toxoid (PEDIARIX), Hib conj vaccine (OMPC) (MSD) and (PREVNAR). It was reported after the initial dose of ROTATEQ the patient experienced diarrhea, fever and vomiting within 24 hours, on 13-MAY-2008, of receiving the vaccine. The patient was taken for unspecified medical attention. It was reported the patient tolerated subsequent doses of ROTATEQ without incident (specific 2nd and 3rd dose dates not provided, "final dose taken recently"). Subsequently, the patient recovered from diarrhea, fever and vomiting. A product quality complaint was not involved.

VAERS ID:329006 (history)  Vaccinated:2008-05-12
Age:54.0  Onset:2008-07-21, Days after vaccination: 70
Gender:Male  Submitted:2008-10-17, Days after onset: 88
Location:Washington  Entered:2008-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pregabalin 150mg daily, MVI 1 tablet daily.
Current Illness: None
Preexisting Conditions: H/o phantom limb pain secondary to BKA, BPH.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC29336BA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: Experienced 2+ month history of shoulder pain described as sharp and deep in his shoulder.

VAERS ID:334736 (history)  Vaccinated:2008-05-12
Age:0.4  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Michigan  Entered:2008-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPH: DTAP + HIB (TRIHIBIT)SANOFI PASTEURUF105AB1IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04741IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC391861IMRL
Administered by: Other     Purchased by: Public
Symptoms: No adverse event
SMQs:
Write-up: DTaP-Hib combo given before 15 months of age. No side effects reported.

VAERS ID:338144 (history)  Vaccinated:2008-05-12
Age:15.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Male  Submitted:2009-01-12, Days after onset: 245
Location:Pennsylvania  Entered:2008-12-16, Days after submission: 27
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: The subject had a history of PENICILLIN allergy. The subject had a history of previous INFLUENZA vaccinations, but no history of adverse events following these injections. The subject had no other history of adverse events following previous vaccinations, with the exception of soreness at injection site (unspecified). The subject was not taking any concomitant medications at the ti
Diagnostic Lab Data: UNK
CDC Split Type: A0728847A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS  UNRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Private     Purchased by: Private
Symptoms: Incorrect dose administered, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a consumer and described the occurrence of injection site soreness in a 15-year-old male subject who was vaccinated with HEPATITIS B. A physician or other health care professional has not verified this report. The subject''s medical history included PENICILLIN ALLERGY. Previous vaccinations included a completed HEPATITIS B series; manufacturer (unspecified; given in 1997). Concurrent vaccinations given on 12 May 2008 included POLIOMYELITIS vaccine booster dose; manufacturer unspecified. On the afternoon of 12 May 2008, the subject received an unspecified dose of HEPATITIS B vaccine (unknown, right arm). Within one day after vaccination with HEPATITIS B vaccine, the subject experienced injection site soreness. The subject''s mother reported that her son inadvertently received an extra dose of HEPITITIS B vaccine on 12 May 2008, even though he had already received a complete HEPITITIS B vaccination series in 1997. The reporter was unsure of the HEPITITIS B vaccine was manufactured by GlaxoSmithKline or Merck. At the time of reporting, the outcome of the events was unspecified.

VAERS ID:340330 (history)  Vaccinated:2008-05-12
Age:16.0  Onset:2008-05-12, Days after vaccination: 0
Gender:Female  Submitted:2009-02-20, Days after onset: 284
Location:Illinois  Entered:2009-02-23, 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: Concerta
Current Illness: Pregnancy NOS (LMP = 5/19/2008); Penicillin allergy; Attention deficit/hyperactivity disorder
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0901USA03717
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1757U2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Drug exposure during pregnancy, Eclampsia, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning a 17 year old female patient with attention deficit/hyperactivity disorder and penicillin allergy who on 27-NOV-2007 was vaccinated with the first dose of GARDASIL (lot# 659437/1266U) 0.5 ml intramuscularly. On 31-JAN-2008, the patient received the second dose of GARDASIL (lot# 659055/1522U) 0.5 ml intramuscularly. The patient received the third dose of GARDASIL (lot# 659182/1757U) 0.5 ml intramuscularly on 12-MAY-2008. Concomitant therapy included methylphenidate hydrochloride. The patient was pregnant after receiving the three doses of GARDASIL. No adverse effect was reported. The patient sought unspecified medical attention. Estimated last menstrual period: 19-MAY-2008, Estimated delivery date: 23-FEB-2008. Follow up information has been received from the physician, who reported that on 26-JAN-2009, the female patient delivered a normal and healthy male baby weighing 3062g and apgar score 7/9. There were no congenital anomalies and complications or abnormalities. No complications during the labor/delivery and diagnostic tests during pregnancy were not performed. No infections or illnesses during the pregnancy. The patient had hypertension, eclampsia and seizure during her pregnancy. The patient did not have prenatal care. Upon internal review, seizure was determined to be an other important medical event. Additional information has been requested.

VAERS ID:342746 (history)  Vaccinated:2008-05-12
Age:10.0  Onset:2009-02-23, Days after vaccination: 287
Gender:Male  Submitted:2009-03-21, Days after onset: 25
Location:Unknown  Entered:2009-03-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None noted
Diagnostic Lab Data: No labs performed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Rash papular, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient received varicella vaccine at ages 19 months and 10 years -on 5/12/08-. The vaccine was administered in the left arm at 10 years of age, location of injection at 19 months not available in current medical record. On 2/23/09, patient presents with URI and rash. The rash is described as papulovesicular lesions and clusters to left back, side and abdomen- appears to follow T-10 or T-11 dermatome. Treated with CAPSAICIN cream.

VAERS ID:369083 (history)  Vaccinated:2008-05-12
Age:43.0  Onset:2008-05-13, Days after vaccination: 1
Gender:Male  Submitted:2009-11-20, Days after onset: 556
Location:California  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE 12/22/09 Opioid dependence; history of polysubstance dependence with current marijuana abuse; nicotine dependence; rule out mood disorder; rule out anxiety disorder; resolved acute withdrawal syndrome
Diagnostic Lab Data: White count was elevated. 12/22/09 White count elevated
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1418U0 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Altered state of consciousness, Decreased appetite, Diarrhoea, Headache, Hyperhidrosis, Injection site swelling, Pain, Pyrexia, White blood cell count increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow)
Write-up: Severe headache and bodyache followed by fever of 102.3 the following day after the shot. Also swelling at the injection site. The night of the second and third day profuse sweating and diarrhea. The diarrhea could have been due to not being able to take fluids. One more thing loss of apitite and sense of surroundings set in on the second day. Theses symptoms lasted for approximately one week with the fever tapering of a little each day. 12/22/09 DC summary and medical records received for DOS 05/09/08-05/31/08.Pt. initially presented to chemical dependency unit, referred by employer. Received pneumococcal vaccination while detoxing and developed fever and slightly elevated white count for several days which resolved. Also c/o tenderness in right arm near vaccination site, which also resolved. Pt. left AMA insisting all problems were related to vaccine. Readmitted next day to complete detox program. Became disruptive and failed to comply with program and left AMA, without option of readmission. DC DX: Opioid dependence; history of polysubstance dependence with current marijuana abuse; nicotine dependence; rule out mood disorder; rule out anxiety disorder; resolved acute withdrawal syndrome; possible pneumococcal vaccination reaction, resolved.

VAERS ID:387094 (history)  Vaccinated:2008-05-12
Age:82.0  Onset:2009-12-02, Days after vaccination: 569
Gender:Male  Submitted:2010-04-30, Days after onset: 148
Location:Minnesota  Entered:2010-05-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Write-up: Subject in pneumococcal vaccine trial, with severe COPD hospitalized w/ stroke. Vaccination took place 5/12/08. According to physician the relationship is ''none''.

VAERS ID:388612 (history)  Vaccinated:2008-05-12
Age:5.0  Onset:2009-10-31, Days after vaccination: 537
Gender:Male  Submitted:2010-05-14, Days after onset: 195
Location:New York  Entered:2010-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: serum immunoglobulin G 11/02/09 - $g1.10 1.43; serum immunoglobulin M 11/02/09 <1:10 - 1:20:00; body temp 11/02/09 100.1 degre -
CDC Split Type: WAES1001USA02067
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Mumps, Parotitis, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information has been received from a physician concerning a 6 year old male who on 19-JUL-2005 and 12-MAY-2008 was vaccinated with the first and second dose of MMR II respectively (route, site, and lot number not reported). On 02-JAN-2010 the patient experienced mumps (the date diagnosed was reported as 23-NOV-2009). The patient also experienced stomach pain and was afebrile. On 23-NOV-2009, the first blood work was done which revealed serum IgM <1:10, serum IgG 7.16 and serum amylase 568. The outcome for mumps was not reported. Follow-up information was received which reported that on 31-OCT-2009 (previously reported on 02-JAN-2010) the 6 year old patient (also reported as 11 year old) experienced mumps. The patient was diagnosed on 02-NOV-2009. The patient had a fever of 100.1 degree F and right side parotitis. On 02-NOV-2009, the first blood work was done which revealed serum IgM 1:20:00, serum IgG 1.43. This is one of several reports from the same source. No further information is available.

VAERS ID:389544 (history)  Vaccinated:2008-05-12
Age:76.0  Onset:2009-03-01, Days after vaccination: 293
Gender:Male  Submitted:2010-05-27, Days after onset: 451
Location:Unknown  Entered:2010-05-28, 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: cancer; chemotherapy
Preexisting Conditions:
Diagnostic Lab Data: unknown
CDC Split Type: WAES1004USA04358
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Public     Purchased by: Other
Symptoms: Herpes zoster, Non-Hodgkin's lymphoma
SMQs:, Malignant tumours (narrow), Malignant lymphomas (narrow)
Write-up: Information has been received from a consumer''s wife concerning his husband, a 77 year old male patient with cancer and chemotherapy since 01-APR-2009 who on 12-MAY-2008 was vaccinated with a dose of ZOSTAVAX (Merck) (dose, route and lot number not reported). Concomitant therapy included doxorubicin and cyclophosphamide. The caller stated that on 25-JAN-2010 her husband developed shingles; she believed it was less effective because of the chemo. The patient sought for unspecified medical attention. Follow up information has been received which indicated that the patient received immunization at his county''s Health Department and there was no doctor involved. In March 2009 the patient was diagnosed with Non-Hodgkin''s Lymphoma. On 01-APR-2009 he began chemotherapy. The patient''s last chemotherapy was on 22-JUL-2009. It was reported that recovery was going well. In January 2010 the patient came down with shingles. They had been told that chemotherapy, at times, could take immunity away. Upon internal review, "diagnosed with Non-Hodgkin''s Lymphoma" was considered to be an other important medical event. Additional information has been requested.

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