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Case Details (Sorted by Vaccination Date)

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VAERS ID: 294061 (history)  
Age: 56.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2007-10-22
Entered: 2007-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2452AA / - RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / - LA / IM

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

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:

Write-up: None as of date of infection.


VAERS ID: 294247 (history)  
Age: 57.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA302AA / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0963U / 1 RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Erythema, Induration, Pain in extremity, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro; Diovan; Atenolol; Nasonex; Dinalire; Tramadol; Calcitrate
Current Illness: None
Preexisting Conditions: Hypertension, Depression
Diagnostic Lab Data: BP 130/60; P 58; R 16; T 98.6
CDC Split Type:

Write-up: (R) arm/deltoid - pain, soreness, warmth, erythema, swelling, induration - extending around front of arm, and toward elbow.


VAERS ID: 294258 (history)  
Age: 15.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2502AA / 0 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2155CA / 0 UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1344U / 0 UN / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: None
Preexisting Conditions: Supraventricular tachycardia - surgery 2006
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10-24-07 Pt Rt arm is red, swollen, tender to touch. Fever 100-102. Area is red about size of 9 1/2 tall, 6 1/2 wide redness. Very painful.


VAERS ID: 294260 (history)  
Age: 13.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-24
   Days after onset:0
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 RA / IM
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Chest discomfort, Chest pain, Headache, Heart rate increased, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient received the MCV4 Meningococcal and T-Dap vaccine at approximately 2:30 pm on October 22, 2007. She awoke the next day with a rapid heartbeat, chest pain/tightness, sore throat and headache. She was seen at her primary care physicians office on October 23, 2007. He indicated that she possibly is having an adverse reaction to her vaccines. He prescribed her Zithromax and is re-checking her heart rate in one week. If it is still elevated, he will order an EKG.


VAERS ID: 294262 (history)  
Age: 60.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-24
   Days after onset:2
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2446AA / 0 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Chills, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: SEVERE RIGORS, FEVER TO 100.8 AND MUSCLE ACHING LASTING 12-14 HRS. RESPONDED TO TYLENOL AND WARMING.


VAERS ID: 294268 (history)  
Age: 0.8  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2474AA / 0 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Computerised tomogram normal, Convulsion, Lumbar puncture normal, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: Recurrant otits media 11/20/07-records received-HX of otitis media.
Diagnostic Lab Data: Die to questionable focal nature, prolonged seizure and prolonged somnelent state after seizure(possibly due to ativan), a CT scan was done with adn without contrast and LP was done. Both were normal. Child was obxerved in hospital for 24 hours and then discharged. EEG will be done due to possible focal seizure. 11/20/07-records received-Chemistry WNL. CT scan and spinal fluid normal. Cultures of urine, spinal fluid and blood negative.
CDC Split Type:

Write-up: Child was given an influenza vaccine on the afternoon of 10/22/07 at approximatly 3pm. At 3am on 12/23/07 mom wake to find the chidl with fever. The child then began to seize. Mom felt that seizure was focal and that it began with the left hand and arm. She cannot be certain of this though. Child was taken to the ED and ativan was need to stop the seizure. On arrival to ED the seizure was generalized in nature. Total duration was about 20 to 25 minutes of seizure time. 11/20/07-records received for DOS 10/23-10/24/07-DC DX: Febrile seizures possibly atypical with the concern about initial focal left-sided seizure that later generalized although the mother is not fully confident that it was localized. Presented to ED actively seizing. Temperature in ED 103.8. At home crying twitiching of left arm and left leg. Staring with eyes open. In ED generalized seizure observed lasting 20-25 minutes. Twelve hours prior to onset of seizure seen in PCP office because she was pulling at her ears and not sleeping well for 24-48 hours. PE in office ears normal.


VAERS ID: 294285 (history)  
Age: 57.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-24
   Days after onset:0
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0962U / - RL / -

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

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:

Write-up: Red at injection site, warm at site


VAERS ID: 294295 (history)  
Age: 41.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-24
   Days after onset:2
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS - / 20 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Musculoskeletal pain, Myalgia, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Terrible swelling at injection site (like a softball) with horrific pain in the muscle and shoulder joint! Red, patchy rash covering almost entire upper arm from elbow to shoulder joint!


VAERS ID: 294303 (history)  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-24
   Days after onset:0
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF110AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700H / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0504U / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Breast feeding, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

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:

Write-up: Vaccines done 10/22/07. Mom noted flecks of blood in stool, no other sx. Breast feeding, no formula.


VAERS ID: 294305 (history)  
Age: 45.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-24
   Days after onset:0
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0200U / 1 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2862AA / - LA / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro; Albuterol; Clarinex; Advair; Singulair
Current Illness: None
Preexisting Conditions: PCN; Demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 294307 (history)  
Age: 16.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-23
   Days after onset:1
Entered: 2007-10-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2469AA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1265U / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Musculoskeletal stiffness, Skin warm
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

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:

Write-up: Pt became warm and dizzy. Had pt hut her head down on the table, applied ice to her neck. Pt passed out several seconds later, became stiff as I was holding her, then became limp for sev seconds before awakening. Had pt lay down with legs elevated for about 15 min.


VAERS ID: 294315 (history)  
Age: 52.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Red yeast rice, St Johns Wart
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received PPV shot on Monday 10-22-07. Swelling to area on arm, redness, sore. Went back to doctor on 10-23-07 and now being treated for cellulitis with 875 mil amoxy. Follow up on 10-26-07.


VAERS ID: 294316 (history)  
Age: 4.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2606AA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A01702 / 3 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1076U / 1 LA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Physical exam only. Performed by ER physician, and PCP
CDC Split Type:

Write-up: Rt upper arm swelling after approx 24 hrs of receiving polio vaccination. After approx 32 hrs, the arm became warm, erythematous, and tender


VAERS ID: 294200 (history)  
Age: 11.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2007-10-23
Entered: 2007-10-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2631AA / 0 RA / IM

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

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

Write-up: Rt. arm is red and swollen. Tender 5x3 cm


VAERS ID: 294399 (history)  
Age: 10.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1120U / 1 RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Erythema, Pain, Pruritus, Rash papular, Sick relative, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: had a mild cough. normal exam and no other complaints
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Morning after shots, she noticed an itchy raised spot on her back. Subsequently she developed 5 more lesions. They were itchy, but then became painful. They appear to be erythematous, papular with small excoriated centers. No pustules. Cough did seem worse, but she had other ill contacts in the family.


VAERS ID: 294405 (history)  
Age: 26.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1993AA / - LA / SC

Administered by: Military       Purchased by: Unknown
Symptoms: Ear discomfort, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Received vaccine on 10/22/07, next day complained of severe headache, ears felt blocked, nausea and vomiting.


VAERS ID: 294421 (history)  
Age: 47.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2499AA / - RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 09624 / 0 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pain in extremity, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: PT STATES HER ARM IS VERY SORE AND HAS A 2 AND 1/2 IN RAISED AREA AFTER RECEIVEING BOTH A FLU SHOT AND PNEUMONIA SHOT. SHE IS ALSO COMPLAINGING OF A 103 DEGREEE FEVER


VAERS ID: 294432 (history)  
Age: 64.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA296GA / - RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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: Breat cancer 1988; polio (childhood)
Diagnostic Lab Data: ED staff felt swelling was unrelated to flu vaccine and referred pt to ortopedist.
CDC Split Type:

Write-up: Patient received vaccination in right arm 10/24/07 at 12 noon. Next morning upper right arm was swollen and painful to move; swelling was anterior and superior to vaccination site. No complaints of difficulty breathing, chest pain, nausea, vomiting, fever, joint pain or pain upon touchen swollen extremity.


VAERS ID: 294434 (history)  
Age: 35.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2438AA / 0 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Flushing, Joint swelling, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Allergy to Strawberries and Raspberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received vaccine 10/22/2007@2:30pm. At 5:30pm had rash on arms legs and tops of feet. None on torso. Pt took Benadryl at home. Morning of 10/23/2007 pt still had rash and red cheeks. Physician at her work place gave Zantac and Loratidine. Wed AM 10/24/2007 pt had joint pain in wrists, elbows, knees and ankles. Hands and ankles were swollen. Pt saw private physician and was given injection of Kenalog. Thurs 10/25/2007 after tx at Dr. office pt sx almost completely resolved.


VAERS ID: 294452 (history)  
Age: 0.2  
Gender: Male  
Location: Colorado  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-24
   Days after onset:2
Entered: 2007-10-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2657AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UT207AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0169 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35168 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Electroencephalogram, Hypotonia, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? Yes
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: No
Preexisting Conditions: No
Diagnostic Lab Data: Normal head CT, ECG, CXR EEG pending LABS: EKG revealed RVH. Head CT scan revealed plagiocephaly. CXR revealed airways disease.
CDC Split Type:

Write-up: 5 hours after receiving DTaP #1, IPV #1, Hib #1, Prevnar #1, Rotateq #1 pt had 20 minute episode of acute pallor, cyanosis, and was limp. Evaluated at ER, transferred to hospital. Observed overnight, tests normal. Patient reviewed fully to date. 0/30/07 Reviewed pcp records which consisted of vax records, ER records & hospital records. Vax record confirms dose & lot #s as reported. ER records indicate patient seen in ER on 10/22/2007 for ALTE. Awakened from nap, turned pale w/cyanotic lips, eyes that were not alert, limp body, not reponsive to stimulation followed by slow improvement back to normal. Transferred to higher level of care & kept in observation overnight. No further episodes & was d/c to outpatient f/u. Seen by pcp on 10/24 & f/u CXR, EKG & EEG to be done. FINAL DX: ALTE. 1/7/08 Reviewed additional hospital records received. No new information.


VAERS ID: 294467 (history)  
Age: 50.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-23
   Days after onset:1
Entered: 2007-10-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2510AA / - LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Erythema, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chantix, Bupropion SR
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pruritus, edema, & erythema in hands & knees beginning night of vaccine and continuing throughout the next day-did not reside with Claritin or Benadryl MD visit needed


VAERS ID: 294473 (history)  
Age: 54.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown       Purchased by: Public
Symptoms: Abdominal pain upper, Anaphylactic reaction, Dysphonia, Headache, Hyperhidrosis
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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:

Write-up: Got vax 10/22-After 20 minutes developed episode of anaphylaxis, hoarseness, sweating, headache, and stomach cramps. Patient took Benadryl


VAERS ID: 294495 (history)  
Age: 8.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1182U / 1 UN / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~2~8.00~In Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None needed
CDC Split Type:

Write-up: Swelling left arm within 12 hours after Varivax given but recovering well. No cellulitis no pain. No use of arm - seen 10-25-07.


VAERS ID: 294505 (history)  
Age: 73.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0554U / - LA / IM

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

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: Allergies: PCN, ASA; Ovarian cancer
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Erythema from shoulder to elbow on side of injection, no fever, chills, began to resolve prior to office visit.


VAERS ID: 294445 (history)  
Age: 23.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-10-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. UNKNOWN / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Ear pain, Fatigue, Headache, Injection site pruritus, Insomnia, Malaise, Nausea, Pharyngolaryngeal pain, Presyncope, Pyrexia, Rash erythematous, Rash macular, Rash pruritic, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: no known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: site of injection - pruritis, headache, insomnia, pruritic macular erythematous rash on face neck trunk and arms, near syncope, fatigue, sore throat, ear ache, fever-subjective, joint aches, nausea, vomiting, malaise


VAERS ID: 294514 (history)  
Age: 64.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-26
   Days after onset:4
Entered: 2007-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA031AA / - RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0990U / 0 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Influenza, Injection site mass, Muscle swelling, Myalgia, Pain, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Maxzide 37.5/25mg levothyroxine 0.025mg Lexapro 10mg Prevacid 30mg MVI Calcium/Vit d 600mg KCl supplement
Current Illness: none
Preexisting Conditions: Menier''s Disease enlarged spleen w/low wbc count hypothyroidism GERD osteoporosis depression
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever of 100.9 F, aches all over (like flu symptoms) on evening of vaccination. This continued for 24 hours. On 2nd day post-vaccination, had a knot in muscle of administration with localized, non-pruritic rash of red, splotchy areas with muscle tenderness/soreness.


VAERS ID: 294515 (history)  
Age: 50.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-26
   Days after onset:4
Entered: 2007-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2465AA / 5 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Headache, Malaise, Muscle spasms, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~NULL~~In Patient
Other Medications: None
Current Illness: None stated
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Employee received influenza vaccination on 10/22/07 at approx. 9:30 am and at approx. 6:15 pm the employee started to not feel well, dizziness, warm and developed a headache, Leg/feet cramps bilateral lasting a few minutes two times that evening(per employee toes curled), approx 10:00 pm employee states fever of 103 F. Employee went to sleep, woke up aprox 1:00 am soaking wet, no fever. Headache remained. Employee called department manager next am to call in sick for work, employee still had headache, planned on coming in later in afternoon. Dept Mgr called this nurse and reported incident. This nurse called employee, employee stated "I''m doing better now"Headache remained, no fever, no dizziness, no return of leg/toe cramps. Employee instructed if symptoms persist or return of fever, or new symtoms to call this nurse or ER as needed. Emp. reported to work 10/23 at 1:00 pm with mild headache, no other symptoms. Aprox. 8:15 pm on 10/23 employee stated "I felt back to normal". 10/24 Emp. reported no further problems.


VAERS ID: 294516 (history)  
Age: 14.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-26
   Days after onset:4
Entered: 2007-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2380BA / 0 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Chills, Hypoaesthesia, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad)

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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT HAD CHILLS, NUMBNESS, AND REDNESS OF EYES


VAERS ID: 294517 (history)  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-26
   Days after onset:3
Entered: 2007-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2457DA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1331U / 1 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: VARICELLA AND FLU VACCINE GIVEN ON 10/22/07 LEFT ARM. PATIENT RETURN TO CLINIC ON 10/24/2007. HE SAW DR. PRESENTED WITH LEFT ARM SWOLLEN AND RED FROM ELBOW TO SHOULDER AND WARM TO TOUCH. PER DR. BENADRYL WAS ADMINITERED PO 25 MG.


VAERS ID: 294586 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-26
   Days after onset:3
Entered: 2007-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289BA / 4 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2490AA / 2 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z1069 / 3 RA / IM

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

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

Write-up: Presented to ER with Urticaria 24 hours after administration of:Influenza ; Dtap; IPV


VAERS ID: 294618 (history)  
Age: 57.0  
Gender: Male  
Location: New York  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-23
   Days after onset:1
Entered: 2007-10-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 08857 / 1 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PROVOCHOL; ATENOLOL;PRILOSEC; CLARITIN
Current Illness: None
Preexisting Conditions: Environmental allergies; increase Cholesterol; Hypertension
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8 hours after vaccine patient developed body aches, fever 99.6 and cellulitis. Keflex given for cellulitis


VAERS ID: 294620 (history)  
Age: 29.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-26
   Days after onset:4
Entered: 2007-10-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Erythema, Injection site erythema, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yasmin; Vitamin B Complex
Current Illness:
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tetanus/ Diphtheria/ Pertussis vaccine administered on 10-22-07 in left deltoid area at 11:00. At 1406, emp return to clinic c/o itchy feeling all over redness noted to skin in chest area and above left deltoid vaccine site. Doctor administered 0.3 ml of 1:1000 Epinephrine subcutaneous via left upper arm. Emp sent home via her grandmother at 1503 after full recovery.


VAERS ID: 294663 (history)  
Age: 66.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-29
   Days after onset:7
Entered: 2007-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. UNKNOWN / 0 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Herpes zoster, Secondary transmission
SMQs:

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

Write-up: Patient''s wife developed shingles immediately following injection of o.patient. Patient''s wife has had lymphoma of thyroid about 5 years ago.eular doctor She was taken to emergency room on Saturday October 27, 2007 about 11 AM and was treated by Dr. Her regular doctor is MD.


VAERS ID: 294669 (history)  
Age: 73.0  
Gender: Female  
Location: Kansas  
Vaccinated:2007-10-22
Onset:2007-10-25
   Days after vaccination:3
Submitted: 2007-10-29
   Days after onset:4
Entered: 2007-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1132U / 0 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain upper, Diarrhoea, Gastroenteritis, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt has diabetes. She is on an insulin pump, but had no c/o''s. She was here for her annual physical, at the time of the pnemonia immunization.
Preexisting Conditions: Microalbuminuria, Obesity, depression: Resolved, proteinuria,Hypercholestolemia,Diabetes,Hypertension,Trigeminal neuralgia,Sleep apnea with distrurbance,Clinical C Difficile, Sleep Apnea with desturation. Allergies: Penicillin, Tylox, Codeine, Diamox, Avandia, Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt received pneumovax imm on 10/22/07. She reports she had her grandchildren with her, and they ''all had the flu". Pt c/o diarrhea,stomache ache,nausea, and left lower leg had bumps slightly raised since she received the imm.Pt was seen in Dr''s office by PA on 10/26/07. Assessment: Gastroenteritis and Rash, possibly a localized reaction. She was treated with Phenergan 25 mg q 6 hrs PRN for nausea, stop erythromycin unitl diarrhea stops,immodium PRN, bland diet,Rash: Alternate hydrocortisone and neosporin topically and instructed to call the office or return to the office if symtoms continued or worsened.


VAERS ID: 294701 (history)  
Age: 69.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-26
   Days after onset:4
Entered: 2007-10-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2464AA / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1035F / - RA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Simvastatin, Zyrtec, Isosorbide, Astellin Nasal Spray, Spectracef
Current Illness: None
Preexisting Conditions: See attached records 11/5/07-records received-Anxiety disorder. Seasonal allergic rhinitis. Hyperlipidemia.
Diagnostic Lab Data: See attached H & P and lab test office notes, and med list 11/5/07-records received-WBC 24.2, blood culture no growth.
CDC Split Type:

Write-up: Was given Pneumonia vaccine IM in RD on 10/22/07. Came back 10/23 with cellulitis from injection site down to mid forearm and elbow swollen hot and red. Area was marked and was told if it enlarged to go to ER, which she did. Was admitted. 11/5/07-records received for DOS 10/23-10/27/07-DC DX: Right arm cellulitis. Asthmatic bronchitis. Hyperlipidemia. Left forearm intravenous infiltration. Anxiety disorder. Seasonal allergic rhinitis. Evening after her injection developed pain redness and aching in right arm over the site of previous injection. Following morning noticed spreading erythema and pain in arm.


VAERS ID: 294785 (history)  
Age: 83.0  
Gender: Female  
Location: Indiana  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-29
   Days after onset:7
Entered: 2007-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0554U / - LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Chills, Erythema, Mental status changes, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Allergies: PCN - anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Localized, redness, swelling, erythema, fever, chills, mental status change.


VAERS ID: 294813 (history)  
Age: 38.0  
Gender: Female  
Location: North Dakota  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-25
   Days after onset:1
Entered: 2007-10-30
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80682 / - RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0883F / - RA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BCP
Current Illness:
Preexisting Conditions: PCN; BACTRIM; DIVERTICULITIS; ANXIETY. PMH: Diverticulosis, hemorrhoids. Allergies: PCN, Bactrim. Antivert causes arthralgias.
Diagnostic Lab Data:
CDC Split Type: 0714

Write-up: Fever, chills, erythema, heat and swelling right upper arm. 11/13/2007 MR received for DOS 10/23-24/2007 with D/C Dx of Allergic Reaction to immunization with mostly local allergic reaction. Temperature spike. Pt presented to ER with severe pain, heat and swelling in the R arm where flu and pnuemo vax given. Was given abx and d/c. Later in the day she presented again with high fever, sweats and chills. T=104.2 after Tylenol and Motrin. PE (+) for H/A, joint and back aches, and R arm erythema, swelling and pain. (+) dehydration as well. Txd with abx, steroids, IVF and antihistamines with improvement. F/U appt 10/25 with pt feeling much better.


VAERS ID: 294823 (history)  
Age: 49.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-30
   Days after onset:8
Entered: 2007-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80435 / - LA / UN

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

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

Write-up: Immediate large baseball size welt at injection site. Lasted several days. No known sensitivity to eggs or Thimerosal.


VAERS ID: 294825 (history)  
Age: 51.0  
Gender: Female  
Location: Iowa  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-29
   Days after onset:7
Entered: 2007-10-30
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2442AA / - LA / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 20 mg, Zbaby aspirin/day Milk thistle, multivitamin
Current Illness: None
Preexisting Conditions: Sulfa 3rd degree heart block (pacemaker) lobular carcinoma
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness about an hour after injection-pain for 7 days Redness was about 2" x 1/2 ". There was a line that appeared to be a broken vessell near site. Hot to touch for 5 days and had a hard knot Took Benadryl and Ibuprofen first 2 days and ice pack


VAERS ID: 294989 (history)  
Age: 10.0  
Gender: Male  
Location: Unknown  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-30
   Days after onset:8
Entered: 2007-10-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0993U / 2 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Blood culture, Body temperature increased, Injection site pain, Injection site swelling, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: folic acid; hydroxyurea
Current Illness: Sickle cell anaemia
Preexisting Conditions: No reaction on previous exposure to vaccine
Diagnostic Lab Data: blood culture 10/23?/07; body temp 10/23/07 102 degr
CDC Split Type: WAES0710USA04963

Write-up: Information has been received from a pharmacist concerning a 10 year old male child with sickle cell anaemia, no known drug allergies, and no history of a reaction on previous exposure to Pneumovax 23 (2 prior doses, dates unknown), who on 22-OCT-2007 was vaccinated IM with a third dose, 0.5 ml, of Pneumovax 23 (lot #657529/0993U). Concomitant therapy included folic acid, hydroxyurea and influenza virus vaccine (date and manufacturer unspecified). On 22-OCT-2007, following the vaccination, the child experienced pain at the injection site, and his mother gave him ibuprofen (MOTRIN) as treatment. On 23-OCT-2007, when the child returned from school, his temperature and reached 102 degrees F, and he had pain and swelling of right arm from the elbow to the shoulder. The pain worsened with movement. The child was taken to an emergency room, and was admitted to the hospital. Treatment included morphine and intravenous antibiotics, including ceftriaxone (ROCEPHIN) and cefotaxime (CLAFORAN). At the time of this report, the child was still hospitalized, and had not recovered. The reporting pharmacist considered the events to be serious as an other important medical event. Additional information has been requested.


VAERS ID: 295012 (history)  
Age: 74.0  
Gender: Male  
Location: New York  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2007-10-31
Entered: 2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA282DA / - LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2730AA / 0 RA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ambulates with difficulty, uses walker.
Preexisting Conditions: h/o prostate Ca with radiation treatment greater than one year previous.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: no adverse event. Tdap vaccine given to an individual greater than 64 years of age.


VAERS ID: 295032 (history)  
Age: 0.5  
Gender: Female  
Location: Oregon  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U2156AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459LA / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143E / 2 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Blood culture negative, CSF cell count normal, CSF culture negative, CSF test normal, Computerised tomogram normal, Convulsion, Crying, Culture urine negative, Drooling, Electrocardiogram normal, Electroencephalogram normal, Gaze palsy, Irritability, Screaming, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild gross motor delay; Colic 11/7/07-records received-HX of head shaking and body shaking when she was 1 month old.
Diagnostic Lab Data: LP/ CSF NL; EEG NL; EKG NL; BCX/UCX/CSF CX NL; HEAD CT NL 11/7/07-records received-CSF culture negative, Protein and glucose normal. CBC-WBC 16.1, segs 47. CT head normal. EEG normal.
CDC Split Type:

Write-up: The evening of imm''s - irritability, crying, increasing to unconsolable screaming for over 12 hours starting the next morning, seizure like activity x 1 - shaking, eye rolling, drooling approximately 19 hours after imm''s. No fever. Hospitalized x 2 days for w/u of seizures in infant. 11/7/07-records received for DOS 10/23-10/25/07- DC DX: Possible seizures, developmental delay, infection ruled out. Day prior to admission she was noted by PCP to be mildly developmentally delayed in her gross motor functions. Not sitting up, rolling front to back only. Later same day became irritable, fussy and next afternoon whole body shaking and her eyes rolled up. Parents are poor historians as they are both diagnosed with MR and are delayed.


VAERS ID: 295043 (history)  
Age: 2.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-31
   Days after onset:9
Entered: 2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2489MA / - RL / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cyanosis, Death, Irritability
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? Yes
   Date died: 2007-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol (2.5mg/3ml-Bullets) 3 ml BID or TID & PRN; Robinul (0.2mg/ml) 2 ml TID Prevacid SoluTab (15mg/tab) 1 tab BID(am & hs) Glycolax 2 tsp QD Children's Tylenol 4ml Q4 hours PRN increased Temperature
Current Illness:
Preexisting Conditions: This child was in a program. He had a multitude of diagnoses and problems including interrupted development of white matter of the brain, seizures, arthryogryposis of CNS origin, cyanotic spells, apneic events, problems with thermoregulation, reflux, aspiration. He had a pacemaker implanted about a year ago and had been doing much better since then. Parents report he has not have a respiratory or cardiac arrest since then. He did still have seizures monthly. He had posturing and tics on a daily basis. He had an uncoordinated swallow and was at high risk for aspiration. I am the child''s nurse case manager and I have only been working with the family for about 4 months (the family was transferred to me due to internal staff reassign-ments).
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child had flu shot @ about 10 am. Waited in office for 20 minutes. Went home w/mother and private duty nurse. Nurse reported he was fussy after the immunization. She held him until he went to sleep. They put child to bed in parental bedroom upstairs. Nurse went to kitchen to get g-tube feeds ready. Apnea alarm went off shortly thereafter. When RN got to the child, he was face down in the bed and blue. They administered CPR, called 911. He was airlifted to hospital, where he was pronounced dead approximately two hours after receiving the flu shot. 11/13/07 Received autopsy report which reveals COD as complications of cerebral dysgenesis of indeterminate etiology; arthrogryposis multiplex congenita was a significant contributing factor. Had been placed on side for nap but was found prone. Disabilities rendered unable to lift head/body to protect airway. 11/16/07 Received vax records from pcp. VAERS database updated w/same.


VAERS ID: 295049 (history)  
Age: 0.53  
Gender: Female  
Location: South Carolina  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-23
   Days after onset:1
Entered: 2007-10-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2606AA / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

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

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: Premie 28wk gestation
Diagnostic Lab Data: Rx to Synagis
CDC Split Type:

Write-up: gave oral Rotateq at 11:20-11:25, at 11:30 Synagis injection given in (R) leg at same time DTaP given in (L) leg, @ 11:35 splotchy red rash on both legs starting slightly above knees to bottom of feet-observation after Benadryl rash started fading & @ 15 min later came back not as bad as first time, faded, pt. sent home.


VAERS ID: 295052 (history)  
Age: 0.8  
Gender: Female  
Location: Georgia  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459PA / - RL / IM

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

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

Write-up: Receive influenza vaccine 10-22-07. Urticarial rash on both legs.


VAERS ID: 295053 (history)  
Age: 60.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-24
   Days after onset:1
Entered: 2007-10-31
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1080U / 0 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paroxetine 30mg
Current Illness: None
Preexisting Conditions: Depression
Diagnostic Lab Data: None Performed
CDC Split Type:

Write-up: Erythematous patch approx 4 inches in diameter around administration site on left arm w/ itching; started itching about 23 hrs after administration.


VAERS ID: 295057 (history)  
Age: 31.0  
Gender: Female  
Location: Maryland  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-24
   Days after onset:2
Entered: 2007-10-31
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2490AA / - LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cough, Headache, Injection site erythema, Injection site induration, Injection site pain, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen-200 mg
Current Illness: no illness
Preexisting Conditions: Amoxicillin, Codeine, PCN/Sulfa meds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythema (L) arm, c/o pain (L) arm tender. *Indurated has gotten sick with vaccine before achey coughing c/o headaches. Total body pain.


VAERS ID: 295107 (history)  
Age: 69.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Cherry color pin point papules. VS Q 4 x 24, O2 sats.


VAERS ID: 295111 (history)  
Age: 75.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: cherry color pin point papules v.s. one time x 24 hr O2 sat


VAERS ID: 295112 (history)  
Age: 83.0  
Gender: Male  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: cherry color pin point papule v.s. every 4 hr x 24 hr O2 sats


VAERS ID: 295113 (history)  
Age: 86.0  
Gender: Male  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: cherry color pin point papules v.s. every 4 hrs x 24 hrs O2 sats


VAERS ID: 295114 (history)  
Age: 95.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: Cherry color pin point papules. VS Q4 x 24, O2 sats.


VAERS ID: 295115 (history)  
Age: 98.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: cherry color pin point papules v.s. every 4 hrs x 24 hrs O2 sats


VAERS ID: 295116 (history)  
Age: 75.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: Cherry color pin point papules. VS Q4 x 24, O2 sats.


VAERS ID: 295117 (history)  
Age: 84.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: cherry color pin point papules v.s. every 4 hrs x 24 hrs O2 sat


VAERS ID: 295118 (history)  
Age: 91.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: cherry color pin point papules v.s. every 4 hrs x 24 hrs O2 sats


VAERS ID: 295119 (history)  
Age: 84.0  
Gender: Male  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: Cherry color pin point papules. VS Q4 x 24, O2 sats.


VAERS ID: 295120 (history)  
Age: 76.0  
Gender: Male  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

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

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:

Write-up: Cherry color pin point papules. VS Q4 x 24, O2 sats.


VAERS ID: 295121 (history)  
Age: 72.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-25
   Days after onset:2
Entered: 2007-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78480 / - UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: cherry color pin point papules vs every 4 hr x 24 O2 sats


VAERS ID: 295154 (history)  
Age: 13.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-23
   Days after onset:0
Entered: 2007-10-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB207BA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1184U / 1 LA / SC

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

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

Write-up: Mother reports tennis ball size area of redness on L arm at site of immunization.


VAERS ID: 295160 (history)  
Age: 29.0  
Gender: Female  
Location: Nevada  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-26
   Days after onset:2
Entered: 2007-10-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (TEVAX) / GLAXOSMITHKLINE BIOLOGICALS TD166 / - RA / UN

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

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

Write-up: Redness and swelling on the right delt.


VAERS ID: 295194 (history)  
Age: 31.0  
Gender: Female  
Location: Mississippi  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-31
   Days after onset:7
Entered: 2007-11-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site swelling, Local swelling, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reoprted
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MS07029

Write-up: reorted on 10/29 that she received a flu shot 10/22 @ employee flu clinic. Had soreness and swelling that afternoon. Next day shes said she had swelling @ site; on 10/24 noticed swelling in L neck area. Had some soreness in that area, but not a present. Still has minior swelling in that area. To make appointment with PMD. No fever after flu shot or at present.


VAERS ID: 295243 (history)  
Age: 35.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-30
   Days after onset:7
Entered: 2007-11-01
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80061 / - LA / UN

Administered by: Public       Purchased by: Private
Symptoms: Headache, Mobility decreased, Neck pain, Pain in extremity, Periarthritis
SMQs:, Parkinson-like events (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

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: systemic lupus
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received flu vaccine on Mon 10/22, by Tue 10/23: she was c/o pain up her arm to neck with a headache. Wed prn she was unable to life her head due to severe neck pain. Thur. she saw her MD who related this to "capsulitis" and instructed her to use Advil and Claritin for 2 wks Along with PT for 2 wks


VAERS ID: 295262 (history)  
Age: 1.5  
Gender: Female  
Location: Virginia  
Vaccinated:2007-10-22
Onset:2007-11-01
   Days after vaccination:10
Submitted: 2007-11-01
   Days after onset:0
Entered: 2007-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B061BB / 3 UN / IM

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

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:

Write-up: Patient came for sick visit on 11-1-07 and wanted us check thighs where shots were given, areas are red - maybe one papule at shot site, no vesicles. Lateral side 6-8 round raised papules, treat as if chicken pox. Dxc? chickenpox - vaccine related


VAERS ID: 295345 (history)  
Age: 69.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2007-11-02
Entered: 2007-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1081U / - - / SC

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

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

Write-up: hard red knot approximately 3" in diameter;very tender and itched for approximately 7 days


VAERS ID: 295548 (history)  
Age: 12.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2007-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 0 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 125111 / 0 RA / SC

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

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

Write-up: Swelling at injection site, red - hurts when moving arm.


VAERS ID: 295602 (history)  
Age: 5.0  
Gender: Male  
Location: New York  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-10-23
   Days after onset:0
Entered: 2007-11-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2450AA / 3 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0838U / 1 UN / SC

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

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

Write-up: Localized reaction-red area on skin and painful


VAERS ID: 295620 (history)  
Age: 3.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-11-05
   Days after onset:14
Entered: 2007-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2528AA / 1 LL / IM

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

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

Write-up: Within 5-10 minutes after receiving the vaccine, the patient developed facial hives with some itching. Some facial flushing with 1-2 target lesions on the back.


VAERS ID: 295633 (history)  
Age: 38.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-25
   Days after onset:3
Entered: 2007-11-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER C2512AC / 13 LA / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Anthrax (no brand name)~UN~29.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None Performed
CDC Split Type:

Write-up: Patient breaks out in hives around his neck, under his axilla, and groin, chest, thigh, back. Patient described this reaction as occurring any time his body temperature rises due to illness. Occurs with each Anthrax vaccine.


VAERS ID: 295719 (history)  
Age: 66.0  
Gender: Female  
Location: Utah  
Vaccinated:2007-10-22
Onset:2007-11-03
   Days after vaccination:12
Submitted: 2007-11-06
   Days after onset:3
Entered: 2007-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1087U / 4 LA / SC

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

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:

Write-up: He called to report that he came down with shingles since the shot.


VAERS ID: 295738 (history)  
Age: 0.2  
Gender: Male  
Location: Ohio  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-31
   Days after onset:7
Entered: 2007-11-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF210AA / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0972U / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad)

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

Write-up: Vaccines given 10/22/07 On 12/24/07 developed projectile vomiting and dizziness lasting until 10/29. Still with dizziness. No fever


VAERS ID: 295739 (history)  
Age: 69.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-30
   Days after onset:8
Entered: 2007-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 0554U / 0 RA / SC
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 05546 / 0 RA / SC

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

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

Write-up: Rt arm Reddened and swollen to elbow after Pneumonia Vac. Rocephin 1gm IM given and Rx Bactrim DS once BID #20


VAERS ID: 295747 (history)  
Age: 49.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-10-24
   Days after onset:0
Entered: 2007-11-06
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2769AA / 0 LA / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Arthralgia, Erythema, Myalgia, Pain, Pyrexia, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: 12 x 12 cm area of erythema, increased temp of area/pain; fever of 102.0 2 hours after Motrin 600mg; joint and muscle pain 2 days after Adacel injection.


VAERS ID: 295908 (history)  
Age: 0.2  
Gender: Male  
Location: Louisiana  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-11-07
   Days after onset:16
Entered: 2007-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 0 UN / UN
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF206AA / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007E / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drooling, Skin test, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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. 11/27/07-HX of tongue thrusting.
Diagnostic Lab Data: Infant prick skin tested on 11/7/07 with histamine and saline controls as well as with Rotateq vaccine; positive wheal and flare to the vaccine with negative reaction to saline control and positive histamine response to the positive control. 11/27/07-records received-CBC band 11%. Electrolytes and urine normal.
CDC Split Type:

Write-up: Infant received multiple parenteral vaccines as well as oral Rotateq at his 2 month visit; time administered between 10-11 am. No reaction while in the pediatricians office, but by 5 pm was noted by mother to have progressively increased drooling and prominent tongue swelling, requiring an Emergency Room visit at 7pm where he was treated with oral steroids in the ER followed by 4 daily doses of Orapred. Mother notes resolution of tongue swelling by day 2-3. No hives or local reactions at the sites of the parenteral vaccines were noted at any time. 11/27/07-records received for DOS 8/16/07-Status post possible reaction to immunization condition much improved. Evening of injection tongue protruded, lower lip swollen. Low grade fever.


VAERS ID: 296232 (history)  
Age: 56.0  
Gender: Male  
Location: New York  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-11-06
   Days after onset:14
Entered: 2007-11-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2524AA / - LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Electrocardiogram, Facial bones fracture, Full blood count, Influenza like illness, Laboratory test, Nausea, Pain, Spinal X-ray, Syncope, Tooth injury, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOCOR, LIPITOR, LOPID, INTRAVENOUS FLUIDS
Current Illness:
Preexisting Conditions: Elevated cholesterol, herniated disc.
Diagnostic Lab Data:
CDC Split Type: 200703668

Write-up: A 56-year-old male patient with a history of elevated cholesterol and a herniated disc received an intramuscular left deltoid injection of Fluzone (lot number U2524AA) on 22 October 2007. Approximately three hours post-vaccination, the patient began experiencing flu-like symptoms, including generalized body aches, nausea, and vomiting. The following day, he experienced a syncopal episode resulting in a fractured nose and chipped front tooth. He was seen in the emergency room, where he underwent an EKG, CBC, SMA7, C-spine, and Zocor, Lipitor, and Lopid. At the time of the report, the patient had not yet recovered.


VAERS ID: 296695 (history)  
Age: 78.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-11-14
   Days after onset:22
Entered: 2007-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2442AA / - LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Neck pain, Pyrexia, Vaccination complication, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec,Dyazide
Current Illness: Patient had very mild otitis externa had no fever.
Preexisting Conditions:
Diagnostic Lab Data: I do not have any of this information
CDC Split Type:

Write-up: Patient developed Fever 101 or above neck pain and vomiting on the day after recieving the vaccine. Patients daughter called to report symptoms she was advised to toake the patient to the ER for emergent evaluation of symptoms. The patients was taken for evaluation several days later to Dr. I donot have any of the information as far as test or treament which was rendered. Patient was seen by a neurologist and found to have encephalitis thought to be a result of the flu immunization


VAERS ID: 299662 (history)  
Age: 14.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-11-14
   Days after onset:22
Entered: 2007-11-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 1 UN / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA04763

Write-up: Information has been received from a physician concerning a 14 year old female who on 20-AUG-2007 was vaccinated intramuscularly with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot number 658490/0802U) There was no concomitant medication. On 22-OCT-2007 the patient received her second dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot number 658563/1063U) intramuscularly. On 23-OCT-2007 the patient experienced a fever of 103.1F, headache, chills, nausea and fatigue. The patient sought unspecified medical attention. At the time of the report, 23-Oct-2007, the patient still had not recovered. Additional information has been requested.


VAERS ID: 297820 (history)  
Age: 2.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-11-20
   Days after onset:29
Entered: 2007-11-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR LUT2459RA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1437F / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B5884SC / 3 UN / IM

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

Life Threatening? No
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:

Write-up: High fever 103.2 degrees and vomiting. Was taken to the E.R that night.


VAERS ID: 297872 (history)  
Age: 60.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2007-10-22
Onset:2007-10-24
   Days after vaccination:2
Submitted: 2007-11-27
   Days after onset:34
Entered: 2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Public       Purchased by: Private
Symptoms: Erythema, Pain, Swelling, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Food allergies (scallops) sulfur, penicillin and sulfite allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling soreness area approximately 3" diameter. Hives beginning throat and inside arms and spreading to face and legs. Duration approximately 3 days.


VAERS ID: 298206 (history)  
Age: 64.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-11-27
   Days after onset:36
Entered: 2007-11-29
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2478BA / - - / -

Administered by: Public       Purchased by: Private
Symptoms: Eye pruritus, Eye swelling, Lip swelling, Pharyngeal oedema, Restlessness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Oropharyngeal allergic conditions (narrow), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 45 minutes after vaccination, thought she had an almond stuck in her throat - drank copious amounts of water. Restless, itchy eyes all night. Woke up the next morning - eyes, lips and right side of throat swollen. Benadryl x 24 hrs, no further flu shots (ate almonds with no problem since then).


VAERS ID: 298337 (history)  
Age: 35.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-11-14
   Days after onset:23
Entered: 2007-11-30
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2734AA / - LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Activities of daily living impaired, Immediate post-injection reaction, Injection site pain, Joint range of motion decreased, Sleep disorder
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt. reported pain in vaccinated arm beginning almost immediately after receiving Tdap, pain increased over time and by day 7 it extended from elbow to neck with limited ROM in shoulder. Pain interferred with sleep and ADLs. Temporary relief with heat, acetaminophen. No visible swelling, erythema. Started ibuprofen 600 mg tid with improved ROM. Pain still present but improving day 23.


VAERS ID: 298341 (history)  
Age: 66.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-11-05
   Days after onset:14
Entered: 2007-11-30
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78994 / - - / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Actonel RD Allergy injection
Current Illness: None
Preexisting Conditions: Grasses, trees, cats, dogs, mold, dust, ragweed, Novacine, babituates
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Intense itching, hives, low grade fever 99.2 - 100.2


VAERS ID: 298695 (history)  
Age: 0.67  
Gender: Male  
Location: Iowa  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2007-12-04
Entered: 2007-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0239U / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, No adverse reaction
SMQs:, Medication errors (narrow)

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:

Write-up: There were no adverse effects or treatments


VAERS ID: 299095 (history)  
Age: 41.0  
Gender: Male  
Location: Virginia  
Vaccinated:2007-10-22
Onset:2007-11-11
   Days after vaccination:20
Submitted: 2007-12-07
   Days after onset:26
Entered: 2007-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None at time of vaccination
Current Illness: None
Preexisting Conditions: None PMH: URI s/s of sinus pressure, post nasal drip, rhinitis & HA x 2 wks.
Diagnostic Lab Data: None; sxs resolving
CDC Split Type:

Write-up: Developed Bell''s Palsy 3 weeks after receipt of the inactivated influenza vaccine. 12/28/07 Reviewed medical records which reveal patient experienced left facial weakness, left eye tearing & left facial droop 11/11/07, 3 wks s/p flu vax. Saw pcp on 11/13 for sinusitis then later tx w/antiviral & steroids. Returned to clinic 12/3 w/dry cough x 2 wks & was dx w/acute ethmoidal sinusitis. FINAL DX: Bell''s palsy.


VAERS ID: 299358 (history)  
Age: 45.0  
Gender: Male  
Location: Washington  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-12-12
   Days after onset:51
Entered: 2007-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA029AA / 0 LA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no~ ()~NULL~~In Patient
Other Medications: Tums, Ibuprophen, tylenol
Current Illness: na
Preexisting Conditions: Hx Asthma, Acne, inguinal pain, ulcer disease
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Approximately 1.0 hours after injection on Flulaval Lot#AFLLA029AA given IM patient developed diffuse erythema to back with scattered raised wheels. Scattered patches of same to both arms. NKDA. No other signs or symptoms of adverse reaction. No known exposures to new environmental elements. Symptoms responded well to Benadry by mouth.


VAERS ID: 299441 (history)  
Age: 1.11  
Gender: Male  
Location: Indiana  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-12-13
   Days after onset:51
Entered: 2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460FA / 0 UN / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB200AA / 0 UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1351U / 0 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0426U / 0 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Crying, Dyspnoea, Irritability, Pyrexia, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Acid Reflux PMH: GERD, poor weight gain, resolving w/GI consult. Questionable mild reactive airway disease.
Diagnostic Lab Data: Information can be obtained from Methodist Hospital. Hospital LABS: CXR WNL. Stools guaic neg. Urine & blood c/s neg.
CDC Split Type:

Write-up: My son developed a high fever for several days after the vaccination. He also displayed rapid and uncontrollable shaking,seizure like episodes that resulted in him being hospitalized. He also experienced breathing difficulty, drowsiness and excessive crankyness/crying. 1/11/08 Reviewed pcp medical records which included vax records w/lot #s & databse updated w/same. Records reveal patient w/thick eye discharge 10/22/07 otherwise in good health & meeting developmental milestones. Dx w/conjunctivitis & tx w/eye drops. Returned to pcp 10/31 w/vomiting,lethargy, fever, dyspnea, reduced oral intake, & not acting himself x 3 days. Dx w/viral disease. Admitted to hospital 10/31-11/1/2007 w/fever & URI. Returned to pcp 11/26/07 w/purulent discharge from eyes x 3 days, nasal discharge x 4 days, cough. Dx w/conjunctivitis & OM right ear. Tx w/antibiotics 1/15/08 Reviewed hospital medical records which reveal patient experienced fever & abnormal movements. Developed low grade fever (99-100) & cold s/s 5 days prior to admit. Parent & 3 siblings w/colds s/s. On day of admit, had vomiting & temp max 102. Parent noted slow rhythmic body contractions followed by drowsiness. Sent to daycare & continued to have jerky movements & wide based gait noted when taken to pcp on day of admit. Admitted 10/31-11/1/2007. On exam had fluid collection right ear. FINAL DX: Viral syndrome.


VAERS ID: 302288 (history)  
Age: 78.0  
Gender: Male  
Location: Unknown  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2007-12-21
   Days after onset:59
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Laboratory test, Stool analysis
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: COSOPT; AVODART; PRILOSEC
Current Illness: Blood pressure high; Enlarged prostate; Glaucoma
Preexisting Conditions:
Diagnostic Lab Data: diagnostic laboratory; stool analysis
CDC Split Type: WAES0710USA06070

Write-up: Information has been received from a 78 year old male with blood pressure high, enlarged prostate and glaucoma who on 22-OCT-2007 was vaccinated with ZOSTAVAX. Concomitant vaccine therapy that day included influenza virus vaccine (unspecified) (manufacturer unknown). Concomitant therapy included AVODART, COSOPT and PRILOSEC. At the time of reporting, 29 OCT 2007, the patient was recovering, and due to be seen by his physician that same day. There was no product quality complaint. Follow up information was received from the consumer who reported that he was experiencing "violent diarrhea" for four weeks and is under the care of two physicians. The consumer noted he did not think that this was related to the vaccine. It was also reported that unspecified blood work and a stool test were obtained, of which the results were not provided. The consumer did not provide physician contact information. No further information is expected. Additional information has been requested.


VAERS ID: 303577 (history)  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-10-22
Onset:2007-11-19
   Days after vaccination:28
Submitted: 2008-01-15
   Days after onset:57
Entered: 2008-01-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1060U / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Cervical dysplasia, Smear cervix abnormal
SMQs:, Reproductive premalignant disorders (narrow), Uterine and fallopian tube malignant tumours (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Pap test, 11/19/07, abnormal
CDC Split Type: WAES0712USA02651

Write-up: Information has been received from a physician concerning a 26 year old female who on 23-JUL-2007 was vaccinated intramuscularly with her first dose of Gardasil (lot# 658100/0525U). On 22-OCT-2007 the patient was vaccinated intramuscularly with her second dose of Gardasil (lot# 658556/1060U). On 19-NOV-2007 the patient experienced an abnormal Pap with results of atypical squamous cells of undetermined significance. The patient''s abnormal Pap and atypical squamous cells of undetermined significance persisted. The patient sought medical attention in the office. Additional information has been requested.


VAERS ID: 304205 (history)  
Age: 32.0  
Gender: Female  
Location: Mississippi  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2008-01-16
   Days after onset:85
Entered: 2008-01-29
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA027AA / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0690861A

Write-up: This case was reported by a healthcare professional and described the occurrence of injection site redness in a 32-year-old female subject who was vaccinated with Flulaval for prophylaxis. The healthcare professional is the subject. The subject reported that she had received influenza virus vaccine in previous years and experience transient low-grade fever and aches. Concurrent medications included Yaz. On 22 October 2007 the subject received unspecified dose of Flulaval (.5 ml, unknown, left arm). On 23 October 2007, within 24 hours after vaccination with Flulaval, the subject experienced injection site redness, injection site soreness, and injection site warmth. The subject was seen by a physician. The subject stated that she did not experience the fever and aches that she had experienced with previous influenza vaccinations. At the time of reporting the events were unresolved. The subject also reported a product complaint because she is concerned over the potential for a contaminated or defective product. The healthcare professional considered the events were probably related to vaccination with Flulaval.


VAERS ID: 307908 (history)  
Age: 1.5  
Gender: Female  
Location: Florida  
Vaccinated:2007-10-22
Onset:2007-10-27
   Days after vaccination:5
Submitted: 2008-03-04
   Days after onset:129
Entered: 2008-03-17
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject''s medical condition was considered healthy.
Diagnostic Lab Data: UNK
CDC Split Type: A0691553A

Write-up: This case was reported by a healthcare professional to a sales representative and described the occurrence of erythema multiforme in an 18-month-old female subject who was vaccinated with Havrix (GlaxoSmithKline). The subject''s medical condition was considered "healthy." The healthcare professional did not report if the subject received any other vaccinations or concurrent medications on the date of the Havrix administration. On 22 October 2007 the subject received 1st dose of "pediatric" Havrix (unknown). On 27 October 2007, 5 days after vaccination with Havrix, the subject experienced rash or erythema multiforme. The subject was seen by a physician on 29 October 2007. The subject had also visited a pumkin farm following the vaccination. The healthcare professional considered the events were clinically significant (or requiring intervention). At the time of reporting the events were worse.


VAERS ID: 310028 (history)  
Age: 85.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2008-03-26
   Days after onset:156
Entered: 2008-04-16
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified); LIPITOR; ACTONEL
Current Illness: Drug hypersensitivity; Sulfonamide allergy; Chronic obstructive pulmonary disease; Hypercholesterolaemia
Preexisting Conditions: Colon cancer; Prostate carcinoma
Diagnostic Lab Data: None
CDC Split Type: WAES0801USA05049

Write-up: Information has been received from a consumer concerning her 85 year old husband with allergy to aspirin and ACULAR and a history of colon cancer who on 22-OCT-2007 was vaccinated with a single dose of ZOSTAVAX (Oka/Merck). Concomitant therapy included ACTONEL, LIPITOR and number of other medicines (unspecified). On 22-OCT-2007 the patient developed a rash on his abdomen, on back and on top of his feet and ankles. There were total of approximately 40 red welts on patient''s body and it caused lot of itching. The patient took BENADRYL and had a dexamethazone injection. The rash lasted for 2 weeks. At the time of report the patient had recovered. No diagnostic laboratory tests were undertaken. A product quality complaint was not involved. Additional information has been requested. This is in follow-up to report(s) previously submitted on 1/26/208. Information has been received from a consumer concerning her 85 year old husband with allergy to ASPIRIN and ACULAR and a history of colon cancer who on 22-OCT-2007 was vaccinated with a single dose of ZOSTAVAX (Merck). Concomitant therapy included ACTONEL, LIPITOR and number of other medicines (unspecified). On 22-OCT-2007 the patient developed a rash on his abdomen, on back and on top of his feet and ankles. There were totatl of approximately 40 red welts on patient''s body and it caused lot of itching. The patient took BENADRYL and had a dexamethasone injection. The rash lasted for 2 weeks. At the time of report the patient had recovered. No diagnostic laboratory tests were undertaken. A product quality complaint was not involved. Follow-up information was received from a certified medical assistant. This 86 year old female withi allergies to ASPIRIN, ACULAR and SULFA, COPD, hypercholesterolemia and a history of prostate cancer and colon cancer was vaccinated IM in the right arm on 23-OCT-2007 (previously reported as 22-OCT-2007) with a dose of ZOSTAVAX (Merck) (lot # "08866"). There was no illness at the time of vaccination. At 10:00 a.m. on 24-OCT-2007 (previously reported as 22-OCT-2007) the patient had an unrticarial eruption on his torso, ankle and thigh, the patient was noted to be very pruritic and uncomfortable. Unspecified medical attention was sought. The patient''s reaction lasted 4-5 days (previously reported as 2 weeks). The patient was reportedly recovered. Additional information is not expected. This is in follow-up to report(s) previously submitted on 3/26/2008; 6/24/2008. Follow up information was from the consumer who wanted to know if there was a greater chance of the vaccine not working because of the adverse event. She provided no additional adverse event information regarding her husband''s experience. Additional information is not expected.


VAERS ID: 312871 (history)  
Age: 18.0  
Gender: Female  
Location: Georgia  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2008-05-14
Entered: 2008-05-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Blood test, Infectious mononucleosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: diagnostic laboratory - blood work
CDC Split Type: WAES0804USA01971

Write-up: Information has been received from a consumer concerning her 18 year old daughter who on 22-OCT-2007 was vaccinated with the first 0.5 ml dose of GARDASIL. The was no concomitant medication. In early February 2008, the patient developed mono. The patient had a high fever of 101 deg F and missed 2 weeks of school. The patient has not yet received the second dose. Unknown medical attention was sought. Patient outcome was recovered on an unspecified date. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 313276 (history)  
Age: 16.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2008-05-14
   Days after onset:205
Entered: 2008-05-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 1 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Chills, Injection site rash, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: WAES0804USA05303

Write-up: This is in follow-up to report(s) previously submitted on 5/14/2008. Initial and follow up information has been received from a nurse practitioner concerning a 16 year old female who on 22-OCT-2007 was vaccinated in the morning IM in the left arm with a 2nd dose of GARDASIL (lot#658563/1063U). On 22-OCT-2007, in the PM the patient developed a low grade fever, rash surrouding injection site, and also experienced nausea and chills and vomiting (x1 episode) after receiving her vaccination. Subsequently, the patient recovered from low grade fever, rash surrounding injection site, nausea, chills and vomiting 1 or 2 days later. The patient sought unspecified medical attention by calling the office. Additional information has been requested.


VAERS ID: 318594 (history)  
Age: 15.0  
Gender: Female  
Location: Iowa  
Vaccinated:2007-10-22
Onset:2007-10-30
   Days after vaccination:8
Submitted: 2008-07-09
   Days after onset:253
Entered: 2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. UNKNOWN / 1 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain upper, Activities of daily living impaired, Arthralgia, Blood test normal, Chest pain, Disturbance in attention, Dyspnoea, Fatigue, Headache, Hyperaesthesia, Lymphadenopathy, Malaise, Mononucleosis heterophile test negative, Pain, Pneumonia, Sinusitis, Streptococcus identification test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Rash; Fever~Influenza (Seasonal) (no brand name)~1~7.20~In Patient
Other Medications: None
Current Illness: none
Preexisting Conditions: Food Allergies; Environmental Allergies; Eposodic Asthma; Antibiotic Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: On July 25, 2007 patient went into the Pediatrician''s office for a School Physical. The nurse practitioner recommended the Gardasil vaccine. After discussing with her the possible side effects and the fact that patient, has many allergies and I was concerned about possible reactions to the vaccine. The nurse assured us that the vaccine that should not give her a problem. I agreed to the vaccine. The second shot was given to patient on or about October 22, 2007. Within a week of getting, the second vaccine patient started complaining of generally not feeling well. Patient began feeling very tired and generally "achy" all over. She started missing school. Through the entire month of November, patient missed school occasionally due to fatigue and overall achiness. This progressed and became worse. By the end of December, patient had started missing entire weeks of school. She had headaches, joint pain, ached all over, fatigue, difficulty breathing on occasion. Because patient was so ill that when it was time to receive the 3rd shot of Gardasil, we chose to wait even though the doctors reassured us that it would be alright. The symptoms appeared to be consistent with Mono, so in early January we took her to the doctor. He ran Mono tests, Strep tests and blood tests. The strep test was positive, the mono test was negative and the blood tests showed no problems. The doctor prescribed on Antibiotics for the strep. Through the entire Month of January, she was ill, and went through several rounds of antibiotics. Her glands were swollen, her body was in pain, her stomach and chest hurt, legs and joints hurt (at times you could not even touch her, she would cry in pain). There were days that she just could not get out of bed, severe fatigue. By February, patient had developed pneumonia and was so ill that the doctor contemplated putting her in the hospital. The only reason he did not hospitalize her was that due to her allergies to antibiotics he indicated that he really did not have anything he could treat her with intravenously and “there are things going around the hospital that if she were to get, we would have no defense for!” We were visiting the doctor''s office on a weekly basis. Prior to the diagnosis of pneumonia, the diagnosis was”just a virus.” By the beginning of March, patient started having the severe headaches, stomach pain, fatigue and continued with overall pain. The doctor diagnosed her with a “sinus infection," and put her on Antibiotics for several weeks. After two or three rounds of the antibiotic, with no improvement in her condition, she stopped taking the antibiotics. n addition to the above noted symptoms reported to the doctors, patient reported difficulty concentrating. We have enlisted the help of a Integrated Manual Therapist to get the toxins out of her body. She has been in treatment since mid April and has been improving. She still has occasional severe headaches and stomach pain, but not to the extent, they were. The fatigue is still an issue but much less.


VAERS ID: 318596 (history)  
Age: 12.0  
Gender: Female  
Location: Iowa  
Vaccinated:2007-10-22
Onset:2007-11-05
   Days after vaccination:14
Submitted: 2008-07-09
   Days after onset:246
Entered: 2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. UNKNOWN / 1 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain upper, Arthralgia, Disturbance in attention, Dizziness, Drug hypersensitivity, Eating disorder, Fatigue, Headache, Pain, Paraesthesia, Sinusitis, Weight decreased
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Rash, Fever~Influenza (Seasonal) (no brand name)~1~7.20~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Environmental Allergies; eposodic asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was 11 on July 25, 2007 when she went into the Pediatrician''s office for a School Physical. Patient received the first vaccine during the visit and received the second shot on or about October 22, 2007. Patient began struggling with fatigue and general achiness about 2 weeks after the vaccine. This progressed and became worse. She had issues with fatigue and overall body pain, joint pain, headaches and stomachaches. Patient was able to work through it part of the time but still missed a lot of school. At the end of February, Patient had severe headaches, dizziness, stomach pain, and fatigue. Patient had virtually stopped eating. She had lost 10 pounds in a matter of a month. The diagnosis was “sinus infection.” The doctor prescribed an antibiotic. Patient had an adverse reaction to the antibiotic and had to be prescribed a different one. She was on Antibiotics for several weeks without any improvement. In addition to the above noted symptoms reported to the doctors, patient reported difficulty concentrating and severe leg pain and tingling down to her ankles. We have enlisted the help of a Integrated Manual Therapist to get the toxins out of her body. She has been in treatment since mid April and has been improving. She is still having occasional severe headaches, stomach pain and fatigue. Patient has begun eating again but has not gained any weight back (she has lost a total of 20 pounds).


VAERS ID: 318965 (history)  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2008-07-08
   Days after onset:260
Entered: 2008-07-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

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

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: WAES0806USA00772

Write-up: Information has been received from a consumer who reported that on 18-MAY-2007 she was vaccinated with the first dose of GARDASIL (lot #, and route not reported). The consumer reported that on 22-OCT-2007 she was vaccinated with the second dose of GARDASIL (lot #, and route not reported). She noted that she did not receive the third dose of GARDASIL in January, because she had the flu. No further information was provided. Additional information is not expected.


VAERS ID: 322930 (history)  
Age: 21.0  
Gender: Male  
Location: Ohio  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2008-07-30
   Days after onset:281
Entered: 2008-08-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Therapeutic response unexpected
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: baclofen; bromcocriptine; VALIUM; BOTOX
Current Illness: Dystonia
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0711USA00891

Write-up: Information has been received from a consumer regarding his 21 year old son with dystonia and no allergies who on approximately 22-OCT-2007 "two weeks ago" was vaccinated with a dose of PNEUMOVAX 23. Concomitant therapy included VALIUM, baclofen, BOTOX and bromocriptine. On approximately 23-OCT-2007 "within a day or two after receiving the vaccine", the patient experienced improvement with his dystonia. It was also reported that he had shown improvement when he has taken treatments for pneumonia as well. No diagnostic laboratory studies were performed. At the time of this report, the patient was recovering. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 323394 (history)  
Age: 75.0  
Gender: Male  
Location: California  
Vaccinated:2007-10-22
Onset:2007-10-23
   Days after vaccination:1
Submitted: 2008-07-30
   Days after onset:281
Entered: 2008-08-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0989U / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Hyperaemia, Oedema, Swelling, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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: None
Diagnostic Lab Data: None
CDC Split Type: WAES0801USA03488

Write-up: Information has been received concerning a 75 year old male with no pertinent medical history, who on 22-OCT-2007 was vaccinated IM in the right deltoid, with a second dose of pneumococcal 23v polysaccharide vaccine (lot #658449/0989U) (first dose administered in 1999). There was no illness at the time of vaccination. On 23-OCT-2007, at 8:00 am, the patient developed "swelling, edema, hyperemia were significant, tenderness minor." Treatment included quinolones (manufacturer not specified) for 5 days, and the patient recovered within 3 days. Additional information has been requested.


VAERS ID: 327519 (history)  
Age: 9.0  
Gender: Male  
Location: Alabama  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2008-09-05
Entered: 2008-09-24
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Military       Purchased by: Other
Symptoms: Allergy test negative, Eczema, Inappropriate schedule of drug administration, Skin lesion, Skin reaction
SMQs:, Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: Unknown
Preexisting Conditions: The subject has no history of allergies. The subject experienced the same events following administration of Aventis''s Flu shot (1st flu shot given to the subject). He had over 300 lesion at that time. These events occurred in this subject in 2006 following vaccination with a Glaxosmithkline flu vaccine. Refer to case number A0739853A for details Surrounding the first report.
Diagnostic Lab Data: Unspecified allergy testing came back negative, Including a test egg allergy.
CDC Split Type: A0739862A

Write-up: Skin reaction, Medication error, Nonspecific reaction, Skin lesion. Eczema, Adverse event. This case was reported by the mother of a consumer and described the occurrence of skin reactions (dermatological reaction) in a 9 year old male subject who was vaccinated with influenza virus vaccine (flu vaccine, Glaxosmithkline) for prophylaxis. A physician or other health care professional has not verified this report. Concurrent medications included Multivitamins. On 22-October- 2007, in the afternoon, the subject received unspecified dose of Flu vaccine, the subject developed what the mother referred to as a dermatological reaction (skin reaction). A systemic reaction. He developed lesions (described as nummular) on his hands, wrists, arms and the back of the ankles. It had been called eczema as well as some other unidentifiable term (spngia). The condition has lasted for about 8 months as of the time of reporting and the mother did report that there was only one lesion left. The condition responds to steroids, but when they are stopped the symptoms return. The subject has also been treated with mupirocin (clay park labs) and this worsened the lesions. The child has reportedly seen several dermatologists as well as allergist. Hwas tested for everything and it all comes back negative. the first flu vaccine the subject ever recieved was by aventis and he ended up with over 300 lesions. at the time of reporting the outcome of the events were unspecified. This was also considered to be a medication error as Glaxosmithkline flu vaccine is not indicated for use in pediatric subjects. These events occurred in this subject in 2006 following vaccianition with a Glaxosmithkline flu vaccine. Refer to case number A0739B53A for details surrounding the first report.


VAERS ID: 326462 (history)  
Age: 20.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-10-22
Onset:0000-00-00
Submitted: 2008-09-29
Entered: 2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1177U / - UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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:

Write-up: Varicella inadvertently given to pregnant woman.


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