MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 485503 cases in entire database

Case Details (Sorted by Vaccination Date)

This is page 3091 out of 4856

Result pages: prev   2992 2993 2994 2995 2996 2997 2998 2999 3000 3001 3002 3003 3004 3005 3006 3007 3008 3009 3010 3011 3012 3013 3014 3015 3016 3017 3018 3019 3020 3021 3022 3023 3024 3025 3026 3027 3028 3029 3030 3031 3032 3033 3034 3035 3036 3037 3038 3039 3040 3041 3042 3043 3044 3045 3046 3047 3048 3049 3050 3051 3052 3053 3054 3055 3056 3057 3058 3059 3060 3061 3062 3063 3064 3065 3066 3067 3068 3069 3070 3071 3072 3073 3074 3075 3076 3077 3078 3079 3080 3081 3082 3083 3084 3085 3086 3087 3088 3089 3090 3091 3092 3093 3094 3095 3096 3097 3098 3099 3100 3101 3102 3103 3104 3105 3106 3107 3108 3109 3110 3111 3112 3113 3114 3115 3116 3117 3118 3119 3120 3121 3122 3123 3124 3125 3126 3127 3128 3129 3130 3131 3132 3133 3134 3135 3136 3137 3138 3139 3140 3141 3142 3143 3144 3145 3146 3147 3148 3149 3150 3151 3152 3153 3154 3155 3156 3157 3158 3159 3160 3161 3162 3163 3164 3165 3166 3167 3168 3169 3170 3171 3172 3173 3174 3175 3176 3177 3178 3179 3180 3181 3182 3183 3184 3185 3186 3187 3188 3189 3190   next


VAERS ID:331023 (history)  Vaccinated:2008-10-28
Age:4.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Male  Submitted:2008-10-31, Days after onset: 2
Location:Washington  Entered:2008-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2955BA5IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2763AA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: Pt was here for influenza vaccine, given DTAP that was intended for sibling at the same visit. 10/28 pt was here for Influenza vaccine, given DTAP that was intended for sibling at the same visit. 10/29-phone call to mother, child had stomach ache no vomiting no fever. 10/30-phone call to mom-fever last night, tactile, resolved this AM.

VAERS ID:331049 (history)  Vaccinated:2008-10-28
Age:4.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-10-28, Days after onset: 0
Location:Massachusetts  Entered:2008-11-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Flu test (+) A (+) B (Rapid Test)
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURU246UCA5UNLA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2766AA UNLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0831 UNUN
Administered by: Public     Purchased by: Public
Symptoms: Headache, Influenza serology positive, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Received flu shot yesterday c/o increase fever $g104 degrees F. headache, sore throat. Flu test shown (+) A & B

VAERS ID:331050 (history)  Vaccinated:2008-10-28
Age:32.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-29, Days after onset: 1
Location:Illinois  Entered:2008-11-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes; Asthma; HTN; Allergies (Seasonal)
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89882 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Nausea, Oedema peripheral
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Headache, nausea, swelling of entire arm all within 45 minutes. Patient used ice on injection site and Benadryl 25mg.

VAERS ID:331103 (history)  Vaccinated:2008-10-28
Age:64.0  Onset:0000-00-00
Gender:Female  Submitted:2008-10-30
Location:Nebraska  Entered:2008-11-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GLUCOSAMINE; FOSAMAX; MOBIC
Current Illness: None
Preexisting Conditions: Osteoporosis, COPD, Hx lung cancer, Deg disc disease
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Initially developed sore upper L arm with gradual increase soreness by Wednesday upper arm including biceps, triceps and deltoid all redness with swelling. Today fever noted @ 38.5

VAERS ID:331104 (history)  Vaccinated:2008-10-28
Age:37.0  Onset:0000-00-00
Gender:Female  Submitted:2008-10-29
Location:Ohio  Entered:2008-11-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTOX: DIPHTHERIA TOXOIDS (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right arm redness & swelling.

VAERS ID:331127 (history)  Vaccinated:2008-10-28
Age:37.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Male  Submitted:2008-11-03, Days after onset: 5
Location:Georgia  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: N/A~ ()~NULL~~In Patient
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE)PFIZER/WYETH    
PNC: PNEUMO (PREVNAR)PFIZER/WYETH    
Administered by: Unknown     Purchased by: Private
Symptoms: Hyperaesthesia, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Shot administered in patient''s right shoulder above bi-cep. Patient experienced significant pain at the site of injection. Patient also developed a swelling, discolored red skin, and sensitivity to touch from the site of injection extending down the arm and around the inner bicep. Symptoms lasted 6 days and was treated with ibuprofin.

VAERS ID:331128 (history)  Vaccinated:2008-10-28
Age:4.0  Onset:2008-10-31, Days after vaccination: 3
Gender:Female  Submitted:2008-11-03, Days after onset: 3
Location:New Jersey  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillian
Current Illness: Left Otitis Media
Preexisting Conditions:
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2999AA4IMLA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2765AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA12293SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.404X/1084X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0996X/4067X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Seen in our office on 10/28/08 for 4 year WCU. Recieved Dtap, MMr, FLu, IPOL, and Varivax. Woke up on 10/31/08 with left upper arm swellung, red and indurated. Seen in our office and prescibed Augmentin.

VAERS ID:331152 (history)  Vaccinated:2008-10-28
Age:55.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-29, Days after onset: 1
Location:South Carolina  Entered:2008-11-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type': SC0813
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2828A IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chills, Nausea, Pain, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Got flu vaccine 10/28/08 @ 3pm. Around 5 pm, felt nauseated; around 7:30 felt achy all over, especially shoulders and back. Then had chills and shakiness, vomited 5-6 times. that evening. Weak but much better next day did not go to physician.

VAERS ID:331157 (history)  Vaccinated:2008-10-28
Age:45.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 6
Location:Oregon  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Allergy to Suprax; Allergy to Zithromax; Environmental allergy; Penicillin allergy; With the exception of the influenza virus vaccine, the subject had no adverse events following receipt of other previous immunizations.
Diagnostic Lab Data: Unk
CDC 'Split Type': A0754508A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA3508A UNUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Lymph node pain, Lymph node palpable, Lymphadenopathy, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of lymphadenopathy in a 45-year-old female subject who was vaccinated with FLUARIX (GlaxoSmithKline). The subject''s medical history included allergy to SUPRAX, allergy to ZITHROMAX, environmental allergy and penicillin allergy. With the exception of the influenza virus vaccine, the subject had no adverse events following receipt of other previous immunizations. Concurrent medications included Oral contraceptives, NASACORT, XYZAL and Allergy shot. The subject received no other vaccinations on the date of receipt of FLUARIX. On an unspecified date in 2007, the subject received unspecified dose of Influenza vaccine (unknown). On an unspecified date in 2007, less than one year after vaccination with Influenza vaccine, the subject experienced lymphadenopathy. The lymphadenopathy resolved after eight days. On 28 October 2008 between 5:00 p.m. and 5:30 p.m., the subject received unspecified dose of FLUARIX (.5 ml, unknown, right arm). On the morning of 29 October 2008, 1 day after vaccination with FLUARIX, the subject experienced lymphadenopathy, erythema, lymph node palpable and lymph node tenderness. The healthcare professional considered the events that occurred on 29 October 2008 were clinically significant (or requiring intervention). The subject received treatment with steroids. At the time of reporting the events were unresolved. The healthcare professional considered the events were probably related to vaccination with FLUARIX. Nurse practitioner states subject received FLUARIX on 28 October 2008, and the following morning she developed lymphadenopathy on her neck region. Specifically, she has swollen lymph nodes above her clavicle on the right side mid-way up, and it is the diameter of a golf ball and is raised approximately 1-2 centimeters, and there is generalized erythema at this site. The swollen node is visible without palpation. Surrounding that area, there are palpable nodes that are each a centimeter in size. Below the clavicle, there are several poorly defined palpable nodes. Additionally, there are tender infraclavicular anterior nodes, axillary nodes, and tender nodes at the groove between the shoulder and chest. There is also a weblike red pattern over the neck area and upper chest. Currently, the subject is being treated with steroids. The reporter believes this is probably caused by FLUARIX since the subject experienced the same events last year after receiving the flu vaccine (Lymphadenopathy was experienced at the same location after receiving last year''s flu vaccine (unknown which brand), however, it occurred a little bit later and lasted for 8 days).

VAERS ID:331177 (history)  Vaccinated:2008-10-28
Age:21.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 6
Location:Wisconsin  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasmin multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2998BA5UNLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling cold, Hot flush, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt c/o body aches, hot and cold flashes, and nausea.

VAERS ID:331178 (history)  Vaccinated:2008-10-28
Age:16.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-31, Days after onset: 3
Location:South Carolina  Entered:2008-11-03, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0548X1UNUN
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Fall, Head injury, Loss of consciousness, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: 340P pt had vasovagal syncope, fell and hit head after injection with prompt recovery. 6p-pt returned to have arm checked for fx and became weak and passed out while sitting, pt sent to ER.

VAERS ID:331182 (history)  Vaccinated:2008-10-28
Age:4.0  Onset:2008-10-30, Days after vaccination: 2
Gender:Female  Submitted:2008-11-03, Days after onset: 4
Location:California  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions:
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2955BA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Dtap redness notice 10/30/08 swelling redness measure 20mm x 20mm apply ice right away

VAERS ID:331200 (history)  Vaccinated:2008-10-28
Age:17.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 6
Location:California  Entered:2008-11-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: antimicrobial (unspecified); NUVARING; Influenza virus vaccine
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0810USA05135
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Hypotonia, Presyncope
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a consumer concerning her 17 year old grand-daughter with allergy to penicillin and no pertinent medical history reported who on 28-OCT-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included NUVARING, flu vaccine (unspecified) (also given on 28-OCT-2008) and unspecified antibiotic. After receiving her first dose of GARDASIL, on 28-OCT-2008, in the physician''s office, the patient almost fainted and her head was flopping around. The consumer stated that she thought it looked like a seizure. At the time of reporting, the patient was recovering. Upon internal review, seizure was considered to be other important medical event. Additional information has been requested.

VAERS ID:331216 (history)  Vaccinated:2008-10-28
Age:2.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-10-28, Days after onset: 0
Location:North Carolina  Entered:2008-11-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': NC08106
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2294BA0UNUN
Administered by: Public     Purchased by: Public
Symptoms: Incorrect dose administered, Medication error
SMQs:
Write-up: Gave adult Td instead of child flu. Medication error.

VAERS ID:331235 (history)  Vaccinated:2008-10-28
Age:8.0  Onset:2008-10-30, Days after vaccination: 2
Gender:Male  Submitted:2008-11-04, Days after onset: 5
Location:Florida  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1155X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Joint swelling, Pallor, Rash papular, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: VARICELLA REACTION RED WARM SWOLLEN SHOULDER WITH PAPULAR BLANCHING RASH ON ARMS.

VAERS ID:331239 (history)  Vaccinated:2008-10-28
Age:22.0  Onset:2008-10-31, Days after vaccination: 3
Gender:Female  Submitted:2008-11-04, Days after onset: 4
Location:Michigan  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: clt was diagnosed with bronchitis approx 3 days after vaccination.
Preexisting Conditions: Allergies to Augmentin & Penicillin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1740U0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Eye swelling, Ocular hyperaemia, Pruritus, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: On 10-31-08 this clt was seen in walk-in clinic because of hive reaction possibly from HPV vaccine given on 10-28-08. Clt reports on Friday am, she woke up with swollen, red eye. Later that day, foot started itching and noticed on set of hives on foot. C/o being itchy all day. Later that day, developed blister like hives on back. Was instructed to use OTC Benedryl and was given an RX for Prednisone plus ABX for bronchitis.

VAERS ID:331263 (history)  Vaccinated:2008-10-28
Age:10.0  Onset:2008-10-30, Days after vaccination: 2
Gender:Female  Submitted:2008-11-04, Days after onset: 5
Location:New York  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: denies
Preexisting Conditions: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0334X1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Localized redness and swelling at the site of injrction

VAERS ID:331283 (history)  Vaccinated:2008-10-28
Age:35.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-04, Days after onset: 7
Location:California  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroxin Lipator Premerin
Current Illness: none reported
Preexisting Conditions: No known
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA178AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad)
Write-up: Received flu vaccination in left deltoid, reported that it hurt deeply. The pain continued and it worsened.The joint and shoulder continues to hurt and has not improved significatnly without Advil. She has pain with movement of shoulder.

VAERS ID:331284 (history)  Vaccinated:2008-10-28
Age:34.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2008-11-04, Days after onset: 7
Location:California  Entered:2008-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA178AA3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Injection site erythema, Injection site swelling, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: 10/31/08 @ 4:30pm: P.C. from pt. notifying PH of adverse reaction to flu shot. By same evening of injection, pt. noticed redness and swelling to site. Woke up next morning to increased redness and swelling with onset of diarrhea, nausea, and fever of 101.8. Took Ibuprofen and Benedryl with good relief (denies respiratory distress). Did not seek medical attention. States feels better today.

VAERS ID:331293 (history)  Vaccinated:2008-10-28
Age:87.0  Onset:0000-00-00
Gender:Female  Submitted:2008-10-31
Location:California  Entered:2008-11-04, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA174AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1161X0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Fatigue, Injection site erythema, Injection site swelling, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: severe redness and swelling of entire right upper arm as well as lethargy and fatigue

VAERS ID:331327 (history)  Vaccinated:2008-10-28
Age:42.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-29, Days after onset: 1
Location:Minnesota  Entered:2008-11-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2810AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Eye pruritus, Eye swelling, Headache, Lacrimation increased, Nasal congestion, Ocular hyperaemia, Sensation of foreign body, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow)
Write-up: Approx 2 hrs after vaccine, scratchy throat, headache, followed by red itchy watery eyes, nasal congestion, feeling of having a lump in throat. Most symptoms subsided over night but puffy, red eyes w/ discharge cont to next day. Alleviated w/Benadryl.

VAERS ID:331330 (history)  Vaccinated:2008-10-28
Age:43.0  Onset:2008-10-30, Days after vaccination: 2
Gender:Female  Submitted:2008-10-30, Days after onset: 0
Location:Oregon  Entered:2008-11-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEXA; TREXIMET
Current Illness: None
Preexisting Conditions: Migraine; Depression/Anxiety
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU27508A UNLA
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Lymphadenopathy, Malaise
SMQs:
Write-up: Axillary lymphadenopathy on the side of injection. No localized reaction at injection site. She has malaise, fatigue.

VAERS ID:331337 (history)  Vaccinated:2008-10-28
Age:71.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-30, Days after onset: 2
Location:Missouri  Entered:2008-11-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2785HH IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Chills, Cough, Diarrhoea, Dizziness, Heart rate increased, Night sweats, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: shot given at 3:00 pm- at 7:00 started with raspy cough- then rapid heart beat- nearly fainted- diarrhea-chills-2x vomited- severe chills-then night sweats. weakness the next day.

VAERS ID:331341 (history)  Vaccinated:2008-10-28
Age:3.0  Onset:2008-10-30, Days after vaccination: 2
Gender:Female  Submitted:2008-10-31, Days after onset: 1
Location:Georgia  Entered:2008-11-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2760AA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction 2d after vaccine given. Redness, swelling, and warmth at site.

VAERS ID:331344 (history)  Vaccinated:2008-10-28
Age:17.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Female  Submitted:2008-10-29, Days after onset: 0
Location:Nebraska  Entered:2008-11-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Urogram- large amount of blood; UA with micro and calcium kreatonine peding
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0548X0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Haematuria, Urine analysis, Urogram abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad)
Write-up: Hematuria noted at 2:30 am on 10/29/2008. Patient had received 1st GARDASIL shot on 10-28-08 at 09:05am

VAERS ID:331353 (history)  Vaccinated:2008-10-28
Age:65.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-10-30, Days after onset: 2
Location:Minnesota  Entered:2008-11-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA359CA1 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1295X0 RA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient reports pain in his right arm 10/28 when trying to sleep on right side. He has an area on his right upper arm that is 8 inches by 5 inches anterior upper arm about 3 inches below injection site that is red and warm to touch. Noted 10/29. Keflex 500mg one every 6 hours for 10 days. Treatment started 10/30/08.

VAERS ID:331361 (history)  Vaccinated:2008-10-28
Age:58.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Female  Submitted:2008-10-30, Days after onset: 1
Location:Illinois  Entered:2008-11-05, Days after submission: 6
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: Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89923 UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0038U1UNRA
Administered by: Public     Purchased by: Private
Symptoms: Injected limb mobility decreased, Pain in extremity, Pruritus, Rash, Skin striae, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Received flu & pneumonia vaccine approx 8:45 am on 10-28-08. By noon her arm became extremely sore to where she could not lift it. Rash under the skin & scratchy throat began 10-29-08 in the evening. Red streaks were 5" by 5" in diameter & even under her armpits. She began to cx of itching on her ears, nose, head. Nurse adv. to seek medical attention. Taking Claritin in afternoon and Benadryl in p.m.

VAERS ID:331363 (history)  Vaccinated:2008-10-28
Age:2.0  Onset:2008-10-30, Days after vaccination: 2
Gender:Female  Submitted:2008-10-30, Days after onset: 0
Location:Michigan  Entered:2008-11-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2766AA2IMLL
Administered by: Private     Purchased by: Public
Symptoms: Drooling, Nasal congestion, Pyrexia, Sick relative, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Fever 103 degrees digital ax on 10-29-2008. Mild nasal congestion. No rash no vomiting no drooling. Siblings had a febrile illness 2 wks ago.

VAERS ID:331386 (history)  Vaccinated:2008-10-28
Age:51.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Male  Submitted:2008-10-31, Days after onset: 2
Location:New York  Entered:2008-11-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0979X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Erythema, Injection site erythema, Injection site rash, Injection site warmth, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 10/28/08 Received PNEUMOVAX 23 next day c/o achy, chills, sore arm, presented on 10/31/08 with c/o red painful arm. Right deltoid arm had 6" x 4" reddened hot splotchy area, instructed Benadryl, ice, rest.

VAERS ID:331393 (history)  Vaccinated:2008-10-28
Age:70.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 8
Location:Florida  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril; metformin
Current Illness: none
Preexisting Conditions: Diabetes, hypertension
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA356AA IMLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU20778A IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 70 year old female with 2inch round area of erythema, warmth and tenderness at injection site began shortly after receiving injection and sought treatment 4 days later.Patient placed on keflex for treatment of possible cellulitis secondary to injection.

VAERS ID:331395 (history)  Vaccinated:2008-10-28
Age:33.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Female  Submitted:2008-11-05, Days after onset: 7
Location:Ohio  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: No
Preexisting Conditions: Mitral Valve prolapse
Diagnostic Lab Data: Had CBC and basic metabolic panel drawn on 11/03 and does not have results back yet.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2771AA4IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Asthenia, Back pain, Dizziness, Fatigue, Feeling cold, Feeling hot, Full blood count, Hypoaesthesia, Injection site induration, Injection site pain, Malaise, Metabolic function test, Myalgia, Nausea, Paraesthesia, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad)
Write-up: On Oct 29th c/o numb, cold spot on right thigh that would come and go. The next day the same thing happened but more frequently. At the injection site of left deltoid she had some generalized stiffness and soreness which always occurs for her after a flu shot. This lasted for a couple of days. In addition to thigh the numbness also occured in right arm above the elbow. Same sensation, coming and going. C/o fatigue and weakness, and c/o extreme heat emanating from her head, felt like head was on fire. Saturday felt Ok when awakened but decided to go to Urgent Care anyway. What was a cold numbness became a white hot pain. In addition she c/o of intermittent numbness in neck, tops of shoulders, back, toes and left shin. C/o low back pain, fatigue, nausea and felt ill all over. In the evening she had the head burning again. To touch she was cool but felt like ears and cheeks were on fire. On Sunday felt better other than a little bit faint. On Monday intermittent feeling of weakness and fatigue and a few episodes of the white hot pain in head. Some muscle soreness in joints especially in wrists, right hip and neck. Occasionally felt sharp pin like sensation in neck and back. Also had some numbness and ringing in her ears. Had blood drawn for CBC and basic metabolic panel on 11/3. No results are back yet. Felt better Tuesday but had shooting needle-like pain in fingers of left hand. Some numbness in left leg and arm. Today she feels like her cheeks and ears are on fire and she just doesn''t feel well at all. She has not been able to see her regular physician as of this time. Trying to make an appt with his covering physician. She was advised by Urgent Care physician to go to the Emergency Room if she has numbness that does not go away or if she starts vomiting.

VAERS ID:331397 (history)  Vaccinated:2008-10-28
Age:63.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 8
Location:Massachusetts  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Received IV antibiotics
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAF11A180AA IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Cellulitis
SMQs:
Write-up: Developed cellulitus as a result of influenza vaccination

VAERS ID:331398 (history)  Vaccinated:2008-10-28
Age:62.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Male  Submitted:2008-11-05, Days after onset: 7
Location:Pennsylvania  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Imipramine, Pravastatin Vardenafil
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Asthenia, Dizziness, Dysphonia, Dyspnoea, Heart rate increased, Hypertension, Impaired work ability, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient had very high blood pressure(214/112) the day following the flu shot, difficulty breathing, hoarseness, very pale, very weak, dizzy, fast heart rate. Saw family doctor on 10-29-2008 doctor prescribed Atenolol and patient was told to go home and rest for a couple of days. Patient was unable to work the rest of the week.

VAERS ID:331421 (history)  Vaccinated:2008-10-28
Age:50.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 8
Location:Illinois  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No!
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2743AA5IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Angioedema, Cough, Dysphonia, Dyspnoea, Eye pruritus, Eye swelling, Feeling abnormal, Lip swelling, Ocular hyperaemia, Paraesthesia oral, Productive cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Received vaccine around 11:15am. Started coughing with mucus and congestion around 2:30 pm. Also felt eyes swelling, became hoarse. Took over the counter Benadryl and Robitussin. Layed down. Started to feel mouth and tongue get funny. Headed to ER. Upon arrival to ER having trouble breathing. Ended up admitted to hospital. Discharge with oral Prednisone. Unsure of actual meds given in ER. No other abnormal ingested foods or meds that day. Influenza vaccine was only difference-11/14/08-records received for DOS 10/28/08-presented to ED with C/O harsh barky cough and lips swelling on evening after receiving flu vaccine. Eyes itchy and red. Tingling in lips. Admitted overnight for angioedema questionable reaction to flu vaccine.

VAERS ID:331425 (history)  Vaccinated:2008-10-28
Age:69.0  Onset:2008-11-04, Days after vaccination: 7
Gender:Male  Submitted:2008-11-05, Days after onset: 1
Location:New York  Entered:2008-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol XL, Cozaar, Lipitor, Lexapro, Synthroid
Current Illness: none
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DECAVAC)SANOFI PASTEURU2287CA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt developed a large hive at site of injection one week after injection.

VAERS ID:331476 (history)  Vaccinated:2008-10-28
Age:18.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 8
Location:Texas  Entered:2008-11-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium (unspecified); vitamins (unspecified)
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0810USA05093
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0947X IMUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a nurse concerning a 18 year old female who on 28-OCT-2008 was vaccinated with the first dose of GARDASIL (lot# 0947X). Concomitant therapy included multivitamins VI and calcium (unspecified). The patient had a seizure after vaccination and received medical attention while in the physician''s office. Subsequently, the patient recovered from seizure. Upon internal review, seizure was determined to be an other important medical event. Additional information has been requested.

VAERS ID:331492 (history)  Vaccinated:2008-10-28
Age:45.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Female  Submitted:2008-10-31, Days after onset: 2
Location:Oregon  Entered:2008-11-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: same as current exam~Influenza (no brand name)~1~44~In Patient
Other Medications: TriNessa, Nasacort AQ, Xyzol, allergy shots
Current Illness: None
Preexisting Conditions: PCN, Erythromycin, Suprex, Numerous mild envirnomental allergies- sinusitis
Diagnostic Lab Data: None
CDC 'Split Type': OR200838
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA3508A1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Lymph node pain, Lymphadenopathy, Neck pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: R supraclavicular 4-5 cm tender lymph node surrounded by 1-2 cm tender nodes. R Inferclavicular nodes also swollen/tender but more precisely defined. All with overlying erythema with connecting lines between nodes. Several anterior axillary nodes enlarged but not tender. On neck nodes are not enlarged but neck is sl tender esp ant cervical clavicle. Afebrile.

VAERS ID:331507 (history)  Vaccinated:2008-10-28
Age:44.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-30, Days after onset: 2
Location:New Mexico  Entered:2008-11-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA381CA UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Nasal congestion, Postnasal drip
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Erythema/redness 8x9 cm. T 97.6. Symptoms started 3-4 hrs after injection. Post-nasal drip with nasal congestion.

VAERS ID:331512 (history)  Vaccinated:2008-10-28
Age:52.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-10-29, Days after onset: 1
Location:Texas  Entered:2008-11-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF426AA SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt. was given YF vaccination SQ in fatty posterior of R arm. After 3 minutes, injection site was red and swollen the size of a nickel. I went and gave patient 2 tabs of IBUPROFEN P.O.; Ice pack was applied to the site. MA gave the Patient BENADRYL 50 mg PO. as per RN, we had pt. lay down for 20 minutes. Pt. was checked at frequent intervals after the 20 minutes RN went in the room w/me to check on the patient. Pt. was requested to sit up, his skin color looked good and he stated he had no symptoms and that he felt fine, Pt. was released and left the office.

VAERS ID:331580 (history)  Vaccinated:2008-10-28
Age:  Onset:2008-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2008-11-07, Days after onset: 10
Location:Unknown  Entered:2008-11-07
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':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT2788IA IM 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB289AA IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0736X IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: mild rash

VAERS ID:331657 (history)  Vaccinated:2008-10-28
Age:61.0  Onset:2008-11-03, Days after vaccination: 6
Gender:Female  Submitted:2008-11-03, Days after onset: 0
Location:Massachusetts  Entered:2008-11-07, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies to ace inhibitors
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA154AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0555U IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injected limb mobility decreased, Oedema peripheral, Pain in extremity, Skin warm, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt. complains of pain, unable to lift arm, redness swelling warm to the touch. Started later that day and last 3 days. No treatment given.

VAERS ID:331662 (history)  Vaccinated:2008-10-28
Age:6.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-10-31, Days after onset: 3
Location:North Carolina  Entered:2008-11-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: grass allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2809AA UNLL
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness and induration and warmth at injection site. $g 8 cm

VAERS ID:331664 (history)  Vaccinated:2008-10-28
Age:36.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Massachusetts  Entered:2008-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Depression with SI
Preexisting Conditions: Allergic to latex
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURB22494A IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.9722106 IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Rash, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow)
Write-up: Received flu vac received 10/28/08 1912 L deltoid T max 38.5 red, warm to touch, rash that came to expand x 24 hours. PO keflex d/c, then Vancomycin x 2 doses then Bactrim DS.

VAERS ID:331676 (history)  Vaccinated:2008-10-28
Age:2.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-06, Days after onset: 9
Location:Texas  Entered:2008-11-07, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3178AB0IMLL
HEP: HEP B (FOREIGN)MERCK & CO. INC.059744IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB245AA1IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0667K1SCRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH0504573IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.078880SCLL
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Crying, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad)
Write-up: Child received immunizations on 10/28/08 around 11:00 AM, he developed fever about 700PM that evening, per mother of child. He cried at intervals thru the night, the next AM he was noted having a high pitch cry and loss of appetite. He was taken to Hospital ER that evening with temp of 103 degrees. Childs crying was secondary to pain from immunizations. Pt was tx with Tylenol. Mom states child continued a high pitch cry at intervals until 11/3/08. Fever abated on 11/2/08, Mom told incident to Health Dept on 11/5/08.

VAERS ID:331707 (history)  Vaccinated:2008-10-28
Age:30.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-07, Days after onset: 10
Location:Florida  Entered:2008-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NASONEX
Current Illness: N/A
Preexisting Conditions: TWISTED THE LUMBAR 4 IN BACK APPROX 1 WEEK PRIOR TO VACCINE. PT IS BEING TREATED BY A CHIROPRACTOR & MASSAGE THERAPIST.
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2805AA3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Erythema, Heart rate increased, Hypoaesthesia, Injected limb mobility decreased, Injection site pain, Pain in extremity, Presyncope
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Approx. 30 mins after receiving the flu shot, pt. reported pain and numbness in L arm, fingers, and hand. Pt also fely VERY dizzy & light headed, to the point of nearly blacking out. Patient also experienced rapid heart beat. There was no redness or swelling in the area the vaccine was administered. There was some decrease in mobility of L arm, fingers and hand. Pt. suffered extreme pain and soreness in the area around the injection for 6 days. Pt indicated she would take Aleve & come to the CHD for evaluation, but did not come in.

VAERS ID:331717 (history)  Vaccinated:2008-10-28
Age:63.0  Onset:2008-11-02, Days after vaccination: 5
Gender:Unknown  Submitted:2008-11-07, Days after onset: 5
Location:Oregon  Entered:2008-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lipitor, zetia, aspirin
Current Illness: no
Preexisting Conditions: vicodin=itch, niacin=flush, avapro=rash,
Diagnostic Lab Data: Directed to make an appt today.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2998BA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pustule, Injection site rash, Injection site reaction, Injection site urticaria, Musculoskeletal pain, Musculoskeletal stiffness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt developed welts at the injection site on theright deltoid and a stiff right neck about 6 days after the injection.He then developed pain at the shoulder and pustules at the rash. A few days later bumps behind right ear appeared as well as bumps on right arm.

VAERS ID:331777 (history)  Vaccinated:2008-10-28
Age:19.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-28, Days after onset: 0
Location:Alabama  Entered:2008-11-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89984 IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0551X IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness around injections site with swelling

VAERS ID:331766 (history)  Vaccinated:2008-10-28
Age:57.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-05, Days after onset: 8
Location:New Hampshire  Entered:2008-11-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown, but denied fever
Preexisting Conditions: Allergy to sulfa + hx multiple other allergies (unknown which ones)
Diagnostic Lab Data: EKG; BW - results unknown
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR02751AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Electrocardiogram, Feeling abnormal, Hypoaesthesia oral, Laboratory test, Lip swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Approx. 4 1/2 hours after vaccine noted "Something wrong in throat". 7 hrs after vaccine "lips tripled, tongue felt as if recovering from Novocain". Following morning, lips still a little tirply and felt loopy". Went to ER -Rx with Nebulizer IM steroid

VAERS ID:331794 (history)  Vaccinated:2008-10-28
Age:  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-06, Days after onset: 9
Location:Texas  Entered:2008-11-10, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported.
Diagnostic Lab Data: None reported.
CDC 'Split Type': 200803390
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Dyspnoea, Lip swelling, Respiratory tract congestion
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Seriousness Criteria: Other-Medically Significant. Initial information was received on 30 October 2008 from a health care professional. A female patient received an injection of FLUZONE (lot number, route, site and number of previous doses were not reported) on 28 October 2008. Four hours post vaccination the patient reported swollen lips, tight chest, shortness of breath, and congestion. The patient took two BENADRYL, symptoms decreased and the patient was back to work the following day. However, the patient''s recovery status was not reported. List of Documents held by Sender: None.

VAERS ID:331833 (history)  Vaccinated:2008-10-28
Age:86.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-30, Days after onset: 2
Location:North Carolina  Entered:2008-11-10, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PLAVIX; PILLBaker BHER asa arthistis med (celender); Ferrowxsituabl
Current Illness: Arthurts; 41BP heart probles
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89621 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Reports itching, redness and warmth at site 10/28/2008. Blister formed 10/29/2008. Today reddened area measure 120 mm x 100mm. Blister 45mm x52mm. Area still appears red at FU

VAERS ID:331841 (history)  Vaccinated:2008-10-28
Age:53.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 6
Location:California  Entered:2008-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: (Allergic to sulfur, adhesive tape, sulfonylureas); Obesity; PVD; Deg cervical disc; DM2; Sleep apnea
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS88C454IMLA
Administered by: Private     Purchased by: Private
Symptoms: Aphonia, Cough, Dyspnoea, Nausea, Pharyngeal oedema, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Throat swelling and chronic cough for over half an hour, hives during coughing episode. Nauseated feeling, loss of voice, shortness of breath. Voice returned next day. Scratchy throat for three days. No treatment sought.

VAERS ID:331846 (history)  Vaccinated:2008-10-28
Age:0.8  Onset:0000-00-00
Gender:Female  Submitted:2008-11-03
Location:Minnesota  Entered:2008-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None. Parent called next day - reported no adverse reaction or illness.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B12AA2IMRL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2797CA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF241AC2IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH808702C2IMLL
Administered by: Public     Purchased by: Public
Symptoms: Incorrect dose administered
SMQs:
Write-up: Patient given 0.5cc, adult dose of Preservative-free FLUZONE

VAERS ID:331869 (history)  Vaccinated:2008-10-28
Age:76.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-10-29, Days after onset: 1
Location:Florida  Entered:2008-11-10, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1382Y1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red Swelling to right arm elbow to shoulder, warm, fever.

VAERS ID:331870 (history)  Vaccinated:2008-10-28
Age:39.0  Onset:2008-10-31, Days after vaccination: 3
Gender:Female  Submitted:2008-10-31, Days after onset: 0
Location:New Jersey  Entered:2008-11-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NKA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2332DA UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling at injection site 5 cm x 3 cm area. Benadryl 50mg IM x 1 dose given.

VAERS ID:331964 (history)  Vaccinated:2008-10-28
Age:31.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-05, Days after onset: 8
Location:Minnesota  Entered:2008-11-11, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: See Back TOPAMAX, Primidone, KEPPRA, LEXAPRO and NExium.
Current Illness: None
Preexisting Conditions: See Back. PMH: Esopahageal reflux. hyperlipidemia. Mental retardation. Seizure d/o. Hx of Stevens-Johnson Syndrome. Multiple drug and food allergies Mildly mentally handicapped; Epilepsy; Erythema Multiforme; (Allergic to all antibiotics except CIPRO)
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2760AA0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Oropharyngeal pain, Respiratory distress, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 5 hours after getting flu shot patient''s airway began to close. Rushed to ER meds administered and kept patient overnight. 11/18/2008 MR received for DOS 10/28-29/2008 with D/C DX: Possible allergic reaction to Flu shot, now doing well. The pm of Flu shot pt developed a sore throat, recurrant coughing, SOB and respiratory distress. Tx with epi and solumedrol with no recurrance of sx.

VAERS ID:332161 (history)  Vaccinated:2008-10-28
Age:0.4  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-12, Days after onset: 15
Location:California  Entered:2008-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Blood; CSF; CT/MRI 1/13/09-records received-LP and blood tests normal, cultures no growth. WBC 19.7. EEG focal epileptogenic abnormality in central area. MRI extra-axial fluid that can be normal. CT scan normal.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B192AA1UNLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF497AA1UNRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC861421UNRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1928U1PO 
Administered by: Public     Purchased by: Public
Symptoms: Blood test normal, Computerised tomogram normal, Convulsion, Culture negative, Electroencephalogram abnormal, Lumbar puncture normal, Nuclear magnetic resonance imaging normal, Pyrexia, Status epilepticus, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 2 seizures in 4 m/o at 9 pm and 12 midnight. No fever until about 24 hours after vaccination/seizures. Previously well: PMH not contributory. 1/13/09-records received for DOS 10/29-10/31/08 and 11/8-11/11/08-DC DX: Siezure. Status epilepticus. Fever.

VAERS ID:332525 (history)  Vaccinated:2008-10-28
Age:76.0  Onset:2008-10-31, Days after vaccination: 3
Gender:Female  Submitted:2008-11-13, Days after onset: 13
Location:Utah  Entered:2008-11-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ACTONEL
Current Illness:
Preexisting Conditions: No known allergies, no illness at time of vaccination.
Diagnostic Lab Data:
CDC 'Split Type': 200803415
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Diplopia, Paraesthesia, Visual tracking test abnormal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Ocular motility disorders (broad)
Write-up: This report was received from a health care professional on 03 November 2008. Seriousness Criteria: Other-Medically Significant. A 76-year-old female patient, with no reported medical history and no illness at time of vaccination, received an intramuscular left deltoid injection of FLUZONE SV (lot number not reported) on 28 October 2008. Concomitant medication included Actonel. On 31 October 2008 she awoke with diplopia and paresthesia of the left hand. An exam revealed limited tracking in the left eye, with no other symptoms. She was scheduled to see an opthamologist on 04 November 2008. Outcome was not reported. Documents held by sender: None.

VAERS ID:333814 (history)  Vaccinated:2008-10-28
Age:0.5  Onset:2008-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2008-11-14, Days after onset: 17
Location:New Jersey  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0810USA04927
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Information has been received from a nurse concerning a 6 month old patient who on 28-OCT-2008 was vaccinated with dose 1 of ROTATEQ. No symptoms reported. No product quality complaint. Additional information has been requested.

VAERS ID:333815 (history)  Vaccinated:2008-10-28
Age:0.5  Onset:2008-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2008-11-14, Days after onset: 17
Location:New Jersey  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0810USA05151
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 0UNGM
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This is in follow-up to report(s) previously submitted on 11/14/2008. Information has been received from a nurse concerning a 6 month old patient who, on 28-OCT-2008, was vaccinated with dose 1 of ROTATEQ. No symptoms reported. No product quality complaint. Additional information has been requested.

VAERS ID:334958 (history)  Vaccinated:2008-10-28
Age:15.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-14, Days after onset: 17
Location:Ohio  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0810USA05117
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X1UNUN
Administered by: Other     Purchased by: Other
Symptoms: No reaction on previous exposure to drug, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from an office manager concerning a 15 year old female, allergic to penicillin, who on 12-AUG-2008, was vaccinated with a first dose of GARDASIL (Lot # 660620/0571X), 0.5 ml. It was reported that the patient did not experience any adverse event on first dose. On 29-OCT-2008, the patient was vaccinated with a second dose of GARDASIL (Lot # 659184/0843X). Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA) and vitamins (unspecified). The office manager reported that the patient fainted after getting the second dose of GARDASIL on 28-OCT-2008.The patient recovered the same date. No lab/ diagnostic tests were performed. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested.

VAERS ID:332646 (history)  Vaccinated:2008-10-28
Age:64.0  Onset:2008-10-31, Days after vaccination: 3
Gender:Male  Submitted:2008-11-05, Days after onset: 5
Location:Unknown  Entered:2008-11-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No prior allergic reaction to flu vaccine.
Diagnostic Lab Data: Temperature, 97.4 F,11/01/2008; Pulse, 58, 11/01/2008; Respiration, 14, 11/01/2008; Blood Pressure, 121/84, 11/01/2008; Weight, 168 lb, 11/01/2008; Pulse Oximetry, 95, 11/01/2008
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER892973P IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature, Heart rate decreased, Malaise, Oxygen saturation normal, Rash erythematous, Rash generalised, Rash pruritic, Respiratory rate, Throat irritation, Weight
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Flu shot 10/28. Not feeling well just after getting flu shot. Fine red itchy rash all over body which developed yesterday. Reports throat is itchy but able to swallow with no difficulty. Symptoms: Skin rash, Treatment Drugs used: DIPHENHYDRAMINE dose 25 units: MG Freq: PRN Route; PO, HYDROCORTISONE dose: Units: Freq: PRN Route: TOP

VAERS ID:332681 (history)  Vaccinated:2008-10-28
Age:49.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Unknown  Submitted:0000-00-00
Location:New Mexico  Entered:2008-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SINGULAR; ADVAIR; FLONASE; VICODIN; PATANOL; IMITRIX; ZYRTEC; XOPENEX
Current Illness: None
Preexisting Conditions: Sulfa; Trimipramine maleate; MUCOMYST
Diagnostic Lab Data: CBC; 25.7 WBC; 88% Neutrophils; Blood Cultured (-)
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLAL83AA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1383U1UNRA
Administered by: Private     Purchased by: Private
Symptoms: Blood culture negative, Body temperature increased, Chills, Erythema, Full blood count, Headache, Injection site pain, Injection site rash, Injection site swelling, Lymphadenitis, Myalgia, Nausea, Neutrophil percentage increased, Pyrexia, Swelling, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Woke up 130 after injection with painful R shoulder + swelling + rash in this area. Fever, chills, myalgia down throughout R side of body, down to hip. Temp to 103, swelling in axillary area, reddened area, nausea, mild headache.

VAERS ID:332739 (history)  Vaccinated:2008-10-28
Age:  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2008-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA366BA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Persistent deltoid pain esp. w/abduction. Onset w/vaccination

VAERS ID:332788 (history)  Vaccinated:2008-10-28
Age:42.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-19, Days after onset: 22
Location:Colorado  Entered:2008-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none noted
Preexisting Conditions: none known
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS88117 6P IM 
Administered by: Public     Purchased by: Private
Symptoms: Fatigue, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Employee had extreme fatigue, malaise for one week after receiving annual influenza vaccine. Also reported left arm where vaccine was given was so sore that she was unable to sleep on that side.

VAERS ID:332875 (history)  Vaccinated:2008-10-28
Age:7.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-13, Days after onset: 16
Location:Oregon  Entered:2008-11-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergies: Cefzil
Diagnostic Lab Data:
CDC 'Split Type': 0R200844
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2808AA4IMLA
Administered by: Other     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 1005-Flu vaccine given. 1330-hives noted 1400-Benadryl given Benadryl repeated at 2000 and 0800, 1400, and 2000 on 10/29/2008

VAERS ID:332876 (history)  Vaccinated:2008-10-28
Age:10.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-13, Days after onset: 16
Location:Oregon  Entered:2008-11-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: allergies Benadryl;Valpruicacid; Varricella Vaccine
Diagnostic Lab Data: 10/29/08-child tested for allergies- tested (+) for egg allergy
CDC 'Split Type': 0R200845
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2808AA6IMRA
Administered by: Other     Purchased by: Public
Symptoms: Allergy test positive, Allergy to vaccine, Drug hypersensitivity, Food allergy, Irritability, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: 1115-FLUZONE given; 1130 child developed hives and fussiness;1140-epinephrine given, MD notified; 1152-prednisolone 10 mg given, continued twice daily for 3days.

VAERS ID:333925 (history)  Vaccinated:2008-10-28
Age:12.0  Onset:2008-11-05, Days after vaccination: 8
Gender:Male  Submitted:2008-12-01, Days after onset: 26
Location:Washington  Entered:2008-12-04, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB555AAA2IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08053UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1670U1UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2953AA UNLA
Administered by: Private     Purchased by: Public
Symptoms: Headache, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Rash, fever, headache since 11-28-08.

VAERS ID:334051 (history)  Vaccinated:2008-10-28
Age:81.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Male  Submitted:2008-12-03, Days after onset: 35
Location:Wisconsin  Entered:2008-12-05, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NIASPAN; ATENOLOL; COUMADIN; NITRO PASTE; LASIX; K-DUR; INSULIN; ASA
Current Illness:
Preexisting Conditions: The patient had no concurrent illnesses at the time of the vaccination on 28 October 2008. The patient does have an allergy to penicillin and history of cerebrovascular accident (CVA), Type I Diabetes, hypertension (HTN), vitamin D deficiency, mitral valve disorder, anemia, atrial fibrillation (A-FIB), aortic valve disorder, thrombocytopenia, testicular hypofunction, edema, hyperli
Diagnostic Lab Data: None
CDC 'Split Type': 200803800
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2808A IMRA
Administered by: Private     Purchased by: Other
Symptoms: Fatigue, Injection site mass, Injection site pain, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Initial report received on 29 November 2008 from a physician. An 81-year-old male patient, had received an intramuscular right deltoid injection of FLUZONE SV 2008-2009 on 28 October 2008, and the following day, developed a 4cm painful lump at the injection site. He subsequently developed generalized fatigue, pain in his legs, and aching in his body. At the time of this report, all symptoms were still persisting. The patient has extensive medical history that includes penicillin allergy, history of cerebrovascular accident (CVA), Type I Diabetes, hypertension (HTN), vitamin D deficiency, mitral valve disorder, anemia, atrial fibrillation (A-FIB), aortic valve disorder, thrombocytopenia, testicular hypofunction, edema, and hyperlipidemia. It was not reported whether the patient received any treatments for the symptoms, but it was reported that no relevant diagnostic tests or laboratory data were performed. At the time of this report, it was unknown if the patient had recovered. Documents held by sender: None.

VAERS ID:334265 (history)  Vaccinated:2008-10-28
Age:22.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Unknown  Submitted:2008-11-07, Days after onset: 9
Location:Delaware  Entered:2008-12-09, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV149 SC 
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500556P IN 
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURERVV04003A ID 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: Developed N/V, HA and myalgias after FLUMIST, SPV, and ANTHRAX. Went to ER, seen in MTF for the 2 days. Given symptomatic treatment. Symptoms resolved.

VAERS ID:334432 (history)  Vaccinated:2008-10-28
Age:94.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-10, Days after onset: 13
Location:Arkansas  Entered:2008-12-09, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2757AA0IMLA
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)
Write-up: Red, swollen area at injection site

VAERS ID:334767 (history)  Vaccinated:2008-10-28
Age:74.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-10, Days after onset: 13
Location:Massachusetts  Entered:2008-12-09, Days after submission: 29
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: H/O throat cancer with radiation tx 2 yrs ago, h/o emphysema
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1679U IMRA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD200 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: "Right bicep swelled up" evening after vaccine (10/28/08 evening). Called MD who instructed to apply ice. Pt did so with resolution.

VAERS ID:335251 (history)  Vaccinated:2008-10-28
Age:76.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-12-12, Days after onset: 45
Location:Florida  Entered:2008-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LOZOL; ACTOS; propanolol; PRILOSEC; TRIOLIDE; ZOLOFT; COLAN SR; CELEBREX
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLAA154AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0619X IMRA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling & pain Rt. arm.

VAERS ID:335439 (history)  Vaccinated:2008-10-28
Age:0.6  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 27
Location:Nebraska  Entered:2008-12-16, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B156EA2IMLL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB436AA2IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF407AA2IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC053792IMRL
Administered by: Public     Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: PEDIARIX vaccine given; Hepatitis B vaccine also given (Hep B is component of PEDIARIX) No reaction observed or reported to date.

VAERS ID:335443 (history)  Vaccinated:2008-10-28
Age:1.1  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 27
Location:Nebraska  Entered:2008-12-16, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB262IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB260IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF505AB2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0666X0SCRL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.C053793IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: Patient given PEDIARIX; not indicated yet at this time. No reaction reported/ observed on this date.

VAERS ID:335445 (history)  Vaccinated:2008-10-28
Age:0.5  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 27
Location:Nebraska  Entered:2008-12-16, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B156EA2IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF505AB IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 2IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0642X2PO 
Administered by: Public     Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: patent given PEDIARIX combination vaccine and also given hepatitis B and polio vaccines. (These are components of PEDIARIX). no reaction reported/observed.

VAERS ID:335448 (history)  Vaccinated:2008-10-28
Age:0.2  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-11-24, Days after onset: 27
Location:Nebraska  Entered:2008-12-16, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B156EA0IMLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB516AA1IMRA
HIBV: HIB (ACTHIB)SANOFI PASTEURUFV07AA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0996X1IMLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC053790IMLA
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0642X0PO 
Administered by: Public     Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: Pt. given PEDIARIX combination vaccine and also given Hepatitis B and Polio vaccines. (These are components of PEDIARIX). No reaction reported/deserved.

VAERS ID:335468 (history)  Vaccinated:2008-10-28
Age:0.3  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 27
Location:Nebraska  Entered:2008-12-16, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B156EA0IMLL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB516AA1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF505AB0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHA0996X0IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: No adverse event
SMQs:
Write-up: Pt given PEDIARIX combination vaccine and also given Hepatitis B and Polio vaccines. These are components of PEDIARIX). No reaction reported/observed.

VAERS ID:335472 (history)  Vaccinated:2008-10-28
Age:0.5  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 27
Location:Nebraska  Entered:2008-12-16, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B156EA1IMUN
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB516AA2IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUF505AA IMUN
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0996X1IMUN
Administered by: Public     Purchased by: Other
Symptoms: No adverse event
SMQs:
Write-up: Patient given PEDIARIX combination vaccine and also given Hepatitis B and Polio vaccine''s(these are components of PEDIARIX). No reaction reported/observed.

VAERS ID:335972 (history)  Vaccinated:2008-10-28
Age:0.5  Onset:0000-00-00
Gender:Female  Submitted:2008-12-23
Location:Indiana  Entered:2008-12-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2291BA0IMLL
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS 2IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC575432IMLL
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None

VAERS ID:336029 (history)  Vaccinated:2008-10-28
Age:21.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-12-23, Days after onset: 56
Location:Iowa  Entered:2008-12-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: numerous allergies
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2996AA1IMUN
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Muscle contractions involuntary, Myalgia, Sciatica
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Dystonia (broad), Eosinophilic pneumonia (broad)
Write-up: Dear Dr. I received a Tdap in your office on 10/28/2008. On 10/29/2008 I started a 6-1/2 week course of severe, progressive large muscle belly prolonged contractions which would work its way out of one group over the course of 2-3 days while starting in another, usually involving 2-3 at one time. It was debilitating. I could not clean, sit, engage my muscles, go anywhere, do anything. I had read the vaccine sheet and felt due to my numerous allergies I was having a reaction to the latex or some other ingredient, so was taken BENADRYL, anti-inflammatory of ibuprofen 600 mg 3 times a day, and massaging, using heat and thought it would just run its course. Each muscle belly involved became harder to massage out and came back more quickly. I finally decided to live, as we had canceled a trip 3 weeks earlier, figuring I could hurt and massage there as easily as I could here. We went on travel 12/14/2008. It was a big mistake as the trip was miserable. I ended up having to aggressive massage a new muscle group, the inner thigh muscle down to inside the knee, which had worked me up as a new mass of muscle involvement at 4 a.m. that day, and I had massaged it out for 2 hours before we left. It was a problem most of the time in the car, and I was working up a sweat massaging about 50 minutes at a time, getting total relief once massaged out, but then would lock all back up again within 3 minutes. It was a agonizing day and night and we ended up in the ER the next morning. As we understand it, there is no test for tetanus, and this is an unusual presentation, and none have been reported like this to the CDC, so they really did not know what to think of it, but did rule out everything else. They put me on clindamycin, one of the drugs of choice for tetanus, and muscle relaxant of VALIUM. I have had such progressive good result in 5 days of antibiotic with 5 days left to go, all muscle bellies relaxing and no longer tender, no new involvement and finally starting to feel human again, being able to do normal things like decor

VAERS ID:336093 (history)  Vaccinated:2008-10-28
Age:31.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-12-28, Days after onset: 61
Location:Pennsylvania  Entered:2008-12-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: CK 268 nl
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSU2788EA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Mobility decreased, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Parkinson-like events (broad)
Write-up: Persistant Arm pain with difficulty lifting arm and pain when grasping objects

VAERS ID:337600 (history)  Vaccinated:2008-10-28
Age:66.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-01-16, Days after onset: 80
Location:Florida  Entered:2009-01-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: n/a
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2791AA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Hemiparesis, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Write-up: Within 30 minutes of vaccination to the left upper arm, patient felt weakness in right side (muscular and joint) from right hip to knee; weakness lasted 45 min to an hour.

VAERS ID:338963 (history)  Vaccinated:2008-10-28
Age:  Onset:2008-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2009-01-07, Days after onset: 71
Location:Kentucky  Entered:2009-01-30, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0756078A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA168AA0UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1161X0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pharmaceutical product complaint
SMQs:
Write-up: This case was reported by a pharmacist and described the occurrence of a product complaint in a subject of unspecified age and gender who was vaccinated with FLULAVAL (GlaxoSmithKline). Concurrent vaccination included PNEUMOVAX 23 (Merck) given on 28 October 2008. On 28 October 2008 the subject received a dose of FLULAVAL at 0.5 ml. Following administration of FLULAVAL, the pharmacist noted that there was a small piece of foreign matter in the vaccine vial. It was estimated that perhaps 5 subjects may have been injected with FLULAVAL from this vial. This was considered to be a product complaint. The pharmacist was not aware of any adverse events following this occurrence. The pharmacist did not have any specific information regarding the subjects involved. The pharmacist called back on 29 October 2008 to report that it was noted that a piece of the vial stopper was missing from the rim and that was the particulate that was floating in the vaccine solution. He was fairly certain that this was the particulate, but still has the vial for testing if necessary.

VAERS ID:347407 (history)  Vaccinated:2008-10-28
Age:  Onset:2008-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2009-05-15, Days after onset: 199
Location:Pennsylvania  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0810USA04953
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a registered nurse (R.N.) concerning a patient who on 28-OCT-2008 was vaccinated with a dose of VARIVAX (Merck) instead of ZOSTAVAX (Merck) (MSD). No symptoms reported. Additional information has been requested.

VAERS ID:352075 (history)  Vaccinated:2008-10-28
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:2009-03-27
Location:California  Entered:2009-07-16, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no concurrent illnesses, no known allergies, no pre-existing medical conditions and they had not been taking any concomitant medications.
Diagnostic Lab Data: From information received 29/Dec/2008, no relevant laboratory and diagnostic tests were performed.
CDC 'Split Type': 200803883
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB251CA IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0836 SCLA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF432A SCLA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Headache, Joint swelling, Mass, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Initial report was received 03 December 2008 from a health care professional. A 56-year-old male patient with no known allergies and no past medical history, had received a subcutaneous left arm injection of VF VAX, lot number UF432AA, and a subcutaneous left arm injection of IPOL, lot number A0836-2, and an intramuscular left deltoid injection of HAVRIX, lot number AHAVB251CA (manufactured by GlaxoSmithKline) on 28 October 2008, and one week later, he developed a cough, nasal congestion, a headache and swelling at the elbow without pain (left or right not specified). The patient was evaluated by their physician, however their recovery status was not reported. The patient had no concurrent illnesses at the time of vaccination and had not been taking any concomitant medications. No additional information was provided. Follow-up information was received 29 December 2008 from a health care professional. The patient had swelling of the left elbow with a five cm diameter lump noted. The patient had been checked by their private medical doctor (PMD) however no relevant laboratory and diagnostic tests were performed and no treatments were prescribed. The patient recovered on 03 December 2008. No further information was provided. Follow-up information received on 24 March 2009 from a health care professional. The patient was reported to have been fine. However, he still had a small mass at his left elbow, which had decreased in size and was not causing him any discomfort. The patient did go on his trip without any problems from the lump. According to the reporter, the patient''s physician did not know what caused the lump and couldn''t state if it was from the vaccines that he had received. Documents held by sender: None.

VAERS ID:355545 (history)  Vaccinated:2008-10-28
Age:35.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-02-27, Days after onset: 122
Location:Nevada  Entered:2009-08-13, Days after submission: 166
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions: Patient is scheduled to deliver via Cesarean section
Diagnostic Lab Data:
CDC 'Split Type': MEDI0007511
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500577P IN 
Administered by: Private     Purchased by: Other
Symptoms: Contraindication to vaccination, Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: A non-serious, spontaneous report of "gave it unknowingly to a pregnant women in her 3rd trimester" was received from a physician concerning a 35 year-old female. The patient''s medical history included hypothyroidism, gestational diabetes, asthma and gastroesophageal reflux disease. Concomitant medications include levothyroxine since Feb-2008, glyburide since Nov-2008 and prenatal vitamins since May-2008. (Reference MEDI-0007555). The patient received FLUMIST for flu vaccination on 28-Oct-2008 during her 3rd trimester of pregnancy. The pregnancy was completed 2-Feb-2009 at full term via C-section. There were no complications with delivery and there were no adverse events, congenital anomalies or neonatal illness reported. Additional information was received on 27-Feb-2009 and incorporated into the narrative: pregnancy outcome.

VAERS ID:355132 (history)  Vaccinated:2008-10-28
Age:1.1  Onset:2008-10-30, Days after vaccination: 2
Gender:Male  Submitted:2009-08-08, Days after onset: 282
Location:Ohio  Entered:2009-08-25, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB247AA0UNLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1250X0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Communication disorder, Cough, Crying, Expressive language disorder, Irritability, Lethargy, Listless, Pyrexia, Rash, Screaming, Sleep disorder, Speech disorder developmental, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: 2 days after my son received MMR and Hep A on 10/28/08 he had high fever, inconsolable, listless, lethargic for two weeks. He is now receiving therapy for Expressive/Receptive speech delay. 9/2/09 PCP medical records received DOS 10/28/09 to 4/28/09. Assessment: Delayed expressive language per state developmental service. Patient developed congestion coughing, fever, fussy, screaming, crying and lots of mucus. Disrupted sleep. Rash on back not vaccine injection site. URI. Parent concerned that child does not communicate, just cries, not expressing himself or verbalizing. Modified Checklist for Autism in Toddlers - several non-critical items of concern.

VAERS ID:358080 (history)  Vaccinated:2008-10-28
Age:59.0  Onset:2008-11-12, Days after vaccination: 15
Gender:Female  Submitted:2009-04-20, Days after onset: 158
Location:Maryland  Entered:2009-09-23, Days after submission: 156
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Uterine fibroids. 10/12/09 Hospital records, DC summary, received service dates 11/26/08 to 12/03/08. Tonsillectomy, chevron osteotomy, ectopic pregnancy. Former smoker. 2 glasses wine per night. 10/14/09 Neurology consult records received, service dates 11/25/08 to 8/25/09.PMH: Depression and as above.
Diagnostic Lab Data: (See attached). 10/12/09 Hospital records, DC summary, received service dates 11/26/08 to 12/03/08. LABS and DIAGNOSTICS: CSF - RBC 3 /mm3 (H), Protein 120 mg/dL (H). CHEM - Sodium 132 mmol/L (L) BUN 24 mg/dL (H). CBC - WBC 4.53 K/MM3 (L). IGG 1670 mg/dL (H). Lymab (Lyme Disease) Antibody test - WNL. ANA - WNL. CRP - WNL. Rheumatoid Factor - WNL. 10/14/09 Neurology consult records received, service dates 11/25/08 to 8/25/09. Labs and diagnostics: ANA-Negative, CRP-Negative, Rheumatoid factor-Negative, Lyme testing-Negative. EMG-Abnormal.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED00849211A IMRA
Administered by: Private     Purchased by: Other
Symptoms: Antinuclear antibody negative, Areflexia, Arthralgia, Ataxia, Back pain, Blood immunoglobulin G increased, Blood product transfusion, Blood sodium decreased, Blood urea increased, Borrelia burgdorferi serology negative, Burning sensation, C-reactive protein normal, CSF protein increased, Electromyogram abnormal, Fall, Gait disturbance, Guillain-Barre syndrome, Hypoaesthesia, Insomnia, Muscular weakness, Pain in extremity, Paraesthesia, Pollakiuria, Red blood cells CSF positive, Rheumatoid factor negative, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Tumour lysis syndrome (broad)
Write-up: (See attached). 10/12/09 Hospital records, DC summary, received service dates 11/26/08 to 12/03/08. Assessment: Guillain-Barre Syndrome. Patient noted achiness in her back and down into her legs one week ago. Pain increased and developed in palms and fingertips, generalized tingling sensation in toes and finger tips. Patient presents with burning sensation in lateral thighs and aching feeling in calves. Fingertips and feet are numb. Urinary frequency. Little sleep at night. Muscle weakness extremities, deceased temperature and pain sensation. Wide-based, ataxic gait. Needs assistance with ambulation. IVIG. ICD-9 Codes: 357.0 Ac Infect Polyneuritis, 781.3 Lack of Coordination, 782.0 Skin Sensation Disturbance, 788.41 Urinary Frequency, 781.2 Abnormality of Gait. 10/14/09 Neurology consult records received, service dates 11/25/08 to 8/25/09. Assessment: Guillain Barre Syndrome. Patient presented with a 1 week history of weakness, pain, and achiness in back and legs. Pain in palms and fingertips, tingling and parasthesias. Tingling progressed to the toes. She also developed imbalance and weakness with several falls. Reflexes are absent throughout. Upon follow up from hospitalization: remains unsteady, using a cane. Unable to drive. Feet feel like bricks. Needs assistance with ADL''s (showering). Pain can be incapacitating. Knee pain since fall 6 weeks ago. Absent reflexes in LE''s, diminished reflexes in biceps. Gait is shaky. 8/25/09-Compared with the initial study on 11/26/09 the degree of demyelination and axonal loss is worse, likely a reflection of continued injury to the nerves during the acute phase of her illness.

VAERS ID:392349 (history)  Vaccinated:2008-10-28
Age:40.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2010-06-14, Days after onset: 594
Location:Texas  Entered:2010-07-02, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: It was reported that the subject has no relevant medical history. She has previously received flu shots.
Diagnostic Lab Data: UNK
CDC 'Split Type': A0755632A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA380AA1IMUN
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Incorrect dose administered, Pain in extremity, Wrong drug administered
SMQs:
Write-up: This case reported by a healthcare professional and described the occurrence of sore arm in a 40-year-old female subject who was vaccinated with FLUARIX. On 16 October 2008 the subject received a dose of FLUARIX (unknown). On 16 October 2008, at an unspecified time after vaccination with FLUARIX, the subject experienced sore arm. The event resolved. Later, on 28 October 2008, the subject went in to receive another vaccine and inadvertently received a 2nd dose of FLUARIX. This was considered to be a maladministration (asymptomatic/extra dose given). No adverse events were reported. Follow-up information was received on 01 December 2008, via healthcare professional who reported the subject''s event was due to erroneous administration. The subject was given a second dose of FLUARIX (intramuscular) 12 days after a single seasonal dose of received. The subject had a sore arm after the first dose on 16 October 2008 and fatigue 24 hours after the second dose was given on 28 September 2008.

VAERS ID:400051 (history)  Vaccinated:2008-10-28
Age:15.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 645
Location:Ohio  Entered:2010-09-08, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0908USA04224
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0652X2IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a health professional concerning a 15 year old female with a penicillin allergy who on 28-OCT-2008 was vaccinated IM with a third dose of GARDASIL (Lot# 661766/0652X) at 11:45 a.m. into the right deltoid. Concomitant therapy included a third dose of DEPO-PROVERA (manufacturer unknown) IM in the right gluteus in the same day at 11:45 a.m. The health professional reported that the patient received the two vaccines and she had put the needles in sharps and the patient fell straight back to the floor, fainted and hit head. Subsequently the "squad" was called. The patient sought medical attention at SQUAD to hospital. At the time of this report, the patient''s outcome was unknown. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:333606 (history)  Vaccinated:2008-10-28
Age:6.0  Onset:2008-10-29, Days after vaccination: 1
Gender:Male  Submitted:2008-11-25, Days after onset: 27
Location:Foreign  Entered:2008-12-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Unk
CDC 'Split Type': B0547174A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  IMUN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a regulatory authority and described the occurrence of injection site warmth in a 6-year-old male subject who was vaccinated with INFANRIX (GlaxoSmithKline) for prophylaxis. Previous and/or concurrent vaccination included MMRV (non-GSK); Sanofi Pasteur MSD; intramuscular; given on 29 October 2008. On 28 October 2008, the subject received unspecified dose of INFANRIX (intramuscular, unknown injection site), lot number not provided. On 29 October 2008, 1 day after vaccination with INFANRIX, the subject experienced redness of more than 10 cm in diameter at the injection site with heat and pain. The reaction worsened during two days. The regulatory authority reported that the events were clinically significant (or requiring intervention). At the time of reporting the events were improved. The regulatory authority reported that the events were possibly related to vaccination with INFANRIX.

VAERS ID:335565 (history)  Vaccinated:2008-10-28
Age:0.3  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2008-12-17, Days after onset: 50
Location:Foreign  Entered:2008-12-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: The patient has no relevant medical history.
Diagnostic Lab Data: Body temperature, 28-OCT-2008, 38.6 deg. C, normal
CDC 'Split Type': NLWYEG02764308
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)PFIZER/WYETH 0IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature increased, Convulsion, Crying, Hypotonic-hyporesponsive episode, Pallor, Pyrexia, Respiratory rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information regarding PREVENAR was received from a healthcare professional via a regulatory authority regarding a 3-month-old female patient who experienced crying, fever, breathing rate increased, convulsion and hypotonic-hyporesponsive episode. The patient received the first dose on 28-Oct-2008. Additional suspect medication included a not specified vaccine. One hour after the vaccinations the patient experienced pallor during her sleep on 28-Oct-2008. 6.5 hours later the patient experienced hypotonic-hyporesponsive episode, breathing rate increased, fever and convulsion. She was examined by a GP and after 45 minutes she opened her eyes and was subsequently hospitalized. There the patient became alert again and recovered. No additional information was available at the time of this report.

VAERS ID:337662 (history)  Vaccinated:2008-10-28
Age:0.2  Onset:2008-12-01, Days after vaccination: 34
Gender:Male  Submitted:2009-01-16, Days after onset: 46
Location:Foreign  Entered:2009-01-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': B0549445A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS  UNUN
HIBV: HIB (HIBERIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41CA267A0PO 
Administered by: Other     Purchased by: Other
Symptoms: Crying, Emotional distress, Hypotonia, Intussusception, Screaming
SMQs:, Peripheral neuropathy (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: This case was reported by a physician and described the occurrence of intussusception in a 3-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). In November 2008, when the subject was 2 month old, he received 1st dose of ROTARIX (oral), lot number not provided. The subject was completely fine after vaccination. In December 2008, 1 month after vaccination with ROTARIX, the subject experienced intussusception. The subject was hospitalised. The subject''s condition settled on its own. At the time of reporting the event was resolved. The physician considered the event was unlikely to be related to vaccination with ROTARIX. Follow-up received on 6 January 2008: Previous to vaccination, the subject was in good health with no known medical history. On 28 October 2008, the subject was vaccinated with ROTARIX. On 1 December 2008, 34 days after vaccination with ROTARIX, the subject experienced intussusception. The subject was transferred to another hospital where the diagnosis of intussusception was made. Surgery was not performed as the subject''s condition settled on its own, prior to treatment. On 1 December 2008, the event was resolved. The 2nd dose of ROTARIX was scheduled for 4 December 2008. The reporter did not feel that ROTARIX was the cause of intussusception. Follow-up received on 14 January 2009: On 1 December 2008, the subject experienced sudden onset of severe crying with a bout where he stopped crying, but he was still distressed and looking limp. Then started increased screaming. He was brought to hospital. The tests performed there were not known. The subject was then transferred, still screaming to another hospital where the diagnosis of intussusception was made. At that hospital, the events settled without treatment.

VAERS ID:338132 (history)  Vaccinated:2008-10-28
Age:42.0  Onset:2008-11-07, Days after vaccination: 10
Gender:Female  Submitted:2009-01-23, Days after onset: 77
Location:Foreign  Entered:2009-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Avelox allergy; Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Allergy test, negative
CDC 'Split Type': A0760980A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB121BA0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Acne, Allergy test negative, Angioedema, Condition aggravated, Dizziness, Dysphagia, Erythema, Face oedema, Oral pruritus, Pharyngeal inflammation, Swollen tongue, Tongue paralysis
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: This case was reported by a consumer and described the occurrence of dizziness in an adult female subject who was vaccinated with TWINRIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. Concurrent medical conditions included penicillin allergy. On October 2008 and 2 December 2008 the subject received 1st dose and 2nd dose of TWINRIX (unknown). On an unknown date in 2008, ten days after vaccination with TWINRIX 1st dose the subject experienced dizziness, itchy tongue, throat inflamed and red and pimples near the neck. The subject took BENADRYL 25 mg two tablets. Three days later symptoms increased, "became worst". Therefore the subject took BENADRYL one tablet every four hours for one week. Symptoms were stable. On 2 December 2008 one hour after vaccination with TWINRIX 2nd dose, the subject experienced some symptoms "re-appeared but worse". In addition the subject had pimples in her arms. Since subject received 2nd dose she has experienced dizziness several times during the day and the tongue itches as well. The subject was not hospitalized. At the time of reporting the events were unresolved. Follow up received by physician on 14 January 2009 indicated that concurrent medical conditions included AVELOX allergy and PENICILLIN allergy. Reporter stated that the subject received 1st dose of TWINRIX on 28 October 2008 and 2nd dose of TWINRIX on 02 December 2008, (intramuscular) both doses from the same batch. On 07 November 2008, 10 days after vaccination with 1st dose of TWINRIX the subject experienced itchy tongue, with edema, dizziness, facial edema, sensation of incoordination of the tongue and feels that she cannot coordinate her swallowing. All events resolved with the exception of dizziness. The subject experienced angioedema. On 12 December 2008, one hour after vaccination with 2nd dose of TWINRIX, the subject experienced another episode of angioedema, and exacerbation of her dizziness. Dizziness improved by Holidays 2008. This case was assessed as medically seri

VAERS ID:338387 (history)  Vaccinated:2008-10-28
Age:16.0  Onset:2008-11-05, Days after vaccination: 8
Gender:Female  Submitted:2009-01-26, Days after onset: 82
Location:Foreign  Entered:2009-01-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: WBC count, 18000; Serum C-reactive protein, 28 mg/dl
CDC 'Split Type': WAES0901USA03202
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: C-reactive protein increased, Juvenile arthritis, Pyrexia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (narrow)
Write-up: Case initially received from a health authority (reference # PEI2008021125) on 15-JAN-2009. It was reported that a 16-year-old female patient was vaccinated with a third dose of GARDASIL (lot# and injection site not reported) intramuscularly on 28-OCT-2008. On 05-NOV-2008 the patient experienced high fever, which initially could not be explained. Finally, diagnosis of Still''s disease was established and treatment with prednisolone was started after 15 days. Then, the fever stopped. On an unspecified date, a blood sample was taken and showed leukocytemia (18.000, unit not reported) and elevated C-reactive protein (28 mg/dL). At the time of reporting to health authority (11-DEC-2008) treatment with prednisolone was ongoing. On the reporting form, the reporter is asking whether there could be a possible relation with GARDASIL. Other business partner numbers include E200900266. No further information is available.

VAERS ID:340574 (history)  Vaccinated:2008-10-28
Age:0.2  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-02-24, Days after onset: 119
Location:Foreign  Entered:2009-02-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Unk
CDC 'Split Type': B0560924A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSA20CA429B0IMUN
HIBV: HIB (HIBERIX)GLAXOSMITHKLINE BIOLOGICALSA20CA429B0IMUN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERA20CA429B0IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH319330IMUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Crying, Gaze palsy, Hypotonia, Loss of consciousness, Pallor, Pyrexia, Respiration abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: This case was reported by a regulatory authority (NL-LRB-82765) and described the occurrence of crying in a 3-month-old female subject who was vaccinated with INFANRIX-IPV/HIB (GlaxoSmithKline), PREVENAR (non-GSK). Relevant medical history: none. Concomitant medication: none. On 28 October 2008, the subject received 1st dose of INFANRIX-IPV/HIB (intramuscular, unknown injection site), 1st dose of PREVENAR (intramuscular, unknown injection site). On 28 October 2008, 6.5 hours after vaccination with INFANRIX-IPV/HIB and PREVENAR, the subject experienced crying, abnormal respiration, pallor, hypotonia, unconsciousness and convulsion. On 28 October 2008, 7 hours after vaccination with INFANRIX-IPV/HIB and PREVENAR, the subject experienced fever (38.6 deg. C) and eyeballs turned upwards. 45 minutes after the start of the convulsion, the girl opened her eyes, but her eyes turned away. She was admitted to the hospital where she became alert again. No hospital information has been received yet. At the time of reporting the events were resolved. The regulatory authority reported that the events were possibly related to vaccination with INFANRIX-IPV/HIB and PREVENAR. No further information could be obtained; this case has therefore been considered closed.

VAERS ID:343533 (history)  Vaccinated:2008-10-28
Age:0.6  Onset:2008-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-04-03, Days after onset: 157
Location:Foreign  Entered:2009-04-06, Days after submission: 3
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient previously experienced pyrexia after receiving the first dose of PREVENAR and INFANRIX HEXA on 28-Jul-2008 (see related case DE-WYE-G03423409). Past vaccinations included first and second doses of PREVENAR and INFANRIX HEXA on 28-Jul-2008 and 04-Sep-2008. The second dose of PREVENAR and INFANRIX HEXA had been well tolerated without symptoms. The patient''s mother underwent a surgery because one thyroid nodule was removed and afterwards the mother took Thyroxine. Neither seizure nor epilepsy are known as family medical history.
Diagnostic Lab Data: Urine analysis (results: without any pathological findings) and CSF test (results: without pathological findings) were done in Oct-2008. On 28-Oct-2008 test results were: body temperature (results: 36.9 deg. C.); body temperature (results: 37.6 deg. C.); neurological examination (results: according to the patient''s age: without any pathological findings); physical examination (results: good general condition, no skin efflorescence, eupnea, lungs bilateral well ventilated, heart sounds normal, no heart murmurs, inguinal pulse bilateral palpable, abdomen soft, bowel sounds normal, spleen not palpable); blood lactic acid (results: 1.8 mmol/L); platelet count (results: 370/nl); mean cell volume (results: 81.4 fl); haematocrit (results: 48 %); h
CDC 'Split Type': DEWYEG03011809
Vaccination
Manufacturer
Lot
Dose
Route
Site
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN)GLAXOSMITHKLINE BIOLOGICALSA21CA438E2IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH348772IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase normal, Blood chloride normal, Blood creatinine increased, Blood lactic acid normal, Blood magnesium decreased, Blood urea normal, Body temperature increased, C-reactive protein increased, CSF cell count normal, CSF glucose normal, CSF lactate, CSF protein normal, CSF test normal, Convulsion, Electroencephalogram abnormal, Epilepsy, Gaze palsy, Grand mal convulsion, Haematocrit normal, Haemoglobin increased, Lumbar puncture, Mean cell volume normal, Muscle spasms, Muscle twitching, Musculoskeletal stiffness, Neurological examination normal, Platelet count normal, Pyrexia, Red blood cell count increased, Ultrasound scan normal, Urine analysis normal, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (broad)
Write-up: Additional information was received regarding two additional events, course of the events, lab results and patient''s and family medical history. Information regarding PREVENAR was received from a healthcare professional via a regulatory authority (PEI) regarding a 6-month-old female patient who experienced seizures, body temperature of 36.9 degrees celcius and suspected early babyhood benign epilepsy. The patient received the third dose on 28-Oct-2008. Additional suspect medication included INFANRIX HEXA which was administered on the same day. On 28-Oct-2008 the patient received the third dose of PREVENAR and INFANRIX HEXA. In the evening the patient had a body temperature of 36.9C and after the patient slept for 30 minutes the patient lay in supine position and gazed with view deviation upwards. The patient experienced twitching of the whole body, her arms were flexed and she clenched her fingers. The status lasted for 3-4 minutes and the parents administered paracetamol and called the emergency doctor. On arrival of the emergency doctor the patient had a body temperature of 37.6 C. The patient was hospitalized and on 29-Oct-2008, 18 hours after the third vaccination with PREVENAR and INFANRIX HEXA, the patient again experienced seizure. The seizure lasted for 10 minutes, was considered life threatening and led to prolongation of hospitalization of the baby. Furthermore the patient three times experienced generalized tonic clonic seizure for 3-5 minutes on 30-Oct-2008. The patient received 5mg Diazepam rectal on 29-Oct-2008 and on 30-Oct-2008. On 31-Oct-2008 the patient twitched three times, her body was stiff and she gazed. This seizure ceased without treatment. The EEG, sonogram and lumbar puncture were without any pathological findings but the diagnosis early babyhood benign epilepsy was suspected. The patient was adjusted to Sultiam therapy on 30-Oct-2008 and with this therapy, she experienced no further cramps since 01-Nov-2008. The patient was discharged from hospital on 03-Nov-2008. The outcome of fever was unknown and the outcome of epilepsy and seizure was stated as not recovered but it was reported that the patients condition was well at the time of the report and that it was planned to withdraw the anticonvulsive therapy in three months. It was reported that the patients pediatrician and the childrens clinic assume that the vaccinations triggered the event as no other trigger, like an infection, was present at the time of the event. See related case: DE-WYE-G03423409 regarding the same patient who experienced fever after receiving the first dose of PREVENAR and INFANRIX HEXA. This case is being treated according to the foreign act.

VAERS ID:346227 (history)  Vaccinated:2008-10-28
Age:40.0  Onset:0000-00-00
Gender:Male  Submitted:2009-05-12
Location:Foreign  Entered:2009-05-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyronajod
Current Illness: Nonsmoker; Overweight
Preexisting Conditions: Goiter diffuse; Smoking; Strumectomy
Diagnostic Lab Data: UNK
CDC 'Split Type': D0061395A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA376BB IMLA
Administered by: Other     Purchased by: Other
Symptoms: Radiculitis brachial
SMQs:
Write-up: This case was reported by a physician via a sales representative and described the occurrence of neuritis in a 40-year-old subject who was vaccinated with INFLUSPLIT SSW 2008 / 2009. On an unknown date in October 2008 the subject received an unspecified dose of INFLUSPLIT SSW 2008/2009 (0.5 ml unknown). Less than one year post vaccination with INFLUSPLIT SSW 2008 / 2009, on an unknown date, the subject experienced neuritis. At the time of reporting the outcome of the event was unspecified. Please see case D0061373A for information about neuritis post vaccination with INFLUSPLIT SSW 2008 / 2009 experienced by the wife of the subject. Follow-up information was received on 07 May 2009 from the reporting physician. The case was upgraded to serious. The subject''s medical history included Strumectomy for goiter diffuse and smoking. Concurrent medical conditions included non-smoker since November 1993 and overweight. Concurrent medications included Thyronajod for state post strumectomy since 1996. On 28 October 2008 the subject received unspecified dose of Influsplit SSW 2008 / 2009 (0.5ml, intramuscular, left deltoid. Less than one week post vaccination with INFLUSPLIT SSW 2008/2009, on an unknown date in October 2008, the subject experienced neuritis, specified as brachial plexitis left. The subject was hospitalised for an unknown period of time. The subject was treated with high-dose cortisone for this event. After about two months, on an unknown date in December 2008, the events were resolved. The reporting physician considered that event was almost certainly related to vaccination with INFLUSPLIT SSW 2008 / 2009. Please see case D0061373A for information about neuritis post vaccination with INFLUSPLIT SSW 2008 / 2009 in another subject. Contrary to initial information this subject was not the wife of the subject of this case. No further information will be available.

VAERS ID:351176 (history)  Vaccinated:2008-10-28
Age:18.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-10
Location:Foreign  Entered:2009-07-13, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0907USA00783
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1147U0IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Mononeuritis, Pain in extremity, Vaccine positive rechallenge
SMQs:, Peripheral neuropathy (broad)
Write-up: Information has been received on 02-Jul-2009 from a gynaecologist concerning an 18 year old female who on 28-OCT-2008 was vaccinated with the first dose of GARDASIL (lot#1147U, batch# NH17630, route and site of administration not reported). On 27-JAN-2009 the patient was vaccinated intramuscularly the second dose of GARDASIL (lot# not reported) into the upper arm. After the first vaccination with GARDASIL the patient experienced pain in arm. Duration not reported. After the second vaccination the patient experienced pain in her arm. Pain was more intense than after the first vaccination. Patient was referred to a neurologist who diagnosed a mononeuritis by irritation of a nerve. The patient was treated with gabapentin, and she refused the third dose of GARDASIL. The outcome was not reported. Mononeuritis was considered to be other medically important condition by the reporter. Other business partner numbers included: E200905634. Additional information has been requested.

VAERS ID:441751 (history)  Vaccinated:2008-10-28
Age:14.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-07
Location:Foreign  Entered:2011-11-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1110USA04110
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cervical conisation, Cervical dysplasia, Cervix disorder
SMQs:, Reproductive premalignant disorders (narrow), Uterine and fallopian tube malignant tumours (broad)
Write-up: Information has been received from a physician (local reference number ISR-036-OCT11) concerning a 16 year old female patient with no sexual activity prior to vaccination who on 17-APR-2008 (also reported as approximately on 17-APR-2008) at the age of 14 years old, was vaccinated with a first dose of GARDASIL (lot number, dose and route not reported); on 01-JUL-2008 (also reported as approximately on 01-JUL-2008) was vaccinated with a second dose of GARDASIL (lot number, dose and route not reported) and on 28-OCT-2008 (also reported at approximately on 28-OCT-2008) was vaccinated with a third dose of GARDASIL (lot number, dose and route not reported). The physician reported that in 2010, the patient experienced a premalignant cervical lesion most likely Cervical Intraepithelial Neoplasm (CIN) grade III. Typing was unknown. On an unspecified date the patient underwent conization. Subsequently, the patient recovered from CIN grade III in 2010. Upon internal review CIN III was considered to be an other important medical event. Additional information is not expected.

Result pages: prev   2992 2993 2994 2995 2996 2997 2998 2999 3000 3001 3002 3003 3004 3005 3006 3007 3008 3009 3010 3011 3012 3013 3014 3015 3016 3017 3018 3019 3020 3021 3022 3023 3024 3025 3026 3027 3028 3029 3030 3031 3032 3033 3034 3035 3036 3037 3038 3039 3040 3041 3042 3043 3044 3045 3046 3047 3048 3049 3050 3051 3052 3053 3054 3055 3056 3057 3058 3059 3060 3061 3062 3063 3064 3065 3066 3067 3068 3069 3070 3071 3072 3073 3074 3075 3076 3077 3078 3079 3080 3081 3082 3083 3084 3085 3086 3087 3088 3089 3090 3091 3092 3093 3094 3095 3096 3097 3098 3099 3100 3101 3102 3103 3104 3105 3106 3107 3108 3109 3110 3111 3112 3113 3114 3115 3116 3117 3118 3119 3120 3121 3122 3123 3124 3125 3126 3127 3128 3129 3130 3131 3132 3133 3134 3135 3136 3137 3138 3139 3140 3141 3142 3143 3144 3145 3146 3147 3148 3149 3150 3151 3152 3153 3154 3155 3156 3157 3158 3159 3160 3161 3162 3163 3164 3165 3166 3167 3168 3169 3170 3171 3172 3173 3174 3175 3176 3177 3178 3179 3180 3181 3182 3183 3184 3185 3186 3187 3188 3189 3190   next

New Search

Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=3091&PERPAGE=100&ESORT=V
AX-DATE


Copyright © 2014 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166