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Case Details (Sorted by Vaccination Date)

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VAERS ID:323491 (history)  Vaccinated:2008-08-27
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-27
Location:North Carolina  Entered:2008-08-27
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: None reported on immunization consent and questionaire.
Preexisting Conditions: None reported on immunization consent and questionaire.
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2685AA1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Accidental overdose, Inappropriate schedule of drug administration
SMQs:, Drug abuse and dependence (broad)
Write-up: Client presented at immunization clinic at 0928am for a meningococcal vaccine required for college. Client stated that she had never received the vaccine previously. Client was given the Menactra vaccine at 0945am. After administration and while entering vaccine information into the county record system (M&M) and the NCIR it was noted that the client had received the Menactra vaccine previously on 06/27/2007. Client and parent was immediately informed of error and CDC was notified -call reference # 1-62191992 at 0954am. Client left clinic having no symtpoms of adverse reaction and phone number was taken to follow up with client with CDC recommendations. CDC recommendations were relayed to client at 1009am via telephone call. Client was informed to contact PMD or EMS for adverse reactions and then to please report to VAERS and to health center. Client verbalized understanding.

VAERS ID:323509 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Male  Submitted:2008-08-27, Days after onset: 0
Location:Wisconsin  Entered:2008-08-27
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2417AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2864AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1911U1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fall, Head injury, Joint injury, Nausea, Neck pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: 11 year old male patient was administered 3 immunizations as stated below. His 2 sisters and mother were in the room with him. After his shots were done, the youngest sister (8 y.o) fainted. She had not had any shots. Shortly after his sister fainted the patient said he felt somewhat queasy. We kept him under observation for the next 15-20 minutes, he said he was feeling better. We moved the family into another waiting room and told them to remain seated for another 15-20 minutes. About 10 minutes later the mother called out as the patient fainted. He was seated at the time so his chair ended up tipping to the left and he fell to the ground. He aroused quickly, pulse and respirations were WNL and regular. He was alert and oriented x3 once aroused. He stated that the side of his left temple and his knees hurt and his neck was a little sore from when he fell. It appeared that he may have had small "rug burns" on the side of his left temple and on both knees. We had him stay with us in the office for another 30 minutes under our observation. He ate a granola bar and after a while stated he felt better. We discussed the signs/symptoms of concussion with mother, advised her to follow-up with MD if he exihibits s/s or any other unusual behavior. Escorted family to car w/out incident.

VAERS ID:323517 (history)  Vaccinated:2008-08-27
Age:23.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-08-27, Days after onset: 0
Location:Texas  Entered:2008-08-27
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 except penicillin allergies.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0229X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: Patient called & stated that she begin having symptoms of diarrhea, nausea & dizziness 1 1/2 hours after her injection. No redness or swelling at injection site.

VAERS ID:323529 (history)  Vaccinated:2008-08-27
Age:4.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-08-27, Days after onset: 0
Location:Louisiana  Entered:2008-08-27
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC21B054AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA03013IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0264X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.423X1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Immediate post-injection reaction, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: MMR 0.5cc administered to right arm, Immediate swelling and redness. Tender to palpate. Advised warm compresses to area. Tylenol every 6 hours and Benadryl every 6 hours.

VAERS ID:323641 (history)  Vaccinated:2008-08-27
Age:7.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-28, Days after onset: 0
Location:California  Entered:2008-08-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1906U SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: marked erythema at injection site the day after vaccination... 2 large clear fluid filled blisters developed on day 2. Complains of itching and some pain. No fever. Ice only provided some relief. Brought to clinic for evaluation.

VAERS ID:323756 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:North Dakota  Entered:2008-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 5mg, daily PRN
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type: ND0804
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B085BA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA12183IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0664X1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0392X1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: All over body rash, mostly on truck, spreading towards extremeties and itchy.

VAERS ID:323761 (history)  Vaccinated:2008-08-27
Age:0.5  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-29, Days after onset: 1
Location:Missouri  Entered:2008-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: redness at injection site~DTaP + HepB + IPV (Pediarix)~0~7~In Patient
Other Medications: none listed
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B167AA1IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF472AA1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC873381IMLL
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Urticaria reported by child''s primary care physician on 8/28/08

VAERS ID:323780 (history)  Vaccinated:2008-08-27
Age:53.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:Oregon  Entered:2008-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none~ ()~~0~In Patient|none~ ()~~0~In Sibling
Other Medications: Lisinopril 5 MG Q day, Lodine XL 500mg BID, Compounded Estrogen/Progestrogen caps: E2 1.5mg,E3 1mg, Pro. 300mg total doserepo at HS, Restoril 30mg Q HS. I had had no evening meds at the time of symptoms reported above.
Current Illness: None. I was vaccinated by the employee health nurse, thus my answer to #15 and 16 above.
Preexisting Conditions: Allergy to Morphine. Degenerative Disc Disease, High Blood Pressure, Post menopausal symptoms since menopausal onset at age 48, and chronic insomnia.
Diagnostic Lab Data: EKG, Chemistry Panel, CBC, chest x-ray:see above.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2994BA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blood potassium decreased, Chest X-ray normal, Chest discomfort, Dizziness, Electrocardiogram ambulatory, Electrocardiogram normal, Full blood count normal, Heart rate normal, Laboratory test normal, Oxygen supplementation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: I am unsure if my symptoms are vaccine related, but they were new and did occur the evening of the next day after the vaccine Tdap was taken. I forgot about the vaccine at the time of the ER visit and did not mention it to the provider at the time. I had fluttering in my chest, weakness, and light-headedness that lasted off and on, but mostly on for a total of about 50 minutes. My pulse felt normal at the time at 64. I called the ambulence because symptoms were not abating with calming deep breaths. I had had a few seconds of light-headedness about 2 hours before with no other symptoms while cooking dinner. At the time of symptoms in the chest, I was laying down channel surfing on the couch. I had no pain. In the ambulence and at ER my EKG''s were normal. I did have a low potassium, but not very low. I had eaten 5 times during the day, as usual with balanced nutrition. The ER doctor has scheduled a halter monitor, thinking that I could have had a session of bigeminal rhythms that just self corrected before the EKG''s were done. I felt symptom free after a while with only oxygen. The ER doctor thought the potassium might explain the weakness and I took a dose of 40 meq. before discharge. I have no cardiac history and my only risk factors are high blood pressure, being menopausal, and my age. All other lab values and chest X-ray were normal. I am rarely ever ill.

VAERS ID:323793 (history)  Vaccinated:2008-08-27
Age:10.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-29, Days after onset: 1
Location:California  Entered:2008-08-29
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1000U1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site irritation, Injection site pruritus, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Arm began to swell at 3pm 8/28/08. Blistering appeared on arm at site of vaccine (left tricep) at 10-11pm 8/28/08. Patient presented with mother to clinic at 9:30am, 8/29/08 with complaint of blistering, itching and burning sensation at site and burning sensation on left anterior and lateral aspect of lower leg. I, PHN, observed confluent blistering with irregular borders measuring 1.5cm by 3cm. Suggested palliative tx-ice, Domboro, calamine, benadryl for itching, cover with gauze to prevent scratching or transmission, keep clean, seek antibiotic tx if area becomes infected. acetaminophen if fever develops. RTC if worse.

VAERS ID:323823 (history)  Vaccinated:2008-08-27
Age:0.3  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Utah  Entered:2008-08-29
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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B142AA1IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF259AA1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC940961IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0277X1PO 
Administered by: Private     Purchased by: Public
Symptoms: Lymphadenopathy, Mass, Nuclear magnetic resonance imaging abnormal, Tenderness
SMQs:
Write-up: 3x4 cm mass-tender behind right ear. Ultrasound showed collection of enlarged lymph nodes.

VAERS ID:323824 (history)  Vaccinated:2008-08-27
Age:91.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Illinois  Entered:2008-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: diarrhea
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0612X UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site cellulitis
SMQs:
Write-up: Pt s/p Pneumovax vaccine 8/27/08 now with cellulitis (L) deltoid.

VAERS ID:323870 (history)  Vaccinated:2008-08-27
Age:15.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-08-27, Days after onset: 0
Location:Louisiana  Entered:2008-09-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair; Singulair; Vera Mist; Pataday drops
Current Illness: None
Preexisting Conditions: Allergy shots with doctor
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB253BA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0063X1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dyspnoea, Fatigue, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Raised rash on face and neck about 3-4 hrs after vaccines administered. Pruritic. Plans to go to PMD today. And shortness of breath, difficulty breathing, extreme fatigue.

VAERS ID:323876 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-27
Location:Wisconsin  Entered:2008-09-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~0~In Sibling|none~ ()~~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB2529AA3IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2425AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B0125AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: BOOSTRIX given today - but he also had one 5/2/07. (No symptoms/signs) (this simply acknowledges that this given too soon past DTaP)

VAERS ID:323878 (history)  Vaccinated:2008-08-27
Age:6.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-09-02, Days after onset: 5
Location:Michigan  Entered:2008-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 8-27-08 OV was seen for c/o sore throat and productive cough, with exposure to mono. H/O fever 1 week previous to 8-27-08 appointment. Rapid strep was negative and mom declined mono testing. The provider determined that there was no mono presentation. Was diagnosed with URI. Temp at this visit was 98.5F, tympanic.
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0432X1SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Gait disturbance, Injection site erythema, Injection site swelling, Injection site warmth, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient received VZV vaccine 8-27-08 to left leg, by the SC route. Presented in office 8-29-08 with a 24 hour history of fever (101.5 ax), painful left leg with limping, and swelling at the injection site. Right thigh circumference is 27 1/4 cm and the left thigh circumference is 33cm. At the injection site there is an 80cm X 120cm area of erythema, which is sligtly firm, non-indurated, and warm to touch. There was no streaking and the child had full ROM of left leg. Mom was instructed by MD to use ice, Motrin and Benadryl. This was the second dose of VZV that patient received, his first dose was on 1-6-2003.

VAERS ID:323885 (history)  Vaccinated:2008-08-27
Age:4.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-09-02, Days after onset: 5
Location:Michigan  Entered:2008-09-02
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2953BA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA10603IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: On8-27-08,received DTap and IPV 2pm. 8-28-08 woke up with fever, T-101 gave tylenol. 8-30-2008 afebril, noon vomited x1 only. 8-31-2008 mom noticed hives,@ 4:30pm took him to IMC. Dose 1 @ 5:45pm. Prelone 15/5 one tsp BID x 3 days, 1 tsp per day x 3 days, then 1/2 tsp per day x 3 days. Benedryl given midnight. 9-1-08 hives worse, seen in office 9-1-8 & 9-2-08. told hives may continue several weeks, recheck in office in 2 weeks if no improvement. Needs allergy referral prior to Td or Tdap.Also start Zytec instead of benedryl.

VAERS ID:323893 (history)  Vaccinated:2008-08-27
Age:15.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-09-02, Days after onset: 4
Location:California  Entered:2008-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD 08/27/08
Current Illness: None noted
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1486U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2430AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BO19AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right and Left upper arm with round,red, slightly raised, warm and painful areas. Temp 98.4. Client reports that last noc both arms hurt more, today 8/29/08 @ 3:20pm the pain is still present but less.

VAERS ID:323903 (history)  Vaccinated:2008-08-27
Age:12.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-09-02, Days after onset: 6
Location:California  Entered:2008-09-02
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB289BA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2659AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0272X1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: syncopal episode after receiving 5 IZs & PPD

VAERS ID:323937 (history)  Vaccinated:2008-08-27
Age:1.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:Kentucky  Entered:2008-09-02, 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: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0454X0SCLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC659333IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0394X0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Vaccinations at 10AM on 8-27-08 with onset of urticaria at 530PM on 8-27-08. ER visit at 6PM on 8-27-08 and given steroid injection and oral Benadryl. Office visit in doctor''s office on 8-28-08 with continuing urticaria and patient instructed to continue on Benadryl.

VAERS ID:323938 (history)  Vaccinated:2008-08-27
Age:2.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:Nevada  Entered:2008-09-02, 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: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B085AA IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB268AA0IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient had 4 inch round area on L thigh that was very red, hard, swollen & hot to the touch. Prescribed BENADRYL prn & KEFLEX 250/5ml.

VAERS ID:323904 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-09-01, Days after vaccination: 5
Gender:Female  Submitted:2008-09-03, Days after onset: 2
Location:New Jersey  Entered:2008-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. Routine vaccination
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR   RA
Administered by: Private     Purchased by: Unknown
Symptoms: Back pain, Renal pain
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: Patient has lower back pain, in the kidney area. Will contact physician on 3-Sept-08 for follow-up.

VAERS ID:324047 (history)  Vaccinated:2008-08-27
Age:17.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Alaska  Entered:2008-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.144860IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1311U1SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2658AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2966AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Immediate post-injection reaction, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: The client was very anxious before the injections. She was seated on the exam table. Immediately after the injections, she stated she felt dizzy and she became pale. She had an episode of syncope. She reclined on the exam table and was awake/alert within minutes. No injuries.

VAERS ID:324086 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-28, Days after onset: 0
Location:Virginia  Entered:2008-09-03, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0332X1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 5cm x 2 1/2 splotchy red area

VAERS ID:324113 (history)  Vaccinated:2008-08-27
Age:0.6  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-09-02, Days after onset: 6
Location:Florida  Entered:2008-09-04, Days after submission: 2
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: The patient had not been ill at the time of vaccination and had not been taking any concomitant medications. The patient had a history of mild eczema.
Diagnostic Lab Data:
CDC Split Type: 200802749
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2957AA2IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC96205B2IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0406X2PO 
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Convulsion, Mechanical ventilation
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Initial report was received 27 August 2008 from a physician. A seven-month-old female patient with a medical history of mild eczema, experienced a seizure on the same day she had received a third dose intramuscular right thigh injection of DAPTACEL, lot number C2957AA. The patient had received a third dose intramuscular right outer thigh injection of PCV-7, lot number C96205B (manufactured by Wyeth) and a third dose (oral) of "ROTO", lot number 0406X (manufactured by Merck) concomitantly with DAPTACEL. The patient had not been ill and had not been taking any concomitant medications at the time of vaccination. On 27 August 2008 (also reported as 26 August 2008), the patient had been seen by their physician for their routine six month well child check up with no problems noted. The patient was immunized with DAPTACEL, PCV-7 and "ROTO". The patient''s father administered TYLENOL drops post injection and dropped the patient off at day care. The mother picked up the patient at 16:00 from day care and the patient was "OK". At 18:00, the mother noted an increased temperature and started to administer TYLENOL when the patient experienced a seizure. The patient was taken to the emergency room and was reported to be on a ventilator. At the time of the report, the patient''s recovery status was not reported.

VAERS ID:324125 (history)  Vaccinated:2008-08-27
Age:15.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:Pennsylvania  Entered:2008-09-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergies to hot dogs, strawberries, apples, and bananas. PMH: Asthma, bronchitis, recurrent sinusitis last one approx 2 wks prior to admit, scoliosis.
Diagnostic Lab Data: CK elevated at 725 with normal Troponin I LABS: CXR WNL. Repeat EKG WNL. Initial CK 721, CK-MB 10.5(H). Repeat CK 633, CK-MB 6.3. ALT 12(L). Blood c/s neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0571X1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0485X1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Alanine aminotransferase decreased, Blood creatine phosphokinase MB, Blood creatine phosphokinase increased, Blood culture negative, Chest X-ray normal, Chest pain, Dizziness, Electrocardiogram normal, Non-cardiac chest pain, Tremor, Troponin I
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: 24 hours after immunizations, developed L sided chest pain, worse on pressure being applied to the L parasternal area. 28 hours after immunization, involuntary tremors for 3 hours. 9/12/08 Reviewed hospital medical records of 8/28-8/29/08. FINAL DX: chest pain due to skeletal muscle injury; tremors of unknow origin Records reveal patient experienced intermittent left sided substernal chest pain day after vaccinations. Developed dizziness & trembling. Progressed well & was d/c but during d/c had recurrent chest pain. Repeat labs & EKG WNL & d/c to home.

VAERS ID:324126 (history)  Vaccinated:2008-08-27
Age:9.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Male  Submitted:2008-09-03, Days after onset: 5
Location:New York  Entered:2008-09-04, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0421X1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient returned to clinic on 08/29/2008 complaining of tenderness on the outside of the right upper arm. The patient experienced an

VAERS ID:324142 (history)  Vaccinated:2008-08-27
Age:36.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-09-04, Days after onset: 6
Location:New Hampshire  Entered:2008-09-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Epi Pen, Multi vit
Current Illness: none known
Preexisting Conditions: asthma, migraines
Diagnostic Lab Data: CBCD normal, sed rate 7, PT-INR 1.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2994BA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Full blood count normal, International normalised ratio, Prothrombin time normal, Pyrexia, Rash, Red blood cell sedimentation rate normal, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Two days post vaccination pt noticed a red rash on thigh. Fever 101-102 started two days post vaccination. Two days after that noticed a red raised rash on body. Had some generalized swelling. Hx allergy to fish

VAERS ID:324150 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-09-04, Days after onset: 7
Location:Tennessee  Entered:2008-09-04
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: seasonal allergies
Diagnostic Lab Data: Dr. felt it was not vaccine related, but I am having difficulty being so sure. He felt it was an allergic reaction to something ingested, but child has not been exposed to any new foods.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.CONTACT OFFICE1IMLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Headache, Hypersensitivity, Poor quality sleep, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Fever of 100 day 2-5 folowing vaccine, gave motrin; very restless sleep from a normally easy resting child Day 3-6; complaints of headache and dizziness day 4; hives all over torso, chest and butt day 7-8; visited Dr. day 8 and was prescribed steroid; has not returned to prevaccine energy level as of day 8

VAERS ID:324186 (history)  Vaccinated:2008-08-27
Age:2.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-09-02, Days after onset: 4
Location:Texas  Entered:2008-09-04, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB246AA0UNLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0184U0UNLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 48 hours post vaccination chills with fever 102 degrees (fever lasted 24 hours/and red rash covering entire neck (rash lasted 24 hours). Child recovered after 24 hours. Mom did not bring child for Dr to see rash.

VAERS ID:324291 (history)  Vaccinated:2008-08-27
Age:0.5  Onset:2008-08-30, Days after vaccination: 3
Gender:Male  Submitted:2008-09-02, Days after onset: 3
Location:Ohio  Entered:2008-09-05, Days after submission: 3
Life Threatening? No
Died? Yes
   Date died: 2008-08-30
   Days after onset: 0
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: post mortem exam pending LABS: Tox screen & x-rays neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B149AA1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF366AB1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC873401IMRL
Administered by: Private     Purchased by: Public
Symptoms: Aspiration, Autopsy, Cardiac arrest, Death, Excoriation, Pulmonary oedema, Pulse absent, Resuscitation, Small for dates baby, Toxicologic test normal, Unresponsive to stimuli, X-ray normal
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Baby brought to ED by squad. Found unresponsive at home with no pulse. Remained in asystole throughout resuscitation attempt. 10/24/2008 Autopsy report states COD as Undetermined, not c/w SIDS; manner of death undetermined. Report also states pathological diagnoses: pulmonary edema, mild; minor skin injuries to face; small for developmental age by weight & head circumference; and terminal aspiration of gastric contents.

VAERS ID:324308 (history)  Vaccinated:2008-08-27
Age:80.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-31, Days after onset: 3
Location:Missouri  Entered:2008-09-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atenolol; simvastatin; warfarin; Singulair;
Current Illness: Treatment for bat bite (Rabid?)
Preexisting Conditions: Allergic to Morphine - Taking medication for for hypertension and blood thinner - Warfarin
Diagnostic Lab Data: Tests not given - Additional comments above, bitten on side of left arm - Hives broken out along left arm - Between elbow and wrist - Both sides of left arm only
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Bitten by a bat - Believed to be rabid. Initial shots given at hospital. Received right deltoid shots on 8-13-08 - Additional shots on 8-16-08, 8-20-08 and 8-27-08 - Broke out in hives after taking shot on 8-27-08 - Left arm between elbow and wrist covered in hives described as red circular wheals, near location of the bat bite. Told to take Benadryl.

VAERS ID:324354 (history)  Vaccinated:2008-08-27
Age:25.0  Onset:2008-09-01, Days after vaccination: 5
Gender:Female  Submitted:2008-09-05, Days after onset: 4
Location:Maryland  Entered:2008-09-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: migraines
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04003A0OTLA
Administered by: Military     Purchased by: Military
Symptoms: Alopecia, Cough, Injection site pain, Injection site pruritus, Injection site pustule, Injection site rash, Injection site swelling, Lymph node pain, Lymphadenopathy, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 27 August 2008- received smallpox vaccine- constant itching, rash, small postules around injection site. One week later still itching and arm is swollen around injection site. Two weeks later, extremly tender around injection site-painful and lymphnodes on left side of body are swollen-mainly under left arm and groin lymphnodes. Additionally, I had a rather large amount of my hair fall out in the shower on 3 September. Also got anthrax shots 1 and 2 on 15 August and 3 September and have had a constant cough and sore throat since the shots. Not sure which vaccine these adverse events are from. 5 September Dr. put me on quarters and directed me to take Motrin for the pain and use a warm wash cloth on the injection site.

VAERS ID:324397 (history)  Vaccinated:2008-08-27
Age:13.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-09-05, Days after onset: 7
Location:Kentucky  Entered:2008-09-05
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:
Diagnostic Lab Data: none. Labs and Diagnostics: X-ray of the R tib/fib WNL. EKG with occ PVCs. Holter monitor (+) for PVCs
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0229X1UNRA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Electrocardiogram abnormal, Electrocardiogram ambulatory abnormal, Facial pain, Heart rate irregular, Hemiparesis, Hypoaesthesia, Hypoaesthesia facial, Immunisation reaction, Pain in extremity, X-ray limb normal
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Write-up: Weakness, numbness R side of body, numbness R side of face. 9/12/2008 Link to 324856./pc 9/12/2008 PCP records received. WCC 6/27/08 with normal exam except ecchymosis doe to a ball injury of the L hand. HPV#1. Seen 9/5/08 with c/o weakness, R sided numbness and R sided facial pain which began after HPV#2 on 8/27/08. Sx had resolved by OV. DX: HPV reaction. Seen again 9/10/08 for L sided lower back pain and R sided leg pain. Irregular heartbeat noted on PE as well and tenderness of the R calf. DX: Leg and back pain, irregular heartbeat. Sent for EKG Holter monitoring and X-rays.

VAERS ID:324386 (history)  Vaccinated:2008-08-27
Age:19.0  Onset:2008-09-05, Days after vaccination: 9
Gender:Female  Submitted:2008-09-07, Days after onset: 2
Location:Unknown  Entered:2008-09-07
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: Positive pregnancy test on 09/05/2008
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURERFAV 1552SCRA
JEV: JAPANESE ENCEPHALITIS (JE-VAX)SANOFI PASTEUREJN 234A3SCLA
Administered by: Military     Purchased by: Military
Symptoms: Drug exposure during pregnancy, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Patient received anthrax and JEV on 08/27/2008. Before immunizations were given, patient was asked could you be pregnant. Patient stated no per HN. On 09/05/2008, patient had a positive pregnancy test and is currently 6 weeks pregnant. At the time the immunizations were given, the pt was 4 weeks and 5 days pregnant. Patient and MO are aware of the situation.

VAERS ID:324471 (history)  Vaccinated:2008-08-27
Age:15.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:California  Entered:2008-09-08, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0151X1UNLA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Dizziness, severe headache, emesis (x5), resolved the following day.

VAERS ID:324544 (history)  Vaccinated:2008-08-27
Age:12.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Male  Submitted:2008-08-29, Days after onset: 0
Location:New York  Entered:2008-09-08, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB245AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0329X1SCRA
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: Redness and swelling at site - upper right arm. Inner redness 4cm x 6cm, outer redness 15cm x 12cm.

VAERS ID:324727 (history)  Vaccinated:2008-08-27
Age:12.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-09-03, Days after onset: 6
Location:New Mexico  Entered:2008-09-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: migraine, asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2662AA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Headache, Neck pain, Pain in extremity
SMQs:, Arthritis (broad)
Write-up: "Patient" started with pain from neck -$g fingertips on same side as vaccine administered left one day after vaccine; she also had chills. The pain persists for 6 days with change of site to right arm, head and neck ache at different times. At day 6 she was not responding to 2 mg Valium BID or 200 mg Ibuprofen 1-2 times per day. On day 6 we changed to 4 mg Valuim TID and increased Ibuprofen to 600 mg Ibuprofen Q 6 hours.

VAERS ID:324732 (history)  Vaccinated:2008-08-27
Age:10.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-08-27, Days after onset: 0
Location:Iowa  Entered:2008-09-10, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1446U0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.03931SCRA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient fainted after getting her shot. Mom had told us ahead of time she might. We had the back of the exam table in sitting position so she could lean against it. We laid her down and gave her a sucker. After she felt better we sat her up in stances and leg exercises and gave her a mountain dew. She fainted a 2nd time. Had her lay down for about 1/2 hour then had her rest in waiting room then escorted her to her car.

VAERS ID:324739 (history)  Vaccinated:2008-08-27
Age:13.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-30, Days after onset: 2
Location:New York  Entered:2008-09-10, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~0~In Patient
Other Medications:
Current Illness: No
Preexisting Conditions: ADD / Anxiety Disorder
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2687AA0UNLA
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: Full ROM; Right upper arm swollen, mild redness

VAERS ID:324751 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-29, Days after onset: 1
Location:New York  Entered:2008-09-10, 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: None
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2952BA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08363SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0481X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0392X1SCRA
Administered by: Other     Purchased by: Public
Symptoms: 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: Swelling, erythema, tenderness right arm (around injection site).

VAERS ID:324766 (history)  Vaccinated:2008-08-27
Age:9.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-09-02, Days after onset: 4
Location:Washington  Entered:2008-09-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB243AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0393X1UNLA
Administered by: Private     Purchased by: Public
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: Left upper arm swollen, redness, and painful.

VAERS ID:324768 (history)  Vaccinated:2008-08-27
Age:9.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-29, Days after onset: 1
Location:Delaware  Entered:2008-09-10, 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: CONCERTA; HYDROCORTISONE
Current Illness: None
Preexisting Conditions: ADHD, oppositional defiant dx, developmental delay
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVB244BA0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0917X1SCRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2105BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1658U1SCLA
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: swelling, erythema

VAERS ID:324845 (history)  Vaccinated:2008-08-27
Age:34.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:Kentucky  Entered:2008-09-11, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No- pregnant
Preexisting Conditions: depression, NKDA
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURU2067CA0UNRA
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER0727X0UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1960U0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Full blood count, Inappropriate schedule of drug administration, Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Injection site is erythematous and indurated.

VAERS ID:324861 (history)  Vaccinated:2008-08-27
Age:42.0  Onset:2008-09-06, Days after vaccination: 10
Gender:Female  Submitted:2008-09-11, Days after onset: 5
Location:New York  Entered:2008-09-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: Developed varicella zoster

VAERS ID:324976 (history)  Vaccinated:2008-08-27
Age:7.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-09-09, Days after onset: 13
Location:Maine  Entered:2008-09-12, 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: None known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0102X1UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain, Agitation, Diarrhoea, Immediate post-injection reaction, Nausea, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt immediately (1-4 min) developed hives, followed by abdominal cramps, nausea and vomit and diarrhea. She was agitated but had no terpuatory compromise. She received Epipen Jr and symptoms resolved. Rescue came and cleared her.

VAERS ID:325025 (history)  Vaccinated:2008-08-27
Age:4.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-09-09, Days after onset: 12
Location:Massachusetts  Entered:2008-09-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2397BA IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA03013IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0664X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0602X1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Had MMR right deltoid. Has 3x5" erythema, hot to touch. Advised ice, APAP.

VAERS ID:325079 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-08-30, Days after onset: 3
Location:California  Entered:2008-09-15, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURACAB084AA4IMRA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS1442U1IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHBVB524AA3IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.1230U1SCLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right deltoid, red, swollen, warm to touch (5" x 5") ice pack for 15 minutes every 2 hours.

VAERS ID:325215 (history)  Vaccinated:2008-08-27
Age:1.3  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-09-11, Days after onset: 14
Location:New York  Entered:2008-09-16, 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: No
Preexisting Conditions: Atopic Dermatitis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0356X0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0434X0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dermatitis diaper, Diarrhoea, Oedema peripheral, Rash macular, Viral pharyngitis, Viral skin infection
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Patient presented to office 24 hours after receiving MMR and Varivax with swollen hands and feet and macular, lacy rash on face, arms and legs. Sibling reacted "violently" to Benadryl. No other treatment. Also seen 5 days later with viral pharyngitis and viral rash, diarrhea and cough. Treated with Nystatin cream to diaper rash.

VAERS ID:325223 (history)  Vaccinated:2008-08-27
Age:8.0  Onset:0000-00-00
Gender:Female  Submitted:2008-09-12
Location:Washington  Entered:2008-09-16, 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: Superficial cat scratches
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2952AA5UNLA
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: None - incorrect vaccine given for age. No adverse reaction.

VAERS ID:325228 (history)  Vaccinated:2008-08-27
Age:0.3  Onset:0000-00-00
Gender:Female  Submitted:2008-09-08
Location:Michigan  Entered:2008-09-16, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B150AA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF419AA0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC504570IMRL
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Child received ROTATEQ and was 14 week old.

VAERS ID:325554 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2008-09-18
Location:South Carolina  Entered:2008-09-18
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: SC0808
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC4B085AA4IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.084241SCRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC940963IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.033241SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: PHN gave Prevnar inappropriately regarding age. No symtoms/rx observed.

VAERS ID:325607 (history)  Vaccinated:2008-08-27
Age:16.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-09-03, Days after onset: 6
Location:Michigan  Entered:2008-09-19, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: MI2008020
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB246AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU264AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B019AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash erythematous, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Client began getting an itchy, raised, red rash on stomach, first noticed in morning of 8-28-08. Since then, rash has continued to spread down trunk, onto legs, down arms and on face. Rash continues to be itchy, client taking Benadryl for itching, says it seem to help. Denies fever, malaise.

VAERS ID:325746 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-09-06, Days after vaccination: 10
Gender:Male  Submitted:2008-09-16, Days after onset: 10
Location:New Jersey  Entered:2008-09-22, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2687AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B024DB0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash consistent with erythema multiforme. Started 10 days after vaccines.

VAERS ID:325766 (history)  Vaccinated:2008-08-27
Age:39.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2008-08-29, Days after onset: 1
Location:Unknown  Entered:2008-09-22, Days after submission: 24
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1551UNRA
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURW04003A0 LA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Induration, Oedema peripheral, Pruritus, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 17 cm x 16 cm area of redness, swelling to elbow. Indurated, itches, swelling.

VAERS ID:325852 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-09-19, Days after onset: 23
Location:Illinois  Entered:2008-09-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt. was walking down hallway after receiving the Gardasil vaccine. Pt fainted for about 5 seconds, was conscious and able to answer questions. Pt was guided to floor by a nurse after attended to by RNs and MDs. Pt left ambulatory

VAERS ID:326425 (history)  Vaccinated:2008-08-27
Age:14.0  Onset:2008-09-17, Days after vaccination: 21
Gender:Female  Submitted:2008-09-29, Days after onset: 12
Location:Wisconsin  Entered:2008-09-29
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0538X0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Varicella
SMQs:
Write-up: Developed mild case of chicken pox.

VAERS ID:326531 (history)  Vaccinated:2008-08-27
Age:0.3  Onset:2008-09-04, Days after vaccination: 8
Gender:Male  Submitted:2008-09-15, Days after onset: 11
Location:Florida  Entered:2008-09-30, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: (-) CSF cxs; (-) viral cxs for stool, throat; (-) CSF for enterovirus LABS: CSF: WBC 21(H), RBC 9(H), glucose 59(N), protein 30(N). CBC, chemistry & UA neg. Blood, CSF & urine c/s neg. Stool & throat c/s for virus pending. CXR WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2956BA1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF473AA1IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA10601SCLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC69205A1IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0309X1PO 
Administered by: Private     Purchased by: Private
Symptoms: Blood culture negative, CSF culture negative, CSF glucose normal, CSF protein normal, CSF test abnormal, CSF white blood cell count increased, Chest X-ray normal, Conjunctival hyperaemia, Culture stool negative, Culture throat negative, Culture urine negative, Diarrhoea, Enterovirus serology test negative, Full blood count normal, Irritability, Laboratory test normal, Meningitis aseptic, Oral intake reduced, Pleocytosis, Pyrexia, Rash generalised, Red blood cells CSF positive, Similar reaction on previous exposure to drug, Urine analysis normal, Virus culture negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Conjunctival disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Decreased po 1-2 d after vaccines, "fussy" 2-3 d after vaccine rash to back, face, torso approx 4 d after vaccines fever (102) 1 hr after vaccines -irritability -$g to ER and had septic w/u with pleocytosis-admitted for meningitis. 10/7/08 Reviewed hospital medical records of 9/4-9/7/2008. FINAL DX: aseptic meningitis. Records reveal patient experienced rash all over that resolved after 2 days, irritability, conjunctival injection, loose stools & fever x 4-5 days s/p vaccinations. Had irritability, fever & loose stools s/p 2 mo vaccines as well. Seen in ER where CSF (+). Initially tx w/IV antibiotics until c/s neg. ID consult done. Fever resolved & improved. D/C to home w/PCP f/u.

VAERS ID:326983 (history)  Vaccinated:2008-08-27
Age:25.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-10-03, Days after onset: 36
Location:Ohio  Entered:2008-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PCN, SHELLFISH
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1481SCRA
Administered by: Military     Purchased by: Military
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: PT RECIEVED ANTHRAX VACCINE ON 27 AUG 08, ON 28 AUG 08 @ APROX. 1700 PT BECAME HAD EXTREME NAUSEA AND FATIGUE THAT LASTED UNTIL APROX 1200 HRS ON 30 AUG 08.

VAERS ID:326992 (history)  Vaccinated:2008-08-27
Age:0.4  Onset:2008-09-28, Days after vaccination: 32
Gender:Female  Submitted:2008-10-03, Days after onset: 5
Location:Virginia  Entered:2008-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no; term AGA infant
Preexisting Conditions: no PMH: being w/u by genetics for possible Robinow syndrome
Diagnostic Lab Data: stool RV Ag positive on 29 Sept 2008; received Pediarix, "Prevnir", Hib, RotaTeq on 27 Aug 2008 LABS: bicarb 11, BUN 50, Na 150, chloride 118.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.NOT RECORDED1PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Blood chloride increased, Blood sodium increased, Blood urea increased, Decreased activity, Dehydration, Diarrhoea, Electrolyte imbalance, Fontanelle depressed, Gastroenteritis, Irritability, Pallor, Pyrexia, Rotavirus test positive, Sick relative, Somnolence, Urine output decreased, Vomiting
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad)
Write-up: patient hospitalized with severe diarrhea and dehydration after two doses of PR-V (RotaTeq); date of dose 1: 17 June 2008; date of dose 2: 27 August 2008; date of hospitalization 28 September 2008; hospital stay will be at least 5 days; stool rotavirus antigen positive in lab at hospital 10/7/08 Reviewed hospital medical records of 9/28-10/2/2008. FINAL DX: dehydration w/electrolyte abnormalities; gastroenteritis; rotavirus antigen(+) Records reveal patient experienced vomiting, watery diarrhea, fever, irritability, increased sleep, UOP decreased, decreased activity, pale & sunken anteriorfontanelle x 2 days. Family had been ill w/similar symptoms. Tx w/IVF until electrolytes corrected then transitioned to oral. Improved & d/c to home w/PCP f/u.

VAERS ID:328367 (history)  Vaccinated:2008-08-27
Age:9.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Male  Submitted:2008-10-13, Days after onset: 47
Location:Washington  Entered:2008-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAVB222AA1IMUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0413U1SCUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC526016BA4IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1893U1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: No adverse reaction noted/reported. Patient was given Tdap; was to get Dtap.

VAERS ID:328739 (history)  Vaccinated:2008-08-27
Age:24.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-10-08, Days after onset: 42
Location:Unknown  Entered:2008-10-15, 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: vitamins (unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0809USA00222
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Alopecia, Breast feeding
SMQs:
Write-up: Information has been received regarding a case in litigation concerning a 24 year old female with no relevant medical history or allergies who on 25-JUN-2008 was vaccinated with a first dose of GARDASIL vaccine (yeast) (lot number, injection site and route not reported). Concomitant therapy included vitamins (unspecified). On 27-AUG-2008 the patient was vaccinated with a second dose of GARDASIL vaccine (yeast) (lot number, injection site and route not reported). On 27-AUG-2008, also reported as starting the day of her second shot of vaccine, the patient experienced hair falling out in handfuls. The patient also reported that she was breastfeeding her 6 month old daughter. The patient''s daughter developed a rash on her face. No medical attention was sought. The patient''s event persisted. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:328837 (history)  Vaccinated:2008-08-27
Age:0.5  Onset:0000-00-00
Gender:Female  Submitted:2008-10-08
Location:Unknown  Entered:2008-10-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0809USA00440
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure via breast milk, Rash
SMQs:, Anaphylactic reaction (broad), Neonatal exposures via breast milk (narrow), Hypersensitivity (narrow)
Write-up: Information has been received regarding a case in litigation concerning a 6 month old female infant whose mother on 25-JUN-2008 was vaccinated with a first dose of GARDASIL. Injection site and route not reported). On 27-AUG-2008 the mother was vaccinated with a second dose of GARDASIL. Injection site and route not reported). The mother reported that she was breastfeeding the baby. The baby developed a rash on her face. The mother took the baby to the pediatrician to see if it was vaccine-related. The outcome of the baby was unspecified. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:328840 (history)  Vaccinated:2008-08-27
Age:21.0  Onset:2008-08-30, Days after vaccination: 3
Gender:Female  Submitted:2008-10-08, Days after onset: 39
Location:Ohio  Entered:2008-10-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives; SYNTHROID; ZOCOR
Current Illness: Hypothyroidism; Hypercholesterolaemia
Preexisting Conditions: Hives
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA00452
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1486U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Ear discomfort, Nasal congestion, Oropharyngeal pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 21 year old female with hypothyroidism and hypercholesterolaemia and a history of hives in the past who on 27-AUG-2008 was vaccinated intramuscularly with the first 0.5 ml dose of GARDASIL vaccine (yeast) (lot no. 659655/1486U). Concomitant therapy included (SYNTHROID), (MSD) and hormonal contraceptives (unspecified). On 30-AUG-2008 the patient developed hives on both upper and lower extremities, stuffy nose, sore throat and "a full feeling" in her ears. The physician stated that the patient was "cleaning out a friend''s apartment on 29-AUG-2008 and was exposed to a lot of dust and mold at that time". The patient was examined in the office on 03-SEP-2008 and was prescribed topical steroid cream. At time of this report, the patient''s symptoms persisted. Additional information has been requested.

VAERS ID:328899 (history)  Vaccinated:2008-08-27
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2008-10-08
Location:Kentucky  Entered:2008-10-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA01220
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a physician concerning a 13 year old female who on 27-AUG-2008 was vaccinated with the second dose of GARDASIL. The patient developed right side "body tingling" of the arm and leg. The symptoms resolved on their own. The patient sought medical attention by phone call. The physician did mention that he received conflicting information from the patient and her mother. No further information is available.

VAERS ID:329509 (history)  Vaccinated:2008-08-27
Age:20.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-10-14, Days after onset: 46
Location:New York  Entered:2008-10-17, 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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA02397
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Rash papular
SMQs:
Write-up: Information has been received from a registered nurse concerning a 20 year old female with no pertinent medical history or allergies who on 04-JUN-2008 and 27-AUG-2008 was vaccinated intramuscularly with her 0.5 mL first and second doses of GARDASIL (lot #660391/0063X, 660557/0072X), respectively. There was no concomitant medication. On 29-AUG-2008 the patient developed a small bump in her right axilla. Medical attention was sought via call by the patient''s mother. No laboratory or diagnostics tests were performed. The bump resolved without treatment within 12 hours. On 04-SEP-2008 the patient developed a large bump in her left axilla which resolved without treatment in 2 days. Additional information has been requested.

VAERS ID:330500 (history)  Vaccinated:2008-08-27
Age:26.0  Onset:2008-08-30, Days after vaccination: 3
Gender:Female  Submitted:2008-10-14, Days after onset: 45
Location:Unknown  Entered:2008-10-17, 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: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0809USA04564
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)
Write-up: Information has been received from a 26 year old female who on 27-AUG-2008 was vaccinated with the first dose of GARDASIL. The patient had a menstrual period on 06-AUG-2008 and next period on 30-AUG-2008. Her periods are normally regular. The patient did not seek medical attention. Additional information is not expected.

VAERS ID:329637 (history)  Vaccinated:2008-08-27
Age:0.3  Onset:2008-09-25, Days after vaccination: 29
Gender:Male  Submitted:2008-10-22, Days after onset: 27
Location:Washington  Entered:2008-10-22
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 11/20/08-records received-Upper respiratory infection 1 week prior.
Preexisting Conditions: Congenital hydronephrosis resolved by 3 months of age.
Diagnostic Lab Data: 11/20/08-records received-Upper GI study concern of malrotation. Abdominal films demonstrating contrast in small bowel and did not appear dilated. Ultrasound positive. Air contrast enema unsuccessful in reducing intussusception.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B150AA1IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF465AB1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC504571IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0278X1PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal X-ray, Enema administration, Explorative laparotomy, Intussusception, Lethargy, Ultrasound abdomen abnormal, Vomiting, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient developed intussusception. Air enema reduction was unsuccessful and patient had to have surgical reduction of intussuscepted bowel. 11/20/08-records received-for DOS 9/26-9/28-08-DC DX: Intussusception. Presented to ED with nonreducible intussusception and increasing lethargic, emesis bilious. Exploratory laparotomy with manual reduction of ileocolic intussusception.

VAERS ID:330864 (history)  Vaccinated:2008-08-27
Age:68.0  Onset:2008-08-31, Days after vaccination: 4
Gender:Female  Submitted:2008-09-03, Days after onset: 3
Location:North Carolina  Entered:2008-10-31, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FOSAMAX; PREMARIN; CRESTOR; UNIRECTIC
Current Illness:
Preexisting Conditions: Sulfa Drugs; High B/P; High cholesterol under Rx
Diagnostic Lab Data: MD Diagnosed Cellulitis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2995AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Cellulitis, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Rc''d shot and had no problems until AM of 4th day. Red and hard area (10 mm) over injection site. Tenderness and rapidly spreading swelling down arm towards elbow (about 1" from elbow) came to HD 9/3/08 and arm still red and swollen.

VAERS ID:331381 (history)  Vaccinated:2008-08-27
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2008-10-27
Location:Unknown  Entered:2008-11-05, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1760SCRA
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURERVV04003A0 LA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA05220IMRA
Administered by: Military     Purchased by: Military
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Patient received live vaccine while pregnant (smallpox). Also received Anthrax, and Typhoid. Pt reported to immunization clinic 23 Oct 2008 to report she was 9 weeks pregnant.

VAERS ID:331466 (history)  Vaccinated:2008-08-27
Age:71.0  Onset:2008-08-30, Days after vaccination: 3
Gender:Female  Submitted:2008-11-05, Days after onset: 67
Location:Texas  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: (after onset of sx) Pain medication did not specify, Laxatives, flu vaccine 10/24/08
Current Illness: None
Preexisting Conditions: "Had Emphysema in 1993"
Diagnostic Lab Data: Ultrasound done 10/24/08 @ PCP''s office.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0462U0UNLA
Administered by: Public     Purchased by: Private
Symptoms: Abdominal distension, Herpes zoster, Muscle spasms, Ultrasound scan normal
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient stated that she started feeling cramps & bloating in June (received shingles vaccine on 8/27/08). Patient claims that symptoms began the Saturday after receiving the vaccine. Dr diagnosed patient w/shingles @ the ER. Patient was given pain medication & told that nothing else could be done. Since then she has followed-up w/her PCP who per patient performed an ultrasound on her abdomen & found nothing wrong w/her pain meds & laxatives were given for condition.

VAERS ID:331537 (history)  Vaccinated:2008-08-27
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2008-11-06
Location:New York  Entered:2008-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog,NPH
Current Illness:
Preexisting Conditions: IDDM
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0279X0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B028AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0433X1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt. reports hives for 1 week after adminstration of vaccines.

VAERS ID:333994 (history)  Vaccinated:2008-08-27
Age:14.0  Onset:2008-09-10, Days after vaccination: 14
Gender:Female  Submitted:2008-11-14, Days after onset: 65
Location:Massachusetts  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clindamycin
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Serum B.burgdorferi, negative; Serum creatine kinase, negative; Serum ANA, negative; Serum rheumatoid factor, negative; Serum Epstein-Barr, negative; Erythrocyte, negative; Complete blood cell, negative
CDC Split Type: WAES0810USA01164
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody negative, Blood creatine phosphokinase normal, Borrelia burgdorferi serology negative, Epstein-Barr virus test negative, Fatigue, Full blood count normal, Myalgia, Red blood cell sedimentation rate normal, Rheumatoid factor negative
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Information has been received from a physician concerning a 14 year old female with no medical history and no known drug allergies who on 27-AUG-2008 was vaccinated with a first 0.5ml dose of GARDASIL intramuscularly. Concomitant therapy included topical clindamycin. The patient experienced myalgia in calves, lower thigh, back and neck after the vaccination in 10-SEP-2008-17-SEP-2008. She also is experiencing fatigue. Medical attention was sought, the patient was seen in the office. Laboratory tests were performed, all of following were negative: lyme panel, CPK level, antinuclear antibody, rheumatoid factor, mononucleosis, sedimentation rate 2, CBC. The patient has not recovered at the time of report. Additional information has been requested.

VAERS ID:333580 (history)  Vaccinated:2008-08-27
Age:12.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2008-08-29, Days after onset: 1
Location:Wisconsin  Entered:2008-12-01, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2581AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2997AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0443X1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Size 10 cm X 8.5 cm red, warm, hard, itchy at injection site (R) arm.

VAERS ID:333690 (history)  Vaccinated:2008-08-27
Age:62.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Hawaii  Entered:2008-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor; Auphex; Diatepum; Ventalin HF; Aduair HF
Current Illness: None
Preexisting Conditions: Asthma, Hyperupemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1383U UNUN
Administered by: Private     Purchased by: Private
Symptoms: Asthma, Condition aggravated, Erythema, Headache, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Fercrisness, headache, muscle ache, arm pain, redness. Asthma symptoms

VAERS ID:333878 (history)  Vaccinated:2008-08-27
Age:57.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-12-04, Days after onset: 99
Location:Virginia  Entered:2008-12-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain upper, Arthralgia, Body temperature increased, Fatigue, Headache, Influenza like illness, Injection site swelling, Mobility decreased, Nausea, Pain, Tenderness
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Temp: 100 - 101.7 Wed evening through Sat, 8/30/08. Flu like symptoms: fatigue, joints ached, nausea, stomach ache, severe headache. Injection site (right arm) swollen. Mobility of right arm limited for a week (could only lift arm alittle bit); it took 2 weeks to be free of pain, tenderness. Could not do usual activities for 4 days. Very weak for a week, as if a charging freight train had hit me. Called emergency Thurs evening, 8/28/08.

VAERS ID:336662 (history)  Vaccinated:2008-08-27
Age:14.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-12-12, Days after onset: 107
Location:Alabama  Entered:2008-12-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine, PROZAC, Gabapentin,CLARATIN,Metformin,Mirtazapine
Current Illness:
Preexisting Conditions: Type 2 diabetes mellitus, anxiety disorder, disturbance of skin sensation, insomnia, hyperlipidemia
Diagnostic Lab Data: Diagnostic laboratory all testing was normal
CDC Split Type: WAES0811USA02158
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Asthenia, Disorientation, Dizziness, Hypoaesthesia, Laboratory test normal, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Initial and follow-up information has been received from a medical assistant concerning a 14-year-old female patient with type 2 diabetes, anxiety disorder, Disturbance of skin sensation, insomnia hyperlipidemia and no drug allergies, who on 27-Aug-2008 was vaccinated IM with the first dose of 0.5ml GARDASIL (lot number and injection site not reported). Concomitant therapy included PROZAC, CLARATIN, Mirtazapine, Famotidine (reported as "Samotidine" , manufacturer unknown) and gabapentin for type 2 diabetes, anxiety disorder, disturbance of skin sensation, insomnia, and hyperlipidemia. On 27-Aug-2008 after receiving GARDASIL, the patient experienced numbness all over and passed out; she also experienced immediate dizziness, weakness, and disorientation. Since 28-Aug-2008, the patient has experienced daily episodes of temporary numbness of both feet which lasted an unspecified length of time. The episodes have increased to 2-3 times per day and the numbness, during each episode, now extends from the feet to the mid-chest. The patient was referred for neurologic and orthopedic consultation, providers unspecified and ''all testing was normal" The medical assistant also stated that the patient "has missed a lot of school recently because of the symptoms". In October 2008 the patient did receive the second dose of GARDASIL. At the time of reporting, the patient has not recovered. Additional information has been requested.

VAERS ID:337546 (history)  Vaccinated:2008-08-27
Age:15.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2009-01-12, Days after onset: 137
Location:Missouri  Entered:2009-01-16, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.174OU0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR62638AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR02889AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Myalgia, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Within 24 hours of HPV dose given on 08/27/2008 - Had rash over trunk of body, Lasting 3 days did not seek medical attention. Within 24 hrs after 6/25/2008 vaccinations- had high fever, muscle aches 3-5 days, did not seek medical attention.

VAERS ID:339027 (history)  Vaccinated:2008-08-27
Age:4.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Male  Submitted:2009-02-04, Days after onset: 160
Location:New Mexico  Entered:2009-02-04
Life Threatening? No
Died? Yes
   Date died: 2008-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizures in past 2/17/09-records received-history of febrile seizures. mild asthma
Diagnostic Lab Data: Autopsy found no other cause of death.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B116AB4IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1662U1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1307U1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Autopsy, Convulsion, Death, Pyrexia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (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: Patient had fever within 24 hours of vaccine administration. Patient was found unresponsive the next morning. Patient had a history of febrile seizures. 2/17/09-records received-COD died from complications of a seizure disorder. Seizure disorder, clinical history of febrile seizures. Asthma Clinical history of mild asthma. histologic changes in large airways consistent with mild asthma.

VAERS ID:345477 (history)  Vaccinated:2008-08-27
Age:27.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2009-04-30, Days after onset: 244
Location:North Carolina  Entered:2009-05-01, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VOLTAREN
Current Illness: (R) hip lateral tear
Preexisting Conditions: No drug allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF456AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Axillary pain, Body temperature increased, Erythema, Induration, Injection site pain, Injection site swelling, Lymphadenopathy, Malaise, Myalgia, Oedema
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: At 24-36 hours, pain, swelling at injection site. Low grade temperature 99 degree to 100 degree. Myalgias, malaise. At 48 hours with squamous erythema, edema, induration. Maximum diameter about 10cm. Axillary pain and fullness. No palpable discrete lymphadenopathy.

VAERS ID:347689 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2009-05-15, Days after onset: 261
Location:Pennsylvania  Entered:2009-05-21, 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:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0809USA00367
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0507X UNRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, No reaction on previous exposure to drug, 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: Initial information has been received from a registered nurse concerning her 5 year old daughter who on 27-AUG-2008 was vaccinated with a dose of VARIVAX (Merck) in the right arm (lot number 660568/0507X) (injection route not reported) and a dose of DTaP (manufacturer unknown) in the right arm, a dose of MMR II (MSD) in the left arm and a dose of poliovirus vaccine (manufacturer unknown) in the left arm. On 27-AUG-2008 night, the patient had a slight fever. On 28-AUG-2008, also reported as the following day, the patient developed severe swelling (approximately 3 x size of her left arm) of her right arm. The patient''s right arm also became hot and red. The reporter noted that it "looked like cellulitis". The swelling, redness and warmth extended from the top of the patient''s shoulder to her elbow. The patient was seen in the physician''s office on 28-AUG-2008 and was treated with BENADRYL and TYLENOL. It was also reported that the patient had no adverse events following prior vaccination (she previously had all routine vaccinations). The patient''s mother was going to monitor the patient''s arm. If the patient did not improve she planned on taking her to the emergency room. Follow-up information was received from the registered nurse also the patient''s mother which reported that the patient''s symptoms had improved significantly on 31-AUG-2008. The patient went for a follow-up appointment on 02-SEP-2008 with the physician. According to the patient''s mother, the physician thought that this was not an adverse reaction to vaccine, but a possible error in technique with the administration of IM injection of DTaP or the patient moved during administration. The patient''s mother indicated that the physician stated that he thought it was a collection of blood due to this that caused the events. The physician also told the patient''s mother that he did not agree that the patient shouldn''t receive vaccine in the future. The patient''s mother did not have lot number available but she still requested a lot check. A standard lot che

VAERS ID:350068 (history)  Vaccinated:2008-08-27
Age:3.0  Onset:2008-09-03, Days after vaccination: 7
Gender:Male  Submitted:2009-05-29, Days after onset: 268
Location:Unknown  Entered:2009-06-17, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0810USA00010
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (PRIORIX)GLAXOSMITHKLINE BIOLOGICALS 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a consumer concerning her 3 year old son with no pertinent medical history or allergies who on 27-AUG-2008 was vaccinated with his first dose of MMR II (lot# not available) in the arm. There was no concomitant medication. On 03-SEP-2008 "1 week after receiving the vaccination" the patient experienced rash under his arms and a fever. The patient recovered from the rash " less than a week after the rash appeared." No labs or diagnostic studies were performed. There was no product quality complaint. (Consumer declined demographic information or her son''s physician''s information). No further information was given. Additional information has been requested.

VAERS ID:353575 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-28, Days after vaccination: 1
Gender:Female  Submitted:2009-07-30, Days after onset: 336
Location:Maryland  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: body temp, 08/28/08, 102 degrees
CDC Split Type: WAES0809USA00085
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1537U IMUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Erythema, Injection site reaction, Pain, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Information has been received from a healthcare worker (office manager) concerning a 5 year old female with no allergies/drug reactions and no pertinent medical history who on 27-AUG-2008 was vaccinated IM with PNEUMOVAX (lot # 659010/1537U). Concomitant therapy included (INFANRIX) (lot # not reported), (IPOL) (lot # not reported), MMR, (lot # not reported), and VARIVAX (lot # not reported). On 28-AUG-2008 the patient developed local reaction at injection site including pain, erythema, warmth and a fever of about 102 degrees F. The patient sought unspecified medical attention. At the time of the report the patient was recovering from local reaction at injection site including pain, erythema, warmth, and a fever of about 102 degrees F. No other information was available. Additional information has been requested.

VAERS ID:355120 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-08-29, Days after vaccination: 2
Gender:Female  Submitted:2008-09-19, Days after onset: 21
Location:Minnesota  Entered:2009-08-13, Days after submission: 328
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: MEDI0007121
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Private     Purchased by: Other
Symptoms: Incorrect dose administered, Medication error
SMQs:
Write-up: A Non - serious spontaneous report of administered two doses of vaccine in two day period has been received from a nurse concerning a 5-year old female patient. No medical or medication history were reported for this patient. The patient received FLUMIST intranasally in one office on 27AUG2008 and received another dose at a different office by the same physician on 29Aug2008. The patient received FLUMIST for flu prevention. The office were reportedly not computerized and the second office did not have the patient''s chart. The physician''s office confirmed that there were no adverse events associated with this medication error; therefore, treatment and reporter/ sponsor causality assessments are not applicable, and the event is considered resolved. Additional information was obtained on 19Sep2008 and incorporated into the narrative: confirmation from the physician''s office that no adverse events occurred from the medication error.

VAERS ID:358644 (history)  Vaccinated:2008-08-27
Age:41.0  Onset:2008-12-15, Days after vaccination: 110
Gender:Female  Submitted:2009-09-29, Days after onset: 287
Location:Texas  Entered:2009-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB178AB0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2581AA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURERA09230IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0529X0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Alopecia universalis, Asthma, Back pain, Blood creatine phosphokinase increased, Ear pain, Hearing impaired, Hyperbilirubinaemia, Hypothyroidism, Liver function test abnormal, Palpitations, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Hypersensitivity (broad)
Write-up: Diagnosis :Hypothyroidism, Abnormal Liver function screening (Hyperbilirubinemia), heart palpitations, alopecia universalis, asthma, elevated creatine. Additional: back aches, earache (partial loss of hearing in left ear), Vertigo.

VAERS ID:376524 (history)  Vaccinated:2008-08-27
Age:14.0  Onset:2008-12-25, Days after vaccination: 120
Gender:Female  Submitted:2010-01-11, Days after onset: 382
Location:Illinois  Entered:2010-01-11
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: Stroke at birth nothing else
Diagnostic Lab Data: Spoke with Dr Dec 10 2009. We discussed it as side effects from GARDASIL, she advised to report it here
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0845X0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Body temperature decreased, Erythema, Pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Dec 25 2008 hot shower, produced red itchy welts. Jan 1st 2009 to present time. Cold temp 35 degrees or below when outside for more than a few minutes. Red welts that are itchy and painfully appear. Last about 30 mins after body warms up.

VAERS ID:379399 (history)  Vaccinated:2008-08-27
Age:4.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Male  Submitted:2008-08-27, Days after onset: 0
Location:Georgia  Entered:2010-02-04, Days after submission: 526
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2356BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08053SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0328X1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Eye swelling, Pruritus generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Mom called from Emergency Room 30 minutes after pt received vaccines. Hives & itching all over, eyes swollen.

VAERS ID:384570 (history)  Vaccinated:2008-08-27
Age:5.0  Onset:2008-09-01, Days after vaccination: 5
Gender:Male  Submitted:2010-03-03, Days after onset: 548
Location:New Jersey  Entered:2010-04-06, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No relevant medical history. The subject is not allergic to eggs. It was unknown if adverse events were reported with previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0812635A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS 0UNLL
Administered by: Private     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: This case was reported by a physician and described the occurrence of hives in a 5-year-old male subject who was vaccinated with HAVRIX, (GlaxoSmithKline). There were no concurrent medications. On 27 August 2008 the subject received 1st dose of HAVRIX (unknown). In September 2008, at an unspecified time after vaccination with HAVRIX, the subject experienced hives. The subject was treated with BENADRYL on 11 September 2008. The subject consulted a health care professional regarding the event. At the time of reporting the outcome of the event was resolved. On 19 October 2009, a physician reported that a subject experienced hives after receiving HAVRIX. The subject was not allergic to eggs. He was given BENADRYL on 11 September 2008. His hives lasted for one month. In 2009, the subject received FLUZONE and broke out in hives two days after receiving via a prefilled syringe. Follow up information was received on 30 October 2009. The physician did not have any details to add to this case and requested that the case be closed. Follow up information was received on 16 November 2009 via the reporting physician. The physician had "nothing else to add".

VAERS ID:391380 (history)  Vaccinated:2008-08-27
Age:24.0  Onset:2008-09-03, Days after vaccination: 7
Gender:Female  Submitted:2010-06-04, Days after onset: 639
Location:Texas  Entered:2010-06-24, Days after submission: 20
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: none.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3048AA0UNUN
Administered by: Private     Purchased by: Private
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: Never been ill her life - took vaccine and started having seizures. Have not stopped.

VAERS ID:396858 (history)  Vaccinated:2008-08-27
Age:1.0  Onset:2008-09-09, Days after vaccination: 13
Gender:Female  Submitted:2010-08-30, Days after onset: 720
Location:Texas  Entered:2010-08-30
Life Threatening? Yes
Died? Yes
   Date died: 2008-09-23
   Days after onset: 14
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Plasminogen Activator Inhibitor was over 1000 (should be less than 25). This was not a genetic blood clotting problem.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04920SCLL
Administered by: Unknown     Purchased by: Other
Symptoms: Brain oedema, Computerised tomogram abnormal, Death, Diarrhoea, Lethargy, Nasopharyngitis, Nuclear magnetic resonance imaging abnormal, Plasminogen activator inhibitor increased, Pyrexia, Thrombosis, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: Minor cold for about a week and a half. Then a fever started on 9-19-08. Doctor visit/urgent care the next day on 9-20-08, doctor found nothing wrong. Urgent care and ER on 9-21-09 after an episode of shaking and a higher fever. Vomiting at urgent care. IV was inserted at urgent care. Diarrhea started after IV. Ambulance to the ER. Extreme lethargy. Spinal tap. Doctors weren''t sure what was wrong. A CT scan around midnight (Sunday night) didn''t find anything wrong. Second CT scan on 9-22-08 found swelling on the brain. MRI later on 9-22-08 found a blood clot. Our daughter died on 9-23-08. We were told by two specialists that it was vaccine-related, but they wouldn''t tell us more.

VAERS ID:399392 (history)  Vaccinated:2008-08-27
Age:4.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2010-08-04, Days after onset: 707
Location:Unknown  Entered:2010-09-08, Days after submission: 35
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: WAES0911USA01273
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: Information has been received from a physician assistant concerning a 4 year old female who on 27-AUG-2009 was inadvertently vaccinated with the first dose of GARDASIL (IM, 0.5ml) instead of "IVP" (human error not PQC). No adverse effects reported. At the time of the report, the outcome was unknown. Additional information has been requested.

VAERS ID:324468 (history)  Vaccinated:2008-08-28
Age:0.5  Onset:2008-08-28, Days after vaccination: 0
Gender:Female  Submitted:2008-09-04, Days after onset: 7
Location:New York  Entered:2008-09-08, 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: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3174AA0IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC45724E2IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1390U PO 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: Redness at site, irritability. BENADRYL and TYLENOL given.

VAERS ID:324486 (history)  Vaccinated:2008-08-28
Age:5.0  Onset:2008-08-29, Days after vaccination: 1
Gender:Male  Submitted:2008-08-29, Days after onset: 0
Location:Missouri  Entered:2008-09-08, Days after submission: 10
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: MO-2008-24
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2956BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA10603SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0664X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0331X1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left Deltoid swollen, warm to the touch, itching, red

VAERS ID:324492 (history)  Vaccinated:2008-08-28
Age:1.4  Onset:2008-09-05, Days after vaccination: 8
Gender:Male  Submitted:2008-09-08, Days after onset: 3
Location:Minnesota  Entered:2008-09-08
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 (DAPTACEL)SANOFI PASTEURC2955BA3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0454X0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0605X0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Blister, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Pt started with a fever 09/05/08. Pt has multiple blisters in trunk and a few on face and legs noted 09/07/08

VAERS ID:324538 (history)  Vaccinated:2008-08-28
Age:1.0  Onset:2008-08-30, Days after vaccination: 2
Gender:Female  Submitted:2008-09-03, Days after onset: 4
Location:Maryland  Entered:2008-09-08, 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: Amoxicillin 8/19 - 8/22; Omnicef 8/22 - 9/1/08
Current Illness: Recovering Otitis media - on Omnicef
Preexisting Conditions: RAST tests negative for egg/milk/peanut
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB243AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0662X0SCRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC69205B3IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0394X0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash, Rhinorrhoea, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Received vaccines on 8/28/07 and mom states that 2 days later, patient developed rash (hives) that''s more on body. Patient also with runny nose.

VAERS ID:324681 (history)  Vaccinated:2008-08-28
Age:0.3  Onset:2008-08-28, Days after vaccination: 0
Gender:Female  Submitted:2008-09-09, Days after onset: 12
Location:North Dakota  Entered:2008-09-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: LABS: WBC 27K(H). Blood culture neg. CRP 1.2(H).
CDC Split Type: ND0805
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC1B153BA1IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF263AA1IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC45724E1IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0502X1PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood culture negative, C-reactive protein increased, Diarrhoea, Immunisation reaction, Lethargy, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: vomiting, loose stool x1 9/23/08 Reviewed hospital medical records of 8/28-8/30/2008. FINAL DX: vomiting, lethargy, resolved. Suspect immunization reaction. Records reveal patient experienced vomiting & lethargy later on the day of vaccination then became lethargic. Tx in ER w/IVF & IV antibiotics. Improved & d/c to home.

VAERS ID:324710 (history)  Vaccinated:2008-08-28
Age:1.0  Onset:2008-08-30, Days after vaccination: 2
Gender:Male  Submitted:2008-09-04, Days after onset: 5
Location:California  Entered:2008-09-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Right chest with cyst
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURAVPC2953AA UNLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB235BAD UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0482X UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0539X UNLA
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Fever and generalized rash - onset few days after vaccination rash is measles-like.

VAERS ID:324784 (history)  Vaccinated:2008-08-28
Age:1.1  Onset:2008-09-06, Days after vaccination: 9
Gender:Female  Submitted:2008-09-10, Days after onset: 4
Location:California  Entered:2008-09-10
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: Congenital hydronephrosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB235BA0IMUN
HIBV: HIB (HIBERIX)GLAXOSMITHKLINE BIOLOGICALSUF46AA3IMUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0482X0SCUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC861413IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0532X0SCUN
Administered by: Public     Purchased by: Public
Symptoms: Decreased appetite, Injection site cellulitis
SMQs:
Write-up: cellulitis left thign and decreased appetite.

VAERS ID:325778 (history)  Vaccinated:2008-08-28
Age:63.0  Onset:2008-09-05, Days after vaccination: 8
Gender:Male  Submitted:2008-09-22, Days after onset: 17
Location:Florida  Entered:2008-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0293X0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Blister, Erythema
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Zoster vaccine administered 08//28/2008 A week later a blister developed on my left side. It is the size of a 50 cent piece, bright red with smaller blisters within. As of today it is still pronounced with micro blisters surounding it. The blisters have broken from friction of clothing but have never become really pussing or leaked fluid in a noticable amount.

VAERS ID:326987 (history)  Vaccinated:2008-08-28
Age:14.0  Onset:2008-08-29, Days after vaccination: 1
Gender:Female  Submitted:2008-10-03, Days after onset: 35
Location:Wisconsin  Entered:2008-10-03
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: Icthyosis and mild eczema. Exercise induced cough. acne.
Diagnostic Lab Data: CBC, blood culture negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2638AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0444X1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain upper, Blood culture negative, Cough, Full blood count, Headache, Irritability, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)
Write-up: Nausea post vaccine 10:30 AM. School, home ill 4 PM. Gradual increasing. took ibuprofen 200 mg 2-3 per 4-5 hours with some relief. Then stomach ache. Slight cough. Used ice. Office visit for severe headache. Appeared highly irritable and in pain. Moderately cooperative, appropriate for teenager in severe pain. 0-10 pain choice self rated "58". C/o headache, L arm pain.Demerol 20 mg IV given with some significant relief. Pain level 3-4-5/10. Home. Full recovery 4-5 days.

VAERS ID:333764 (history)  Vaccinated:2008-08-28
Age:32.0  Onset:2008-08-28, Days after vaccination: 0
Gender:Female  Submitted:2008-09-17, Days after onset: 20
Location:North Carolina  Entered:2008-12-03, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivit
Current Illness: none
Preexisting Conditions: mitral valve prolapse
Diagnostic Lab Data: None to date
CDC Split Type: NC08112
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2997AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cardiac flutter, Chest pain, Cold sweat, Heart rate increased, Hyperhidrosis, Neck pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Arthritis (broad)
Write-up: 9/17/2008 PM of injection, pt reported increased pulse rate, heart fluttering, sweaty and clammy with some chest pain and pain up (L) side of neck into jaw x approx. 5 hrs. Then it subsided without any preventative interventions. Since has had sl. incidents then last pm another full blown episode x 2hrs- Pt sent to Cardiologist.

VAERS ID:347369 (history)  Vaccinated:2008-08-28
Age:20.0  Onset:2008-08-29, Days after vaccination: 1
Gender:Female  Submitted:2009-05-15, Days after onset: 259
Location:Pennsylvania  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: serum varicella zoster, positive immunity (1.3)
CDC Split Type: WAES0810USA04025
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1877U0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site rash, Injection site vesicles, Rash vesicular, Varicella zoster virus serology positive
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 20 year old female patient with no know drug allergies, no seasonal/environmental allergies and without birth defects and pre-existing medical conditions, who on 28-AUG-2008 was vaccinated with the first dose of VARIVAX (Oka/Merck) (Lot number 659722/1877U) IM in the right deltoid. On 21-OCT-2008, the patient went for the second dose of VARIVAX (Oka/Merck), she reported a "very small blister like rash" distal to right deltoid administration site of the first dose of VARIVAX (Oka/Merck) given on 28-AUG-2008. The patient reported this reaction to the primary care physician when she noticed the rash on 29-AUG-2008 early in the morning (previously reported on the same day), and no treatment was received. The lesions lasted three days. On 03-SEP-2008, the patient recovered. The registered nurse consulted with the certified registered nurse practitioner (immediate supervisor) and the second dose of VARIVAX (Oka/Merck) was not given. Titers drawn indicated positive immunity (1.3). No further information is available.

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