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Case Details (Sorted by Vaccination Date)

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VAERS ID:322417 (history)  Vaccinated:2008-08-18
Age:60.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-18, Days after onset: 0
Location:Indiana  Entered:2008-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None; Hypersensitivity; Hyperlipidaemia; Hypertension; Depression; Anxiety; Pollen allergy; Drug hypersensitivity
Preexisting Conditions: Levaquin allergy rash; Hypertension, Hyperlipidemia
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0888U0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Malaise, Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Rash/hives over entire body within 60 min of injection. Patient returned to office; was given 125mg IM of Solumedrol and prescription for Clarinex. This is in follow-up to report(s) previously submitted on 9/24/2008. Information has been received from a nurse, concerning a male who on sometime last week (approximately 18-AUG-2008) was vaccinated with ZOSTAVAX (Merck). The patient sought medical attention. There was no product quality complaint. Follow-up information has been received from a registered nurse, concerning a 60 year old male patient with hyperlipidemia, hypertension, depression, anxiety, rash while on therapy with LEVAQUIN and allergy to grass, pollen and wheat, who on 18-AUG-2008 was vaccinated with 1 vial/ single dose of ZOSTAVAX (Merck) (Lot #658084/0888U) in left arm. Concomitant therapies included CYMBALTA, ADVICOR, UNIVASC, vitamins (unspecified) and chondroitin sulfate sodium (+) glucosamine sulfate. On 18-AUG-2008, the patient experienced generalized rash, hives entire body and general malaise. The patient recovered. The patient was enrolled in the Varicella Zoster Virus Identification Program to identify if VZV is present and if it is present to identify if it is associated with the wild type (WT) VZV strain or with the OKA/Merck vaccine VZV strain. Additional information is expected.

VAERS ID:322633 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-19, Days after onset: 1
Location:New York  Entered:2008-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: N/A~ ()~NULL~~In Patient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
Other Medications: PPD Mantoux Test Intradermal on LFA
Current Illness: No
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1372U1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0301-21IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0454X1SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2937BA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood glucose normal, Cold sweat, Dizziness, Heart rate increased, Muscular weakness, Nausea, Neck pain, Oxygen saturation normal, Oxygen supplementation, Pallor, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Approximately 1 min. after the administration of vaccines the pt began c/o dizzines, nauseas, neck pain, weakness and tingling on both arms, pt was cold to touch, pale, sweaty. Immediately was place on the exam table on supine position, glucose fingerstick was perform which was 77 mg/dl, the doctor was notify of the reaction, vitals was taken BP- 148/80,P- 116,R- 30, SO2 Sat-100%, supplemental oxygen with mask was provided, the doctor ordered Epinephrine 0.3 cc SC which was administer on RA, MD called 911 to request an ambulance for pt to be transporter to ER, F/U call was made by MD the day after who spoke with the mother and mom state that pt is stable and that she was D/C the same day after a few tests in the ER.

VAERS ID:322643 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-19, Days after onset: 1
Location:Wisconsin  Entered:2008-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 105 fever~DTaP (no brand name)~2~1~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B023AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0088X1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Nervousness, Pain, Restlessness, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: "Achy" am after vaccinations. Given Motrin by parent at 4:30 pm and 11:00 pm on 8-18-08. Also complained of feeling "nervous, restless" at 10:30 pm on 8-18-08. Did not fall asleep until 2:30 am. Slept through night until 9:00 am on 8-19-08. On 8-19-08, feels o.k. - no restlessness. Plans to inform physician.

VAERS ID:322644 (history)  Vaccinated:2008-08-18
Age:17.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-19, Days after onset: 1
Location:Texas  Entered:2008-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Pt denied any
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU25710IMLA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Haemorrhage, Skin laceration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hostility/aggression (broad)
Write-up: Patient received MCV-4 in L deltoid 0.5 ml at approx 4pm accompanied by his mother and sister. Pt waiting in hallway for his sister to get her shot. Pt fell to the floor. Pt had cell phone on a chain around his neck it was in back of his head when he hit the floor. Skin laceration noted to back of his head by EMT. Pt awake alert. Pressure applied bleeding stop. Pt stated he has been getting black out spells approx 3 per month. Pt taken to EMT.

VAERS ID:322656 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-20, Days after onset: 2
Location:Guam  Entered:2008-08-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2397CA UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA0492 UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0146X UNLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 8 x 10 cm indurated area with erythema - Rt thigh. Instructed to apply warm compresses to area. Rx: Duricef 250/5 cc BID x 5 days.

VAERS ID:322659 (history)  Vaccinated:2008-08-18
Age:5.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-19, Days after onset: 0
Location:North Carolina  Entered:2008-08-19
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 (TRIPEDIA)SANOFI PASTEURU2397BA3IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF427AB IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA1060 IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0440X1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Red indurated upper (R) thigh. 5 in x 5 in. ? Varicella, ? DTaP.

VAERS ID:322660 (history)  Vaccinated:2008-08-18
Age:42.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-18, Days after onset: 0
Location:Illinois  Entered:2008-08-19, 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: NI
Current Illness: None
Preexisting Conditions: Skelaxin Allergy
Diagnostic Lab Data: NI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)SANOFI PASTEURB01821IMLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Client stated via telephone that after leaving the center he became nauseated with 3 episodes of vomiting. He also c/o a severe headache.

VAERS ID:322717 (history)  Vaccinated:2008-08-18
Age:10.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-20, Days after onset: 1
Location:New Jersey  Entered:2008-08-20
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0273X1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives back, neck, chest. Rx SINGULAIR not helped BENADRYL helped. Started PRELONE 15mg PO OD x3d as of 8/20/08.

VAERS ID:322740 (history)  Vaccinated:2008-08-18
Age:18.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-20, Days after onset: 2
Location:Missouri  Entered:2008-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tb
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2661AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 8-18-08 10:30AM - Patient fainted. Revived with cool compresses, ammonia inhalant. Patient vomited. BP 98/58 P.60. 11AM. Patient still complains of nausea and continues to vomit intermittent color pink, talkative, sitting, up, still complained of nausea. Patient escorted out via wheelchair to car with mom and brother. Continued to vomit on and off thru the day. Patient went to work; no complaints next day.

VAERS ID:322743 (history)  Vaccinated:2008-08-18
Age:24.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-19, Days after onset: 1
Location:Illinois  Entered:2008-08-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: IMPLANON
Current Illness: None
Preexisting Conditions: None. PMH: low blood pressure.
Diagnostic Lab Data: 7/8/09 ER records received DOS 8/18/08. LABS and DIAGNOSTICS: Urinalysis - colorless, hazy, RBC +4, WBC +4, squamous epi moderate, mucus rare. Head CT WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0250X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Amnesia, Bradyphrenia, Computerised tomogram normal, Convulsion, Disorientation, Dizziness, Feeling abnormal, Headache, Hypotonia, Immunisation reaction, Myalgia, Nystagmus, Postictal state, Presyncope, Red blood cells urine positive, Syncope, Urinary incontinence, Urinary sediment present, Urine abnormality, Urine analysis abnormal, Urine colour abnormal, White blood cells urine positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Proteinuria (broad), Tubulointerstitial diseases (broad)
Write-up: Pt was administered GARDASIL injection-tolerated well. Less than five minutes later, while checking out, pt stated she was feeling funny, light headed, was taken into an exam room and sat on the table. Pt became limp, closed her eyes and made a few strange noises, and began to seize, made sounds 3 more times and urinated on herself. Dr came in and checked her breathing and took her blood pressure. Pt regained consciousness after approximately 2 minutes, but remained disoriented for another several minutes. During this post-ictal period, Dr. arrived. Pt states she felt like everything was a dream. Transport was called to take the patient to the emergency department. 7/8/09 ER records received DOS 8/18/08. Assessment: Possible vasovagal episode vs seizure. Patient presents after seizure at MD''s office, amnesia for event, urinary incontinence, general body aches. 7/13/09 Neuro consult rec''d dated 8/22/08 with dx: vasovagal syncope. Seen if f/u to above ER visit. Pt reports being "slow" since episode with some H/A, dizziness and nystagmus. Seizure activtiy 2'' to being upright during syncope episode. Syncope precipitated by Gardasil shot. Does not think seizure d/o

VAERS ID:322744 (history)  Vaccinated:2008-08-18
Age:38.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-20
Location:Michigan  Entered:2008-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: hypothyroidism, rheumatoid factor +
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2997AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm red, warm, swollen, and very sore. Treatment-MOTRIN, ice.

VAERS ID:322748 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-20, Days after onset: 1
Location:Illinois  Entered:2008-08-20
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2607AA4IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB253AA1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10093SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0868U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Dark red, warm, swollen, painful area ~6 x 8cm anterior Rt. deltoid. Mother reported giving TYLENOL & applying cold pack. Client said it "feels better now."

VAERS ID:322749 (history)  Vaccinated:2008-08-18
Age:0.4  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-19, Days after onset: 1
Location:New Hampshire  Entered:2008-08-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC351721UNRL
Administered by: Private     Purchased by: Public
Symptoms: Immediate post-injection reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Immediately following vaccine patient developed hives on her leg which resolved very quickly. No further vaccines given.

VAERS ID:322750 (history)  Vaccinated:2008-08-18
Age:13.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-20, Days after onset: 1
Location:Maryland  Entered:2008-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abcess on leg at time of vaccination. Abcess being treated with anti-biotics. Abcess treatment began on 8/12/08 by emergency roo
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.153760SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site warmth, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Received vaccine on 08/18/08, on 08/19/08 patient had 4x6" area of erythema, tender and warm to touch at site of injection on left deltoid, had a fever of 101/5 and malaise. Symptomatic care advised.

VAERS ID:322779 (history)  Vaccinated:2008-08-18
Age:10.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-20, Days after onset: 2
Location:Arizona  Entered:2008-08-20
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0171X1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Induration and redness around injection site approx 2" in diameter.

VAERS ID:322780 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-20, Days after onset: 2
Location:New Jersey  Entered:2008-08-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B064AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04913SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0916X1SCRA
Administered by: Private     Purchased by: Private
Symptoms: 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 region of arm swollen and warm to touch

VAERS ID:322781 (history)  Vaccinated:2008-08-18
Age:3.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-20, Days after onset: 1
Location:Utah  Entered:2008-08-20
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 (DAPTACEL)SANOFI PASTEURC2955BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08053IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0916X1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0177X1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site cellulitis
SMQs:
Write-up: Cellulitis L arm around vaccine site - onset 8/19 tx with PO AUGMENTIN.

VAERS ID:322865 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-21, Days after onset: 3
Location:Missouri  Entered:2008-08-21
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:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.G73641SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local reaction, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Mild/moderate local reaction 6cm x 4cm area of erythema back of left arm; (+) itchy; Zyrtec 10mg tabs 1 tab po q day and Ibuprofen prn

VAERS ID:322889 (history)  Vaccinated:2008-08-18
Age:15.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-21, Days after onset: 3
Location:Kansas  Entered:2008-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0279X0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash erythematous, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: BROKE OUT IN FINE RED RASH,ALL OVER BODY, INCLUDING FACE. RASH NOT NECESSARILY HEAVIER AROUND INJECTION SITE. RASH STARTED ALITTLE LATER THE SAME DAY AS VACCINATION --- CONTINUED FOR NEXT 36 TO 48 HRS. NO DIFFICULTY BREATHING OR ANY OTHER S/S. SG

VAERS ID:322904 (history)  Vaccinated:2008-08-18
Age:17.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-21, Days after onset: 3
Location:Michigan  Entered:2008-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Drysol 20% topical solution. Prescribed day of visit (prior to rxn).
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2687AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Limb discomfort, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm injection given on swollen, redden, warm to touch. Pt states began 1 hr after injection. Waited til next day to report when swelling got bigger, arm tighter. Came in next day for steroid injection, orders for Xyzal, benadryl and oral steriods. Came back next day after treatment for re-assessment. Swelling improved considerably per doctor''s assessment.

VAERS ID:322913 (history)  Vaccinated:2008-08-18
Age:13.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-21, Days after onset: 3
Location:Florida  Entered:2008-08-21
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: Mild acne
Diagnostic Lab Data: Urine - trace WBCs, mod blood, about to start mensed. CBC, WBC 5.5 with 75% segs, 12% monos, CMP normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0070X2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0088X1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blood urine present, Full blood count, Headache, Lymphadenopathy, Malaise, Metabolic function test normal, Monocyte percentage increased, Nausea, Neutrophil percentage, Pain, Pyrexia, Vomiting, White blood cell count normal, White blood cells urine positive
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad)
Write-up: 2 hrs after getting GARDASIL #3 and VARIVAX #2, patient had body aches, headache. Later that evening, had fever to 102. Woke 4AM with nausea, vomiting x 2-3. Nausea, malaise persisted. Seen in office for evaluation 8/19, was afebrile, mild cervical and inguinal adenopathy.

VAERS ID:322919 (history)  Vaccinated:2008-08-18
Age:1.3  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-21, Days after onset: 2
Location:California  Entered:2008-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2950AA3UNRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC808843UNLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Slightly swollen and red

VAERS ID:322925 (history)  Vaccinated:2008-08-18
Age:10.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2008-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1892U1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen (L) deltoid, warm to touch. Tx Benadryl.

VAERS ID:323042 (history)  Vaccinated:2008-08-18
Age:23.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-20, Days after onset: 2
Location:Utah  Entered:2008-08-22, 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: No
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2996AA0UNRA
Administered by: Other     Purchased by: Private
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: Pt came in for a TD and I gave the TDAP on 8/18/200. He returned 8/20/08 to have his PPD read. Pt had no adverse reaction or symptoms noted from TDAP.

VAERS ID:323046 (history)  Vaccinated:2008-08-18
Age:17.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Nebraska  Entered:2008-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2569AA UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021AA UNLA
Administered by: Public     Purchased by: Public
Symptoms: No adverse event
SMQs:
Write-up: No adverse events

VAERS ID:323051 (history)  Vaccinated:2008-08-18
Age:18.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-18, Days after onset: 0
Location:Kentucky  Entered:2008-08-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seasonal Allergic Rhinitis
Diagnostic Lab Data: CT Scan of head and c/s normal x fen left max sinusitis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500541P0IN 
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVB264AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2618AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF452AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0137X0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Computerised tomogram normal, Head injury, Headache, Hypoaesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient syncope when standing after immunization striking head on wall. Patient woke rapidly but had persistent complaint of headache and feeling numb all over. Also complained of chest pain occasionally - All VS - were stable - 120/74 BP immediately after.

VAERS ID:323075 (history)  Vaccinated:2008-08-18
Age:5.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-08-22, Days after onset: 2
Location:Iowa  Entered:2008-08-22
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: Herpes simplex Left eye
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B084AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04524IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0239X1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0421X1SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site inflammation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Left leg inflammation, fever

VAERS ID:323076 (history)  Vaccinated:2008-08-18
Age:10.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-08-22, Days after onset: 2
Location:California  Entered:2008-08-22
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: unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0336X1SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Immune was placed two days ago , site area appears red, swollen, warm to touch and soreness of the arm. Pt denies fever or head aches. Pt''s mom was advise to put cold compreses and to give some Tylenol tx symptoms or to come back if worsening on the next few days.

VAERS ID:323109 (history)  Vaccinated:2008-08-18
Age:0.2  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-22, Days after onset: 3
Location:California  Entered:2008-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denied
Preexisting Conditions: History of hospitalization at 1 month old for high fever, possible viral infection.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B143AA IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF369AA IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC57537 IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0140X PO 
Administered by: Public     Purchased by: Unknown
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 8/18/2008 noon: Pediarix - Hib, PCV7, Rotavirus (1st) vaccinated. 8/2-/08 2pm: mother said baby started rashes from 8/19/2008 - all over the body - small scattered rashes. 8/21/2008 2pm: F/u call. Mother said rashes almost gone.

VAERS ID:323119 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-22
Location:North Carolina  Entered:2008-08-22
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
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B027AA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Accidental overdose, Inappropriate schedule of drug administration
SMQs:, Drug abuse and dependence (broad)
Write-up: Patient was given 2 Tdap vaccines a week apart.

VAERS ID:323126 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-08-22, Days after onset: 2
Location:Massachusetts  Entered:2008-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERU2356BA4IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERA03013SCLA
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER0452X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0602U1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Both arms red, swollen, hematoma, hives from site of vaccine down arms. No resp. issues. Advised BENADRYL q 6 hours - call if no improvement.

VAERS ID:323127 (history)  Vaccinated:2008-08-18
Age:8.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-22, Days after onset: 3
Location:Missouri  Entered:2008-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin pump
Current Illness: None
Preexisting Conditions: VUR - IDDM
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB294BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0424X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Skin warm
SMQs:
Write-up: 8x10cm back of L arm warm to touch. Observe - no other Tx.

VAERS ID:323130 (history)  Vaccinated:2008-08-18
Age:6.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-21, Days after onset: 2
Location:New York  Entered:2008-08-22, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0~In Patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Physical exam and follow-up only - localized reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B064AA4IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB292AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1905U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Local reaction, Physical examination
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Child received on 8/18/2008. Parents report that within 24 hours both vaccine sites became red, warm and swollen. Child complained of itching at sites. Cool compresses applied.

VAERS ID:323131 (history)  Vaccinated:2008-08-18
Age:0.8  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-22, Days after onset: 4
Location:Maryland  Entered:2008-08-22
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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B163BC2IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUF449AA1IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC659312IMUN
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever

VAERS ID:323133 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-08-22, Days after onset: 2
Location:Maryland  Entered:2008-08-22
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 (DAPTACEL)SANOFI PASTEURAC14B084AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA01703IMLL
Administered by: Private     Purchased by: Private
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: Left leg red, hard, swollen; warm to touch

VAERS ID:323094 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-23, Days after onset: 4
Location:New Hampshire  Entered:2008-08-23
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: Obesity, hypertension
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2665AA-STATE0IMLA
Administered by: Unknown     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: Presented to clinic 8/21 with swelling from Left shoulder to elbow, diffuse erythema, no tenderness. No treatment was indicated.

VAERS ID:323099 (history)  Vaccinated:2008-08-18
Age:0.3  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-23, Days after onset: 5
Location:New York  Entered:2008-08-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: not known~ ()~NULL~~In Patient|fever, diarrhea, fussy, crying, won''t sleep, withdrawn and non interactive,~DTaP + IPV + Hib (Pen
Other Medications: none
Current Illness: no
Preexisting Conditions: premature twin
Diagnostic Lab Data: none, just fever of 102 by thermometer
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURUNKNOWN1IMUN
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1IMUN
RVX: ROTAVIRUS (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Crying, Diarrhoea, Diet refusal, Insomnia, Irritability, Pyrexia, Rash generalised, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Fever of 102 degrees, diarrhea, not eating, vomiting, rash all over body, fussy, crying, won''t sleep, can''t put the baby down or he cries. Fever gone after five days, eating better but still fussy, not sleeping good and rashy.

VAERS ID:323100 (history)  Vaccinated:2008-08-18
Age:0.3  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-23, Days after onset: 5
Location:New York  Entered:2008-08-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unknown~ ()~NULL~~In Patient|fever,diarrhea, rash, fussy/crying, not sleeping,not eating,~DTaP + IPV + Hib (Pentacel)~1~0~In Sib
Other Medications: none
Current Illness: no
Preexisting Conditions: premature twin
Diagnostic Lab Data: fever verified by thermometer
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEUR 1IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH 1IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 1PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Abnormal behaviour, Crying, Diarrhoea, Diet refusal, Insomnia, Irritability, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow)
Write-up: Fever of 102, fussy, diarrhea, not eating, vomiting, not sleeping, crying, can''t put him down, fussy, non interactive-not playing, cooing, babbling. Fever and diarrhea gone after 5 days but still fussy, won''t sleep and non interactive.

VAERS ID:323103 (history)  Vaccinated:2008-08-18
Age:0.5  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-24, Days after onset: 6
Location:Texas  Entered:2008-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient is also on propranolol and prednisolone to treat a large infantile hemangioma.
Current Illness: None. Patient was very happy and healthy.
Preexisting Conditions: PHACE Syndrome - large infantile hemangioma (caused blindness in right eye), complete agensis of the corpus callosum.
Diagnostic Lab Data: A nurse with the doctor''s office suggested tips on how to help get the vomitting under control. She was willing to make an appointment for the doctor to see the child, but we didn''t think it would accomplish much of anything and therefore t
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
RVX: ROTAVIRUS (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Unknown
Symptoms: Diarrhoea, Irritability, Lethargy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow)
Write-up: Patient became very fussy and lethargic about a few hours after five different vaccines were administered. The next morning, she began vomiting, which continued for more than 24 hours. Then she experienced fever and diarrhea the following 24 hours. She remained fussy and leghargic the entire time. We called the doctor''s office numberous times. In the meantime, she''s on other medications administered orally, which she was unable to keep down.

VAERS ID:323166 (history)  Vaccinated:2008-08-18
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-22
Location:California  Entered:2008-08-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Penicillin/Augmentin PMH: reconstructive ureter surgery, 1999.
Diagnostic Lab Data: CSF culture - no growth; Neg gram stain; CSF WBC = 49; Protein 28; Glucose 51 LABS: CSF: WBC 49, neutros 33, lymphs 53, monos 12, protein 28, glucose 51. CT of head WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2420AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: CSF culture negative, CSF glucose normal, CSF protein normal, CSF white blood cell count increased, Computerised tomogram normal, Enterovirus infection, Gram stain negative, Headache, Meningitis viral, Nausea, Photophobia, Pyrexia, Sick relative
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Admit to hospital 8/20/08, HA, fever, nausea x 2days. HA following MENACTRA given 8/18/08 - sister also diagnosed meningitis and hospitalized 8/12/08; she also received vaccine 8/18/08 9/26/08 Reviewed hospital medical records of 8/20-8/23/2008. FINAL DX: viral meningitis, enterococcus. Records reveal patient experienced HA, photophobia, fever & nausea. Younger sibling admitted w/same. Tx w/IV antibiotics & antivirals. Improved & d/c to home.

VAERS ID:323167 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-22
Location:California  Entered:2008-08-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CSF WBC = 21; Neg gram Stain; CSF culture - No growth LABS: CSF: neutros 92%, lymphs 3%, monos 5%; protein 23, glucose 66.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2420AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: CSF culture negative, CSF glucose normal, CSF protein normal, CSF white blood cell count increased, Enterovirus infection, Gram stain negative, Headache, Meningitis viral, Pyrexia, Respiratory rate increased, Sick relative, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Admit to hospital 8/21/08. Fever, vomiting x 2 days - HA after receiving vaccine. Brother admitted with meningitis to same hospital 8/20/08. He also received vaccine 8/18/08. 9/26/07 Reviewed hospital medical records of 8/21-8/23/2008. FINAL DX: enterococcal viral meningitis Records reveal patient experienced HA x 2 days. Seen in outlying ER where LP (+). Older sibling admitted w/same. Fever, increased respiratory rate. Tx w/IV antibiotics & antivirals. Improved & d/c to home.

VAERS ID:323174 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-21, Days after onset: 2
Location:Connecticut  Entered:2008-08-25, 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: WBC 12,600; 82% Neutrophils; ESR = 32
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2565AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Headache, Neck pain, Neutrophil percentage increased, Red blood cell sedimentation rate increased, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Arthritis (broad)
Write-up: T = 103, HA, Neck pain

VAERS ID:323255 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-21, Days after onset: 2
Location:California  Entered:2008-08-25, 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: short stature, Aortic stenosis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2935AA1UNRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04901UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0413U1UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.189241UNRA
Administered by: Private     Purchased by: Other
Symptoms: Rash, Rash papular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Mother noted a rash on both arms after receiving MMR LD; DTaP (LD); VARIVAX (RD). On 8/18/08 no fever, some swelling, no erythema, no ischemia. Exam revealed papular non vesicular rash billious, no erythema. BENADRYL

VAERS ID:323287 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-18, Days after onset: 0
Location:Arizona  Entered:2008-08-26, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB291AA0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2552AA0UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC2994BA UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0391X0UNUN
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Pallor, Visual disturbance
SMQs:, Anticholinergic syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: She felt light headed and became pale after her fourth shot. She said that all the colors in the room started blending together. She felt light headed. She never passed out.

VAERS ID:323289 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-19, Days after onset: 0
Location:Washington  Entered:2008-08-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: None
Diagnostic Lab Data: None done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2420AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2937BA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Pain in extremity, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 8/19/08 3AM: vomiting + arm pain. 2PM: vomited. 4PM: no longer vomited=slight fever.

VAERS ID:323290 (history)  Vaccinated:2008-08-18
Age:15.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-08-21, Days after onset: 1
Location:Georgia  Entered:2008-08-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol MDI-prn
Current Illness: none
Preexisting Conditions: RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0229X0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2998BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Ear pain, Facial palsy, Pharyngolaryngeal pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Seen on 8/21/08 - dx with Bell''s palsy - sx include L ear pain, sore throat, "can''t move L side of face". Placed on prednisone 20mg bid x5d.

VAERS ID:323298 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-19, Days after onset: 1
Location:California  Entered:2008-08-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD, Sanofi, C2998, Lt ID
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Pte taken to ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB239AA0IMUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2665AA0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC998BA0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0170X1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Dyskinesia, Eye rolling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Pte. felt dizzy and was fainting. She sat on a chair and her body became very still she rolled over her eyes and had jerky movements for a few seconds.

VAERS ID:323305 (history)  Vaccinated:2008-08-18
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-21
Location:Indiana  Entered:2008-08-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERC29518A IMLA
Administered by: Public     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Patient was on table, mother signed her initials to vaccine records. Medical assistant gave vaccine. Mother stated after vaccine was given, this is not (brother) was sitting on chair (Spanish speaking) communication poor.

VAERS ID:323328 (history)  Vaccinated:2008-08-18
Age:31.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-26, Days after onset: 7
Location:Louisiana  Entered:2008-08-26
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
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2299DA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Induration, Injection site pain, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: MASSIVE ERYTHEMA, EDEMA,HARDNESS, PAIN INJECTION SITE PROGRESSED UNTIL 2 DAYS POST INJECTION. ANTIBIOTIC COURSE, STEROID CREAM BEGAN WITH RAPID RECOVERY

VAERS ID:323362 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-26, Days after onset: 8
Location:Texas  Entered:2008-08-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2934AA4IMLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.1259U IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08053SCRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site discolouration, Injection site induration, Injection site pain, 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 leg was noted to be painful and hard after immunization. Enlarged with itching Left thigh with 13x6cm area of mild discoloration and warmth spreading from her injection site medially.

VAERS ID:323488 (history)  Vaccinated:2008-08-18
Age:12.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Male  Submitted:2008-08-27, Days after onset: 7
Location:Unknown  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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2632AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2767AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1806U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Received three immunizations in the arms on 8/18/08 on Wed. the 20th he developed a high fever of 103f and severe pain all the way down both legs starting at the waist and down both legs. Legs were very painful to touch. By Thurs. the 21st the fever and leg pains were gone and just had mild soreness at injection sites on arms.

VAERS ID:323489 (history)  Vaccinated:2008-08-18
Age:5.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-27, Days after onset: 8
Location:North Carolina  Entered:2008-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NO~ ()~NULL~~In Patient|NO~ ()~NULL~~In Sibling1|NO~ ()~NULL~~In Sibling2
Other Medications: SINGULAIR ON 8-17-08
Current Illness: NO
Preexisting Conditions: ALLERGIES AND ASTHMA
Diagnostic Lab Data: NO
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU2354BA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: PT RECEIVED TDAP, MMR, VARM AND IPV ON 8-18-08 NOTED REDNESS, PAINFUL, WARM TO TOUCH AND EDEMA TO RIGHT ARM; LOCATION OF TDAP. PT WAS TAKEN TO URGRET CARE ON 8-19-08. PT WAS REASSESSED IN OFFICE ON 8-20-08 AND TREATMENT ORDERED.

VAERS ID:323508 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-27, Days after onset: 9
Location:Michigan  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: NONE
Current Illness: NO
Preexisting Conditions: ALLERGIES HEART MURMUR
Diagnostic Lab Data: CBC COMP METABOLIC PANEL CRP STSH MONO ESR EBV BLOOD CULTURE08
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB264AA1IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2889AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood culture, Blood thyroid stimulating hormone, C-reactive protein, Epstein-Barr virus antibody, Full blood count, Laboratory test, Liver function test abnormal, Pyrexia, Rash, Red blood cell sedimentation rate, Urticaria
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: HIVE LIKE RASH FEVER ELEVATED LFT

VAERS ID:323580 (history)  Vaccinated:2008-08-18
Age:21.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-27, Days after onset: 9
Location:Maryland  Entered:2008-08-28, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: diagnostic laboratory, 08/18/08 - blood work at emergency room (not specified)
CDC Split Type: WAES0808USA03618
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0762U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Dysarthria, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Information has been received from a Registered nurse concerning a 21 year old female patient with no known drug allergies, no pertinent medical history who on 18-AUG-2008 was vaccinated with a first dose of RECOMBIVAX HB lot # 0762U. There was no concomitant medication and no other vaccination given to the patient. The nurse reported that twenty minutes after vaccination the patient developed malaise, fever and slurred speech after getting the dose of RECOMBIVAX HB. She was sent to the emergency room (ER) and was treated with intravenous (IV) corticosteroids (unspecified) and BENADRYL to prevent neurological disorder. Unspecified laboratory tests were done at the E.R. The patient left ER on course of oral prednisone which was completed on 25-AUG-2008. The patient recovered and went back to work. The reporter considered patient getting I.V. steroids and BENADRYL in the emergency room (ER) was an intervention to prevent a serious criteria and it was reported as an other medical event (OME). The nurse reported that the events were related to RECOMBIVAX HB. This is one of two reports from the same source. Additional information has been requested.

VAERS ID:323590 (history)  Vaccinated:2008-08-18
Age:0.5  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-20, Days after onset: 2
Location:Iowa  Entered:2008-08-28, Days after submission: 8
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:
Current Illness: nasal congestion
Preexisting Conditions: PMH: ex-preemie w/early feeding intolerance since resolved.
Diagnostic Lab Data: elevated CRP at 2.6 LABS: WBC 14.2K, absolute neutros 5.9K. Blood & CSF c/s neg. CSF virus cultures neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B141BA IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUF373AB IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC45721K IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0616X PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Blood culture negative, C-reactive protein increased, CSF culture negative, Fontanelle bulging, Irritability, Nasal congestion, Neutrophil count decreased, Pyrexia, Rhinorrhoea, Thrombocythaemia, Viral infection, Virus culture negative, White blood cell count normal
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow)
Write-up: Pt nasally congested 8/17. Had vaccinations 8/18 at 3:30pm. Congestion worsened that evening. Fever in am of 101 degrees core. At noon dad noticed anterior fontanelle bulging. Child alert but slightly more fussy than usual. Eating fair but improving by this afternoon. 10/1/08 Reviewed hospital medical records of 8/19-8/21/2008. FINAL DX: viral syndrome; meningitis ruled out; pre-existing diaper dermatitis Records reveal patient experienced fever & bulging fontanel day after vaccinations. Had rhinorrhea, mild thrombocytosis & decreased abs neutros. Tx w/IV antibiotics & antivirals. Improved & d/c to home.

VAERS ID:323603 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-19, Days after onset: 0
Location:Washington  Entered:2008-08-28, 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: None
Preexisting Conditions: Rickets at 4 months
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2955AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04913SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0480X1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0393X1SCRL
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling in left thigh

VAERS ID:323605 (history)  Vaccinated:2008-08-18
Age:0.7  Onset:0000-00-00
Gender:Male  Submitted:2008-08-18
Location:Nebraska  Entered:2008-08-28, 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: Well child check
Preexisting Conditions: None known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B142AA2UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA01110UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC650432UNLL
Administered by: Private     Purchased by: Public
Symptoms: Overdose
SMQs:, Drug abuse and dependence (broad)
Write-up: Two Ipol Shots were given at 3:45 pm

VAERS ID:323608 (history)  Vaccinated:2008-08-18
Age:5.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-22, Days after onset: 3
Location:California  Entered:2008-08-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2934AA4 LL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA016923 LL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0775U1 RL
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right leg upper 20 X 25 cm; right leg lower 10 X 20 cm areas red and hot to touch.

VAERS ID:323644 (history)  Vaccinated:2008-08-18
Age:30.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-28, Days after onset: 9
Location:New Jersey  Entered:2008-08-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, ortho tri cyclen lo
Current Illness: none
Preexisting Conditions: n/a
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN0IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1IMRA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTDUNKNOWN0PO 
Administered by: Private     Purchased by: Private
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Very itchy rash started the day after first pill and continued days after last pill was taken.

VAERS ID:323653 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-28, Days after onset: 9
Location:North Carolina  Entered:2008-08-28
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: ADHD, RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB238AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2422AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1894U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: R arm swollen, red and warm to touch around injection site

VAERS ID:323802 (history)  Vaccinated:2008-08-18
Age:6.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-31, Days after onset: 13
Location:Minnesota  Entered:2008-08-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: he had gotten bopped in the nose playing with a friend, and had had one bloody nose a day for the two days prior to the vaccine, otherwise healthy.
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAUB243AA0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Bloody noses anywhere from 1 to 3 per day, every day since the immunization was administered up through the 28th, when he had 2 bloody noses. While he can get a bloody nose that will bleed from the same spot for a couple of days until healed, he has never had bloody noses for 10 days straight before.

VAERS ID:323808 (history)  Vaccinated:2008-08-18
Age:0.3  Onset:2008-08-24, Days after vaccination: 6
Gender:Female  Submitted:2008-08-31, Days after onset: 7
Location:Georgia  Entered:2008-08-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NTR
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH 0IMRL
Administered by: Private     Purchased by: Unknown
Symptoms: Childhood disintegrative disorder
SMQs:, Psychosis and psychotic disorders (broad)
Write-up: 1 week following 4 month check-up/vaccination visit, noticed significant reduction in language skills previously mastered and eye contact.

VAERS ID:324007 (history)  Vaccinated:2008-08-18
Age:48.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-09-03, Days after onset: 15
Location:South Carolina  Entered:2008-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol XL, Micardis, flexeril,Effexor XR,trandolapril,verapamil
Current Illness: none
Preexisting Conditions: HTN,Anxiety/Depression, history of tachycardia, hisotry of pulmonary embolus post op peritoneal cystectomy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3027AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Chills, Headache, Injection site swelling, Injection site warmth, Local reaction, Nausea, Photophobia, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Tdap administered on 8/18/08. On 8/19 next day, had fevers, chills, nausea and seen at Convenience Care medical center for same. Nausea lasted all week, large local reaction with heat,swelling in left deltoid at administration site. Had photophobia, crown headache. Missed three days of work.

VAERS ID:324056 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-08-20, Days after onset: 1
Location:Georgia  Entered:2008-09-03, Days after submission: 14
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: Local reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0250X1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1490U1SCRA
Administered by: Military     Purchased by: Military
Symptoms: Local reaction
SMQs:
Write-up: Local reaction onset x 24 hours after vaccination. Cool compresses/OTC antihistamine.

VAERS ID:324060 (history)  Vaccinated:2008-08-18
Age:0.2  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-25, Days after onset: 7
Location:Unknown  Entered:2008-09-03, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B1413A0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF250AD0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC575410IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1830U0PO 
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, swelling of injection site.

VAERS ID:324071 (history)  Vaccinated:2008-08-18
Age:54.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-25, Days after onset: 7
Location:California  Entered:2008-09-03, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL
Current Illness: leg pain, follow up from Em Rm visit
Preexisting Conditions: High blood pressure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Broke out in rash-Hives lasted until Friday 22nd, itching 3 hrs after Benadryl shot-Benadryl pills

VAERS ID:324077 (history)  Vaccinated:2008-08-18
Age:6.0  Onset:2008-08-21, Days after vaccination: 3
Gender:Male  Submitted:2008-08-26, Days after onset: 5
Location:California  Entered:2008-09-03, 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: Allergic to penicillin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB239AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1908U0SCRA
Administered by: Other     Purchased by: Public
Symptoms: Auricular swelling, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Rash to face then spread to trunk, at ear lobe got swollen approximately 8-21-08. Seen 8-23-08. Treated with Benadryl 2 tsp every 4 hours prn for hives.

VAERS ID:324301 (history)  Vaccinated:2008-08-18
Age:9.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-26, Days after onset: 8
Location:Pennsylvania  Entered:2008-09-05, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1670U2UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1020U1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Dyspnoea, Heart rate normal, Injection site swelling, Local reaction, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Given both injections ~3:30 P.M 8/18/08. Left office and mom called about 10 min. later from cell phone to say child c/o chest pain and difficulty breathing. Came right back to office. See office notes (attached). Pt just had NV for immunizations. Was in the car about to leave the parking lot (not 5-10 minutes later), developed CP associated w/ breathing, mom brought him immediately back to our office. Never happened b/f - did have a h/o allergies though, and +fam h/o asthma. On arrival, we brought him to the exam room. He c/o subjective central CP (not reproducible) but assoc w/ deep breaths. NO SOB, dizziness, vomiting, tongue swelling, dyspnea. Appeared comfortable/non-toxic. On initial exam, he had scant faint exp wheezing but good air movement, no Rtx''s or intercostal muscle use. Good cap refill, pulse 80''s-90''s & regular, no oroph erythema or swelling. We gave him a neb tx; he felt much better & remained comfortable throughout. Lung exam was improved (almost normal to begin with). We also gave 25 mg po BENADRYL & 40 mg po prednisone in the office. He stayed here X20-30 minutes for observation & did fine. Caller: parent called at 2000 on 7;19;2008. Concerns/Comments: see prior notes on immunization reaction. Tonight he noted swelling of the arm locally where the injection was given without redness and minimal itching and no pain with use of the arm no CP/SOB. Probably large local reaction. Will use ice and TYLENOL and have them call in the AM if not better. Doctor responded at 20:05 on 7/19/2008.

VAERS ID:324314 (history)  Vaccinated:2008-08-18
Age:1.2  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-09-02, Days after onset: 15
Location:California  Entered:2008-09-05, 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
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB245AA0UNLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0356X0UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC99642 UNRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0137X0UNRL
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Anorexia, Diarrhoea, Fatigue, Immediate post-injection reaction, Irritability, Pyrexia, Rash, Screaming, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Fussy immediately after immunization, screaming, not sleeping well, diarrhea off and on, off and on fever, stomach pain; Lasted 12-13 days, was tired all the time. Rash in day 13. Loss of appetite.

VAERS ID:324675 (history)  Vaccinated:2008-08-18
Age:5.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-09-09, Days after onset: 20
Location:Illinois  Entered:2008-09-09
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2953AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA04923SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0481X1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0591X1SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug hypersensitivity, Injection site cellulitis, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Patient received imms on 8/18/08 and on 8/20/08 her Lt. thigh was red and swollen(5" by 4") per mom.She was seen by her own MD and also 4 times in the ER. Also seen by a pediatrician. Diagnosed with cellulitis and put on Bactrim. It did improve. She was given a second course of Bactrim but developed an allergic reaction to it and was switched to Zithromax.She has had fevers off and on as hihg as 102.5.

VAERS ID:325216 (history)  Vaccinated:2008-08-18
Age:4.0  Onset:0000-00-00
Gender:Male  Submitted:2008-09-12
Location:Washington  Entered:2008-09-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B130AA UNRA
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: None - incorrect vaccine given for age.

VAERS ID:326656 (history)  Vaccinated:2008-08-18
Age:  Onset:2008-08-18, Days after vaccination: 0
Gender:Unknown  Submitted:2008-09-15, Days after onset: 28
Location:New York  Entered:2008-09-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0808USA03176
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: Information has been received from a physician concerning a patient who on 08-APR-2008 and on 18-AUG-2008 was vaccinated with the first and second dose respectively of ROTATEQ vaccine live (human-bovine). No adverse effect were reported. It was unknown if patient sought medical attention. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:327143 (history)  Vaccinated:2008-08-18
Age:13.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-09-15, Days after onset: 28
Location:California  Entered:2008-09-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0808USA03711
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Information has been received from a physician concerning a 13 year old female who on 18-AUG-2008 was vaccinated with the first dose of GARDISIL (Lot No. 659184/0843X). After receiving the first dose, the patient experienced dizziness and vomiting at the physician''s office. At the time of the reporting, the patient had recovered. Additional information has been requested.

VAERS ID:327163 (history)  Vaccinated:2008-08-18
Age:21.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-09-15, Days after onset: 28
Location:California  Entered:2008-09-17, Days after submission: 2
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: WAES0808USA04118
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0570X0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, 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)
Write-up: This is in follow-up to report(s) previously submitted on 9/15/2008. Initial and follow-up information has been received from a physician concerning a 21 year old female with no related medical history who on 18-AUG-2008 was vaccinated into left deltoid with the first dose of GARDASIL. (Dose and site of administration not reported). (Lot # 60616/0570X). There was no illness at the time of vaccination. Concomitant therapy included birth control medication. At 1100 after shot was given patient started feeling dizzy and fainted. It lasted for couple of minutes. The patient fainted after first dose within 2 minutes of receiving injection. No injury sustained. No hospitalization was required. It was unknown if the patient sought medical attention. No further information is available. Additional information has been requested.

VAERS ID:327233 (history)  Vaccinated:2008-08-18
Age:17.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-09-15, Days after onset: 28
Location:Indiana  Entered:2008-09-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Fear of needles
Diagnostic Lab Data: Unknown; blood pressure, 120/7
CDC Split Type: WAES0808USA04147
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0384U2IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR  IMLA
Administered by: Private     Purchased by: Public
Symptoms: Fall, Head injury, Headache, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a registered nurse concerning a 17 year old female with a fear of needles who on 20-AUG-2008 was vaccinated with the third dose of GARDASIL 0.5mg, IM. Subsequently on 20-AUG-2008 the patient fainted and fell on her head. Subsequently, the patient recovered. The patient didn''t seek medical attention. Additional information has been requested. This is in follow-up to report(s) previously submitted on 9/15/2008. Follow up information was received from the registered nurse on 23-DEC-2008: the patient was vaccinated with the third dose GARDASIL (Lot # 657617/0384U) intramuscularly in her right deltoid on 18-AUG-2008 at 10:50, and in the same day she received a dose of ADACEL (Lot # C2730AA) intramuscularly in her left deltoid at 10:46. It was reported that the patient was seated on exam table, talking post injection, did not complain, suddenly at 11:00 fell off left side of table, and landed on head, unconscious for approximately 3 to 4 minutes. No warning before fainting. At 11:10, the patient''s blood pressure was 120/72 and she also had complaint of headache. The patient was examined by the physician. She was found to have full range of motion and had no parathesia. The patient had recovered at the time of this report. No further information is available.

VAERS ID:325395 (history)  Vaccinated:2008-08-18
Age:1.1  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-09-18, Days after onset: 30
Location:Washington  Entered:2008-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no previous illnesses
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Vaccination complication, Varicella post vaccine
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: WIthin 24 hrs of vaccinations being administered my son, who has never been ill, spiked a fever of 103. He had a trip to the Er, a house call and a follow up visit with his primary physican during the next 3 days. His fever did not subside for four days. Four weeks later he developed a case of chicken pox, one of the shots he had been given. The dr was surprised at the severity of his case as well as the timing. He firmly believes the fever following his vacinations is directly related to his immunizations.

VAERS ID:325818 (history)  Vaccinated:2008-08-18
Age:0.2  Onset:2008-08-21, Days after vaccination: 3
Gender:Female  Submitted:2008-09-22, Days after onset: 32
Location:Unknown  Entered:2008-09-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0809USA02620
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)
Write-up: Information has been received from a physician concerning a 2 month old female who, on 18-AUG-2008, was vaccinated with a first dose of ROTATEQ, oral. Three days later, on 21-AUG-2008, the patient experienced hematochezia which was described as "light spotting". One week later, on 28-AUG-2008 the patient again experienced hematochezia also described as "light spotting". Unspecified medical attention was sought. Subsequently, the patient recovered from both events of hematochezia (dates unknown). No product quality complaints were involved. Hematochezia was considered to be an other important medical event. Additional information has been requested.

VAERS ID:326032 (history)  Vaccinated:2008-08-18
Age:42.0  Onset:2008-09-08, Days after vaccination: 21
Gender:Female  Submitted:2008-09-22, Days after onset: 14
Location:Unknown  Entered:2008-09-24, Days after submission: 2
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: Unknown
Diagnostic Lab Data: Viral cultures 9/15/2008: HSV negative; VZV positive (verbal report from lab 9/19/2008)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETHVV04003A   
Administered by: Military     Purchased by: Military
Symptoms: Herpes simplex serology negative, Herpes zoster, Rash erythematous, Rash vesicular, Varicella zoster virus serology positive
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Developed vesicular erythematous skin eruption over left flank in dermatomal distribution, onset "several days" following receipt of SPV left arm given 18 Aug 2008 (exact date of onset unknown). Received AVA #1, typhoid vaccines on 15 Aug 2008, & AVA #2 29 Aug 2008; IZ record indicated exempt status for varicella 2/2 non-susceptibility. Seen by allergist 15 Sep 2008, diagnosed with herpes zoster - no treatment indicated at time.

VAERS ID:326222 (history)  Vaccinated:2008-08-18
Age:67.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-09-25, Days after onset: 38
Location:Michigan  Entered:2008-09-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NORCO/PRN
Current Illness: None
Preexisting Conditions: Menopause, PCN-Pentanyl-IV dye-DEXAPIN/Hyperlipidimia - DJD-asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.038040SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Local reaction, Nausea, Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Some day local reaction was arm sore red warm and big 5PM had softball sized swelling are of injection with some nausea and felt feverish that day. Felt fine next day except re jot soreness and edema con''t X 2-3 wks (in L arm)

VAERS ID:326411 (history)  Vaccinated:2008-08-18
Age:24.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-20, Days after onset: 2
Location:Ohio  Entered:2008-09-29, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)SANOFI PASTEUR 1IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Lymphadenopathy, Pruritus generalised, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rabies vaccine #2 of possible 3 - had itching all over body w/ rash, swollen lymph node to left side of neck.

VAERS ID:328247 (history)  Vaccinated:2008-08-18
Age:65.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-09-24, Days after onset: 36
Location:Maryland  Entered:2008-10-08, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity; chronic obstructive pulmonary disease; hypertension
Preexisting Conditions: Chickenpox
Diagnostic Lab Data: None
CDC Split Type: WAES0808USA03986
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1413U SCUN
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This is in follow-up to report (s) previously submitted on 9/24/2008. Information has been received from a 66 year old male with no allergies who on 18-AUG-2008, 2 days ago, was vaccinated with ZOSTAVAX (Oka/Merck) 0.65 ml (lot # not reported). Concomitant therapy included atenolol. On 19-AUG-2008 the patient experienced rash from elbow to wrist and behind his knees after vaccination. The patient''s rash from elbow to wrist and behind his knees persisted. The patient sought medical attention. Additional information has been requested. Information has been received from a 66 year old male with hypertension, Chronic obstructive pulmonary disease, a history of chickenpox and drug allergies to CELEBREX and CLONAPIN who on 18-AUG-2008, 2 days ago, was vaccinated with ZOSTAVAX vaccine (Oka/Merck) 0.65 ml (lot # 658867/1413U) SC in left arm. Concomitant therapy included atenolol. On 19-AUG-2008 the patient experienced rash from elbow to wrist and behind his knees within 24 hours of vaccination. There was no recent exposure to chickenpox. The patient''s rash from elbow to wrist and behing his knees persisted. The patient sought medical attention. Additional information has been requested.

VAERS ID:328293 (history)  Vaccinated:2008-08-18
Age:7.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-09-24, Days after onset: 37
Location:North Carolina  Entered:2008-10-08, Days after submission: 14
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: WAES0808USA04053
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0298X SCUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: This is in follow-up to report (s) previously submitted on 9/24/2008. Information has been received from a licensed practical nurse concerning a 7 year old patient who on 18-AUG-2008 was vaccinated with ZOSTAVAX (lot#: 659406/0298X) instead of VARIVAX. This was a human error. No adverse events were reported. The patient sought unspecified medical attention. Additional information has been requested. Information has been received from a licensed practical nurse concerning a 7 year old male who on 18-AUG-2008 was vaccinated with ZOSTAVAX vaccine (Oka/Merck) (MSD). This was a human error. The nurse picked the wrong vaccine to give the patient. No adverse events were reported. The patient sough unspecified medical attention. Additional information has been requested.

VAERS ID:328305 (history)  Vaccinated:2008-08-18
Age:  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-09-24, Days after onset: 37
Location:Indiana  Entered:2008-10-08, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0808USA04688
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a nurse, concerning a male who on sometime last week (approximately 18-AUG-2008) was vaccinated with ZOSTAVAX. There was no concomitant medication. The patient experienced generalized rash after vaccination with ZOSTAVAX. The patient sought medical attention, seen in office. There was no product quality complaint. Additional information has been requested.

VAERS ID:328396 (history)  Vaccinated:2008-08-18
Age:0.3  Onset:2008-10-02, Days after vaccination: 45
Gender:Female  Submitted:2008-10-13, Days after onset: 11
Location:New York  Entered:2008-10-14, Days after submission: 1
Life Threatening? No
Died? Yes
   Date died: 2008-10-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown 10/30/08-records received-Pathology report acute abdomen, abdominal compartment syndrome. Omental tissue with foci of acute inflammation and fibrinous exudate. CAT scan no evidence of intussusception.
CDC Split Type: WAES0810USA01805
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2958AA1UNLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF461AA1UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURAC04911UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC692551UNRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0413X1PO 
Administered by: Other     Purchased by: Other
Symptoms: Abdominal compartment syndrome, Abdominal distension, Activated partial thromboplastin time prolonged, Appendicectomy, Appendicitis, Coagulopathy, Computerised tomogram, Death, Endotracheal intubation, Explorative laparotomy, Gastrointestinal necrosis, Hypotension, Inflammation, International normalised ratio increased, Lethargy, Mechanical ventilation, Metabolic acidosis, Necrosis, Occult blood positive, Omentectomy, Pleural effusion, Pyrexia, Renal failure acute, Resuscitation, Thrombocytopenia, Urine output decreased, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (narrow)
Write-up: Information has been received from a physician concerning a patient younger than 6 months who was vaccinated with a dose of oral ROTATEQ. There was no concomitant medication. Subsequently, the patient died after receiving a dose of ROTATEQ. The cause of death has not been reported. Unspecified medical attention was sought. No product quality complaint involved. Additional information has been requested. 10/30/08-records received for DOS 10/2-10/3/08-presented with fever 103 and lethargy, developed abdominal distention and occult blood positive stool. Decreased urine output. Exploratory laparotomy, drainage of peritoneal fluid, omentectomy, appendectomy. Intubation and ventilation and resuscitation. Profound metabolic acidosis. Right pleural effusion. Necrotic omentum. Acute renal failure. 12/1/08-provisional autopsy report received-Provisional clinical diagnosis: suspected abdominal compartment syndrome. Emergency laparotomy with appendectomy, omentectomy and placement of peritoneal drain. Postoperatively developed severe thrombocytopenia and prolong APTT and INR. Hypotensive secondary to suspected ventricular fibrillation. Resuscitation unsuccessful. Pathologic examination of appendix revealed suppurative acute appendicitis with focal transmural necrosis and extensive periappendicitis. 4/6/09-final autopsy report received. Clinical Diagnosis:fever and lethargy. Abdominal distention and hem positive stool with currant jelly appearance. Acute passive hepatic congestion. Congestive splenomegaly. Bilateral renal medullary congestion. Hypotension due to suspected ventricular fibrillation. Postoperative severe thrombocytopenia and abnormal coagulation profile. krk

VAERS ID:329669 (history)  Vaccinated:2008-08-18
Age:19.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2008-10-14, Days after onset: 56
Location:Unknown  Entered:2008-10-17, 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: metoprolol
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA01982
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Dizziness, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with penicillin allergy and sulfonamide allergy and history of tachycardia who on 18-AUG-2008 was vaccinated with the first dose of GARDASIL, 0.5 mL, IM. Concomitant therapy included metoprolol. Since 19-AUG-2008, the patient experienced fever, nausea, vomiting, chills, dizziness and fatigue. On 09-SEP-2008, the patient sought medical attention calling to the office because her symptoms had not resolved. Additional information has been requested.

VAERS ID:329738 (history)  Vaccinated:2008-08-18
Age:0.3  Onset:2008-08-27, Days after vaccination: 9
Gender:Female  Submitted:2008-10-17, Days after onset: 51
Location:Maryland  Entered:2008-10-23, Days after submission: 6
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: none
Preexisting Conditions: None
Diagnostic Lab Data: LABS: CBC, CMP, UA WNL. Urine c/s neg. Stool heme (+). US of abdomen (+) IS. Air enema reduced IS.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B160BA IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.C3438059 IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHC86140 IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0303X1PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Barium double contrast, Culture urine negative, Decreased activity, Enema administration, Full blood count normal, Hypersomnia, Hypophagia, Intussusception, Laboratory test normal, Occult blood positive, Pyrexia, Ultrasound abdomen abnormal, Urine analysis normal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)
Write-up: Pt received 2nd ROTATEQ on 8/18/08 and was admitted and treated for intussusception on 8/27/08. 12/30/2008 Reviewed hospital medical records of 8/27-8/28/2008. FINAL DX: ileocolic intussusception, enema reduced Records reveal patient experienced decreased activity, reduced oral intake, emesis which became bilious, excessive sleepiness & fever. Admitted overnight s/p enema reduction of IS. Progressed well & tolerated diet w/o complication. D/C to home.

VAERS ID:336659 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2008-12-12
Location:Maryland  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: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: irregular periods, contraception. Family hx: cardiovascular dx. HPV#3 given RA on 2/3/09 lot #0650X
Diagnostic Lab Data: None
CDC Split Type: WAES0811USA02188
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Acne, Menstruation irregular, Musculoskeletal discomfort, Musculoskeletal stiffness, Myalgia, Pharyngitis, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Fertility disorders (broad), Arthritis (broad)
Write-up: Information has been received from a 17 year old female who on 18-JUN-2008 was vaccinated "in her buttocks" with a first dose of GARDASIL. In "June 2008", the patient experienced muscle pain and muscle tenderness. On 18-AUG-2008 was vaccinated in her arm with a second dose of GARDASIL. She stated the symptoms never resolved and have become worse since receiving her second dose. At the time of reporting the patient''s muscle pain and tenderness persisted. The patient sought medical attention of the physician. Additional information has been requested. 2/4/09 Received PCP medical records of 8/12-11/12/2008. FINAL DX: none provided Records reveal patient in good health 8/12. RTC 11/12 w/pain right gluteal since received HPV #1 in 6/08 at GYN office. Referred to GYN & neuro if sys persist. Also had pharyngitis 11/12. 2/17/09 Received GYN vaccine records & medical records of 6/18-2/3/09. FINAL DX: none provided Records reveal patient experienced irregular periods, acne otherwise in good health for vaccinations. 6/18 vax given right gluteal. 11/6/08 note states had problems w/muscle in buttock since vax. Had stiffness & discomfort in back & hip. Referred to PCP. RTC 2/3 for HPV #3 w/o complaints at that time.

VAERS ID:337229 (history)  Vaccinated:2008-08-18
Age:67.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-23
Location:Unknown  Entered:2008-12-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Laboratory test
CDC Split Type: WAES0810USA05319
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0412X UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Dental operation, Mouth haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Information has been received from a 67 year old male with no relevant medical history or allergies who had been having both cosmetic dermatology work and periodontal work done for many years. On 18-AUG-2008 the patient was vaccinated with a dose of ZOSTAVAX (lot number 659410/0412X) (injection site and route not reported). Concomitant therapy included baby aspirin. Subsequently the patient and his physician as well noticed that he had been bleeding more during both procedures. Laboratory tests included blood work (results unspecified). Unspecified medical attention was sought. The outcome of the patient''s experiences was unknown. No further information is available.

VAERS ID:336945 (history)  Vaccinated:2008-08-18
Age:18.0  Onset:2008-08-31, Days after vaccination: 13
Gender:Female  Submitted:2009-01-09, Days after onset: 131
Location:Ohio  Entered:2009-01-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuvaring
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.P0072X1IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Fatigue, Feeling cold, Gait disturbance, Headache, Hypersomnia, Hypoaesthesia, Paraesthesia, Sensation of heaviness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad)
Write-up: Woke up that Sunday a.m. feeling very tired. Complained of arms feeling heavy and a headache. Later that day complained of numbness and tingling which progressed bilaterally up both her arms throughout that day and into the next several days. Complained of being cold. She slept up to 16 hours/day. Contacted the physician on-call on Monday (Labor Day) who suggested that we wait a week to see what course the symptoms took. Symptoms continued and progressed to complaints of difficulty walking due to heaviness of legs. Numbness and tingling progressed above elbows, but no further. No difficulty breathing. On Wednesday we went to see her primary care physician who felt she had mono, and that it was not related to the HPV vaccine. (patient had NO sore throat) Her doctor ran blood tests, but these returned negative for mono. Patient began to get less tired and less weak beginning on Friday, September 5th, during the day, but then returned to the weakened state on Saturday through Tuesday. And then rapidly recovered to her usual self by Saturday, September 13th. She has had no recurrence of the symptoms since. (NOTE: Her maternal grandfather was diagnosed with Myasthenia Gravis at age 70, and a cousin on her mother''s side has Juvenile Rheumatoid Arthritis that first surfaced after a tetanus vaccine when she was 10 years old).

VAERS ID:339589 (history)  Vaccinated:2008-08-18
Age:12.0  Onset:2008-09-03, Days after vaccination: 16
Gender:Female  Submitted:2009-02-14, Days after onset: 164
Location:North Carolina  Entered:2009-02-14
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. Seen 2/4/08 for c/o congestion, H/A, fever and abd pain. Assess: Sinustis. Vax given.
Preexisting Conditions: None PMH: none
Diagnostic Lab Data: Large battery of tests performed by Medical Center . Labs and diagnostics: Duodenal bx (-). Stomach bx (+) for chronic gastritis. Esophagus bx (-). H. pylori (-). Biliary patency study WNL. KUB (+) for moderate stool burden. Labs: Strep (-). KUB WNL. Hemoccult (-). ABd US WNL. HIDA scan (+) for biliary dyskinesia-no obstruction. Stool studies (-). EGD (+) for gastric erosions. AST 10. ALT 24. Amylase 21 (L), repeat 39 WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0067X2IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Activities of daily living impaired, Alanine aminotransferase normal, Aspartate aminotransferase normal, Biopsy intestine normal, Biopsy oesophagus normal, Biopsy stomach abnormal, Blood amylase decreased, Condition aggravated, Convulsion, Decreased appetite, Depression, Diarrhoea, Endoscopy abnormal, Gastroenteritis viral, Headache, Helicobacter pylori identification test negative, Hepatobiliary scan, Irritable bowel syndrome, Laboratory test, Migraine, Nausea, Oesophagogastroduodenoscopy, Pain, Panic reaction, Pharyngitis, Pyrexia, Streptococcus identification test negative, Urinary system X-ray, Vaccine positive rechallenge, Viral infection, Weight increased
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (narrow), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow)
Write-up: Patient given 1st dose of Gardasil Lot # 14484 on 2/4/08. Patient became ill with Severe Adominal Pain and Nausea. Patient given 2nd dose of Gardasil Lot # 17574 on 4/16/08. Patient because ill with Severe adominal pain, and Nausea and treated at pediatricans office on 5/1/08. Patient given 3rd dose of Gardasil Lot # 0067X on 8/18/08. Patient returned to Pediatrician on 9/3/08 with Severe adominal pain, severe nausea, and brain freezes or seizure complaints. Since September of 2008, patient has been placed on a modified school schedule and is being treated by Hospital with little to no improvement. Student is unable to attend school except for an average of 2 days per week. Student has become disabled because of pain, nausea, and seizure effects. 2/19/2009 MR received from PCP which include multiple consults and ER visits. Seen 2/4/08 for c/o congestion, H/A, fever and abd pain. Assess: Sinustis. Vax given. WCC 4/16/08 with normal G&D. PE WNL. Vax given. Returned 5/1/08 with c/o fever, diarrhea, decreased appetitie and po intake. Assess: Pharyngitis. Viral syndrome. OV 6/4/09 for nausea and migraine. Assess: VGE. OV 9/3/08 for H/a, nausea, stomach pain. Assess: VGE. Returned 9/15/08 with RUQ pain and diarrhea. Rx: Prilosec. Similar sx 9/22/08, 9/25/08 with fever. Seen 11/10/08 with for daily "brain freeze'' where pt can''t think clearly, panics, with H/A after. Missed 20 days of school this yr. Sx continue to present. Referred to GI 10/6/08 with multiple consults for abd pain with no clear dx-likely functional. Depression noted 1/13/09. Weight gain 2'' to eating to lessen pain. IBS dx 2/16/09 2/26/09 Hospital records received for ER visit 9/29/08 and later diagnostic studies with DX: Abdominal pain. Pt presented with several week hx of RUQ abdominal cramping with nausea. Severity 4-9/10. PE WNL. Referred for out pt tx. Follow-up: I have reported my daughter''s adverse effects to GARDASIL and so far, she hasn''t shown up in your VAERS database. The # assigned was 339589. Can you let me know if you need anything else from me and/or how long it will take before I can query on her information. I also want to ensure that all 3 of her lots are listed. See below: Below is her lot information and # of VAERS reports of each. Shot 1 - 78 events with Vaccine is ''HPV4'' and Lot Number contain ''1448U''. Shot 2 - 70 events with Vaccine is ''HPV4'' and Lot Number contain ''1757U''. Shot 3 - 74 events with Vaccine is ''HPV4'' and Lot Number contain ''0067X''. All of her lots have had multiple adverse effects listed. Can you make sure this is recorded and let me know when her information will be published for query purposes? Thanks for providing this service.

VAERS ID:343924 (history)  Vaccinated:2008-08-18
Age:51.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Female  Submitted:2008-08-21, Days after onset: 1
Location:Kentucky  Entered:2009-04-10, Days after submission: 232
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: Allergies:Keflex,Iodine,Cipro,Ancef, Biaxin,Amoxicillin HX:DM,Hyperlipidemia,HTN,MVP,IBS,Anemia,cervical fusion,hysterectomy,fibrocystic breast disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1381U0IMLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2332CA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Reddened area, size of half-dollar, left arm.Swelling arm/neck/shoulder. MD diagnosed cellulitis.

VAERS ID:346639 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-05-15, Days after onset: 270
Location:Massachusetts  Entered:2009-05-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Lyme (-)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0279X2IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Borrelia burgdorferi serology negative, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Bell''s palsy - few hrs. after Gardasil #3.

VAERS ID:347699 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:2008-09-06, Days after vaccination: 19
Gender:Male  Submitted:2009-05-15, Days after onset: 251
Location:Tennessee  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: WAES0809USA01579
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0332X1SCUN
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Initial and follow-up information has been received from a nurse concerning a 16 year old male who on 22-JUL-1997 was vaccinated with the first dose of VARIVAX (Oka/Merck). On 18-AUG-2008 at 2:57 pm, the patient was vaccinated with the second dose of VARIVAX (Oka/Merck) Lot number 660673/0332X, 0.5 mL, subcutaneously in the right thigh and the patient was also vaccinated with the first dose of HAVRIX IM into the left thigh, Lot # B264AA. It was reported that on 06-SEP-2009 the patient was experiencing fever and runny nose. In follow-up information the nurses reported that the patient''s mother called on 10-SEP-2008, approximately 3 weeks post vaccination stating that on 06-SEP-2008, child''s rash appeared on 3-4 locations on his chest, then several more appeared on his face. It appeared as spider bites. At the time of the initial information reported the patient was recovering. It was also reported in follow-up information that when the patient''s mother reported the rash, the patient had no fever. At the time of the follow-up information reported, the outcome of the patient''s rash was not reported. The patient sought medical attention, called the practice. Additional information is not expected.

VAERS ID:347841 (history)  Vaccinated:2008-08-18
Age:70.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-05-15, Days after onset: 270
Location:Ohio  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0808USA03124
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0736X1SC 
Administered by: Private     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a medical assistant and a nurse concerning a 70 year old female who on 18-AUG-2008 was vaccinated with VARIVAX vaccine (Merck) instead of ZOSTAVAX vaccine (Merck) by accident. The wrong vial was grabbed. It was human error but not a case of product confusion. The patient didn''t experience any known symptoms. It was unspecified if the patient sought medical attention. No further information is available.

VAERS ID:349666 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-06-19, Days after onset: 305
Location:Alabama  Entered:2009-06-22, 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: Pregnancy NOS (LMP = 7/29/2008)
Preexisting Conditions:
Diagnostic Lab Data: urine beta-human, 08/18/08, positive
CDC Split Type: WAES0808USA03705
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1448U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abortion induced, Drug exposure during pregnancy, Urine human chorionic gonadotropin positive
SMQs:, Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received through the pregnancy registry for GARDASIL from a registered nurse concerning a 14 year old female with no pertinent medical history and no history of drug reactions or allergies who on 18-AUG-2008 was vaccinated with the first dose of GARDASIL (lot#: 659653/1448U) 0.5ml IM. There was no concomitant medication. A subsequent pregnancy test on the same day was positive. No problems were reported. The LMP was "3 weeks ago" (on approximately 29-JUL-2008). The EDD is 05-MAY-2009. The patient sought unspecified medical attention. Follow up information has been received from a registered nurse concerning the 14 year old female patient who on an unspecified date had a pregnancy termination. Upon internal review, pregnancy terminated was considered to be an other important medical event. Additional information is not expected.

VAERS ID:350754 (history)  Vaccinated:2008-08-18
Age:16.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2009-07-02, Days after onset: 318
Location:Unknown  Entered:2009-07-06, 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: Unknown
Current Illness: Pregnancy NOS (LMP = 6/17/2008)
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0812USA02378
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1978U1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Neonatal disorder, Poor weight gain neonatal, Premature labour
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal disorders (narrow)
Write-up: Initial and follow-up information has been received from a Nurse Practitioner for the pregnancy registry for GARDASIL From a nurse practitioner concerning a 16 year old female patient with a history of no previous pregnancies who on 18-AUG-2008 was vaccinated with a 0.5 mL second dose of GARDASIL (LOT # 659964/1878U) while she was pregnant. The estimated conception date is 01-JUL-2008 and the estimated delivery date is 24-MAR-2009. The nurse reported that on 18-JUN-2008 the patient received a 0.5 mL first dose of GARDASIL (LOT # 659653/1448U). A healthcare worker in the Nurse Practitioner''s office reported that the patient had no prenatal care until she was 5 months along. She delivered her baby 2 months premature. The baby had reflux issues and slow weight gain. Her neurological status was within normal limits. She did confirm that there were no congenital anomalies and the baby was, otherwise, normal. Upon internal review, premature was determined to be an other important medical event. No further information is available.

VAERS ID:353558 (history)  Vaccinated:2008-08-18
Age:0.5  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2009-07-30, Days after onset: 346
Location:Oregon  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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: body temp, 08/18/08, 104
CDC Split Type: WAES0808USA04048
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Inappropriate schedule of drug administration, Irritability, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)
Write-up: Information has been received from a registered nurse concerning a 6 month old male who on 18-AUG-2008 was vaccinated with a dose of PNEUMOVAX 23 vaccine. Concomitant therapy included DTaP (+) tetanus toxoid and poliovirus vaccine. The nurse reported that the 6 month old child may have received PNEUMOVAX 23 vaccine. The office was not sure that the child received PNEUMOVAX 23 vaccine. The child developed fever up to 104 degrees Fahrenheit and vomiting with increased irritability within 7 hours of vaccination on 18-AUG-2008. The patient sought medical attention by telephone, but no treatment information was provided. At the time of reporting, the patient had not recovered. Additional information has been requested.

VAERS ID:353573 (history)  Vaccinated:2008-08-18
Age:13.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Female  Submitted:2009-07-30, Days after onset: 345
Location:Maryland  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA00048
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1537U IMUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Fatigue, 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 health professional concerning a 13 year old female patient who on 18-AUG-2008 was vaccinated intramuscularly with 0.5 mL PNEUMOVAX 23 vaccine (lot # 659010/1537U). There was no concomitant medication, no allergies and no pertinent medical history. On 19-Aug-2008 the patient developed a local reaction at injection site including pain, erythema, warmth, fever of about 102 degrees F, and tiredness. The patient sought unspecified medical attention. On an unspecified date, the patient recovered from local reaction at injection site including pain, erythema, warmth, fever of about 102 degrees F and tiredness. No other information was available. Additional information has been requested.

VAERS ID:354082 (history)  Vaccinated:2008-08-18
Age:74.0  Onset:2009-04-03, Days after vaccination: 228
Gender:Female  Submitted:2009-08-08, Days after onset: 127
Location:Unknown  Entered:2009-08-13, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1875U UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Pain
SMQs:, Peripheral neuropathy (broad)
Write-up: I received the ZOSTAVAX on April 18, 2008. Two months ago, I started feeling a burning sensation in the skin on the left side of my back. It progressed around to the front with needle- like stabbings into my side and left breast. It didn''t go away, so I saw my internist who, after my describing my pain, prescribed NEURONTIN. It has helped greatly -after 2 weeks-. Is it possible I had the shingles without the rash?

VAERS ID:355084 (history)  Vaccinated:2008-08-18
Age:14.0  Onset:2008-12-01, Days after vaccination: 105
Gender:Female  Submitted:2009-08-24, Days after onset: 265
Location:Texas  Entered:2009-08-24
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: Seen by dermatologist - elsewhere
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0067X0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discolouration, Injection site nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Report by parent of "nodule" developing months after injection (at general vaccine site) - developed sensitivity & darkening. See copy of parent''s letter/photo to me.

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