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Case Details (Sorted by Age)

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VAERS ID: 661415 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Georgia  
Vaccinated:2016-10-21
Onset:2016-10-21
   Days after vaccination:0
Submitted: 2016-10-24
   Days after onset:3
Entered: 2016-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT5629LA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: KEFLEX; kiwi; LEXAPRO
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, tightness in chest, difficulty breathing, rapid pulse. ER MD gave - epinephrine and BENADRYL.


VAERS ID: 661249 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2016-02-18
Onset:2016-02-21
   Days after vaccination:3
Submitted: 2016-10-25
   Days after onset:246
Entered: 2016-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Cold sweat, Computerised tomogram head, Dizziness, Full blood count, Hyperhidrosis, Metabolic function test, Palpitations, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, BMP, urinalysis, CT of the head
CDC Split Type:

Write-up: Hot and cold sweats, palpitations, dizziness.


VAERS ID: 661382 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2016-10-14
Onset:2016-10-18
   Days after vaccination:4
Submitted: 2016-10-25
   Days after onset:7
Entered: 2016-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 24K44 / 7+ RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M018810 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control Drospirenoine estradial 3mg
Current Illness: none
Preexisting Conditions: non
Allergies:
Diagnostic Lab Data: no diagnosis since she took benedryl
CDC Split Type:

Write-up: On 10/19/2016 mother called to state that patient had rash on back that were white and raised not fluid filled. Mom told patient to take a dose of Benedryl on 10/18/2016 and rash went away. It returned then in later in evening so mom had her take another dose of Bendryl. She is at Universit. She let mom know on 10/19/2016 that the rash resolved. Mom thought she should report it since she had gotten the vaccination and a flu shot.


VAERS ID: 661404 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2016-09-30
Onset:0000-00-00
Submitted: 2016-10-25
Entered: 2016-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI684AD / 5 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M77282 / 2 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK RA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Vaccine not specified (no brand name)~~0.00~Patient|~Meningococcal B (Trumenba)~1~0.00~Patient
Other Medications: AMOXICILLIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Abdominal pain
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZERINC2016489666

Write-up: This is a spontaneous report from a contactable nurse. A 20-year-old female patient of an unspecified race and ethnicity received the second dose of TRUMENBA (lot M77282, exp.date 30Jun2017) via intramuscular route in the right deltoid at 19 years on 30Sep2016 15:03 at 0.5 ml single for immunisation. On 30Sep2016 15:03, the patient also received MENVEO on the right arm, and on unknown date the fifth dose of influenza vaccine (lot UI684AD, manufacturer Sanofi Pasteur) via intramuscular route on the left arm. Relevant medical history included abdominal pain (problem stress related) from 30Nov2012 to Apr2013. Concomitant medication included amoxicillin, at 500 mg, 3x/day, for sinusitis. Illness at time of vaccination included sinusitis. The patient had received the first dose of TRUMENBA on unknown date in Jul2016 and had experienced swelling and pain in Aug2016. On unknown date the patient experienced cellulitis, arm hurt, swelling arm, redness, hurts to move it, warm to touch, headache. The patient received AUGMENTIN for cellulitis. The events required an emergency room. The patient was not admitted to hospital. The outcome of the events was reported as unknown. Sender''s Comments: The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, as appropriate. The case will be reassessed if additional information becomes available.


VAERS ID: 661621 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2016-10-03
Onset:2016-10-04
   Days after vaccination:1
Submitted: 2016-10-25
   Days after onset:21
Entered: 2016-10-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 9D325 / UNK RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 153701 / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Chills, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Insomnia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US2016GSK150557

Write-up: This case was reported by a physician and described the occurrence of muscle weakness in a 19-year-old female patient who received BEXSERO (batch number 153701, expiry date April 2017). Co-suspect products included FLUARIX QUADRIVALENT (batch number 9D325, expiry date 15th June 2017). Concurrent medical conditions included insomnia. On 3rd October 2016, the patient received BEXSERO (intramuscular) and FLUARIX QUADRIVALENT (intramuscular). On 4th October 2016, 1 days after receiving BEXSERO and FLUARIX QUADRIVALENT, the patient experienced muscle weakness (serious criteria clinically significant/intervention required), fever and chills. In October 2016, the outcome of the muscle weakness, fever and chills were recovered/resolved. The reporter considered the muscle weakness, fever and chills to be possibly related to BEXSERO and FLUARIX QUADRIVALENT. Additional details were reported as follows: The patient did not have any known allergies and her concurrent condition included insomnia which was ongoing at the time of reporting. The patient received both BEXSERO and FLUARIX QUADRIVALENT vaccines in her right deltoid. The patient experienced weakness of right arm and leg. Multiple attempts were made to communicate with the patient to check the status but no call back was received till the time of reporting. The events were not result of suspected transmission of an infectious agent via medicinal product. The patient did not have any diagnostic tests details which were performed.


VAERS ID: 662047 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: New York  
Vaccinated:2016-10-17
Onset:2016-10-17
   Days after vaccination:0
Submitted: 2016-10-27
   Days after onset:10
Entered: 2016-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS M252Y / 2 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH N11904 / 1 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Chills, Dyspnoea, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, nausea, shortness of breath.


VAERS ID: 662471 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Georgia  
Vaccinated:2016-10-24
Onset:2016-10-25
   Days after vaccination:1
Submitted: 2016-10-30
   Days after onset:5
Entered: 2016-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 13949211A / UNK LA / IM

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

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

Write-up: Redness around injection site. Improved by 10/26/2016.


VAERS ID: 662483 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Colorado  
Vaccinated:2016-10-28
Onset:2016-10-29
   Days after vaccination:1
Submitted: 2016-10-30
   Days after onset:1
Entered: 2016-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED WTS8308 / 2 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE REPORTED.
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNKNOWN AT TIME- SENDING PT TO ER FOR FURTHER EVAL.
CDC Split Type:

Write-up: Pt received flu vaccination on 10/28/16 at approx. 1700. Next day he had a syncopal episode and was advised to hydrate with water and Gatorade, and after reported feeling okay. Later on at home, he noted he had a fever of 105, and did not seek medical advice or treatment, but did not report his fever until Sunday pm when further asked about the events of the previous day. Pt required to go to ER for further eval.


VAERS ID: 662698 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2016-10-19
Onset:2016-10-24
   Days after vaccination:5
Submitted: 2016-10-31
   Days after onset:7
Entered: 2016-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 55349 / 1 LA / UN

Administered by: Other       Purchased by: Military
Symptoms: Dyspnoea, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Hives, shakes, labored breathing.


VAERS ID: 662823 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Michigan  
Vaccinated:2016-10-11
Onset:2016-10-11
   Days after vaccination:0
Submitted: 2016-10-31
   Days after onset:20
Entered: 2016-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI669AD / 2 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS KT54C / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M020103 / 3 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Administered pediatric Hepatitis A vaccine instead of adult Hepatitis A vaccine which was indicated.


VAERS ID: 668439 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2016-11-01
Entered: 2016-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1610USA011758

Write-up: Information has been received from a pharmacist referring to a 19 years old patient. The patient''s concurrent condition, medical history and concomitant therapies were not provided. On an unknown date, the patient received a booster dose RECOMBIVAX HB (strength reported as 10/1.0 microgram/ml, lot #, expiration date and route were unknown) 10 microgram instead of the 5 microgram. No adverse event was reported. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 663280 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2016-10-04
Onset:2016-10-04
   Days after vaccination:0
Submitted: 2016-11-02
   Days after onset:29
Entered: 2016-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT5636NA / 2 RA / -
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH N11903 / 2 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: SORENESS ON LEFT ARM, WERE VACCINATION WAS ADMINISTRATED, CAN''T LIFT LEFT ARM AND PAIN BEEN ON 4 WEEKS SINCE VACCINATION.


VAERS ID: 663515 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Virginia  
Vaccinated:2016-10-28
Onset:2016-10-28
   Days after vaccination:0
Submitted: 2016-11-02
   Days after onset:5
Entered: 2016-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 9K7E4 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site urticaria, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Numerous allergies - long list of allergies to foods, fungus, molds etc. etc. Had flu vaccine last year with no adverse reactions
Allergies:
Diagnostic Lab Data: None -
CDC Split Type:

Write-up: Hives over deltoid area of arm where vaccine was given spreading to neck and surrounding areas; fullness in throat without breathing difficulty; Due to history of numerous allergies - EPIPEN injection given and 911 called.


VAERS ID: 668511 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2016-11-02
Entered: 2016-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / UNK UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1611USA000927

Write-up: This spontaneous report as received from a physician via a field representative refers to a 19 year old female patient. Medical history and concurrent medications were not provided. On an unknown date the patient was vaccinated with GARDASIL 9. On an unknown date the patient experienced migraine and some redness and pain around the injection site. The outcome of the events was unknown. See case 1610USA005927 from the same reporter regarding the patient''s 18 year old sister who experienced the same events. Addition information has been requested.


VAERS ID: 664109 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2016-11-01
Onset:2016-11-01
   Days after vaccination:0
Submitted: 2016-11-04
   Days after onset:3
Entered: 2016-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS AE735 / UNK LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16005 / 2 RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Local reaction, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VENTOLIN; QVAR
Current Illness: None
Preexisting Conditions: CEFZIL; FLOXIN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Localized reaction to MENVEO - swelling, painful, warm to touch, onset about one hour after injection on 11-1-16 - improved at office visit on 11-4-16.


VAERS ID: 664281 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2016-11-01
Onset:2016-11-02
   Days after vaccination:1
Submitted: 2016-11-07
   Days after onset:5
Entered: 2016-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT5636JA / UNK - / IM

Administered by: Public       Purchased by: Private
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Pruritus, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole, lexapro, birth control
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm hurt after shot, woke up and it was very sore, red, swollen, tender, Now itchy. Getting better.


VAERS ID: 669474 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2016-10-12
Onset:2016-10-22
   Days after vaccination:10
Submitted: 2016-10-27
   Days after onset:5
Entered: 2016-11-08
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M011666 / 1 LA / SC

Administered by: Other       Purchased by: Unknown
Symptoms: Arthralgia, Influenza like illness, Malaise, Mononucleosis heterophile test negative, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: "Tendency to react to vaccines" per her mother
Allergies:
Diagnostic Lab Data: None; labeled "side effect"
CDC Split Type:

Write-up: MMR #1 given 10-12. Arthralgias, fever, general malaise for 3 days 10-22. Evaluated 10-24, negative for mononucleosis. Rash, maculopapular, diffuse 10-26 (resolution of flu-like symptoms at time of rash). Still with rash.


VAERS ID: 665017 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Iowa  
Vaccinated:2016-08-25
Onset:2016-08-26
   Days after vaccination:1
Submitted: 2016-11-09
   Days after onset:75
Entered: 2016-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Sulfa allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed hives after receiving the immunization.


VAERS ID: 665316 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2016-07-12
Onset:0000-00-00
Submitted: 2016-11-10
Entered: 2016-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M003659 / UNK UN / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37316 / UNK UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Dizziness, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2016343366

Write-up: This is a spontaneous report from a contactable healthcare professional received via a sales representative. A 19-year-old male patient of an unspecified race received TRUMENBA)(Lot # M37316; Exp. date Apr2017) at 0.5 ml single and human papilloma vaccine (Lot # M003659, Exp. date 20Sep2017), both intramuscular on 12Jul2016 for immunisation. The patient medical history and concomitant medications were not reported. The patient almost passed out on an unspecified date after vaccinations. He elevated his legs and felt better. The event was resolving at time of report. On 12Jul2016, the patient experienced vasovagal near syncope with outcome of recovered. Treatment was not required. Follow-up attempts completed. No further information expected. Follow-up (03Nov2016): New information obtained from a contactable other HCP includes: Patient''s date of birth, vaccines details, additional event (Vasovagal near syncope), onset and outcome, no treatment. Follow-up attempts completed. No further information expected. Sender''s Comments: The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, as appropriate. The case will be reassessed if additional information becomes available.


VAERS ID: 669635 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2016-11-08
Onset:2016-11-08
   Days after vaccination:0
Submitted: 2016-11-10
   Days after onset:2
Entered: 2016-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R65027 / 2 LA / IM

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

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

Write-up: Left Deltoid - 9cm raised warm erythematous area. No exudate. Painful.


VAERS ID: 665599 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: California  
Vaccinated:2016-11-10
Onset:2016-11-10
   Days after vaccination:0
Submitted: 2016-11-11
   Days after onset:1
Entered: 2016-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Dizziness, Flushing, Malaise, Nausea, Pruritus, Skin warm, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: irritability~Meningococcal (no brand name)~2~0.00~Patient
Other Medications:
Current Illness: No
Preexisting Conditions: Seasonal allergies (in the past)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, dizziness, light headed, flushed, hives, intense itching, swelling of face/skin, skin feels hot, feeling ill.


VAERS ID: 665634 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2016-11-12
Onset:2016-11-12
   Days after vaccination:0
Submitted: 2016-11-12
   Days after onset:0
Entered: 2016-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 359MH / 1 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Anaphylactic reaction, Angioedema, Dyspnoea, Flushing, Nausea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Anaphylactic, nausea, flushing, angio-edema, and SOB.


VAERS ID: 666637 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2016-10-13
Onset:2016-10-22
   Days after vaccination:9
Submitted: 2016-11-02
   Days after onset:11
Entered: 2016-11-15
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 169005 / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Discomfort, Pain
SMQs:

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

Write-up: Rcvd flu vaccine 10/13/16. Continued w/discomfort on 10/22/16. No redness, no swelling, full ROM (R) arm. Seen 10/25/16 by PA, for continued pain. Taking NSAID. Seen 11/1/16 with some improvement-continue NSAID and ROM.


VAERS ID: 670868 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: California  
Vaccinated:2016-11-10
Onset:2016-11-11
   Days after vaccination:1
Submitted: 2016-11-18
   Days after onset:7
Entered: 2016-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 156801A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US2016167297

Write-up: This case was reported by a nurse via sales rep and described the occurrence of generalized urticarial in a 19-year-old male patient who received BEXSERO (batch number 156801A, expiry date August 2017). On 10th November 2016, the patient received the 1st dose of BEXSERO 0.5 ml. On 11th November 2016, 1 days after receiving BEXSERO, the patient experienced generalized urticarial. The patient was treated with BENADRYL. On an unknown date, the outcome of the generalized urticaria was unknown. The reporter considered the generalized urticarial to be almost certainly related to BEXSERO. Additional details were provided as follows: Concurrent medical conditions was reported as no known allergies. The patient called the pediatrician because he had hives all over his body. He went to an Urgent Care and was given oral BENADRYL.


VAERS ID: 671428 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2016-08-15
Onset:2016-08-15
   Days after vaccination:0
Submitted: 2016-11-21
   Days after onset:98
Entered: 2016-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK UN / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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

Write-up: Pt went to pharmacy near her college seeking 2nd Mening B vaccine. Was given TRUMENBA. Got BEXSERO as 1st dose. Pt. advised to finish series after 2-15-17 with TRUMENBA.


VAERS ID: 668069 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2016-10-29
Onset:2016-11-13
   Days after vaccination:15
Submitted: 2016-11-23
   Days after onset:10
Entered: 2016-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Recent diarrheal illness
Preexisting Conditions: No known drug allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness and tingling, found to have Guillain Barre Syndrome.


VAERS ID: 668162 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Illinois  
Vaccinated:2016-08-08
Onset:2016-08-09
   Days after vaccination:1
Submitted: 2016-11-16
   Days after onset:99
Entered: 2016-11-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M77282 / 1 LA / IM

Administered by: Private       Purchased by: Military
Symptoms: Injection site erythema, Injection site reaction, Injection site urticaria, Local reaction
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOESTRIN; SEROQUEL; LAMICTAL; FLOVENT
Current Illness: 2013, Asthma; 2013, Rhinitis allergic; 2013, Depression; Affective disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2016383706

Write-up: This is a spontaneous report from a contactable physician. A 19-year-old female patient received the first dose of TRUMENBA (Lot# M77282, Expiry date 30Jun2017, NDC# 0005-0100-01), intramuscular at 0.5 ml, single in the left deltoid on 08Aug2016 10:15 AM. Medical history included mood disorder, asthma on 2013, rhinitis allergic on 2013, anxiety depression on 2013. Concomitant medication included LOESTRIN 1/20 for contraception, SEROQUEL for mood disorder, LAMICTAL for mood disorder, FLOVENT for asthma, all on 2013. The patient experienced patient developed local reactions around the injection site "patches" and a "hive"/three different patches of redness which appeared to be hives on 09Aug2016 with outcome of recovering. Follow-up (29Aug2016): New information obtained from a contactable physician includes: anatomical location and date/time of vaccine administered, additional medical history and concomitant, outcome, onset date of the event updated. Follow-up attempts completed. No further information expected.


VAERS ID: 668125 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2016-11-25
Onset:2016-11-25
   Days after vaccination:0
Submitted: 2016-11-25
   Days after onset:0
Entered: 2016-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L036301 / 1 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ferrous Sulfate, Bisacodyl 5mg, Docusate Na 100mg, ASA 81mg, Vit d3 1000IU, ondansetron ODT 4, Myfortic 360mg, Ranitidine 75mg/5ml, Hydroxychloroquine 200mg,
Current Illness: no
Preexisting Conditions: Pt states lupus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt said she felt faint, lightheaded. Had her lie down with legs elevated. Stated she felt better and requested a bottle of water which was provided. Pt refused any other treatment.


VAERS ID: 668290 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: California  
Vaccinated:2016-11-25
Onset:2016-11-25
   Days after vaccination:0
Submitted: 2016-11-25
   Days after onset:0
Entered: 2016-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 14049211A / UNK RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Eye movement disorder, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No
Preexisting Conditions: None listed on consent form
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a possible seizure within seconds of receiving the flu vaccine. He started to slump down, eyes rolled back, and convulsed. Seizure lasted approximately 10 seconds and then he came to. We gave him water, a candy bar and told him to rest. He left w/his dad after 30 min.


VAERS ID: 668751 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2016-11-28
Onset:2016-11-28
   Days after vaccination:0
Submitted: 2016-11-29
   Days after onset:1
Entered: 2016-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS X15123 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chills, Headache, Injection site pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No just sore at injection site. Some swelling
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart beat 160. Chills. Fever of 102.9. Bad headache.


VAERS ID: 668761 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2013-10-15
Onset:0000-00-00
Submitted: 2016-11-29
Entered: 2016-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Hep A Pediatrics dose administered instead of the Hep A Adult dose.


VAERS ID: 672169 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2016-11-25
Onset:2016-11-25
   Days after vaccination:0
Submitted: 2016-11-29
   Days after onset:4
Entered: 2016-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI678AA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. K018944 / UNK LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1611USA013491

Write-up: This spontaneous report was received from a nurse concerning a patient of unknown age and gender. The patient''s medical history, concurrent conditions and concomitant medications were not reported. On 25-NOV-2016, the patient was vaccinated with an expired dose of VARIVAX, lot # reported as K018944, expiration date: 15-OCT-2016, (dose number, route and anatomical location of administration were unknown). No adverse effect was reported. Additional information has been requested.


VAERS ID: 668897 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Illinois  
Vaccinated:2016-11-30
Onset:2016-11-30
   Days after vaccination:0
Submitted: 2016-11-30
   Days after onset:0
Entered: 2016-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED WT54807 / UNK RA / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 754AB / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5508AA / UNK LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 7RJ9B / UNK RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Dyspnoea, Eye swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt was also given Bicillin IM to Left gluteal muscle Lot #41588 exp. 01JUN2019
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o difficulty breathing, swollen eyes. Benadryl, solumedrol and epi auto inject given.


VAERS ID: 669005 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Missouri  
Vaccinated:2016-11-21
Onset:2016-11-22
   Days after vaccination:1
Submitted: 2016-11-30
   Days after onset:8
Entered: 2016-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 156801A / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site pain, Injection site warmth, Vaccination site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loestrin 1.5/30, sertraline 100mg
Current Illness: No
Preexisting Conditions: Depression with anxiety, history of ADHD, BMI of 35.0-35.9
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received 2nd mening B vaccine on 11/21. The next day pt had a 1inch in diameter round raised area below the vaccine site on her left upper arm. It was a small lump and painful to touch. It was red and hot to touch. It''s now been a week and pt complains that the arm is still tender but has returned to university. The lump is gone.


VAERS ID: 669124 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Indiana  
Vaccinated:2016-11-29
Onset:2016-11-29
   Days after vaccination:0
Submitted: 2016-11-30
   Days after onset:1
Entered: 2016-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 166304 / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Myotonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fainting~Vaccine not specified (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vasovagal syncope with Myotonic activity.


VAERS ID: 670032 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2016-11-11
Onset:2016-11-11
   Days after vaccination:0
Submitted: 2016-12-06
   Days after onset:25
Entered: 2016-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. M035147 / UNK UN / SC

Administered by: Other       Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131611USA006599

Write-up: Information has been received from a pharmacist referring to a 19 year old female patient. The patient''s medical history, concurrent condition and concomitant therapy were not provided. On 11-NOV-2016, a dose of ZOSTAVAX 19400 PFU (dose was unknown; lot number was M035147 with expiration date 25-OCT-2017) was administered subcutaneously to the patient in error today for prophylaxis. The patient was indicated to receive a dose of yellow fever vaccine, manufactured by Sanofi Pasteur. She states that the error was made because she reached in the freezer to get the vaccine, rather than the refrigerator. The patient did receive the dose of yellow fever vaccine in the other arm. No adverse effects were reported. Additional information has been requested.


VAERS ID: 670416 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Nevada  
Vaccinated:2016-12-07
Onset:2016-12-07
   Days after vaccination:0
Submitted: 2016-12-07
   Days after onset:0
Entered: 2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 168802 / UNK - / IM

Administered by: Public       Purchased by: Private
Symptoms: Epistaxis, Fall, Gingival pain, Laceration, Syncope, Tooth loss
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gingival disorders (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none to knowledge
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Followed up with patient the same day (12/07/2016) at 1:18pm and he said he felt fine, except that a little sore on the tooth that''s missing.
CDC Split Type:

Write-up: Patient fainted and fell to the ground within minutes after the flu shot. Patient was discovered when he stood up from the fall outside of the pharmacy drop-off area with bloody nose, few lacerations, and a missing tooth. Pharmacist assessed patient and he said he was fine. Pharmacy staff and store staff helped patient cleaned up and was feeling fine when Aunt came to pick patient up about 25 minutes later.


VAERS ID: 670752 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Montana  
Vaccinated:2016-12-06
Onset:2016-12-07
   Days after vaccination:1
Submitted: 2016-12-08
   Days after onset:1
Entered: 2016-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI678AE / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: inflammatory bowel issues
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness at injection site 12/7/16. At 3:30 AM on 12/8/16, she woke up with pain at the injection site that radiated up her shoulder to the base of her skull.


VAERS ID: 670773 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Georgia  
Vaccinated:2016-11-11
Onset:2016-11-11
   Days after vaccination:0
Submitted: 2016-12-08
   Days after onset:27
Entered: 2016-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Immediate post-injection reaction, Injected limb mobility decreased, Pain, Pain in extremity
SMQs:, Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amethia, Singulair, Allegra.
Current Illness: No
Preexisting Conditions: Peanut/legume allergy, asthma.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate pain following vaccination. I was told it would "burn," but the pain was more of a constant dull throughout. Pain lasted for 3 days, and would be especially bad (sharp pain) any time I moved my arm that received the vaccination. I was basically unable to move my left arm at all for those days.


VAERS ID: 672911 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2016-12-01
Onset:2016-12-01
   Days after vaccination:0
Submitted: 2016-12-16
   Days after onset:15
Entered: 2016-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 392RL / UNK LA / IM

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

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

Write-up: Patient reported generalized itching one hour post vaccine administration.


VAERS ID: 673467 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2016-06-03
Onset:2016-06-07
   Days after vaccination:4
Submitted: 2016-10-06
   Days after onset:121
Entered: 2016-12-19
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ADEN_4_7: ADENOVIRUS TYPES 4 & 7, LIVE, ORAL (NO BRAND NAME) / TEVA PHARMACEUTICALS 34600212 / UNK UN / UN
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED U55306 / UNK UN / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS G499B / UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AH4LF / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L036831 / UNK UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Alanine aminotransferase increased, Antinuclear antibody, Aspartate aminotransferase increased, Blood bilirubin, C-reactive protein normal, Cytogenetic analysis abnormal, Electromyogram abnormal, Hereditary neuropathy with liability to pressure palsies, Hypoaesthesia, Immunoglobulin therapy, Motor dysfunction, Muscle spasms, Muscular weakness, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging brain normal, Peroneal nerve palsy, Red blood cell sedimentation rate increased, Rheumatoid factor negative, Sensory disturbance, Treponema test negative, Urine analysis normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Peripheral neuropathy (narrow), Congenital, familial and genetic disorders (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: none documented
Allergies:
Diagnostic Lab Data: Nuclear Ab F 1:80; ESR, 72; CMP, ALT, 203, AST, 170, bili, 2.0; MRI brain, WNL; Nerve Conduction Studies: prolonged F wave, H reflexes unresponsive sensory and motor distal latencies prolonged in upper extremities; sensory distal latencies absent in lower extremities, right peroneal nerve unresponsive; CRP, RPR, RA, UA WNL
CDC Split Type:

Write-up: 19 yo female with S/S numbness, weakness of left leg and (R) leg thigh 4-5 days after receipt of hep A (lot# G499B SKB), IIV (U55306 CSL), adenovirus (#34600212 BRR), MCV4P (#U5180AA PMC), Tdap (#AH4LF SKB) and varicella (#L036831 MSD). Vaccines were received 3 JUN 2016. Symptoms included cramping in legs and sudden weakness with a (R) foot drop. She had an EMG on 07 JUL 16 which demonstrated upper extremity sensory and motor latencies, and loss of sensory and motor responsiveness to her lower extremities. She received 5 days of IVIG and Is currently receiving PT services. Last progress notes state some improvement in hamstring but otherwise plateaued. Genetic testing positive for HNPP. We have been unable to contact this patient for further assessment, info based on chart review.


VAERS ID: 673711 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2016-12-13
Onset:2016-12-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2016-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5521BA / 2 - / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt fainted for a minute or two, was pale, shaking and grasping for air and was dizzy. Paramedics came, evaluated vital signs and BS; everything was ok at that time.


VAERS ID: 673672 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2016-12-13
Onset:2016-12-14
   Days after vaccination:1
Submitted: 2016-12-19
   Days after onset:5
Entered: 2016-12-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5489AA / UNK RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Fatigue, Muscle tightness, Myalgia, Pain in extremity, Peripheral swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 12/13/16 20 min. after leaving clinic pt states felt tight/sore muscles upper arm. Woke up next morning-entire (R) arm including hand felt sore and was swollen. Reports also feeling fatigue. Tried heat application and oral ibuprofen - 2 liquid gels every 6 hours with improvement. Warm shower helped. Worsened through day. Some relief with ice and ICY HOT applied liberally 12/15-12/16 every few hrs. 12/19 reports lingering soreness but much improved.


VAERS ID: 673865 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2016-10-14
Onset:2016-10-14
   Days after vaccination:0
Submitted: 2016-12-21
   Days after onset:68
Entered: 2016-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M012261 / UNK UN / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Incorrect product storage, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131612USA006635

Write-up: This spontaneous report was received from a nurse referring to a 19 year old patient of unknown gender. The patient''s pertinent medical history, concurrent conditions and concomitant medications were not reported. On 14-OCT-2016, the patient was vaccinated with improperly stored dose of VAQTA (dose and route were not reported) lot #M012261 and expiry date: 01-FEB-2018, (volume/dose reported as 1 (units not provided)) for prophylaxis. The vaccine was exposed to temperature of 49 Fahrenheit for 30 minutes. No previous temperature excursion was reported. The patient was vaccinated with private funds. No adverse effects and no product quality complaint (PQC) were reported. No further information provided. This is one of several reports received from the same reporter. Additional information has been requested. Sender''s Comments: US-009507513-1610USA004376: US-009507513-1610USA003097: US-009507513-1610USA004377: US-009507513-1610USA004378: US-009507513-1612USA006634.


VAERS ID: 674232 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2016-12-22
Onset:2016-12-22
   Days after vaccination:0
Submitted: 2016-12-22
   Days after onset:0
Entered: 2016-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M034896 / 1 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Immediate post-injection reaction, Pallor, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Pt stated he was very anxious about getting vaccination. Immediately after the administration of the Hepatitis A vaccine he stated his vision was getting blurry and his color became pallor. Pt was sitting and lowered his head for a few minutes on instruction. He remained conscious and then raised his head up. His hands were shaky. Pt was given some water to drink and then some cola to drink. He stated he felt better and remained seated for about 20 minutes. His father was with him and was going to drive him home.


VAERS ID: 674332 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2016-12-07
Onset:2016-12-08
   Days after vaccination:1
Submitted: 2016-12-22
   Days after onset:14
Entered: 2016-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M029229 / 2 LA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5539AB / 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M033905 / 2 RA / SC

Administered by: Unknown       Purchased by: Private
Symptoms: Injection site rash, Injection site reaction, Injection site warmth, Rash, Skin lesion, Skin warm, Varicella virus test negative
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: VZV swab of the lesion : Negative
CDC Split Type:

Write-up: 12/7/2016 Patient received Varicella subcutaneous in right arm and MMR subcutaneous and MENACTRA IM in left arm. Patient woke the next morning with a "hot" rash on forehead, cheeks, bridge of nose and behind her right upper arm. She was seen that day by a medical doctor. The provider also noted one lesion at the injection site. The patient denied any shortness of breath or cough. No itching in the throat or mouth. The provider treated her with Alavert and Benadryl. The patient was instructed to take one Alavert in the AM and 2 Benadrly in the PM.


VAERS ID: 674407 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2016-12-08
Onset:2016-12-09
   Days after vaccination:1
Submitted: 2016-12-12
   Days after onset:3
Entered: 2016-12-22
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5478AA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnant / 7 mo
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Warmth and redness approximately 4-4.5 cm in diameter-Patient denies itching but states sited is painful to the touch.


VAERS ID: 675223 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2016-12-27
Onset:2016-12-27
   Days after vaccination:0
Submitted: 2016-12-27
   Days after onset:0
Entered: 2016-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 156701 / 2 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Blindness, Feeling of body temperature change, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, ocp
Current Illness: no.
Preexisting Conditions: Raynaud''s, dextro transposition of great vessels, junctional ectopic tachycardia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o feeling hot, then cold. Then said she couldn''t see. Passed out for a short time. c/o nausea.


VAERS ID: 675519 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Arizona  
Vaccinated:2016-12-28
Onset:2016-12-28
   Days after vaccination:0
Submitted: 2016-12-29
   Days after onset:1
Entered: 2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Nuclear magnetic resonance imaging, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seizure~HPV (Gardasil)~1~18.00~Patient|seizure~HPV (Gardasil)~2~18.00~Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: MRI
CDC Split Type:

Write-up: Syncope and seizure.


VAERS ID: 675686 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2016-12-13
Onset:2016-12-15
   Days after vaccination:2
Submitted: 2016-12-29
   Days after onset:14
Entered: 2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI678AB / UNK RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. MO31557 / 4 RA / IM

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

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

Write-up: Pt. reports tenderness at site next day. By the second day reports swelling, tenderness, feverish at site. Per pt. unable to sleep on that arm. Swelling continued to increase and redness started after 3-4 days. Presented to clinic 12-29-16 with area red, feverish, and knot at injection site.


VAERS ID: 675693 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Arizona  
Vaccinated:2016-12-19
Onset:2016-12-19
   Days after vaccination:0
Submitted: 2016-12-29
   Days after onset:10
Entered: 2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1620501 / 2 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS MB3Y2 / 2 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Dizziness, Loss of consciousness, Muscle twitching, Nausea, Posture abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None reported previous to vaccination, and confirmed again after reaction
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Hep A vaccine in left arm. Chair was turned around to administer Influenza in Right Arm. Within 30 seconds of Influenza vaccination patient slumped in chair and had a temporary loss of consciousness. There appeared to be some arm twitching which may indicate some seizure activity. Her mother was outside of room in waiting area and came in and patient was moved to bench area to lie down. When consciousness was regained seconds later, patient reported feeling lightheaded and "queasy" but otherwise felt ok. Patient remained lying down with her mother and RPh for approx. 20mins in room, and then was walked to her car with her mother and a staff member. No additional action was taken. Mother was advised by RPH to notify healthcare provider of reaction, and to ensure that any future vaccinations, if recommended by provider, are administered in a more controlled healthcare setting.


VAERS ID: 677100 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Iowa  
Vaccinated:2017-01-06
Onset:2017-01-06
   Days after vaccination:0
Submitted: 2017-01-06
   Days after onset:0
Entered: 2017-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS KK3357 / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Nervousness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: Recent stomach, small diet.
Preexisting Conditions: Endometriosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 10 minutes, some tingling in fingers; feeling of nervousness.


VAERS ID: 677223 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Michigan  
Vaccinated:2017-01-06
Onset:2017-01-06
   Days after vaccination:0
Submitted: 2017-01-09
   Days after onset:3
Entered: 2017-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI673AA / 2 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9S54N / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M030380 / 1 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 157601 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine error, 19 y.o. got the pediatric dose of Hep A vaccine.


VAERS ID: 677247 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Michigan  
Vaccinated:2017-01-06
Onset:2017-01-06
   Days after vaccination:0
Submitted: 2017-01-09
   Days after onset:3
Entered: 2017-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI673AA / 2 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9S54N / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M030380 / 1 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 157601 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5539AB / 2 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: 19 y.o. given pediatric dose of Hep A vaccine.


VAERS ID: 677419 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2014-01-10
Onset:2014-04-01
   Days after vaccination:81
Submitted: 2017-01-09
   Days after onset:1014
Entered: 2017-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J012212 / 3 AR / SYR

Administered by: Unknown       Purchased by: Private
Symptoms: Abdominal pain upper, Anxiety, Bacterial test positive, Blood heavy metal increased, Dehydration, Dizziness, Ear infection, Fatigue, Feeling hot, Food allergy, Fungal test positive, Gastrointestinal disorder, Headache, Immune system disorder, Laboratory test abnormal, Middle ear effusion, Parasite blood test positive, Skin infection, Sleep disorder, Thirst, Vaginal infection, Viral test positive
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: biofeedback test indicate high levels of heavy metals, multiple viruses, parasites, fungus, mold overgrowth, bacteria, food toxicity, immune system disorder, anxiety, dehydration
CDC Split Type:

Write-up: Dizziness, headache, ear infection/fluid, dehydration, thirst, food sensitivity, stomach aches, intestinal issues, repeated vaginal infections, fatigue, skin infection, anxiety, sleep issues, overheats.


VAERS ID: 677464 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2017-01-09
Onset:2017-01-09
   Days after vaccination:0
Submitted: 2017-01-10
   Days after onset:1
Entered: 2017-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS TS5F3 / 1 RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M007764 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5259AA / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Loss of consciousness, Muscle twitching
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), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lorazepam; Citalopram
Current Illness: No
Preexisting Conditions: Depression and anxiety
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client was sitting in the chair after being given three vaccines. She lost consciousness and began to have some twitching. We assisted her to lie down and she immediately awoke. The entire episode lasted about 30 seconds. We had her lie down on the exam bed and gave her a bottle of water. Her vital signs were checked BP 11/66 P 56 bpm.


VAERS ID: 677872 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2016-11-25
Onset:0000-00-00
Submitted: 2017-01-12
Entered: 2017-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M017982 / UNK RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131612USA009456

Write-up: This spontaneous report was received from a registered nurse referring to a 19 year old patient of unknown gender. The patient''s medical history, concurrent conditions and concomitant therapies were not reported. On 25-NOV-2016, the patient was vaccinated with a pediatric dose of VAQTA with a lot number M017982 and expiration date of 13-SEP-2017 (strength, dose and route of administration were not provided) for prophylaxis. No adverse events were reported and no product quality complaint was involved. Additional information has been requested.


VAERS ID: 678004 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Missouri  
Vaccinated:2017-01-10
Onset:2017-01-10
   Days after vaccination:0
Submitted: 2017-01-13
   Days after onset:3
Entered: 2017-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / 1 LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Chills, Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ETHINYL ESTRADIOL W/NORGESTIMATE
Current Illness: Drug allergy (Allergy to Penicillin and Drugs that end in Cycline. Have known of allergy to Penicillin since she w)
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none, Comment: Patient Other Relevant History 2: none, Comment:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZERINC2017013842

Write-up: This is a spontaneous report from a contactable consumer reported for her daughter. A 19-year-old female patient received TRUMENBA, via an unspecified route of administration on 10Jan2017 at 0.5ml single in Left Arm for meningococcal immunisation. On an unspecified date in Jan2017 received the 3rd dose of MMR in Left Arm. Medical history included ongoing Allergy to Penicillin and ''Cycline'' drugs. Have known of allergy to Penicillin since she was a toddler. Concomitant medication included ethinyl estradiol, norgestimate. In the past received MMR with no adverse effect. The patient experienced chills on 10Jan2017 with outcome of recovered, and feeling tired on 10Jan2017 with outcome of not recovered.


VAERS ID: 678021 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Maryland  
Vaccinated:2016-11-02
Onset:2016-11-02
   Days after vaccination:0
Submitted: 2017-01-13
   Days after onset:72
Entered: 2017-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Inflammation, Joint range of motion decreased, Musculoskeletal pain, Musculoskeletal stiffness
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe shoulder pain, stiff arm, limited range of motion, weakness, inflammation.


VAERS ID: 678056 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2016-08-15
Onset:2016-10-17
   Days after vaccination:63
Submitted: 2017-01-13
   Days after onset:88
Entered: 2017-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 156701 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood test normal, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 10 mg, Fluticasone nasal spray
Current Illness: Allergic rhinitis symptoms, fatigue
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: Blood work at ER - normal
CDC Split Type:

Write-up: Patient developed acute onset of vomiting on Oct 17, then vomited Oct 19 -20, went to ER on Oct 20th and was rehydrated.


VAERS ID: 678326 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2017-01-17
Entered: 2017-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131701USA003058

Write-up: This spontaneous report was received from a consumer concerning a 19 year old female patient. The patient''s medical history, concurrent conditions, drug reactions/allergies and concomitant medications were not reported. On an unknown date, reported as at the age of 18 years old, the patient was vaccinated with the first dose of GARDASIL 9 as prophylaxis. One year later on an unknown date, at 19 years old, the patient received the second dose of GARDASIL 9 as prophylaxis. (Strength, dose, lot numbers, expiration dates and route of administration were not reported). No adverse effect was reported. Additional information is not expected because contact details were not provided.


VAERS ID: 678346 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2017-01-11
Onset:2017-01-11
   Days after vaccination:0
Submitted: 2017-01-17
   Days after onset:6
Entered: 2017-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. M023932 / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash/Breathing issues~Varicella (Varivax)~~0.00~Patient
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient broke out in rash and had difficulty breathing.


VAERS ID: 678366 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2017-01-09
Onset:2017-01-09
   Days after vaccination:0
Submitted: 2017-01-10
   Days after onset:1
Entered: 2017-01-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1619901 / 2 LA / SYR

Administered by: Other       Purchased by: Private
Symptoms: Eye movement disorder, Loss of consciousness, Malaise, Musculoskeletal stiffness, Posture abnormal
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), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None at present
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None at this pt - referred her to primary MD
CDC Split Type:

Write-up: Patient received flu inj. with no problems. Approximately 5 minutes after injection, she reported "I don''t feel well". She slumped over - when I caught her and lifted her head, her eyes rolled back and she stiffened for approximately 30 seconds. Then she came to she reported she dreamed she was having a car accident while she was unconscious.


VAERS ID: 678543 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2017-01-13
Onset:2017-01-16
   Days after vaccination:3
Submitted: 2017-01-17
   Days after onset:1
Entered: 2017-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158701A / 2 LA / IM

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

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

Write-up: Pain and swelling at site of imm. No streaking. No fever.


VAERS ID: 678976 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-01-19
Onset:2017-01-20
   Days after vaccination:1
Submitted: 2017-01-20
   Days after onset:0
Entered: 2017-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH N16808 / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Hives around injection site.


VAERS ID: 679343 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Indiana  
Vaccinated:2017-01-04
Onset:2017-01-05
   Days after vaccination:1
Submitted: 2017-01-19
   Days after onset:14
Entered: 2017-01-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI673AA / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M035688 / UNK LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1/6/17 spoke with patient. Informed of fever, redness, warmth at site. Arm sore. Encouraged ice packs, MOTRIN, and to see MD. 1/19/17 spoke with patient. Saw MD treated for cellulitis, BACTRIM X 10 days. Condition has improved.


VAERS ID: 679756 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2013-11-27
Onset:2014-02-04
   Days after vaccination:69
Submitted: 2017-01-26
   Days after onset:1087
Entered: 2017-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J011272 / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Anti-aquaporin-4 antibody positive, Blood test abnormal, Eye pain, Neuromyelitis optica spectrum disorder, Optic neuritis, Visual acuity reduced
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Ocular infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: seropositive for AQP4 spinal tap
CDC Split Type:

Write-up: Pain in and around right eye, worsens over time, almost blind by02/09/14. Patient went to ER. Diagnosed with optic neuritis. Was given infusion of Solumedrol for 3 days, then started on prednisone and tapered over 2 weeks. 03/10/14 optic neuritis in left eye. Repeat therapy with prednisone taper over 4 weeks. 04/08/14 symptoms reappear in left eye. Solumedrol given for 5 days, then prednisone taper. Blood test and spinal tap indicate Neuromyelitis Optica. Diagnosed 04/23/14. Since then, repeated bouts of optic neuritis and treatment with Rituximab, Cell Cept and prednisone.


VAERS ID: 679897 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-01-12
Onset:2017-01-12
   Days after vaccination:0
Submitted: 2017-01-23
   Days after onset:11
Entered: 2017-01-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16077 / UNK LA / SYR

Administered by: Other       Purchased by: Other
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US2017005938

Write-up: This case was reported by a non-health professional via call center representative and described the occurrence of injection site pain in a 19-year-old female patient who received MENVEO (batch number M16077, expiry date March 2018). On 12th January 2017, the patient received MENVEO .5 ml. On 12th January 2017, less than a day after receiving MENVEO, the patient experienced injection site pain and numbness. On an unknown date, the outcome of the injection site pain and numbness were unknown. It was unknown if the reporter considered the injection site pain and numbness to be related to MENVEO. Additional details were provided as follows: The patient received a dose of MENVEO in her left deltoid and experienced sharp pain at site. No other information was reported.


VAERS ID: 681223 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-01-06
Onset:0000-00-00
Submitted: 2017-02-03
Entered: 2017-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M021124 / 2 UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131701USA008494

Write-up: This spontaneous report as received from a medical assistant refers to an adult patient of unknown gender. There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On 06-JAN-2017, the patient was vaccinated with two pediatric doses of VAQTA, strength reported as 25/0.5 (no unit was provided), lot # M031806, expiration date 30-MAR-2018, intramuscularly (dose was not reported). There was no adverse effect reported. Additional information has been requested.


VAERS ID: 681739 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: California  
Vaccinated:2017-02-07
Onset:2017-02-07
   Days after vaccination:0
Submitted: 2017-02-07
   Days after onset:0
Entered: 2017-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC 186867 / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Dizziness, Feeling abnormal, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad)

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

Write-up: Feeling uneasy, lightheaded, cheeks feeling hot.


VAERS ID: 682105 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2017-02-10
Onset:2017-02-10
   Days after vaccination:0
Submitted: 2017-02-10
   Days after onset:0
Entered: 2017-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS KK357 / 3 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral birth control
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 10 minutes after employee was given immunization she states she was feeling dizzy. She laid down on exam bed for approx. 5 min. and then sat in chair with no change in dizziness. Denied any other symptoms.


VAERS ID: 682170 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Delaware  
Vaccinated:2017-02-06
Onset:2017-02-06
   Days after vaccination:0
Submitted: 2017-02-10
   Days after onset:4
Entered: 2017-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9M57P / 1 RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L013429 / 1 RA / IM

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

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

Write-up: Patient stated on the evening of the day vaccines were administered he developed a rash on the cubital area of bilateral arms. Rash then progressed to the axilla bilaterally, neck and sides of trunk. Thursday morning (3 days later) patient was seen at school nurse''s office and given Benadryl. Patient was seen that afternoon at Health Center and diagnosed with allergic reaction secondary to vaccine administration Hep A and HPV. Patient was prescribed Prednisone for 6 days.


VAERS ID: 682183 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Oregon  
Vaccinated:2017-02-09
Onset:2017-02-09
   Days after vaccination:0
Submitted: 2017-02-10
   Days after onset:1
Entered: 2017-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT5629NA / UNK LA / IM

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

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

Write-up: Pt mother states that he had a fever of 100.5 with some vomiting.


VAERS ID: 682388 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2017-01-30
Onset:2017-02-01
   Days after vaccination:2
Submitted: 2017-02-07
   Days after onset:6
Entered: 2017-02-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI714AA / 1 LA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 15B201 / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Discomfort, Injection site erythema, Injection site swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Seen at Pediatric 2/1/17 Redness, swelling at the site of meningitis B vaccine. BENADRYL PO Q six hours. 2/2/17 Urticaria possibly due to Men B vaccine. Very itchy and uncomfortable. Started Hydroxyzine 25 mg.


VAERS ID: 682217 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2017-02-12
Onset:2017-02-12
   Days after vaccination:0
Submitted: 2017-02-12
   Days after onset:0
Entered: 2017-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC 186868 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine; sprintec
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt. developed a splotchy rash on calf and arm. The pt. applied benadryl cream to affected areas and redness decreased. She also was going to take benadryl capsule orally, apply an ice pack, and take famotidine tablets as well.


VAERS ID: 682376 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2017-01-27
Onset:0000-00-00
Submitted: 2017-02-13
Entered: 2017-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. L048222 / 2 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131701USA014179

Write-up: This spontaneous report was received from a registered nurse and refers to an adult patient of unknown gender (exact age was not reported). There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On 27-JAN-2017, the patient was inadvertently administered with 1 ml of an expired dose of VAQTA 50/1 U/ ml (lot # L048222, expiration date: 19-DEC-2016) (route of administration and injection site were not reported). No adverse effects were reported. Product quality complaint (PQC) was not involved. Additional information has been requested.


VAERS ID: 682982 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2017-02-13
Onset:2017-02-14
   Days after vaccination:1
Submitted: 2017-02-15
   Days after onset:1
Entered: 2017-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M036153 / 3 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Fatigue, Influenza virus test negative, Malaise, Oropharyngeal pain, Pyrexia, Streptococcus test negative, Urine analysis normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yes~Hep B (no brand name)~1~19.00~Patient|Yes~Hep B (no brand name)~0~19.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to amoxicillin; abdominal surgery as newborn for meconium plug
Allergies:
Diagnostic Lab Data: Rapid influenza; strep; and urinalysis negative for infection
CDC Split Type:

Write-up: Given Hepatitis B vaccination - 3rd dose on 2/13/2017. Next day developed malaise, weakness, fatigue, fever up to 104.7 and mild sore throat.


VAERS ID: 683417 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Georgia  
Vaccinated:2017-01-30
Onset:2017-02-04
   Days after vaccination:5
Submitted: 2017-02-22
   Days after onset:18
Entered: 2017-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M029229 / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None. Pt. has never been immunized as a child. This was his first vaccine.
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started with measles like rash to trunk then spread to arms and legs. Fevers. PCP prescribed Medrol dose pack.


VAERS ID: 683425 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2016-08-19
Onset:0000-00-00
Submitted: 2017-02-21
Entered: 2017-02-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131702USA004180

Write-up: This spontaneous report has been received from a medical assistant referring to a female 15 year old patient. Information regarding medical history, drug reactions, allergies, concurrent conditions and concomitant therapies was not reported. On an unknown dates in 2011, the patient was vaccinated with the first and the second dose of GARDASIL, (strength, route of administration, frequency, lot# and expiration date were not provided) for prophylaxis. Then on 25-JUN-2013, the patient was vaccinated with the third dose of GARDASIL (strength, route of administration, frequency, lot# and expiration date were not provided) for prophylaxis. Also it was stated by the reporter that on 19-AUG-2016, the patient received a dose of GARDASIL 9. No adverse effects were reported. Additional information has been requested.


VAERS ID: 683956 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2016-10-16
Onset:2016-10-16
   Days after vaccination:0
Submitted: 2017-02-27
   Days after onset:134
Entered: 2017-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131702USA000774

Write-up: This spontaneous report was received from a pharmacist and refers to a 19-year-old male patient. The patient''s pertinent medical history, concomitant medications and drug reactions or allergies were not reported. On 02-AUG-2016, the patient received his first dose of GARDASIL injection (dose, route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis. On 16-OCT-2016, the patient received in error a dose of MENACTRA injection (dose, route of administration, anatomical location, lot # and expiration date were not reported), instead of GARDASIL. The pharmacist did not know why this medication error occurred. On 01-FEB-2017 (reported as "today"), the patient returned to the pharmacy to receive his third dose of GARDASIL and during that vaccination session the error was discovered. On 01-FEB-2017, the patient received his second dose of GARDASIL injection (lot # L026034 with expiration date at 23-JUL-2017) (dose, route of administration and anatomical location were not reported) for prophylaxis. The patient did not experience an adverse effect. No product quality complaint (PQC) was involved. Additional information has been requested.


VAERS ID: 683963 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-02-21
Onset:2017-02-21
   Days after vaccination:0
Submitted: 2017-02-27
   Days after onset:6
Entered: 2017-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M034195 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ankle sprain
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131702USA010821

Write-up: This spontaneous report as received from a nurse prescriber via a company representative refers to a 19 year old female patient. The patient''s pertinent medical history included sprained ankle. No historical medications nor drug reactions/allergies were reported. On 21-FEB-2017, the patient was vaccinated with GARDASIL 9 injection, 0,5 ml, first of 3 doses (schedule: 0,2,6 months), intramuscularly (lot # M034195, expiration date unknown) for prophylaxis. Concomitant therapies included IBUPROFEN. On 21-FEB-2017, after receiving her first dose of vaccine, the patient experienced rash and hives on her face and neck and her rash/hives were itchy. The nurse prescriber gave the patient an injection of an unspecified dose of BENADRYL for these effects. The outcome of the events was reported as not recovered. The relatedness between the events and GARDASIL 9 was not reported. Upon internal review the events of itchy rash and hives on face and neck treated with injection of BENADRYL were considered as medically significant. Additional information has been requested.


VAERS ID: 684029 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2017-02-13
Onset:2017-02-16
   Days after vaccination:3
Submitted: 2017-02-27
   Days after onset:11
Entered: 2017-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. M014929 / 1 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None; patient first visit to office
Current Illness: Depression
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore for two-three days but she thought it was better until she rolled over onto her shoulder while in bed. Sore since and it hurts to lift her arm shoulder height or reach across her trunk. No redness or swelling at the injection site noted.


VAERS ID: 684817 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2016-06-07
Submitted: 2016-10-12
   Days after onset:127
Entered: 2017-03-03
   Days after submission:142
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 5G943 / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: 19 year old client was given an adult dose of Hep B Vaccine. Unlike the other immunizations Hep B changes from adolescent to adult dosing at age 20. He B vaccine administration reviewed on CDC immunization web site.


VAERS ID: 684825 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2016-09-13
Onset:2016-09-13
   Days after vaccination:0
Submitted: 2016-10-03
   Days after onset:20
Entered: 2017-03-03
   Days after submission:151
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5020AA / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Pharmacy dispensed expired MENACTRA vaccine to clinic and clinic administered the expired vaccine.


VAERS ID: 684890 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2016-05-25
Onset:2016-06-03
   Days after vaccination:9
Submitted: 2017-03-06
   Days after onset:276
Entered: 2017-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV459A / UNK UN / UN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR L12551 / UNK UN / IM

Administered by: Military       Purchased by: Military
Symptoms: Abdominal X-ray, Anxiety, Biopsy stomach normal, Blood creatine phosphokinase MB increased, Blood magnesium normal, Blood thyroid stimulating hormone normal, Brain natriuretic peptide normal, Chest X-ray abnormal, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Full blood count normal, Haematemesis, Helicobacter test negative, Hyperhidrosis, Impaired work ability, Insomnia, Laboratory test normal, Lymphadenopathy, Metabolic function test normal, Nausea, Nuclear magnetic resonance imaging normal, Oesophagogastroduodenoscopy normal, Pain, Painful respiration, Pneumomediastinum, Pulmonary function test normal, Scan with contrast, Sinus arrhythmia, Spirometry normal, Troponin T normal, Troponin increased, X-ray normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Disorders of sinus node function (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6 Jun 2016, 0900, Trop-T: 0.17; CK-MB, 5.57; CBC, Chem 18, Mg - no significant abnormalities; 6 Jun 2016, 1521,Trop-T: 0.12; 6 Jun 2016, 2058, Trop-T: 0.12; 14 Jun 2016, H pylori AB IgG - NEG; Stomach, random biopsy: No significant histopathologic changes; Stained slides negative for helicobacter and metaplasia; 8 Aug 2016, 1131, Trop-T: <0.01; CBC, TSH, BNP, CMP - WNL; 6 Jun 2016, ECG: NSR with sinus arrhythmia, rightward axis, no S-T/T wave changes Borderline ECG; 6 Jun 2016, CXR: Findings; No focal alveolar consolidation. No evidence of a significant pleural effusion. Significant pneumomediastinum most notable over neck soft tissues and anterior and middle mediastinum on the lateral view. No acute fracture deformity; 6 Jun 2016, CT, chest, w/contrast Extensive pneumomediastinum as described. Esophagus appears within normal limits. Asymmetric right axillary lymph node enlargement; 13 Jun 2016, CXR: Impression: Pneumomediastinum resolved as compared to the radiographs last 6 June 2016. No acute/active cardiopulmonary disease; 13 Jun 2016, Abd series: Normal; 14 Jun 2016, EGD - Summary: Normal esophagus. GE junction visualized. Z-line visualized. Squamocolumnar junction visualized. Normal stomach. Multiple biopsies taken. Normal duodenum; 14 Jul, PFTs - Normal, baseline spirometry and normal flow-volume loops; 8 Aug 2016, ECHO, FINDINGS: No significant abnormality. Left ventricle: Cavity size normal. Wall thickness normal. Systolic function normal, Estimate EF in the range of 60%. Wall motion normal; no regional wall motion abnormalities. Pericardium, extracardiac: No pericardial effusion; 18 Aug 2016, ECHO, Impression: Cluster of lymph nodes in the right axilla with benign features to include short axis dimensions less than 1 cm, cortex less than 3 mm and fatty hila; 9 Aug 2016, MRI, Cardiac w/ and w/o contrast: Final Impressions: Normal left ventricular chamber size and systolic function. LVEF 62%. Normal right ventricular chamber size and systolic function. No significant valvular stenosis or regurgitation, No inducible ischemia or evidence of infarction. No MRI evidence for infiltration or acute myocarditis. Normal coronary artery origins.
CDC Split Type:

Write-up: Onset of left, substernal throbbing chest pain and dyspnea. Pain worse on 6 Jun after 4-mile run. 3 Jun 16 (post-vaccine date (PVD) 9), onset of chest pain (CP) and shortness of breath. CP increased with deep breaths, also reported nausea, and diaphoresis. 6 Jun 16 (PVD 12), sought evaluation for continued CP (10/10) following 4-mile run. Treated with ZOFRAN, morphine, DILAUDID and TORADOL. ECG with NSR, sinus arrhythmia, rightward axis - borderline ECG. Elevated Troponin, CXR showed pneumomediastinum. Admitted to Hospital for pain management and observation. Discharged on OXYCONTIN for chest pain. Placed on limited duty. 13 Jun 2016 (PVD 19), ER evaluation - c/o SOB, CP and vomited blood x 3; anxious --$g ATIVAN. CXR normal. Discharged: anxiety, hematemesis, CP, insomnia r/t medical problems. REC: PFTs, GI eval, albuterol inhaler, repeat ECG, referral to behavioral health. As of FEB 2017, patient continues to have ongoing chest wall pain. Additional cardiology evaluations do not support pain is cardiac in origin.


VAERS ID: 684910 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Illinois  
Vaccinated:2016-12-05
Onset:2016-12-06
   Days after vaccination:1
Submitted: 2017-02-24
   Days after onset:80
Entered: 2017-03-06
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 156801A / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Antinuclear antibody negative, Discomfort, Erythema, Full blood count normal, Metabolic function test normal, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swollen discolored toes~Meningococcal B (Bexsero)~1~19.00~Patient
Other Medications: Multivitamin (OTC)
Current Illness: None
Preexisting Conditions: History of allergies; Irritable bowel
Allergies:
Diagnostic Lab Data: Labs all normal: CBC/CMP/ANA.
CDC Split Type:

Write-up: Rec''d BEXERO 12/5/16 - within 24 hours pt. had red/swollen/tingling toes and distal feet. Persistent signs and symptoms x 2 months. Patient is uncomfortable. Attempted topical ointment (steroid) without relief. No fever. Similar incident with BEXSERO #1 8/1/2016 - lasted approx 10 days.


VAERS ID: 685137 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2017-03-08
Entered: 2017-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2017099015

Write-up: This is a spontaneous report from a Pfizer-sponsored program, IBCC (Inbound Call Center for HCPs), from a contactable nurse practitioner reporting for her son. This 19-year-old male patient received the first single dose of TRUMENBA intramuscular in the left deltoid on an unspecified date during the summer of 2016 for immunization. The patient medical history was none, concomitant medications were not reported. No other vaccines were given the same day or within four weeks. The patient experienced redness (four to five inches redness induration) and pain at the injection site the same day of vaccination. Therapeutic measures were taken as a result of the events and included the administration of ibuprofen (MOTRIN). No Emergency room or physician''s visit and no relevant tests were performed. The patient recovered on an unspecified date in 2016 after about one week.


VAERS ID: 685317 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Michigan  
Vaccinated:2017-02-17
Onset:0000-00-00
Submitted: 2017-03-09
Entered: 2017-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. L031196 / 1 RA / SYR

Administered by: Other       Purchased by: Unknown
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131702USA008411

Write-up: This spontaneous report as received from a medical assistant refers to a patient of unknown age and gender. No information regarding the patient''s pertinent medical history, drug reactions or allergies and concomitant therapies was provided. On 17-FEB-2017, the patient was vaccinated with an expired dose of VAQTA injection, lot # L031196 with expiry date of 05-FEB-2017 (dose, route and site of administration were not reported). No adverse effects were reported. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 685578 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:2017-03-09
Onset:0000-00-00
Submitted: 2017-03-10
Entered: 2017-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS J74EY / 1 LA / SYR

Administered by: Other       Purchased by: Unknown
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pains, symptoms started about 3 hrs after injection, lasted for about 10 minutes.


VAERS ID: 685920 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2017-03-13
Onset:2017-03-14
   Days after vaccination:1
Submitted: 2017-03-15
   Days after onset:1
Entered: 2017-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 166801A / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Eye swelling, Injection site swelling, Local reaction, Pruritus, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL; VYVANSE
Current Illness: None
Preexisting Conditions: AUGMENTIN allergy
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy hives, swelling of face and eyes. Local reaction at injection site, raised area.


VAERS ID: 686113 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Illinois  
Vaccinated:2017-03-14
Onset:2017-03-15
   Days after vaccination:1
Submitted: 2017-03-16
   Days after onset:1
Entered: 2017-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M038226 / UNK RA / SC

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

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

Write-up: Raised, Red , Warm, Swollen area on right posterior side of upper arm (between elbow and shoulder) , effected area measured 145 mm in L x 140 mm in W, more solid and differently colored center of effected area measured 35 mm L x 55 mm W, began with discomfort while sleeping the night after receiving it, the next day it warm and red, 2nd morning after vaccine area presented as documented above.


VAERS ID: 686254 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2017-03-09
Onset:2017-03-09
   Days after vaccination:0
Submitted: 2017-03-10
   Days after onset:1
Entered: 2017-03-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. M029680 / 1 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest discomfort, Dyspnoea, Eye pruritus, Eye swelling, Injection site erythema, Injection site swelling, Injection site urticaria, Pharyngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZYRTEC; SINGULAIR; LEXAPRO; nebulizer; PROAIR; FLOVENT; asthma spacer; EPIPEN; CENTRUM; MOTRIN; ALEVE
Current Illness:
Preexisting Conditions: Asthma; Bees and now pneumonia vaccine. Pollen, hay fever. Needs EPIPEN for Bee Stings; Healthy otherwise
Allergies:
Diagnostic Lab Data: Emergency Room. Steroids and high doses of BENADRYL. Use EPIPEN if needed.
CDC Split Type:

Write-up: Pneumonia shot given high in left shoulder. Hour later left eye swollen and itchy, tightness in chest, breathing difficulty, throat felt like swollen up, red and swollen around shot area with red hives around shot area.


VAERS ID: 686430 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Hawaii  
Vaccinated:2017-03-14
Onset:2017-03-20
   Days after vaccination:6
Submitted: 2017-03-20
   Days after onset:0
Entered: 2017-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV496A / UNK LA / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS BX2X3 / UNK LA / IM
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV15L06E / UNK LA / IM
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV03019C / UNK RA / ID

Administered by: Military       Purchased by: Military
Symptoms: Exposure during pregnancy, Human chorionic gonadotropin positive
SMQs:, Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 20March 2017 - HCG Qual +
CDC Split Type:

Write-up: Patient vaccinated with Anthrax, JEV, smallpox, and Hep B on 14March 2017. On 19March, patient found out she was pregnant with home pregnancy test. On 20March, pregnancy verified by HCG qual. Pt indicated she was not / could not be pregnant on pre-vaccine questionnaires.


VAERS ID: 686798 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-02-06
Onset:0000-00-00
Submitted: 2017-03-22
Entered: 2017-03-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M036458 / UNK UN / UN

Administered by: Other       Purchased by: Unknown
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131703USA000948

Write-up: This spontaneous report was received from a registered nurse, concerning a 19 year-old patient of an unknown gender. There were no concurrent conditions, medical history, drug reactions or allergies or concomitant medications reported. On an unspecified date, the patient was inadvertently vaccinated with a pediatric dose of VAQTA 25/0.5 (units not provided) (dose, frequency and route were not reported) lot # M036458 with expiration date of 02-MAR-2018, for prophylaxis. No adverse effect was reported. No product quality complaint (PQC) was involved. Additional information has been requested.


VAERS ID: 686818 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2010-11-09
Onset:2016-10-27
   Days after vaccination:2179
Submitted: 2017-03-23
   Days after onset:147
Entered: 2017-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV242 / 1 AR / SYR
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3728AA / 1 AR / SYR
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB185AA / 1 AR / SYR
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV09136A / 1 AR / SYR
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR W04003A / 1 AR / -

Administered by: Military       Purchased by: Other
Symptoms: Exposure during pregnancy, Neonatal disorder
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: They are in my records.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My son was born with imperforate anus. I have had at least 18 vaccination shots against my will from 09-13.


VAERS ID: 686896 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Georgia  
Vaccinated:2017-03-14
Onset:2017-03-15
   Days after vaccination:1
Submitted: 2017-03-23
   Days after onset:8
Entered: 2017-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 3003158 / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UI1607AA / 1 LA / SC

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

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

Write-up: Patient took oral typhoid over the course of 1 week as directed. 1 day after completion of the vaccine, patient had high fevers (103), rash and body aches.


VAERS ID: 688637 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Idaho  
Vaccinated:2015-10-02
Onset:2015-11-09
   Days after vaccination:38
Submitted: 2017-02-16
   Days after onset:465
Entered: 2017-03-29
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 1515601 / UNK AR / UN

Administered by: Public       Purchased by: Public
Symptoms: Bladder dysfunction, Injected limb mobility decreased, Lumbar puncture, Mobility decreased, Muscular weakness, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NUVARING
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap-Lumbar Puncture
CDC Split Type:

Write-up: Impaired mobility of arms and legs, impaired function of bladder, weakness in hands, pain.


VAERS ID: 688833 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Washington  
Vaccinated:2017-03-09
Onset:2017-03-09
   Days after vaccination:0
Submitted: 2017-03-30
   Days after onset:20
Entered: 2017-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L014415 / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M039914 / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEXA
Current Illness: Anxiety/depression
Preexisting Conditions: No asthma dx but reports she had nebs Tx frequently as a child
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, malaise, muscle aches (onset 2 hours post vaccines); fever resolved 4 day and later cough developed with 24 hours of vaccines, w/dyspnea


VAERS ID: 688855 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-03-21
Onset:0000-00-00
Submitted: 2017-03-30
Entered: 2017-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R65027 / 3 AR / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Injection site cellulitis, Injection site streaking
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZERINC2017131031

Write-up: This is a spontaneous report from a contactable nurse via Pfizer sales representative. A 19-year-old patient of an unspecified ethnicity and gender received 3 doses of TRUMENBA (Lot # R65027, exp Sep2017) via an unspecified route of administration at single dose: the 1st dose on 17Aug2016, the 2nd dose on 25Nov2016 and the 3rd dose on 21Mar2017 (Lot R65027 Exp Sep2017) for immunisation. The patient medical history and concomitant medications were not reported. The patient returned on 22Mar2017 with cellulitis at injection site with streaking with outcome of unknown.


VAERS ID: 689020 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2017-03-27
Onset:2017-03-28
   Days after vaccination:1
Submitted: 2017-03-29
   Days after onset:1
Entered: 2017-03-30
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R56655 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Iron deficiency; Vit Deficiency; asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Less than 24 hrs after injection pt C/O redness, swelling at site of injection, nausea, vomiting, body aches, fever. 36 hours after injection, vomiting stopped, nausea, redness, body aches, and fever reduced.


VAERS ID: 688943 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Colorado  
Vaccinated:2017-03-21
Onset:2017-03-21
   Days after vaccination:0
Submitted: 2017-03-31
   Days after onset:10
Entered: 2017-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS N49M3 / 3 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158701 / 2 LA / IM

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

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

Write-up: Pt stated that approximately 1hr after administration, she experienced fever $g100, extreme muscle pain, and swelling of upper left arm. Pt states she went to the ER around 2:00AM on 03/22/2017. Pt states she was given IV BENADRYL, and "anti-swelling" medication and was discharged afterwards.


VAERS ID: 688948 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Georgia  
Vaccinated:2017-03-29
Onset:2017-03-29
   Days after vaccination:0
Submitted: 2017-03-31
   Days after onset:2
Entered: 2017-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV15E94E / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR M0113 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Ear congestion, Feeling abnormal, Mononucleosis heterophile test positive, Neck pain, Oropharyngeal pain, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lysteda, ibuprofen
Current Illness: None reported at the time. However, when patient returned after vaccines, she stated she hadn''t felt completely healthy beginning on the day before the vaccines.
Preexisting Conditions: Allergy to nickel group causing rash.
Allergies:
Diagnostic Lab Data: WBC 18.2 k/uL and positive mono test
CDC Split Type:

Write-up: Several hours after injections, she developed pain posterior neck. Reports she has had mild, intermittent sore throat for several days. When she awoke the next day, she had sore throat, pain had extended to anterior neck, ears felt congested, and felt "fuzzy headed."


VAERS ID: 689000 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Michigan  
Vaccinated:2017-03-09
Onset:2017-03-09
   Days after vaccination:0
Submitted: 2017-03-31
   Days after onset:21
Entered: 2017-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 154101 / 1 LA / IM

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

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

Write-up: Patient had fever and chills that evening following getting BEXERO vaccination.


VAERS ID: 690879 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Indiana  
Vaccinated:2017-04-04
Onset:2017-04-04
   Days after vaccination:0
Submitted: 2017-04-05
   Days after onset:1
Entered: 2017-04-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 3003159 / 1 MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Abdominal pain, Diarrhoea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minastrin 24 Fe; Fluocinolone Acetonide oil drops
Current Illness: none
Preexisting Conditions: Eczema in ear canal
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt took tablet #1 of oral Typhoid Rx on 4-4-2017 at 9:30 PM. By 9:35 pm pt C/O abd cramping diarrhea and fever x 2 hours. She then went to bed and slept the night.


VAERS ID: 690909 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Maryland  
Vaccinated:2017-04-04
Onset:2017-04-04
   Days after vaccination:0
Submitted: 2017-04-13
   Days after onset:9
Entered: 2017-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS 626011A / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain, Dizziness, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Dept. of health notified by patient''s employer on 4/10/17 that she would not be coming 4/11/17 for second dose. Complained of n/v, dizziness, HA, abdominal cramping on 4/4/17 at 12 noon (another report started 1730). Went to ER- given ZOFRAN. To discuss with PCP benefits vs. r/s RS continuing series. Patient to ER 4/4/17 at approximately 1900.


VAERS ID: 691063 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Texas  
Vaccinated:1967-06-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2017-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Injury, Peripheral swelling, Photophobia, Victim of crime
SMQs:, Cardiac failure (broad), Angioedema (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)

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

Write-up: June 1967 - My arm swell after vaccine shots - I was sent to Hospital I was given one white tablet. I got severe headaches and my eye became very sensitive to light. I did not know anything about nerve damage at the time. The damage may have also came from another when he grab me by the neck and pulled me to the floor and tried to assault me. Their were witness from both watching. I have sent letters to newspapers asking my story be told in hope that one of the see it and contact me so I can get a legal statement from them. Nothing was done about my eyes until I received a injury in Judo class. My sparing partner threw me and I tired to throw him at the same time and I landed on the back of my head, neck and upper back. My sparing partner feel on my head, eyes and chest. I could not see and my room mate''s told me I should go the hospital because I could get up in next morning and I may not be able to open my eyes. The doctor told me my eyes were highly sensitive to light and he ordered me too pairs of very dark sunglasses. I still have one pair of the in a box. One pair was stolen. To this day they have denied that my eyes became highly sensitive to light due to the injury to my eyes in the judo class. I had forgot about the problem I had after the vaccine shot. At the time I did not know that vaccine''s could do that. I also got sick when they gave Flu shots in 1968-1969 they tried to make it look like it was in my mind.


VAERS ID: 693884 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Illinois  
Vaccinated:2017-05-07
Onset:2017-05-11
   Days after vaccination:4
Submitted: 2017-05-11
   Days after onset:0
Entered: 2017-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Enlarged uvula, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: Feels throat tightening, swollen uvula.


VAERS ID: 693993 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2017-03-06
Onset:0000-00-00
Submitted: 2017-05-11
Entered: 2017-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R56655 / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZERINC2017203741

Write-up: This is a spontaneous report from a contactable consumer via Pfizer sales representative. A 19-year-old male patient of an unspecified race/ethnicity received the first dose of TRUMENBA, via an unspecified route of administration at single dose on an unspecified date for immunisation. The patient medical history and concomitant medications were not reported. On an unspecified date, the patient developed pain at the injection site and the area was red and warm for 3 to 5 days. Final outcome was unknown.


VAERS ID: 694085 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2017-05-12
Onset:2017-05-12
   Days after vaccination:0
Submitted: 2017-05-12
   Days after onset:0
Entered: 2017-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV510A / 1 RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR M1287-1 / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Fainted/Syncope episode shortly after receiving vaccination and getting up to check out. Had already received a blood draw and did not eat breakfast prior to coming to the site. Patient immediately recovered after fainting, alert and oriented, was aware of his surroundings. Did not remember falling to the floor.


VAERS ID: 694416 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2017-05-02
Onset:2017-05-02
   Days after vaccination:0
Submitted: 2017-05-05
   Days after onset:3
Entered: 2017-05-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M161099 / 1 LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Erythema, Pain in extremity, Pruritus generalised, X-ray normal
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergies to latex and milk
Allergies:
Diagnostic Lab Data: X-ray - normal per patient
CDC Split Type:

Write-up: All over itching - onset 5/2/17 in the evening. Redness on cheeks - left cheek mainly. Left thumb to elbow pain - "feel like fracture" - patient was wearing sling. Reported by patient on 5/5/17 to pharmacy.


VAERS ID: 694471 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2017-05-11
Onset:2017-05-15
   Days after vaccination:4
Submitted: 2017-05-15
   Days after onset:0
Entered: 2017-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16096 / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Lymphadenopathy, Pharyngeal oedema, Tonsillar hypertrophy
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given vaccine in pharmacy. At the time of the injection (and 20 minutes after administration, pt had no s/sx of allergy. Four days after immunization, Patient states they have swelling of throat/lymph nodes/ tonsils. However, delayed onset (4 days), so it is unclear if it is bacterial/viral pharyngitis or reaction to vaccine components. I referred patient to ER/urgent care to be evaluated for allergy or other causes, however patient still has not gone to urgent care/hospital for evaluation despite recommendation.


VAERS ID: 694899 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Illinois  
Vaccinated:2017-05-15
Onset:2017-05-15
   Days after vaccination:0
Submitted: 2017-05-17
   Days after onset:2
Entered: 2017-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Chills, Fatigue, Headache, Injection site cellulitis, Mobility decreased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Cellulitis at injection site. Severe muscular pain. Unable to move arm. Throbbing headache/chills/fatigue.


VAERS ID: 695131 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Maryland  
Vaccinated:2017-05-08
Onset:2017-05-09
   Days after vaccination:1
Submitted: 2017-05-18
   Days after onset:9
Entered: 2017-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 166801 / 2 LA / SYR

Administered by: Private       Purchased by: Private
Symptoms: Back pain, Blood test, Dizziness, Fatigue, Headache, Hypotension, Pain in extremity, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Blood work
CDC Split Type:

Write-up: Severe pain from shoulder to fingers. Body tremors, fatigue, headaches, back pain, dizziness, low BP 81/53. 3 ER visits and 2 doctor office no one can diagnose.


VAERS ID: 695354 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2017-05-09
Onset:2017-05-09
   Days after vaccination:0
Submitted: 2017-05-19
   Days after onset:10
Entered: 2017-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (broad)

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

Write-up: Patient is having elbow pain and pain with full extension which they feel started at the time of the vaccine.


VAERS ID: 695387 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2017-05-20
Onset:2017-05-20
   Days after vaccination:0
Submitted: 2017-05-20
   Days after onset:0
Entered: 2017-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR M00831 / 1 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Blood pressure decreased, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: BP initially 80/54 and recovered to 96/68. Pallor when initially responded and color came back to face and lips
CDC Split Type:

Write-up: Pt was entering passenger side of car and had a vasovagal syncopal event.


VAERS ID: 695419 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-04-07
Onset:2017-04-07
   Days after vaccination:0
Submitted: 2017-05-22
   Days after onset:45
Entered: 2017-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M047658 / UNK UN / UN

Administered by: Other       Purchased by: Unknown
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131705USA002857

Write-up: This spontaneous report was received from an office manager and refers to 19 year old patient of unknown gender. There was no information about the patient''s pertinent medical history and drug reactions or allergies. On 07-APR-2017, the patient was vaccinated with a pediatric dose of VAQTA (first dose) 25/0.5 (units were not provided) (lot # M047658 , expiration date: 20-OCT-2017, site and route of administration were not provided). No adverse effect was reported Additional information has been requested.


VAERS ID: 695475 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-05-15
Onset:0000-00-00
Submitted: 2017-05-22
Entered: 2017-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS GY3H5 / 4 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R45100 / 1 RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Hot flush, Lip discolouration, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PRPFIZER INC2017222017

Write-up: This is a spontaneous report from a contactable physician. A 18-year-old patient of an unspecified ethnicity and gender received TRUMENBA, via an unspecified route of administration, on an unspecified date, at single dose, for immunisation. The patient''s medical history was not reported. Concomitant medication included unspecified hepatitis vaccine. The patient experienced hot flashes in all the body, nausea, abdominal pain, syncope and white lips on an unspecified date with outcome of unknown.


VAERS ID: 695569 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2017-05-20
Onset:2017-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS XM59T / UNK RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Flushing, Skin warm, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pacemaker; Insulin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flush, vomiting, warm 30 minutes after injection. Sent out for evolution by physician at clinic at 3:20PM 5/20/17.


VAERS ID: 695635 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2011-07-15
Onset:0000-00-00
Submitted: 2017-05-22
Entered: 2017-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Vitiligo
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~18.00~Patient
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vitiligo skin started loosing pigment first under arms then vagina then eyes and face and around mouth then fingers and hands and wrists and arms.


VAERS ID: 696535 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2017-05-25
Onset:2017-05-25
   Days after vaccination:0
Submitted: 2017-05-25
   Days after onset:0
Entered: 2017-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5513AA / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood glucose, Blood pressure increased, Dysarthria, Electrocardiogram, Heart rate decreased, Mydriasis, Oxygen saturation decreased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: NKDA; JRA
Allergies:
Diagnostic Lab Data: EKG and in office glucose
CDC Split Type:

Write-up: Patient had MENACTRA vaccine. Within 5 min at admin had reaction of dilated pupils, slurred speech, decrease heart rate and oxygen, increased blood pressure. EMS was called and was cleared. Blood sugar and EKG done in office.


VAERS ID: 696757 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Virginia  
Vaccinated:2017-05-24
Onset:2017-05-25
   Days after vaccination:1
Submitted: 2017-05-26
   Days after onset:1
Entered: 2017-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UI660AA / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methylphenidate; Escitalopram
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, raised, itchy rash at injection site.


VAERS ID: 698055 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2017-03-16
Onset:2017-03-17
   Days after vaccination:1
Submitted: 2017-06-02
   Days after onset:77
Entered: 2017-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158401 / 2 LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Dysgraphia, Erythema, Flushing, Grip strength decreased, Hypersensitivity, Hypoaesthesia, Lip swelling, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies: PCN, Bactrim, and Sulfa drugs
Allergies:
Diagnostic Lab Data: Doctor recommended allergy test.
CDC Split Type:

Write-up: Late Friday night, noticed rash and redness on arms. Early Saturday morning around 1:00 AM, woke up to increased rash and redness and swollen lips. Later Saturday morning, woke up to numbness and swelling of fingers and hands which made it difficult and slightly painful to grip objects and write. On Sunday morning, rash and redness increased even more and spread to body and upper thighs, flushed face, and fingers/hands still numb and swollen. Went to doctor''s office around 11:00 AM, and doctor stated symptoms as an allergic reaction to BEXSERO. Doctor prescribed steroids for four days, Claritin, and Benadryl. Symptoms started to slowly decrease on Tuesday and throughout the week.


VAERS ID: 698444 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Maine  
Vaccinated:1999-05-06
Onset:1999-06-01
   Days after vaccination:26
Submitted: 2017-05-31
   Days after onset:6574
Entered: 2017-06-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / UNK UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Electromyogram normal, Eye pain, Headache, Hyperhidrosis, Migraine, Nervous system disorder, Nuclear magnetic resonance imaging brain normal, Photophobia, Rash, Vascular headache
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None at the time
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Negative EMG and Head Imaging
CDC Split Type:

Write-up: Sometime in the early summer of ''99 he began experiencing light-related eye pain and new onset headaches. He remembers headaches which were sharp pains behind the eyes 2-3x/week and severe migraines intermittently. He sought treatment at the clinic and was given Ibuprofen, which he took frequently without significant alleviation of symptoms. He reports he had to "push through the pain" regardless of his training and often tried to rest and use cold compresses on his forehead to alleviate the symptoms. He remembers with each anthrax vaccination he would have an exacerbation of the intensity and duration of headaches for a few days. He always linked his headaches to the anthrax vaccine because he never had significant headaches before, had sustained no head injuries and had no family history of migraines. Symptoms: Vascular headache, rash and oth nonspec skin eruption, generalized hyperhidrosis, unspecified abdominal pain, unsp symp and sign involve ner sysm.


VAERS ID: 698543 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: California  
Vaccinated:2017-06-06
Onset:2017-06-06
   Days after vaccination:0
Submitted: 2017-06-06
   Days after onset:0
Entered: 2017-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS Z25GH / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M017348 / UNK RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16099 / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS F7YE3 / UNK LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UN
Current Illness: None
Preexisting Conditions: White coat syndrome
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient fainted while waiting in line to pay for vaccinations.


VAERS ID: 699135 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Virginia  
Vaccinated:2017-06-07
Onset:2017-06-07
   Days after vaccination:0
Submitted: 2017-06-07
   Days after onset:0
Entered: 2017-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. N003703 / 2 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 168101 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Dizziness, Syncope, Thyroid function test
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), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Thyroid follow up
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data: Thyroid function labs draw
CDC Split Type:

Write-up: At 10:25 pt. was administered HPV #2 on right deltoid IM and BEXSERO on left deltoid IM. Did not mention not feeling well therefore taken to lab for thyroid function testing due to history of hypothyroidism. At 10:30 am pt. was at the lab when the lab tech ask for help, feeling lightheaded, fainted. I helped laying her down to the bed and check her BP was 100/60. 15 minutes later her BP was 98/58 and she was shivering. She stayed there for 10 more minutes. Per mom Pt fainted before with blood flow draw 6/9/17.


VAERS ID: 699160 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2017-05-24
Onset:2017-05-30
   Days after vaccination:6
Submitted: 2017-06-01
   Days after onset:2
Entered: 2017-06-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. M037770 / 1 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site reaction, Soft tissue mass
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray and ultrasound being done
CDC Split Type:

Write-up: 7 1/2 x 8 1/2 cm soft tissue mass at injection site LT upper arm.


VAERS ID: 699100 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-05-15
Onset:2017-05-15
   Days after vaccination:0
Submitted: 2017-06-09
   Days after onset:25
Entered: 2017-06-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. N000326 / 3 LA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R56659 / 2 LA / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Loss of consciousness, Pain in extremity, Peripheral swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Angioedema (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), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2017252000

Write-up: This is a spontaneous report from a contactable consumer (Practice manager) reported same events for 2 twins patients. This is the 2nd of 2 reports. A 19-year-old female patient of an unspecified ethnicity received TRUMENBA via an unspecified route of administration at 0.5ml, single on an unspecified date for immunisation. The patient medical history and concomitant medications were not reported. On 15May2017 the patient passed out as soon as she was administered, fainted, had reactions on her arms very painful, sore and swollen on 15May2017 with outcome of recovered, The outcome of the events was recovered. The same events occurred to her twin sister.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2017252009 same reporter/drug/event, different patient.


VAERS ID: 699343 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-04-17
Onset:2017-04-17
   Days after vaccination:0
Submitted: 2017-06-13
   Days after onset:57
Entered: 2017-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Unknown       Purchased by: Unknown
Symptoms: Incorrect product storage, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: STERILE DILUENT
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131706USA003459

Write-up: This spontaneous report was received from a registered nurse reporting on a 19-year-old old patient of unknown gender. No information regarding the patient''s pertinent medical history, concurrent conditions, concomitant medications, drug reactions or allergies was provided. On 17-APR-2017, the patient was vaccinated with improperly stored dose of VARIVAX injection (dose, frequency and route of administration were not reported, lot # either L050561 with expiration date of 14-DEC-2017 or M019841 with expiration date of 20-APR-2018), for prophylaxis. The Merck (MRK) sterile diluent (lot # and expiration date were not reported) used to reconstitute the VARIVAX was properly stored. The temperature excursion ranged from 6 to 14 degrees Fahrenheit and lasted for 30 minutes. It occurred once on 03-FEB-2017, and was detected by a Digital Data Logger. There was no previous excursion reported. No adverse effects were reported. This was one of several reports received from the same reporter. Additional information has been requested. Sender''s Comments: US-009507513-1704USA010916: US-009507513-1704USA009837:


VAERS ID: 699381 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: South Dakota  
Vaccinated:2017-06-13
Onset:2017-06-13
   Days after vaccination:0
Submitted: 2017-06-13
   Days after onset:0
Entered: 2017-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. M041511 / 1 RA / SC

Administered by: Public       Purchased by: Private
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)

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

Write-up: Pt was administered ZOSTVAX instead of VARIVAX. Called Merck and the stated I needed to report to VAERS.


VAERS ID: 699520 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2016-07-07
Onset:0000-00-00
Submitted: 2017-06-14
Entered: 2017-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. N000326 / 3 LA / UN
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M95612 / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~HPV (Gardasil)~~0.00~Patient|~HPV (Gardasil)~~0.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZERINC2017252881

Write-up: This is a spontaneous report from a contactable other health care professional. A 20-year-old female patient received TRUMENBA (Lot# M95612, Exp date Jul2017), via an unspecified route of administration in arm left, on 07Jul2016, at single dose, for immunisation and the 3rd dose of GARDASIL (Lot# N000326, Exp date Oct2019), via an unspecified route of administration in arm left, on 07Jul2016, at unspecified dose, for immunisation. The patient''s medical history was not reported. Concomitant medications were not reported. The patient previously took 1st and 2nd dose of GARDASIL on unspecified date, for immunisation. The patient experienced injection site swollen, painful and red on an unspecified date with outcome of unknown. Sender''s Comments: Linked Report(s): US-PFIZER INC-2017252924 Same drug/event, different patient.


VAERS ID: 699587 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Georgia  
Vaccinated:2008-06-24
Onset:2009-04-13
   Days after vaccination:293
Submitted: 2017-06-14
   Days after onset:2984
Entered: 2017-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Colposcopy, Dysplasia, Exposure during pregnancy, Smear cervix abnormal
SMQs:, Premalignant disorders, general conditions and other site specific disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No ailments. No previous history of abnormal Pap
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: More frequent Pap tests than average person. Higher risk of cancer.
CDC Split Type:

Write-up: Abnormal Pap result during pregnancy after Gardasil (hpv) vaccine. After having baby. Had a colposcopy, result was moderate to severe dysplasia. Leading my obgyn to do a LEEP procedure.


VAERS ID: 699771 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Florida  
Vaccinated:2017-05-25
Onset:2017-05-26
   Days after vaccination:1
Submitted: 2017-06-01
   Days after onset:6
Entered: 2017-06-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 165401A / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy: Gadolininm derivatives; Nausea
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 102 degrees F Temp. 12 hours after administration.


VAERS ID: 700505 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2017-05-17
Onset:2017-05-18
   Days after vaccination:1
Submitted: 2017-06-21
   Days after onset:34
Entered: 2017-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 AR / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 AR / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 AR / IM
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 AR / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 AR / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 AR / IM
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 AR / IM

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

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

Write-up: Many small fairly firm bumps near the injection site which persist to the present.


VAERS ID: 700761 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2017-06-22
Onset:2017-06-22
   Days after vaccination:0
Submitted: 2017-06-22
   Days after onset:0
Entered: 2017-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158501C / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Dizziness, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOESTRIN FE; ZOLOFT
Current Illness: Denies
Preexisting Conditions: Amoxicillin-pot clavulanate; Anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncopal episode 10 minutes post vaccination (when leaving office) - writer arrived to assist pt within 1 minute post event - pt states "I don''t know what happened - I just felt dizzy and must of went down". Pt oriented x 3, BP = 110/76; P = 68; R = 16. After 10 minutes, pt reports ok to leave. Denies any adverse effects. Boyfriend here and will drive pt home.


VAERS ID: 700766 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Montana  
Vaccinated:2016-12-29
Onset:0000-00-00
Submitted: 2017-06-16
Entered: 2017-06-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 7KK33 / 1 LA / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS Z25GH / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 4SN42 / 1 LA / IM

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

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

Write-up: No adverse affects noted. 19 year old patient received Adult dose of Hep B instead of the Pediatric dose. Pt. verbalized no reaction to Hep B vaccination.


VAERS ID: 700973 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2017-06-16
Onset:2017-06-18
   Days after vaccination:2
Submitted: 2017-06-26
   Days after onset:8
Entered: 2017-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M041212 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient has a written hx of 5 Hep B vaccinations! We did not update the Hep B vaccine the date of this visit due to this was discovered.
Current Illness: none
Preexisting Conditions: environmental allergies
Allergies:
Diagnostic Lab Data: Patient here to clinic this date with rash. Patient treated for viral rash, Provider does not believe it is related to vaccine. Nurse has a duty to report vaccine reax, reported this date when reported to Nurse.
CDC Split Type:

Write-up: Patient noted rash on trunk, flank and buttocks area approximately 48-72 hours after vaccine was given. No swelliing of injection site. Denies s/s allergic reax or anaphylaxis.


VAERS ID: 701033 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Colorado  
Vaccinated:2017-06-26
Onset:2017-06-26
   Days after vaccination:0
Submitted: 2017-06-27
   Days after onset:1
Entered: 2017-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R65026 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood albumin decreased, Blood alkaline phosphatase normal, Chills, Computerised tomogram head normal, Full blood count normal, Headache, Hyperacusis, International normalised ratio normal, Metabolic function test normal, Myalgia, Photophobia, Protein total decreased, Prothrombin time normal, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRINESSA LO
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Head CT without contrast negative; CBC nl; CMP nl except high alk phos 37, low t protein 6.1 and low albumin 3.2; PT/INR nl
CDC Split Type:

Write-up: Sudden onset severe throbbing HA, photophobia, hyperacusis, myalgias, shaking chills tx with IV fentanyl, BENADRYL, ketorolac and IVFs.


VAERS ID: 701215 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Michigan  
Vaccinated:2017-06-20
Onset:2017-06-20
   Days after vaccination:0
Submitted: 2017-06-29
   Days after onset:9
Entered: 2017-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. N005274 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRI-SPRINTEC
Current Illness: NONE
Preexisting Conditions: DRUG ALLERGY TO CEFZIL. MEDICAL CONDITIONS: ALLERGIC RHINITIS, PATELLAR TENDONITIS, DYSMENORRHEA, GERD, KNEE PAIN
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT WAS ADMINISTERED PEDIATRIC DOSE OF HEPATITIS A VACCINE.


VAERS ID: 701258 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2017-06-26
Onset:2017-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N004799 / 3 RA / IM

Administered by: Private       Purchased by: 0
Symptoms: Arthralgia, Headache, Hypoaesthesia, Lip swelling, Myalgia, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CRYSELLE-28
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: SWOLLEN LIPS, FEVER (100.3), HEADACHE, JOINT PAIN, NUMBNESS/TINGLING IN FINGERS THAT WENT AWAY, AND MUSCLE ACHES.


VAERS ID: 702540 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2017-06-03
Onset:2017-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 157601 / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Mobility decreased, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: seasonal allergy; anxiety; back pain
Allergies: seasonal
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Swollen painful arm for 9 days, not able to lift arm up the shoulder.


VAERS ID: 702554 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2017-07-03
Onset:2017-07-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5626AA / UNK LA / IM

Administered by: 0       Purchased by: 0
Symptoms: Injection site erythema, Injection site induration, Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMALOG; MICROGESTIN FE; Vitamin D2
Current Illness: Sunburn
Preexisting Conditions: Type I diabetes
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with redness at site of injection which was slightly warm to touch as well as small hardened lump. Symptoms had appeared approximately 24 hours after injection. Patient advised to seek medical care if lump and redness did not clear or if experiencing fever.


VAERS ID: 703112 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: New York  
Vaccinated:2017-05-15
Onset:2017-05-15
   Days after vaccination:0
Submitted: 2017-05-15
   Days after onset:0
Entered: 2017-07-05
   Days after submission:51
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M039202 / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N00326 / 2 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 7Z925 / 3 LA / IM

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

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

Write-up: Hives on Lt. forearm, denies difficulty in. Allergic.


VAERS ID: 702590 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2017-07-05
Onset:2017-07-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 7439F / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R56659 / 2 RA / IM

Administered by: Private       Purchased by: 0
Symptoms: Chills, Dyspnoea, Erythema, Fatigue, Headache, Injected limb mobility decreased, Nausea, Pain in extremity, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concurrent Hepatitis A vaccine
Current Illness: N/A
Preexisting Conditions: Asthma - cold induced
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sudden onset of extreme exhaustion, nausea, chills, low grade temp, face bright red & puffy, breathing labored. Severe right arm pain & inability to move it. Went to ER. Treated with oxygen & IV fluids. Symptoms resolved spontaneously after approximately an hour. Residual headache & arm pain.


VAERS ID: 702762 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Oregon  
Vaccinated:2017-07-06
Onset:2017-07-06
   Days after vaccination:0
Submitted: 2017-07-07
   Days after onset:1
Entered: 2017-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 15801C / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: CSF test, Chills, Full blood count, Headache, Meningitis viral, Metabolic function test, Nausea, Photophobia
SMQs:, Acute pancreatitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None was well asymptomatic
Preexisting Conditions: None; Anxiety
Allergies:
Diagnostic Lab Data: CBC; CMP; CSF
CDC Split Type:

Write-up: Received BEXSERO on 7/6/17 at approx 16:30 by 18:30-19:00 Had abrupt onset headache severe, photophobia, nausea and rigors. Afebrile went to ER- Had spinal tap Dx viral meningitis Woke today 7/7 at 10:30a and felt fine as of report.


VAERS ID: 702860 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-06-09
Onset:2017-06-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown       Purchased by: 0
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131706USA005152

Write-up: This spontaneous report was received from a Licensed Practical Nurse and refers to a 19 year old patient of unknown gender. No pertinent medical history, drug reactions or allergies were reported. On 09-JUN-2017, the patient was vaccinated with a pediatric dose of VAQTA for prophylaxis (dose, route of administration, anatomical location, lot number and expiration date were not reported). No adverse effects were reported.


VAERS ID: 703001 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2017-07-10
Onset:2017-07-10
   Days after vaccination:0
Submitted: 2017-07-10
   Days after onset:0
Entered: 2017-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N001533 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Heart rate increased, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOFRAN; Vit D3; probiotic; Vit B12; biotin; cod liver oil
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H/O celiac sprue
CDC Split Type:

Write-up: Lightheaded, vomiting, pale, increased HR, causes to rest; drank OJ - back to normal within 1/2 hour.


VAERS ID: 703355 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Oregon  
Vaccinated:2017-07-07
Onset:2017-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R45100 / 1 LA / SYR

Administered by: Private       Purchased by: 0
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Rash on left arm near injection site x 5 days.


VAERS ID: 703586 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Virginia  
Vaccinated:2017-07-10
Onset:2017-07-11
   Days after vaccination:1
Submitted: 2017-07-12
   Days after onset:1
Entered: 2017-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH S26962 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Dizziness, Erythema, Fatigue, Local reaction, Pain, Paraesthesia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Child was lightheaded, body aches, chills, tired easily and local reaction of swelling and redness, tingling down leg, onset day after TRUMENBA.


VAERS ID: 703656 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Nevada  
Vaccinated:2017-07-01
Onset:2017-07-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2017-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS EF773 / 1 RA / IM

Administered by: 0       Purchased by: 0
Symptoms: Dizziness, Fatigue, Nausea, Pallor, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: No Known illnesses.
Preexisting Conditions: No Chronic or Long-Standing Health Conditions
Allergies: No Known Allergies
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Event Syncope: Paleness, Nausea, Dizziness, Fainting, and Visual Disturbance. Patient Fainted, but regained consciousness with a few seconds. I had patient lie on the ground with blanket and pillow underneath, provided cold compress on head, neck, and injection site. I also provide OJ to increase patients blood sugar. I monitored patient for 30 to 45 minutes, notified family via phone. Once patient was stable patient returned home, I contacted patient at 11:31 AM, to make sure patient was home safe and told her to rest for the day. Patient was informed to call Pharmacy or PCP if any further reactions. Also she can take Tylenol or Motrin for injection site soreness.


VAERS ID: 703754 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2017-07-10
Onset:2017-07-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2017-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16005 / 2 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Incorrect product storage
SMQs:, Medication errors (narrow)

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

Write-up: On July 13,2017 the data logs were check and an excertion was noted for July9 at 60.6F for 12.10 hours.


VAERS ID: 703756 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2017-07-12
Onset:2017-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16005 / 2 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Incorrect product storage
SMQs:, Medication errors (narrow)

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

Write-up: On July 13, 2017 it was discovered that there was an excertion on July 9 at 60.6F for 12.10 hours. Refrigerator went out of range.


VAERS ID: 703773 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Washington  
Vaccinated:2017-07-13
Onset:2017-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N004799 / 1 RA / IM

Administered by: Military       Purchased by: 0
Symptoms: Chills, Headache, Nausea, Pain in extremity, Pyrexia, Vaccination site pain, Vaccination site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN; SERTRALINE (ZOLOFT EQ); TRAZODONE; Ethinyl Estradiol + Drospirenone; FLUTICASONE PROPIONATE; CETIRIZINE HCL;
Current Illness: allergic rhinitis; "Person with feared health complaint in whom no diagnosis is made"
Preexisting Conditions: allergic rhinitis
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling and pain in deltoid muscle, Headache, nausea, vomiting. Got HPV9 vaccine yesterday morning at about 10:20 am when she came in for left ankle pain. Later that evening about 19:00 hrs she started feeling pain in her arm, fever chills, headache and nausea with vomiting. Vommited twice last night, and still feels nauseous on exam today. In addition, has frontal throbbing headache denies photo/phonophobia and no pmhx of migraine headaches.


VAERS ID: 703863 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-06-26
Onset:2017-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N003703 / 1 UN / UN

Administered by: Other       Purchased by: 0
Symptoms: Inappropriate schedule of drug administration, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131707USA000197

Write-up: This spontaneous report was received from a medical assistant and refers to a 19-year-old patient of unknown gender. No information regarding the patient''s pertinent medical history, drug reactions or allergies and concomitant medications was provided. On an unspecified date in July 2014, he patient was vaccinated with the first dose of GARDASIL injection (dose, route of administration, lot# and expiration date were not reported). Then, on an unspecified date in August 2014, the patient received the second dose of GARDASIL injection (dose, route of administration, lot#. and expiration date were not reported). On 26-JUN-2017 (reported as today), the patient was vaccinated with a dose of GARDASIL 9 (lot # N003703, expiration date: 29-OCT-2017; dose and route of administration were not reported). That was the third dose of the human papillomavirus vaccine received by the patient. No adverse effects were reported. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 703976 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-07-10
Onset:2017-07-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TETANUS DIPHTHERIA (TENIVAC) / SANOFI PASTEUR A103A / 2 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Asthenia, Dizziness, Instillation site reaction, Nausea, Rash erythematous, Seizure
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KEPPRA; PPD
Current Illness: none
Preexisting Conditions: epilepsy but had been seizure free for over 2 years until receiving this injection
Allergies: none known
Diagnostic Lab Data: She has had a red rash at the site of testing for over 72 hours. Dr. is perplexed as not typically what is seen but is not treating as TB since there is not a hard bump.
CDC Split Type:

Write-up: Seizure occurred 48 hours after the TB test and Tetanus booster vaccine - after being seizure free for 2 years. She felt faint, weak and nauseous immediately following the TB test. She has had Tetanus shot before and no adverse reaction therefore seems related to TB as this was the first test she''s ever received. The TB test was a PPD skin test- intradermal - Lot # C5039AA exp 11/16/2018, manufacturer Sanofi Pasteur.


VAERS ID: 704056 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-06-21
Onset:2017-07-03
   Days after vaccination:12
Submitted: 2017-07-17
   Days after onset:14
Entered: 2017-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158501C / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Groin pain, Lymphadenopathy
SMQs:, Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US2017107464

Write-up: This case was reported by a nurse via call center representative and described the occurrence of lymphadenopathy inguinal in a 19-year-old female patient who received BEXSERO (batch number 158501C, expiry date March 2018). On 21st June 2017, the patient received BEXSERO. On 3rd July 2017, 12 days after receiving BEXSERO, the patient experienced lymphadenopathy inguinal and groin pain. On an unknown date, the outcome of the lymphadenopathy, inguinal and groin pain were unknown. It was unknown if the reporter considered the lymphadenopathy inguinal and groin pain to be related to BEXSERO. Additional details were provided as follows: The patient experienced lymph nodes in groin area after receiving a dose of BEXSERO vaccine in hip area. It felt tender and painful. No additional information provided.


VAERS ID: 704101 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2017-07-13
Onset:2017-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. I049534 / UNK RA / SC

Administered by: Private       Purchased by: 0
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. reported to office after varicella vaccine - rash started on legs and abdomen.


VAERS ID: 704255 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Rhode Island  
Vaccinated:2017-07-19
Onset:2017-07-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / UNK - / -
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR - / UNK - / -

Administered by: Military       Purchased by: 0
Symptoms: Chills, Dyspnoea, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Received small pox vaccination 1 week ago w/o incident
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 1 hour after administration of vaccines, developed rigors, shortness of breath, nausea and vomiting.


VAERS ID: 704593 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2017-06-02
Onset:0000-00-00
Submitted: 2017-06-30
Entered: 2017-07-19
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M039202 / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Drug administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient inadvertently received pediatric Hepatitis A (12mo-18years)(0.5ml), rather that adult Hepatitis A ($g19yrs)(1.0ml). Will contact patient to return to clinic for full therapeutic dose of Hep A.


VAERS ID: 704392 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2003-03-21
Onset:2004-10-01
   Days after vaccination:560
Submitted: 0000-00-00
Entered: 2017-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV074 / 1 LA / SYR
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 UN / -

Administered by: Military       Purchased by: 0
Symptoms: Altered state of consciousness, Anxiety, Appendicectomy, Arthropathy, Asthenia, Blood test, Burning sensation, Dermatitis contact, Drug hypersensitivity, False positive investigation result, Gallbladder polyp, Immediate post-injection reaction, Intervertebral disc degeneration, Muscle tightness, Myalgia, Pain in extremity, Photosensitivity reaction, Staphylococcus test, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dystonia (broad), Biliary neoplasms benign (incl cysts and polyps) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None at the time
Diagnostic Lab Data: I have had several blood tests with my primary care provider since 2004 but they have no idea what is wrong or why I show false positive results for arthritis but still have joint issues. I also gave a false positive result for MRSA and was given Vancomyacin which I found out I was allergic to. Also became allergic to Zofran, Compozine, Reglan used to stop nausea during pregnancy. I am now also allergic to most adhesives and chloro-prep. Never was before. I am now also allergic to Cortozone and steroids in general. Never has a problem before the anthrax shots.
CDC Split Type:

Write-up: Besides the immediate buring like my arm was on fire after getting each shot and having an egg shaped welt on my arm that was extremely painful. I began to have a lot of issues being outside in the sun. It felt as if I was having all the energy sucked out of me. My body would just radiate heat with in a matter of just a couple of minutes of being out in the sun. I very quickly felt as if I would pass out. As the years have gone by this issue has not gone away. I also now have anxiety issues not related to work because I did not go. This anxiety just seemed to come from out of no where. I also have degenerative disc disease and keep having positive results for arthritis but then don''t show the signs for it. My joints feel week and my muscles get really tight to where it is painful and I have to constantly be stretching. I already had to have my appendix removed and now have polyps in my gall bladder.


VAERS ID: 704623 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-07-20
Onset:2017-07-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. N003997 / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Injection site erythema, Injection site irritation
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL); etonogestrel-ethinyl estradiol (NUVARING); FLUTICASONE/SALMETEROL (ADVAIR DISKUS INH); levonorgestrel-ethinyl estradiol (AVIANE);MONTELUKAST SODIUM (SINGULAIR PO).
Current Illness: none
Preexisting Conditions: Malaise and fatigue; Allergy, sequel; Recurrent sinusitis; Iron deficiency; Vitamin D deficiency
Allergies: Other Non-meds (Specify In Comments) 10/08/2012 Allergy - Contact; Swelling Possible allergy to Guava; Symptoms: significant lip swelling (see PAMF note on 8/28/12); Sulfamethoxazole-trimethoprim 02/28/2014 Allergy - Systemic Hives/urticarial   Symptoms: widespread rash; Zithromax [Azithromycin] 02/07/2013  Other (Specify with Comments)  Stomach upset noted 01/2011
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Localized rednes and irritation at site of injection - treatment, monitoring and OTC benadryl and tylenol for inflammation.


VAERS ID: 704697 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2017-06-09
Onset:2017-06-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. N000336 / UNK UN / UN

Administered by: Unknown       Purchased by: 0
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131707USA006645

Write-up: Information has been received from a nurse, referring to a 19 year old male patient. The patient''s medical history, concurrent conditions and concomitant therapies were not reported. On 09-JUN-2017, the patient was inadvertently vaccinated with a dose of PROQUAD lot # N000336 with an expiration date on 03-JUN-2018 (strength, dose, anatomical location and administration route were not reported) for prophylaxis. No adverse effects were reported. No product quality complaint (PQC) was involved.


VAERS ID: 704989 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-04-12
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2017-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. M039202 / UNK - / -

Administered by: Private       Purchased by: 0
Symptoms: Drug administered to patient of inappropriate age, Immunisation, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Pt is 19 yrs old. He received a pediatric dose of Hep A on 4/12/17instead of adult dose. Pt did not have any reaction.Pt notified and revaccinated with adult dose of Hep A on 4/22/17.


VAERS ID: 705048 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2017-04-11
Onset:2017-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS 626011A / UNK UN / UN

Administered by: Private       Purchased by: 0
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given 3 doses RABAVERT vaccine that had been stored improperly in the freezer.


VAERS ID: 705184 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Kansas  
Vaccinated:2017-07-21
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2017-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R65027 / 1 AR / IM

Administered by: Private       Purchased by: 0
Symptoms: Chills, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; Vitamin C; Vitamin D; NASONEX
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, body aches, chills, fever.


VAERS ID: 705098 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2017-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown       Purchased by: 0
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131707USA009290

Write-up: This spontaneous report was received from a registered nurse referring to a 19 year old patient of unknown gender. The patient''s medical history, concurrent conditions and concomitant therapies were not reported. On an unknown date, the patient was vaccinated with a pediatric dose of VAQTA (strength, dose, route, anatomical location, lot number and expiration date were not provided), for prophylaxis. No adverse effects were reported.


VAERS ID: 705131 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Michigan  
Vaccinated:2017-07-21
Onset:2017-07-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 159001A / 1 RA / IM

Administered by: Private       Purchased by: 0
Symptoms: Arthralgia, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, body aches, joint pain, headache


VAERS ID: 705206 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Michigan  
Vaccinated:2017-07-15
Onset:2017-07-15
   Days after vaccination:0
Submitted: 2017-07-17
   Days after onset:2
Entered: 2017-07-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. N001007 / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VENTOLIN HFA; FLONASE; FLOVENT; AVLANE; INDERAL
Current Illness:
Preexisting Conditions: Type B WPW syndrome; asthma; low weight; allergic rhinitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling at injection site. Rash at injection site. Pain at injection site. Given 5-days of prednisone to use ice and MOTRIN.


VAERS ID: 705450 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-05-25
Onset:2017-05-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 159001A / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: The following morning she developed a paresthesia in both legs where they felt numb, and this lasted for 5 days, which made her and her mom feel very anxious and worried about it. No other symptoms, no muscle weakness or paralysis, no pain in her legs, no dizziness, no visual problems.


VAERS ID: 705633 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Colorado  
Vaccinated:2017-06-26
Onset:2017-07-01
   Days after vaccination:5
Submitted: 2017-07-19
   Days after onset:18
Entered: 2017-07-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 159001A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergies trees, weeds, cashews; (2) lip and chin AVM; allergy shot prior; 2 days prior to MenB, OMV; anesthesia 5 days post Men-B
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives.


VAERS ID: 705838 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Indiana  
Vaccinated:2017-07-10
Onset:2017-07-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH - / UNK LA / UN

Administered by: Private       Purchased by: 0
Symptoms: Fatigue, Headache, Injection site erythema, Injection site warmth, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZERINC2017326090

Write-up: This a spontaneous report from a contactable consumer reporting on behalf of her daughter. A 19-year-old female patient received TRUMENBA, via an unspecified route of administration on the left arm at single dose on 10Jul2017 for immunization. The patient had no medical history. The patient concomitant medications were unknown. On 11Jul2017 the patient experienced headache, fever that reached 101.5 degrees, bad muscle and body aches, really tired, site reddish and site warm and nausea. The outcome of the events was reported as recovered for Headache, tiredness and bad muscle and body aches on 16Jul2017, for fever on 14Jul2017, for site reddish and site warm on unknown date. The patient received treatment for the events.


VAERS ID: 706311 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2017-07-28
Onset:2017-07-28
   Days after vaccination:0
Submitted: 2017-07-28
   Days after onset:0
Entered: 2017-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV15M10E / 2 UN / IM
RAB: RABIES (IMOVAX) / SANOFI PASTEUR L0099 / 3 UN / IM

Administered by: Other       Purchased by: Private
Symptoms: Immediate post-injection reaction, Loss of consciousness, Pallor, Seizure like phenomena, Underdose
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), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Medication errors (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MTV; Vitamin D; fish oil; JUNEL FE
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: While administering 2nd vaccine (IMOVAX) pt: stated her eyes were "going black", turned a pale color, and proceeded to pass out in the chair. We elevated her feet and moved her to a reclined position. Pt. came to within 1 minute, Pt appeared to have seizure-like movements for a few seconds before passing out. Pt rested for 15-20 minutes and felt well enough to leave with mom. Pt only received only 1/4 vaccine b4 passing out. I removed needle as patient passed out.


VAERS ID: 706052 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-01-06
Onset:2017-01-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M018436 / UNK UN / UN

Administered by: Unknown       Purchased by: 0
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: STERILE DILUENT
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131707USA011521

Write-up: This spontaneous report was received from a registered nurse and refers to a 19 year old female patient. The patient''s concurrent conditions and medical history were not reported. On 06-JAN-2017, the patient was vaccinated with an improperly stored dose of varicella virus vaccine live (oka/merck)(manufacturer unknown) lot # M018436 with expiration date of 13-APR-2018 (dose, route and frequency were not reported) reconstituted with properly stored sterile diluent (MRK) for prophylaxis. No adverse effects were reported. It was stated that the vaccine underwent a temperature excursion of 6 degrees Fahrenheit to 14 degrees Fahrenheit for 101 days. It was reported that there was no need to repeat vaccine. No previous temperature excursion. The call was not because of a "data logger". There was no Product Quality Complaint (PQC) involved in this case. No further information was provided. This is one of the several reports received from the same reporter. Sender''s Comments: US-009507513-1705USA014053.


VAERS ID: 706216 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: California  
Vaccinated:2017-07-31
Onset:2017-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5654AA / 1 LA / IM

Administered by: 0       Purchased by: 0
Symptoms: Dizziness, Loss of consciousness, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: no
Preexisting Conditions: no
Allergies: No. No known foods, or medication allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Prior administration of the vaccine; patient had mentioned that he was afraid of needle injection. 5 minutes after administration of vaccine, patient went to sit down at the waiting bench for observation. He stated he felt light headed; tingling sensation on the injected left arm; he dropped his cell phone on the floor, and then passed out flat on his tummy on the floor for about 5 second. Nearby stander fire fighter responded right away. Pharmacist activated emergency respond with patient''s stepmom approval. Patient was well alerted, oriented, and ventilating well after the event. Patient stated that he may have bitten his lips. However, no injuries noted at the time of the incident. Patient father cancelled the emergency respond. Patient''s father (who is an endodontist) stated that his son would be okay, and he would not want to seek for Emergency Medical help. Pharmacist asked to observe patient for additional 30 minutes; however, stepmom said they were okay and left the pharmacy area at 2:25PM.


VAERS ID: 706217 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: South Dakota  
Vaccinated:2017-07-27
Onset:2017-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 157601 / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5513AA / UNK RA / IM

Administered by: Private       Purchased by: 0
Symptoms: Erythema, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 07/31/17 1200 Patient''s mother calls and reports to the clinic that patient''s left arm on Friday the day after Men B vaccine was given that redness/swelling and pain did occur. She was reporting because of the size of diameter of the swelling/redness pt''s mother said it was diameter size of baseball. Each day it did improve as weekend progressed and it is currently still sore and slightly red but all s/s are much improved and mom just wanted to make sure it was reported. RN attempted to contact pt directly but unable to get him on the phone. Instruction given to mother that if symptoms are not gone within the next 2 days to have pt come back to clinic to have provider look at arm. As of today the redness and swelling are down to what the normal reaction would be from vaccine.


VAERS ID: 706444 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2017-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown       Purchased by: 0
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131707USA013401

Write-up: This spontaneous report as received from a nurse refers to a 19 year old patient of unknown gender. On an unknown date (reported as a couple of weeks ago), the patient was inadvertently received one pediatric dose of VAQTA 25/0.5 (unit not reported) (dose, lot #, expiration date and route not reported) instead of one adult dose of VAQTA for prophylaxis. No adverse effects were reported.


VAERS ID: 706694 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-06-02
Onset:2017-06-02
   Days after vaccination:0
Submitted: 2017-07-25
   Days after onset:53
Entered: 2017-08-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R45100 / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. reports 2 hr. after administration fever at 102 F and chills, whole body ache, swelling, soreness, redness at site of administration which continued for one week. Then resolved.


VAERS ID: 707013 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Maryland  
Vaccinated:2017-08-02
Onset:2017-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 16B101 / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Dizziness, Dizziness postural, Dyspnoea, Feeling hot, Immediate post-injection reaction, Injection site pain, Swelling face, Throat irritation, Throat tightness, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Whey protein
Current Illness: Poison ivy; Right shoulder strain
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt soreness immediately after at injection site. Woke up this morning, face seemed swollen, particularly on cheeks. Felt dizzy and light-headed. No syncope. Standing up made it worse. Denies blurred vision, shortness of breath, itchy or tightening sensation in throat. No hives. Reports that his face feels warm, no fever.


VAERS ID: 707156 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2017-07-21
Onset:2017-07-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2017-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16096 / 2 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Decreased appetite, Dysphagia, Malaise, Muscular weakness, Pain in extremity, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Autism; Selective mutism
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2-3d after injection, developed leg and arm pains, arm weakness, vision blurring, loss of appetite dysphagia, overall feeling of unwellness. No difficulty walking, no numbness tingling. No gait changes. No difficulty breathing nor inability to swallow. These symptoms persisted for about 7 days, then were improved upon evaluation by me on 8-3-17. At evaluation she still had vision blurring, leg pains but arms were normal, dysphagia resolved; leg pains are improved. Pt does not appear to be Guillain Barre at this time, but she is 2 weeks out from the vaccine at this time.


VAERS ID: 706995 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2017-08-04
Onset:2017-08-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N013695 / 3 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158501C / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Chills, Dizziness, Liver function test, Metabolic function test, Muscle spasms, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: RESPICLICK; FLOVENT; ZOFRAN; CLARITIN; FLONASE; JUNEL
Current Illness: Delayed gastric emptying
Preexisting Conditions: Delayed gastric emptying, asthma, allergies
Allergies: apple, pear, peach, cucumber, tree nuts, vanilla, lactose, gluten and red meat sensitivity
Diagnostic Lab Data: ER visit with hepatic function and BMP labs.
CDC Split Type:

Write-up: A few hours after the vaccine, patient began feeling nauseous, dizzy, vomiting, muscle cramping, and chills. Patient was seen in the ED and was sent home.


VAERS ID: 707201 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Maine  
Vaccinated:2017-08-02
Onset:2017-08-06
   Days after vaccination:4
Submitted: 2017-08-07
   Days after onset:1
Entered: 2017-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / UNK RA / SYR

Administered by: Other       Purchased by: Unknown
Symptoms: Arthralgia, Grip strength decreased, Hypoaesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives~Influenza (Seasonal) (no brand name)~UN~10.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies: penicillin, sulfa, seasonal; heart murmur
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe joint pain in elbows, knees, and shoulders. Hands are becoming numb has difficulty in gripping or making a fist. Shaking in hands began today. Elbows painful to touch. Injection site unremarkable.


VAERS ID: 707266 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2017-07-31
Onset:2017-07-31
   Days after vaccination:0
Submitted: 2017-08-01
   Days after onset:1
Entered: 2017-08-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16084 / 1 RA / UN

Administered by: Other       Purchased by: Private
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Syncope, minor fall, no concussion or bruising, called pt. next day (8/1/17), no complaints.


VAERS ID: 707302 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Missouri  
Vaccinated:2017-06-26
Onset:2017-06-27
   Days after vaccination:1
Submitted: 2017-08-07
   Days after onset:41
Entered: 2017-08-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L038503 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chest pain, Lip swelling, Malaise
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sick, lips swelling, chest pains, all occurred the following morning after receiving vaccine.


VAERS ID: 707384 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2017-07-31
Onset:2017-08-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2017-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M033213 / 2 LA / SC

Administered by: Public       Purchased by: 0
Symptoms: Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Small red bumps to forearm, abdomen and legs. No other signs or symptoms.


VAERS ID: 707580 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-07-24
Onset:2017-07-31
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2017-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M022407 / UNK LA / IM

Administered by: Unknown       Purchased by: 0
Symptoms: Mumps antibody test negative, Rubella antibody negative
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131708USA002094

Write-up: This spontaneous report as received from a other refers to a 19 year old female patient. On 24-JUL-2017 the patient was vaccinated with M-M-R II lot # M022407, intramuscular in the left deltoid for prophylaxis. Other suspect therapies included sterile diluent. On 31-JUL-2017, 8 days after onset of therapy the patient experienced rubella antibody negative and mumps antibody test negative. The outcome of rubella antibody negative and mumps antibody test negative is unknown. Additional information has been requested.


VAERS ID: 707942 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-08-08
Onset:2017-08-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R56659 / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: See attached
CDC Split Type:

Write-up: Patient complained of severe headache and leg pain 30 minutes following the vaccine, she was advised by CPNP, who had ordered the vaccine at her well visit appointment, to go to the ED.


VAERS ID: 708025 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2017-08-01
Onset:2017-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. N012324 / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N012093 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5751AA / 2 RA / IM

Administered by: Private       Purchased by: 0
Symptoms: Contusion, Injection site mass, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NEXPLANON; probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: ND Known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection site reaction of (R) deltoid - lump, swelling, warmth, tenderness, bruising.


VAERS ID: 708042 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2017-08-07
Onset:2017-08-09
   Days after vaccination:2
Submitted: 2017-08-10
   Days after onset:1
Entered: 2017-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R45077 / 1 LA / IM

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

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

Write-up: Area of painful redness started under vaccine, 1 day after administration and still present 4 days later.


VAERS ID: 707719 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2017-08-08
Onset:2017-08-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH S26962 / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Headache, Injection site induration, Injection site pain, Injection site warmth, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 30 minutes after receiving Trumemba patient felt pain at the injection site and also warm and hard. She also had swelling of her lips which lasted 10 minutes, in additions she reported a constant headache that responded to Advil but persisted for 36 hours.


VAERS ID: 708141 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Indiana  
Vaccinated:2017-08-09
Onset:2017-08-09
   Days after vaccination:0
Submitted: 2017-08-09
   Days after onset:0
Entered: 2017-08-11
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 2J2EC / UNK AR / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Gait disturbance, Hyperhidrosis, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Profuse sweating. Dizziness. Shakiness, unsteady on feet.


VAERS ID: 708112 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2017-07-01
Onset:2017-08-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2017-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV510A / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M16014 / 2 LA / IM

Administered by: Military       Purchased by: 0
Symptoms: Headache, Injection site erythema, Injection site oedema, Injection site pain, Malaise, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo Provera
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 19-year-old healthy female who received meningococcal #2 and anthrax #1 to her left deltoid and experienced local site erythema, edema tenderness and possible lymphadenapathy and severe systemic symptoms of fever, malaise, nausea, emesis and headache with a duration of five days.


VAERS ID: 708289 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:2017-05-01
Onset:2017-07-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2017-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: 0
Symptoms: Anogenital warts
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131708USA006364

Write-up: This spontaneous report as received from a consumer refers to a 20 year old male patient. In MAY 2017 the patient was vaccinated with GARDASIL 9 for prophylaxis. In July -2017 the patient experienced anogenital warts. The outcome of anogenital warts was reported as recovering/resolving.


VAERS ID: 708751 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2017-08-11
Onset:2017-08-11
   Days after vaccination:0
Submitted: 2017-08-16
   Days after onset:5
Entered: 2017-08-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 16B101 / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Limb discomfort, Malaise, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/11/2017, Body temperature, 101 degree C
CDC Split Type: US2017125428

Write-up: This case was reported by a nurse via call center representative and described the occurrence of fever in a 19-year-old female patient who received BEXSERO (batch number 16B101, expiry date 28th February 2019). On 11th August 2017 11:30, the patient received the 2nd dose of BEXSERO. On 11th August 2017 16:00, 4 hrs 30 min after receiving BEXSERO, the patient experienced fever, feelings of weakness, headache, lower extremities weakness of, heaviness in limbs, felt faint, fatigue and feeling unwell. The patient was treated with MOTRIN. On an unknown date, the outcome of the fever, feelings of weakness, headache, lower extremities weakness of, heaviness in limbs, felt faint, fatigue and feeling unwell were not recovered/not resolved. It was unknown if the reporter considered the fever, feelings of weakness, headache, lower extremities weakness of, heaviness in limbs, felt fatigue and feeling unwell to be related to BEXSERO. Additional details were provided as follows: Around 4 pm, the patient did not feel well described as, developed a fever of 101 degrees, her legs felt heavy and weak along with fatigue, an extreme headache, felt weak, and even felt faint while driving. The patient returned the office to be seen and was given MOTRIN as treatment. The healthcare professional did not believe the symptoms were disabling, or life threatening.


VAERS ID: 708915 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2017-08-15
Onset:2017-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 195220 / 1 LA / IM

Administered by: 0       Purchased by: 0
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient had hives all over the body.


VAERS ID: 708941 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2017-08-01
Onset:2017-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N004798 / 1 LA / IM

Administered by: 0       Purchased by: 0
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ceterizine, montelukast
Current Illness: none
Preexisting Conditions: asthma
Allergies: nka
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Shortly after receiving the vaccine, patient felt faint. Pt. was placed in a chair. Patient began to sweat profusely and lost color in his face but never loss consciousness. He also claimed he was feeling nauseous. Patient received a cool rag for his forehead and patient requested a dose of benadryl. He was given 10ml of liquid benadryl 12.5mg/5ml. Within approximately 30 minutes, pt began to feel better.


VAERS ID: 709086 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: California  
Vaccinated:2017-08-14
Onset:2017-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5392AB / UNK LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Computerised tomogram head, Fall, Head injury, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT head without contrast
CDC Split Type:

Write-up: Patient fainted in office post vaccine admin. Fell hitting her head, appeared to have seizure lasting just under one minute. Pt. recovered in less than 30 min.


VAERS ID: 709127 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Puerto Rico  
Vaccinated:2017-08-09
Onset:2017-08-09
   Days after vaccination:0
Submitted: 2017-08-10
   Days after onset:1
Entered: 2017-08-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N012093 / 2 UN / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 158501C / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Basophil percentage, Body temperature increased, Chest discomfort, Chills, Eosinophil percentage, Haemoglobin decreased, Lymphocyte percentage, Musculoskeletal stiffness, Nausea, Neutrophil percentage increased, Platelet count normal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Otitis media
Preexisting Conditions: None, except for ADDH
Allergies:
Diagnostic Lab Data: WBC, 13900; Hgb, 13.3; Plt, 261,000 (86 NgL, 2, 1 Eos, 1 base)
CDC Split Type:

Write-up: Patient developed chills, T: 40 degree C, stiffed body, chest discomfort, nausea. Approximately 3 hrs after administration of BEXSERO and GARDASIL seen at ER. Treated with dexamethasone, TORADOL, ZANADOL.


VAERS ID: 709294 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2017-08-22
Onset:2017-08-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5712AA / 2 LA / IM

Administered by: 0       Purchased by: 0
Symptoms: Eye movement disorder, Fall, Feeling abnormal, Hypotonia, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ABOUT 5 YEARS AGO, PATIENT PASSED OUT FOLLOWING MENINGITIS VACCINE
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS SITTING IN CHAIR AND EYES ROLLED, WENT LIMP AND FELL TO THE GROUND. A FEW SECONDS LATER HE REGAINED CONSCIOUSNESS BUT FELT "SLOW" LIKE HE JUST WOKE UP. AFTER 20 MINUTES OBSERVATION HE WAS ABLE TO GO BACK TO WORK.


VAERS ID: 709432 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: New Hampshire  
Vaccinated:2017-08-23
Onset:2017-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 9373E / 1 LA / IM

Administered by: Private       Purchased by: 0
Symptoms: Blood glucose normal, Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: VIS sheet reviewed with patient who verbalized understanding of side effects. Patient reports never having a previous reaction to any vaccine. Hepatitis B vaccine given IM to left deltoid. Patient administered vaccine at 9:05 am. VS taken at 9:10 am BP 110/60, temp 97.0 pulse 75 respirations 14 patient feels well. 9:12 am patient felt faint, dizzy, flushed. Patient was put in 45 degree angle position with feet up, given cold compress, blood, water, blood glucose taken 118. VS BP 110/60, pulse 50, 97% O2, resps 16 provider notified and evaluated patient, juice given with improvement in symptoms. 9:20 VS BP 110/60, pulse 65, O2 99%, resps 14 patient reported improvement in symptoms. 9:32 BP 90/50, resps 14, O2 97%, pulse 78. 9:36 O2 100%, pulse 69 98/60. Patient monitored for nine minutes. 9:45 patient was cleared by physician to leave office. In reviewing the package insert for ENERGIX: low pulse is a listed reaction. He did not lose consciousness and has never had a vasovagal reaction before. He did have breakfast this am. We monitored him as above and will report the reactions to VAERS. He had not blood sugar issues either. I let him know I would not advise further Hep B vaccines given this reaction. I will let his PCP Dr know what happened.


VAERS ID: 709482 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2010-07-15
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2017-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: 0
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131708USA010287

Write-up: This spontaneous report as received from a other health professional refers to a female patient of unknown age. On 15-JUL-2010 the patient was vaccinated with GARDASIL for prophylaxis. On an unknown date the patient experienced urticaria. The outcome of urticaria was reported as resolved.


VAERS ID: 709658 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2017-08-22
Onset:2017-08-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED XT59205 / N/A RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N012093 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5557AB / 2 RA / IM

Administered by: 0       Purchased by: 0
Symptoms: Dizziness, Hyperhidrosis, Immediate post-injection reaction, Muscle contractions involuntary, Nausea, Pallor, Paraesthesia, Sensory disturbance
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Sensation felt down left arm immediately and was followed by faint and nauseous feeling. Became pale and diaphoretic. Hands contracted firmly and extremities felt tingly. All symptoms arose within 30 seconds of vaccine administration and persisted for approximately 10 minutes. After 20 minutes and ~20 oz of water, all symptoms subsided.


VAERS ID: 709829 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2017-08-23
Onset:2017-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. L040960 / 1 LA / SC

Administered by: Other       Purchased by: 0
Symptoms: Headache, Vision blurred, Vitreous floaters
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

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

Write-up: @ 11am the next day after receiving vaccine pt had a headache that lasted an hour; @ 7pm that day he started having blurry vision and floaters on right eye; pt came to clinic 8/26/17 to be evaluated.


VAERS ID: 709838 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Male  
Location: Texas  
Vaccinated:2017-08-23
Onset:2017-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2017-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH R56659 / 1 LA / IM

Administered by: 0       Purchased by: 0
Symptoms: Inflammation, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash and inflammation the size of a tennis ball manifested 4 inches below site of injection.


VAERS ID: 709840 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-09-01
Onset:2012-09-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 AR / IM

Administered by: Private       Purchased by: 0
Symptoms: Blood urine present, Colonoscopy, Cystitis, Cystitis interstitial, Cystoscopy, Fatigue, Fibromyalgia, Impaired work ability, Loss of personal independence in daily activities, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety
Allergies:
Diagnostic Lab Data: Cystoscopy and colonoscopy in 2013.
CDC Split Type:

Write-up: After the second shot I started feeling fatigue and aches. After the third shot it felt like I had a full blown bladder infection. I ended up peeing blood a few days later. After months and months of tests doctors concluded that I have Interstitial Cystitis and fibromyalgia. Now, almost 5 years later I am still suffering from these conditions. Multiple hospital visits from severe pain. Multiple lost jobs and years of school missed.


VAERS ID: 709855 (history)  
Form: Version 2.0  
Age: 19.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2017-08-01
Onset:2017-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2017-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M009764 / 1 LA / SC

Administered by: 0       Purchased by: 0
Symptoms: