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Found 547698 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:406741 (history)  Vaccinated:2010-10-14
Age:32.0  Onset:2010-10-14, Days after vaccination: 0
Gender:Male  Submitted:2010-11-03, Days after onset: 20
Location:New Mexico  Entered:2010-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Yes, inpatient for R heel ulceration
Preexisting Conditions: DM II, HTN, Dislipidemia, amputation of toes on left foot (11/2008)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURV3699AA3IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0884Z1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Adverse reaction, Culture negative, Injection site erythema, Injection site pain, Laboratory test normal, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Over the course of the night, the patient felt pain and redness at the area as well as fevers to 103. The patient had cultures and other lab work sent. These fevers continued approximately 48 hours. The patient denied any cough, abdominal pain, headache, or other localizing complaints. In light of the negative work up and the patient''s improvement, this was felt to be an adverse vaccine reaction mostly likely due to the pneumococcal-23 vaccine.

VAERS ID:406861 (history)  Vaccinated:2010-10-07
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2010-11-04
Location:New York  Entered:2010-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3518AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Developed painful nodule 1x2cm at (L) deltoid injection site. Treated with NSAIDS & warm compresses. Sx continued 3wks after injection.

VAERS ID:406964 (history)  Vaccinated:0000-00-00
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2010-11-04
Location:Arizona  Entered:2010-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Chronic bronchitis
Diagnostic Lab Data: Dr had office visit with pt.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1315Y IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Localized reaction redness around injection site 6 1/2" x 6", use ice oral BENADRYL and Topical BENADRYL.

VAERS ID:406988 (history)  Vaccinated:2010-10-26
Age:32.0  Onset:2010-10-26, Days after vaccination: 0
Gender:Male  Submitted:2010-10-27, Days after onset: 1
Location:Pennsylvania  Entered:2010-11-05, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinusitis 2 wks prior treated for a sinus infection still congested
Preexisting Conditions:
Diagnostic Lab Data: Symptoms lasted 48 hours
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH224AB0UNRA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Dizziness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Chills, body aches, fever (102.4), dizziness. "It just hit me like a ton of bricks" Tx with Ibuprofen/TYLENOL.

VAERS ID:407312 (history)  Vaccinated:2010-10-27
Age:32.0  Onset:2010-11-02, Days after vaccination: 6
Gender:Female  Submitted:2010-11-08, Days after onset: 6
Location:West Virginia  Entered:2010-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted
Preexisting Conditions: None noted
Diagnostic Lab Data: EMG, lumbar puncture, and MRI with no significant findings. All labs WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS464011C0IMAR
Administered by: Military     Purchased by: Private
Symptoms: Electromyogram normal, Hypoaesthesia, Influenza like illness, Lumbar puncture normal, Nausea, Nuclear magnetic resonance imaging normal, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Nausea, vomiting, lower extremity numbness, Flu-like syndrome

VAERS ID:407320 (history)  Vaccinated:2010-10-19
Age:32.0  Onset:2010-10-21, Days after vaccination: 2
Gender:Female  Submitted:2010-11-08, Days after onset: 18
Location:Wisconsin  Entered:2010-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3703AA2IMLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Induration, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Developed redness, warmth and induration.

VAERS ID:407363 (history)  Vaccinated:2010-10-11
Age:32.0  Onset:2010-10-11, Days after vaccination: 0
Gender:Female  Submitted:2010-11-08, Days after onset: 28
Location:Colorado  Entered:2010-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: Exercise-Induced Asthma
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA619AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Feeling abnormal, Feeling drunk, Gastrointestinal disorder, Hyperhidrosis, Injection site pain, Injection site reaction, Nausea, Paraesthesia, Photopsia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Retinal disorders (narrow), Noninfectious diarrhoea (narrow)
Write-up: About one hour after receiving the influenza vaccine, the patient''s left arm began tingling and burning from the site of injection down to the elbow. About 30 minutes later, the patient began to feel "spacy". These symptoms progressed and the patient began to feel nauseous and broke out into a sweat. The patient stated that she basically felt drunk. She also describes experiencing "flashes" in her peripheral vision while driving home as well as GI distress and diarrhea which occurred 5-6 hours after vaccination. The patient stated that her "spaciness" had resolved by that same evening and the next morning she felt normal again. The patient stated that she did not take any medications for relief of these symptoms.

VAERS ID:407459 (history)  Vaccinated:2010-10-26
Age:32.0  Onset:2010-10-26, Days after vaccination: 0
Gender:Female  Submitted:2010-11-04, Days after onset: 9
Location:Illinois  Entered:2010-11-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; Allergic to ROGAINE
Diagnostic Lab Data: CT Scan head & neck
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111774P10IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.086670IMLA
Administered by: Other     Purchased by: Private
Symptoms: Computerised tomogram, Computerised tomogram head, Headache, Hypoaesthesia, Malaise, Oedema peripheral, Paraesthesia
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 10/26 left arm swelling, 10/27 head pain & pressure & felt ill 10/28 left side numbness & tingling.

VAERS ID:407536 (history)  Vaccinated:2010-10-29
Age:32.0  Onset:2010-10-29, Days after vaccination: 0
Gender:Female  Submitted:2010-11-09, Days after onset: 11
Location:Missouri  Entered:2010-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma, Hypothyroidism, Allergic to Ceclor
Diagnostic Lab Data: high white blood cell count
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Decreased appetite, Erythema, Fatigue, Hypotension, Induration, Nodule, Oedema peripheral, Pain in extremity, Pyrexia, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe pain in arm, 3 hard red swollen knots, swelling in arm, fever of 102.5, low blood pressure, loss of appetite, weakness, fatigue.

VAERS ID:407716 (history)  Vaccinated:2010-11-08
Age:32.0  Onset:2010-11-10, Days after vaccination: 2
Gender:Female  Submitted:2010-11-10, Days after onset: 0
Location:New Mexico  Entered:2010-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergies: Aspirin, Radioactive Iodone, environmental Hypothyroidism, GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED11449111A IMLA
Administered by: Other     Purchased by: Private
Symptoms: Axillary pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling under the left arm (Injection given in left arm) about the size of a quarter. Was sore 12 hours later.

VAERS ID:407802 (history)  Vaccinated:2010-11-09
Age:32.0  Onset:2010-11-09, Days after vaccination: 0
Gender:Female  Submitted:2010-11-10, Days after onset: 1
Location:D.C.  Entered:2010-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURD01910IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Injection site erythema, Injection site pruritus, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Nausea and dizziness starting about five hours after vaccination given in the morning and persisting throughout the day and evening. Symptoms resolved by the next morning. Also noted at 5:00 pm itching and redness at site of injection.

VAERS ID:408112 (history)  Vaccinated:2010-10-21
Age:32.0  Onset:2010-10-21, Days after vaccination: 0
Gender:Female  Submitted:2010-10-21, Days after onset: 0
Location:Illinois  Entered:2010-11-12, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH181AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dry skin, Nausea, Pallor, Skin warm
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: 1005A Pt c/o nausea and weakness after injection. Found in bathroom, taken to lounge. Skin warm, dry slightly pale, no SOB noted - pulse 68, steady. Placed in recumbent position, given sip of H2O. Felt better taken to office, symptoms returned 12-15'' later. 911 called. 11/5/10 TC and pt who states ER stated not related to vaccine. Feels good no complaints.

VAERS ID:408183 (history)  Vaccinated:2009-12-17
Age:32.0  Onset:2009-12-18, Days after vaccination: 1
Gender:Female  Submitted:2010-02-02, Days after onset: 46
Location:North Carolina  Entered:2010-11-12, Days after submission: 283
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No known allergies. No illnesses at the time of vaccination per the reporter.
Diagnostic Lab Data:
CDC Split Type: 200905624
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3224BB0IJLA
Administered by: Other     Purchased by: Unknown
Symptoms: Back pain, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial case received on 18 December 2009 from a pharmacist. A 32 year old female patient received a left arm injection of FLUZONE (lot number U3224BB) on 17 December 2009. "Later that day" the patient experienced burning at the injection site and a slight red area. The next day the adverse events continued and the patient developed more burning sensation at the site and redness the size of a "nickle" at the site and swollen area. The patient experienced soreness of back area at trapezius area. The patient was advised to take anti-inflammatory and BENADRYL and to return call if adverse events worsened or continue or to seek health care from a health care professional. It was unknown at the time of the report if the patient recovered. Follow-up information was received on 01 February 2010 from a pharmacist. The pharmacist had suggested the use of Ibuprofen to the patient as an anti-inflammatory. He stated he presumed the adverse events resolved, but has had no further contact with the patient, who lives in another part of the state. The patient''s physician is unknown. It is unknown if the events resolved. Documents held by sender: none.

VAERS ID:408222 (history)  Vaccinated:2010-11-09
Age:32.0  Onset:2010-11-12, Days after vaccination: 3
Gender:Male  Submitted:2010-11-12, Days after onset: 0
Location:Washington  Entered:2010-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1021Z0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Slight redness and tenderness at injection site.

VAERS ID:408440 (history)  Vaccinated:2009-10-20
Age:32.0  Onset:2009-10-20, Days after vaccination: 0
Gender:Female  Submitted:2010-09-09, Days after onset: 324
Location:Florida  Entered:2010-11-12, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0009178
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500754P IN 
Administered by: Public     Purchased by: Other
Symptoms: Incorrect dose administered, No adverse event
SMQs:
Write-up: A non-serious report of "we gave a partial (1/2) of H1N1 Vaccine to 5" was received from a physician concerning a 32-year-old female. The patient''s medical history was not provided. On 20-Oct-2009, the patient was inadvertently administered half of H1N1 dose. There was no adverse event associated with this administration error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved.

VAERS ID:408665 (history)  Vaccinated:2009-11-03
Age:32.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2009-12-23, Days after onset: 50
Location:Louisiana  Entered:2010-11-12, Days after submission: 324
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0009381
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500759P IN 
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: A non-serious spontaneous report of gave pregnant woman H1N1 was received from a nurse practitioner concerning a 32-year-old female. No relevant medical history and concomitant medications was reported for the patient. The patient''s obstetrical history was unknown and estimated date of delivery was 07-Dec-2009. The patient was in her third trimester at 35 weeks gestation. There was no adverse event associated with this pregnancy. Treatment and reporter causality assessments was not applicable and the event vaccine exposure during pregnancy was considered resolved. The outcome of the pregnancy in mid of Dec-2009 was birth to a beautiful, healthy and normal baby girl and both mother and child are doing very well. Additional information was received on 11-Nov-2009 and incorporated into the narrative: obstetrical history, medical history, concomitant medication and estimated date of delivery. Additional information was received on 23-Dec-2009 and incorporated into the narrative: outcome of pregnancy.

VAERS ID:410240 (history)  Vaccinated:2009-10-31
Age:32.0  Onset:2009-10-31, Days after vaccination: 0
Gender:Female  Submitted:2010-02-15, Days after onset: 107
Location:Illinois  Entered:2010-11-12, Days after submission: 270
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No past medical history
Diagnostic Lab Data:
CDC Split Type: MEDI0009416
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Delivery, Drug exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: A non-serious spontaneous report of pt received H1N1 in third trimester was received from a physician concerning a 32-year-old pregnant female. The patient did not have any medical history. The patient''s obstetrical history included gravida two and para one at the time of vaccination. The patient was 29 weeks pregnant or in third trimester of pregnancy at the time of vaccination. The expected delivery date of the patient was 12-Jan-2010. Patient was not taking any concomitant medications. On 31-Oct-2009, the patient received H1N1, Intranasal. On 05-Jan-2010, the patient delivered a normal, healthy baby boy vaginally without complications and the neonate''s weight was 8 lbs at birth. There was no adverse event associated with this pregnancy. Treatment and reporter causality assessments were not applicable. The outcome of the vaccine exposure during pregnancy was resolved. Additional information was received on 15-Feb-2010 and incorporated into the narrative: about pregnancy outcome, date of delivery, type of delivery and condition of the baby.

VAERS ID:410491 (history)  Vaccinated:2009-10-27
Age:32.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 20
Location:Pennsylvania  Entered:2010-11-12, Days after submission: 361
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0009533
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500779P IN 
Administered by: Other     Purchased by: Other
Symptoms: Incorrect dose administered, No adverse event
SMQs:
Write-up: A non-serious spontaneous report of inadvertently given half dose of H1N1 was received from a nurse/health professional concerning a 32-year-old female. The patient''s medical history and concomitant medications was not reported. On 27-Oct-2009, the patient was inadvertently given half dose of H1N1, Intranasal. There was no adverse event associated with this medication error; therefore, treatment and reporter causality assessments are not applicable, and the event is considered resolved.

VAERS ID:410656 (history)  Vaccinated:2009-11-18
Age:32.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2010-04-28, Days after onset: 160
Location:Pennsylvania  Entered:2010-11-12, Days after submission: 198
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient was not ill at time of H1N1 vaccine and other vaccinations given within 4 weeks of the H1N1. Past disease: Anemia; Back pain
Diagnostic Lab Data:
CDC Split Type: MEDI0009872
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500751P IN 
Administered by: Private     Purchased by: Public
Symptoms: Drug exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: A non-serious spontaneous report of a pregnant woman received a dose of H1N1 LAIV was received from a registered nurse/health professional concerning a 32-year-old female. The patient''s medical history included anemia and back pain and obstetrical history included gravida three, para three and LMP date was 03-Jun-2009. The gestation period was 24-weeks and expected date of delivery was 10-Mar-2010. The concomitant medications taken by patient were iron tablets (oral, twice daily) and prenatal vitamins (oral, once daily). The patient was not ill at time of vaccination and no other vaccinations were given within 4 weeks of the H1N1. On 18-Nov-2009, the patient received H1N1, Intranasal for an unknown indication. The patient delivered a female child on 18-Mar-2010. It was full term vaginal delivery with no medical complications. The newborn had a weight of 6lbs 12 oz, length of 19.5 inches and head circumference of 13 inches. The fetus had no complications with delivery. There was no adverse event associated with this pregnancy therefore, treatment and reporter causality assessments were not applicable, and the event vaccine exposure during pregnancy was considered resolved. Additional information was received on 05-Jan-2010 and incorporated into the narrative: past medical history, gestation period, EDD, LMP, gravida and para and concomitant medication. Additional information was received on 28-Apr-2010 and incorporated into the narrative: pregnancy outcome, medical history and neonatal information. Other information received was primary care physician details and patient details.

VAERS ID:410682 (history)  Vaccinated:2009-10-28
Age:32.0  Onset:2009-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 19
Location:Pennsylvania  Entered:2010-11-12, Days after submission: 361
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0009523
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500779P IN 
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Underdose
SMQs:
Write-up: A non-serious spontaneous report of inadvertently given half dose of H1N1 LAIV was received from a nurse/health professional concerning a 32-year-old female. The patient''s medical history and concomitant medications was not reported. On 28-Oct-2009, the patient was inadvertently given half dose of H1N1, Intranasal. There was no adverse event associated with this medication error; therefore, treatment and reporter causality assessments are not applicable, and the event is considered resolved.

VAERS ID:410788 (history)  Vaccinated:2009-11-15
Age:32.0  Onset:2009-11-15, Days after vaccination: 0
Gender:Female  Submitted:2009-12-01, Days after onset: 16
Location:New York  Entered:2010-11-12, Days after submission: 346
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0009739
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Nasal congestion
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: A non-serious spontaneous report of pregnancy was discovered after H1N1 LAIV given and nasal stuffiness has been received from a consumer concerning 32-year-old female, subsequent to H1N1, Intranasal vaccination. Neither relevant medical history nor concomitant medications have been reported. On 15-Nov-2009, the patient received H1N1, Intranasal for an unknown indication. After vaccination the patient came to know that she was pregnant. On 17-Nov-2009, two days after vaccination, the patient experienced nasal stuffiness that lasted for two weeks. The reporter noted the patient seemed to be fine at the time of report. The outcome of vaccine exposure before pregnancy and nasal stuffiness was resolved.

VAERS ID:408267 (history)  Vaccinated:2010-11-11
Age:32.0  Onset:2010-11-11, Days after vaccination: 0
Gender:Female  Submitted:2010-11-13, Days after onset: 2
Location:Maryland  Entered:2010-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Diabetes, over-active thyroid, both well controlled
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Chills, Cough, Headache, Myalgia, Oropharyngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: sore throat, cough, high fever with violent chills, muscle aches, headache

VAERS ID:408543 (history)  Vaccinated:2010-11-12
Age:32.0  Onset:2010-11-12, Days after vaccination: 0
Gender:Female  Submitted:2010-11-15, Days after onset: 3
Location:Rhode Island  Entered:2010-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Hypoaesthesia facial
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: After receiving the flu shot (H1N1 & Seasonal combination (preservative free)), later that night I felt numbness in the left side of my face and have a red patch on my cheek. I received the preservative free shot since I am currently breastfeeding. I still feel numbness in my cheek and the red patch hasn''t gone away yet.

VAERS ID:408842 (history)  Vaccinated:2010-11-01
Age:32.0  Onset:0000-00-00
Gender:Male  Submitted:2010-11-10
Location:Tennessee  Entered:2010-11-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111774P1 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: Patient reported intense pain in joints.

VAERS ID:408855 (history)  Vaccinated:2010-10-08
Age:32.0  Onset:2010-10-14, Days after vaccination: 6
Gender:Female  Submitted:2010-11-10, Days after onset: 27
Location:Indiana  Entered:2010-11-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3699AA UNAR
Administered by: Public     Purchased by: Other
Symptoms: Injection site pain, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt. reported pain at injection site x 2-3 days that resolved then within week (L) shoulder pain began and has not resolved in 3-4 weeks.

VAERS ID:408879 (history)  Vaccinated:2010-11-06
Age:32.0  Onset:2010-11-07, Days after vaccination: 1
Gender:Female  Submitted:2010-11-16, Days after onset: 9
Location:Florida  Entered:2010-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow)
Write-up: Multiple Cold Sores on bottom lip grew. I have had one on occasion- maybe 2-3 times a year. But 2 days after shot I felt multiple breaking out at same time. Wound up with 3 spaced across bottom lip.

VAERS ID:409089 (history)  Vaccinated:2010-10-22
Age:32.0  Onset:2010-10-22, Days after vaccination: 0
Gender:Female  Submitted:2010-11-17, Days after onset: 26
Location:Texas  Entered:2010-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NO LABS DONE. JUST RECEIVED BENADRYL 25MG IM AND MONITORED IN THE OFFICE FOR A COUPLE OF HOURS. SENT HOME TO CONTINUE TAKING BENADRYL X2 MORE DOSES.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3616AA5IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Dizziness, Dysphonia, Dyspnoea, Erythema, Heart rate increased
SMQs:, Anaphylactic reaction (narrow), 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), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: DIFFICULTY BREATHING BEGINNING AT 11:00 AM AND WAS SEEN IN A URGENT CARE FACILITY. BY THE TIME I GOT TO THE URGENT CARE I WAS HOARSE, REDNESS TO FACE AND UPPER CHEST AREA, FAST HEART BEAT IN THE 120''S, AND DIZZINESS.

VAERS ID:409127 (history)  Vaccinated:2010-11-15
Age:32.0  Onset:2010-11-16, Days after vaccination: 1
Gender:Female  Submitted:2010-11-17, Days after onset: 1
Location:California  Entered:2010-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1427Y0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient reports redness and swelling 55 mm diameter @ injection site, Left deltoid. States developed fever for 24 hrs 101 days after the shot.

VAERS ID:409195 (history)  Vaccinated:2010-11-14
Age:32.0  Onset:2010-11-14, Days after vaccination: 0
Gender:Male  Submitted:2010-11-15, Days after onset: 1
Location:Delaware  Entered:2010-11-18, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111815P10IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor, Presyncope
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)
Write-up: Vasovagal response: nausea, diaphoresis, pale, "feeling faint" about 5 min. after injection. Tx: ammonia inhalant, body position, breathing technique.

VAERS ID:409544 (history)  Vaccinated:2010-11-12
Age:32.0  Onset:2010-11-13, Days after vaccination: 1
Gender:Female  Submitted:2010-11-19, Days after onset: 6
Location:Missouri  Entered:2010-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None - (+) Strep 2 days after injection
Preexisting Conditions: Codeine - hives
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3727AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0932Z1SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Pain, Streptococcus test positive
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema, induration (20cm x 10cm) at injection site. Painful with movement et triceps. Prednisone & BENADRYL & ice & close follow-up.

VAERS ID:409509 (history)  Vaccinated:2010-10-14
Age:32.0  Onset:2010-10-15, Days after vaccination: 1
Gender:Female  Submitted:2010-11-21, Days after onset: 37
Location:New Jersey  Entered:2010-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergic to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR    
Administered by: Other     Purchased by: Private
Symptoms: Hypokinesia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: Could not lift arm above shoulder for two days after the vaccine. Five weeks after the vaccine, I still have continuous muscle pain in my arm.

VAERS ID:409664 (history)  Vaccinated:2010-11-02
Age:32.0  Onset:2010-11-04, Days after vaccination: 2
Gender:Female  Submitted:2010-11-22, Days after onset: 18
Location:Idaho  Entered:2010-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mellaril (seizures) - documented in chart 3.2010
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3580AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.09787 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Decreased appetite, Dizziness, Feeling abnormal, Headache, Injected limb mobility decreased, Injection site pain, Migraine, Muscle spasms, Nausea, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: client stated that she started feeling bad on her way to school today and had to pull over due to vomiting. client stated that she has a severe headache. states symptoms began after taking flu and pneumonia immunizations. she also states innoculation location is very tender to touch. + Temperature = 104 degrees (on 11.4.2010). 11.5.2010 = her temperature at about 1500 was 105.3. She has had a migraine for two days that will not go away, her neck is not stiff, when she bends over she gets dizzy and her stomach turns, she hasn''t been eating much, she has been drinking powerade and water, and she has been sleeping a lot. 11.8.2010 VET CALLED THIS MORNING TO REPORT THAT SHE IS HAVING MUSCLE SPASMS IN HER RIGHT ARM, AND CONSEQUENTLY CANNOT LIFT OR MOVE THIS ARM

VAERS ID:409864 (history)  Vaccinated:2010-11-09
Age:32.0  Onset:2010-11-09, Days after vaccination: 0
Gender:Male  Submitted:2010-11-23, Days after onset: 14
Location:New York  Entered:2010-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Severe pain and swelling in arm for a 1 week period

VAERS ID:409878 (history)  Vaccinated:2010-11-23
Age:32.0  Onset:2010-11-23, Days after vaccination: 0
Gender:Female  Submitted:2010-11-23, Days after onset: 0
Location:Connecticut  Entered:2010-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU36210A1IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Cough, Dysphagia, Dysphonia, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)
Write-up: Hoarseness, sore throat, hacking cough, difficulty swallowing.

VAERS ID:409886 (history)  Vaccinated:2010-11-04
Age:32.0  Onset:2010-11-04, Days after vaccination: 0
Gender:Female  Submitted:2010-11-23, Days after onset: 19
Location:Minnesota  Entered:2010-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA580CA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Confusional state, Muscular weakness, Speech disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: After vaccine, pt had mental confusion, felt unsafe to drive, had difficulty speaking x 6 hours. Leg weakness x 4 hours.

VAERS ID:411127 (history)  Vaccinated:2009-11-03
Age:32.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2010-09-27, Days after onset: 327
Location:Unknown  Entered:2010-11-23, Days after submission: 57
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2009US63807
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Case previously recorded as MA2009-3675. Consumer reported the following information via MedCom on 4 NOV 2009: A 33-year-old female patient, who was in the sixth month of her pregnancy was vaccinated i.m. with S-OIV-FLUVIRIN (batch no. unknown) on 3 NOV 2009. No adverse event was reported.

VAERS ID:411146 (history)  Vaccinated:2009-11-28
Age:32.0  Onset:2009-12-01, Days after vaccination: 3
Gender:Male  Submitted:2010-09-27, Days after onset: 299
Location:Unknown  Entered:2010-11-23, Days after submission: 57
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2010US14310
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Food allergy, Milk allergy, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Initial consumer report received on 10 Mar 2010: This patient received FLUVIRIN (batch number unknown), unknown dose, intramuscular on 28 Nov 2009. On an unknown date, two weeks later after vaccination in Dec 2009, the patient experienced rash on arms, armpits, and legs and got itchy, 3 to 6 hours after consumption of shellfish, beer, steak, beef, and milk. It was reported that the patient experienced the above reactions whenever the patient consume any of the above-listed foods and beverages. It was reported that the patient had never experienced this reaction''s prior to receiving the vaccine, and that the patient was able to consume these items prior to receiving the vaccine without any reactions. The outcome of the events was reported.

VAERS ID:411147 (history)  Vaccinated:2009-11-28
Age:32.0  Onset:2009-12-01, Days after vaccination: 3
Gender:Male  Submitted:2010-09-27, Days after onset: 299
Location:Unknown  Entered:2010-11-23, Days after submission: 57
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2010US15177
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Nonspecific reaction, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Initial report received from a consumer on 10 Mar 2010: This patient was vaccinated with FLUVIRIN, (batch no: unknown), (dose: unknown), intramuscularly on 28 Nov 2009. Two weeks later on an unspecified date in Dec 2009 the patient developed reaction 3 to 7 hours after consumption of certain foods and beverages. The patient stated that he had itching and developed a rash on his arms, armpits and legs after consuming shellfish, beer, steak, beef and milk. The patient reported that the reaction happens in response to consumption of any of the above listed foods and beverages, the patient never had these problems prior to receiving the vaccine and he was able to consume these items prior to receiving the vaccination without any reaction. The outcome of the events were not reported. Following an internal review on 07 May 2010 of the data received on 10 Mar 2010, following correction was made. The event was recoded from two weeks later he developed reaction to allergic skin reaction.

VAERS ID:410300 (history)  Vaccinated:2010-10-13
Age:32.0  Onset:2010-10-14, Days after vaccination: 1
Gender:Female  Submitted:2010-11-10, Days after onset: 27
Location:Virginia  Entered:2010-11-29, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Redness
Preexisting Conditions: PERCOCET and PREDNISONE
Diagnostic Lab Data: F/u with PMD 11/04/2010 for allergy testing.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA560BA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Itchiness, redness, hives for about 1 1/2 wks. All symptoms were around the area of the vaccination. Hive started 24 hours after injection.

VAERS ID:410686 (history)  Vaccinated:2010-11-19
Age:32.0  Onset:2010-11-23, Days after vaccination: 4
Gender:Male  Submitted:2010-11-30, Days after onset: 7
Location:Vermont  Entered:2010-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Developed hives after 2009 flu vaccination which slowly improved throughout the year but did not resolve. Otherwise healthy.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA525BA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Developed a severe chronic hive outbreak following flu vaccine. No known allergy to eggs or chicken. No history of hives prior to receiving the 2009 flu shot. In 2009 hives developed several days after receiving the flu shot. Medication was prescribed and the condition could be controlled by the medicine. Several days after receiving the 2010 flu shot, the condition has returned with a vengeance and cannot be controlled even with medication. I suspect that the flu shot has created a chronic hive condition that will not be easily resolved.

VAERS ID:410736 (history)  Vaccinated:2010-10-21
Age:32.0  Onset:2010-11-28, Days after vaccination: 38
Gender:Female  Submitted:2010-11-30, Days after onset: 2
Location:New Hampshire  Entered:2010-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: macrolides, shellfish
Diagnostic Lab Data: diagnosis today, too soon to know longterm outcome
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3642DA IJ 
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Muscle twitching, Sensory loss, VIIth nerve paralysis
SMQs:, Peripheral neuropathy (narrow), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Reactivation of Bell''s palsy on L face, with altered sensation, strength, muscle control and muscle twitches on L. Original Bell''s dx 3/11/2006, with almost complete recovery within months.

VAERS ID:410742 (history)  Vaccinated:2010-11-12
Age:32.0  Onset:2010-11-13, Days after vaccination: 1
Gender:Female  Submitted:2010-11-30, Days after onset: 17
Location:California  Entered:2010-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No. I went to urgent care because I had a coffee burn.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3518BA IJLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Hypoaesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: Chills, then fever, then numbness that began down my left arm and left index and pinky fingers. It is now in my feet and legs too.

VAERS ID:410989 (history)  Vaccinated:2010-11-30
Age:32.0  Onset:2010-11-30, Days after vaccination: 0
Gender:Male  Submitted:2010-12-01, Days after onset: 1
Location:Idaho  Entered:2010-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111814P11IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Rash/hives resolved by BENADRYL. No further adverse affects as of 12/01/10.

VAERS ID:411478 (history)  Vaccinated:2010-12-03
Age:32.0  Onset:2010-12-03, Days after vaccination: 0
Gender:Male  Submitted:2010-12-03, Days after onset: 0
Location:Georgia  Entered:2010-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB185AA1IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0907Z1SCLA
Administered by: Military     Purchased by: Military
Symptoms: Pharyngeal oedema
SMQs:, Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Pt. states swelling of the throat approximately 15 mins. after receiving TWINRIX & MMR vaccines.

VAERS ID:411462 (history)  Vaccinated:2010-11-08
Age:32.0  Onset:2010-11-30, Days after vaccination: 22
Gender:Male  Submitted:2010-12-05, Days after onset: 5
Location:Illinois  Entered:2010-12-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none yet
CDC Split Type:
Vaccination
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IJLA
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: very painful rash most likely (shingles)

VAERS ID:411665 (history)  Vaccinated:2010-11-12
Age:32.0  Onset:2010-11-15, Days after vaccination: 3
Gender:Female  Submitted:2010-11-29, Days after onset: 14
Location:New Jersey  Entered:2010-12-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1116915P UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Body temperature increased, Chills, Conjunctivitis infective, Headache, Oropharyngeal pain, Pain, Upper respiratory tract infection
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: 11/12/10 - vaccine given 11/15/10 - woke w/pink eye -$g given Tobramycin by PMD. 11/16/10 - ZPAK for h/a, aches, chills, temp, sore throat 11/18/10 - ER for URI - FLONASE. 11/20/10 - Put on LEVAQUIN & VIGAMOX.

VAERS ID:411762 (history)  Vaccinated:2010-10-27
Age:32.0  Onset:2010-10-27, Days after vaccination: 0
Gender:Male  Submitted:2010-12-06, Days after onset: 40
Location:Connecticut  Entered:2010-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted
Preexisting Conditions: None noted
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA594BA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Soreness in arm following flu shot. Few days later pain started to get worse. Has difficulty sometimes getting out of bed and putting on seatbelt. Pain at its worst was a 7 or 8. Today it is a 3 or 4. Has seen physician and was put on Naproxen for pain. Has not recovered. Morning is the worst and pain varies from day to day.

VAERS ID:411997 (history)  Vaccinated:2010-10-19
Age:32.0  Onset:2010-10-20, Days after vaccination: 1
Gender:Female  Submitted:2010-11-29, Days after onset: 40
Location:Utah  Entered:2010-12-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to sulfa
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB185AA0IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURE012314SCRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3508AA0IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURD108710IMRA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF799AA0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Body aches (L) deltoid area with tenderness, erythema approx 7-8 cm in diameter, no induration or fluid collection. Fever as stated by patient 103 deg F x 3 to 4 days. Malaise x 7 days. Visit to physicians office x 3. Signs/symptoms resolved. Pt states no residual problems.

VAERS ID:412485 (history)  Vaccinated:2010-11-06
Age:32.0  Onset:2010-11-07, Days after vaccination: 1
Gender:Female  Submitted:2010-12-11, Days after onset: 34
Location:Nevada  Entered:2010-12-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111805P1 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Shoulder and arm swelling x3. Made it difficult to operate a computer mouse. Took Ibuprofen for 24hrs, and swelling/pain diminished.

VAERS ID:412778 (history)  Vaccinated:2010-12-14
Age:32.0  Onset:2010-12-14, Days after vaccination: 0
Gender:Female  Submitted:2010-12-15, Days after onset: 1
Location:Washington  Entered:2010-12-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDM54309 UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52805688  RA
Administered by: Military     Purchased by: Unknown
Symptoms: Chest discomfort, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Itchy throat, face, lips, & nose; chest tightness; symptoms ongoing at time of report; tx: Benadryl 50mg oral

VAERS ID:412872 (history)  Vaccinated:2010-10-06
Age:32.0  Onset:2010-10-08, Days after vaccination: 2
Gender:Female  Submitted:2010-12-15, Days after onset: 68
Location:New York  Entered:2010-12-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH181AB3IM 
Administered by: Public     Purchased by: Private
Symptoms: Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: GENERAL ACHINESS AND SWOLLEN GLANDS; DEVELOPED FEVER 100.8; WENT TO ER ON 10/10

VAERS ID:412894 (history)  Vaccinated:2010-12-11
Age:32.0  Onset:2010-12-11, Days after vaccination: 0
Gender:Female  Submitted:2010-12-13, Days after onset: 2
Location:Unknown  Entered:2010-12-15, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: MRI
CDC Split Type:
Vaccination
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UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Gait disturbance, Hypoaesthesia, Nuclear magnetic resonance imaging spinal cord abnormal, Spinal cord disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: (R) LE numbness, gait difficulty abnormal MRI signal mltple T spine cord levels. Most enhanced conus.

VAERS ID:413129 (history)  Vaccinated:2010-12-14
Age:32.0  Onset:2010-12-14, Days after vaccination: 0
Gender:Female  Submitted:2010-12-17, Days after onset: 3
Location:Nevada  Entered:2010-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI; Allergic Rhinitis; Sinusitis; (Afebrile)
Preexisting Conditions: NKDA - PMH = Allergic Rhinitis; smoker
Diagnostic Lab Data: Pt. went to Urgent Care/ER afterwards (clinic closed at that time) & verified possible adverse reaction to PNEUMOVAX 23.
CDC Split Type:
Vaccination
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0651Z0SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Injection site swelling, Oedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pain, swelling at the injection site, edema/peripheral edema.

VAERS ID:413134 (history)  Vaccinated:2010-12-03
Age:32.0  Onset:2010-12-03, Days after vaccination: 0
Gender:Female  Submitted:2010-12-08, Days after onset: 5
Location:New York  Entered:2010-12-17, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 2nd degree burn to foot
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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TDAP: TDAP (ADACEL)SANOFI PASTEURU2591DA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) deltoid erythema & edema around injection site.

VAERS ID:413280 (history)  Vaccinated:2010-11-22
Age:32.0  Onset:2010-11-29, Days after vaccination: 7
Gender:Female  Submitted:2010-12-14, Days after onset: 15
Location:Michigan  Entered:2010-12-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3616BA IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Abortion spontaneous, Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: Pt''s mother-in-law called pharmacy to report that pt was 4-5 weeks pregnant at the time of immunization & had a miscarriage on 11/29/10.

VAERS ID:413372 (history)  Vaccinated:2010-09-24
Age:32.0  Onset:2010-09-24, Days after vaccination: 0
Gender:Female  Submitted:2010-12-15, Days after onset: 82
Location:Ohio  Entered:2010-12-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Brain tumor 2006 (removed) - Physician did not believe this adverse event was related to brain tumor.
Diagnostic Lab Data: None but did have lab work drawn from left antecubital area a few days prior but had no adverse effects from this.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3568BA0UNLA
Administered by: Military     Purchased by: Other
Symptoms: Hypoaesthesia, Injection site pain, Nerve injury, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Injection site (left deltoid) became sore the day of the injection and then painful. Pain worsened, and pain extended to entire left arm. Also had some numbness to hand & fingers within days of the injection. Pain/numbness persisted $g2 months, but is somewhat better now. Physician anticipated recovery will take 6 months and believed it to be nerve-related damage.

VAERS ID:413527 (history)  Vaccinated:2010-11-26
Age:32.0  Onset:2010-11-27, Days after vaccination: 1
Gender:Male  Submitted:2010-12-17, Days after onset: 20
Location:Washington  Entered:2010-12-27, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety; depression; mild OCD
Diagnostic Lab Data: Blood work was good. She could not say that the symptoms were related to the immunization; however they all began at that time. Pt was unable to perform his duties at work and could not drive to another city, 12/11/10. She provided a medical release for two weeks and suggested he take CELEXA for his anxiety/depression.
CDC Split Type:
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BQ57DA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Ageusia, Altered visual depth perception, Anxiety, Balance disorder, Blepharospasm, Blood test normal, Condition aggravated, Depression, Dizziness, Eye disorder, Feeling abnormal, Head discomfort, Headache, Hypoaesthesia, Impaired driving ability, Impaired work ability, Insomnia, Memory impairment, Mental impairment, Pain in jaw
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Osteonecrosis (broad), Ocular motility disorders (narrow)
Write-up: Headache, head felt heavy 11/26 headache worsened on 11/28 has improved since, but feeling of heaviness has continued. Feeling mentally fuzzy slow mental processing 11/27 began to notice on 11/27 has worsened over time. Feeling dizzy, off balance, depth perception is off 11/27 continued to present. Eye problems, at the start seemed like depth perception was off. Intermittent twitch in left eye 11/29 continues to present. Pain in jaw, hurts to smile, hard to keep lower jaw closed 11/30 pain has lessened in jaw, still hurts to smile. Reported symptoms to clinic 12/02 they advised symptoms should go away with time. Unable to taste food difficulty performing work on computer noticing difficulty remembering names 12/4 continues to present. Reported to Urgent Care who recommended a blood test and to make an appointment with Dr. 12/5. Body feels numb, can''t feel hot water in shower or hands don''t feel heat on the stove 12/6 continues to present. Trouble sleeping, sleep four hours and wake up don''t get deep sleep 12/7 noticed this around 11/26, but thought it would go away. Slower reaction time when driving 12/7 continues to present.

VAERS ID:413585 (history)  Vaccinated:2010-12-20
Age:32.0  Onset:2010-12-24, Days after vaccination: 4
Gender:Female  Submitted:2010-12-27, Days after onset: 3
Location:New York  Entered:2010-12-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA610AA1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Paraesthesia, Tinnitus, Visual impairment
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow)
Write-up: Pt states on 12-24-10 at 7am she had intense ringing in her ears, and her hands & fingers were tingling, her vision was spotty. Episode did not last long.

VAERS ID:413653 (history)  Vaccinated:2010-10-10
Age:32.0  Onset:2010-10-11, Days after vaccination: 1
Gender:Male  Submitted:2010-12-28, Days after onset: 78
Location:Washington  Entered:2010-12-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: hypertension- controlled with medication
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Private     Purchased by: Other
Symptoms: Sinus congestion, Sinus headache
SMQs:
Write-up: Continued sinus congestion and pressure since vaccine. Patient was given killed virus as shot in arm. Has been treating with fluticasone nasal spray with some improvement of symptoms.

VAERS ID:413668 (history)  Vaccinated:2010-12-14
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2010-12-22
Location:New York  Entered:2010-12-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA; Pregnant 26wks
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3271HA0UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Drug exposure during pregnancy, Expired drug administered
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Given FLUZONE vaccine that had expired on 6/30/10.

VAERS ID:413707 (history)  Vaccinated:2010-09-21
Age:32.0  Onset:2010-12-03, Days after vaccination: 73
Gender:Female  Submitted:2010-12-29, Days after onset: 26
Location:Hawaii  Entered:2010-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No but within a day felt tingling in both hands
Preexisting Conditions: HTN
Diagnostic Lab Data: CT brain negative, Lumbar puncture no white cells, MRI brain negative, urine drug negative. Downgoing Babinski, cranial nerves intact
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111791P110IMLA
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Babinski reflex test, CSF white blood cell count negative, Computerised tomogram normal, Dizziness, Drug screen negative, Lumbar puncture, Nuclear magnetic resonance imaging brain normal, Paraesthesia, Paralysis, Scan brain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad)
Write-up: weak, lightheaded all day then proceeded to call 911 in the evening and was paralyzed to all extremities

VAERS ID:413967 (history)  Vaccinated:2010-08-26
Age:32.0  Onset:2010-09-03, Days after vaccination: 8
Gender:Male  Submitted:2010-12-29, Days after onset: 117
Location:Wisconsin  Entered:2011-01-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER  OTUN
Administered by: Military     Purchased by: Military
Symptoms: Allergy to vaccine
SMQs:, Hypersensitivity (narrow)
Write-up: Smallpox vaccine reaction - possible cellulitis.

VAERS ID:414098 (history)  Vaccinated:2010-10-11
Age:32.0  Onset:2010-10-11, Days after vaccination: 0
Gender:Female  Submitted:2011-01-04, Days after onset: 85
Location:Washington  Entered:2011-01-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH181AB UNRA
Administered by: Public     Purchased by: Other
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Swelling & pain in ring finger.

VAERS ID:414113 (history)  Vaccinated:2010-01-04
Age:32.0  Onset:2010-01-04, Days after vaccination: 0
Gender:Male  Submitted:2010-01-05, Days after onset: 1
Location:Arizona  Entered:2011-01-05, Days after submission: 365
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B056AA0UNRA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Dyspnoea, Epistaxis, Headache, Inflammation, Lymphadenopathy, Rhinorrhoea, Sinus headache
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Headache, sinus pressure, dyspnea, runny nose, inflamed, red/mucus pockets, cervical lymph nodes swollen, joint pain.

VAERS ID:414637 (history)  Vaccinated:2011-01-10
Age:32.0  Onset:2011-01-10, Days after vaccination: 0
Gender:Male  Submitted:2011-01-13, Days after onset: 3
Location:North Carolina  Entered:2011-01-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1110Z IMRA
Administered by: Private     Purchased by: Other
Symptoms: Axillary pain, Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt called 1/13/11 to report he had almost immediate pain, redness and swelling at injection site radiating under the right arm (axilla). Another pt. in our clinic reported similar reaction to same med, same lot #.

VAERS ID:415084 (history)  Vaccinated:2010-10-08
Age:32.0  Onset:2010-10-08, Days after vaccination: 0
Gender:Female  Submitted:2011-01-20, Days after onset: 104
Location:Oregon  Entered:2011-01-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: I did not get diagnostic, I literally slept about 20 hours a day for three days and then experienced very acute back pain where I could not walk for 2 weeks following. As mentioned above, I do not believe the back pain is caused specifically by the vaccine, but was a result of the adverse reaction. I know the days of sleep was a direct response to the vaccine.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Other     Purchased by: Private
Symptoms: Activities of daily living impaired, Asthenia, Back pain, Fatigue, Feeling abnormal, Gait disturbance, Hypersomnia, Injection site haematoma, Injection site nodule, Injection site pain, Injection site swelling, Somnolence
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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), Depression (excl suicide and self injury) (broad)
Write-up: I have gotten seasonal influenza vaccines before, and had a prior adverse reaction in 1999, stopped getting them for a couple years, and then started getting them again in 2002 during pregnancy at the urge of my doctor with no side effect. This shot was the seasonal influenza with H1N1 for the 2010 flu year. Initially, significant swelling and bruising at vaccine site. Within hours was extremely sleepy, felt weak. Slept almost constantly for 3 days following the vaccine, other then getting up to eat. Felt weak, tired, drained, abnormal. This led to back pain which I believe was due to being bedridden in sleep for days because of vaccine. This acute back pain caused me to miss work for two weeks. There was a painful knot at vaccine site for weeks.

VAERS ID:415170 (history)  Vaccinated:2011-01-13
Age:32.0  Onset:2011-01-19, Days after vaccination: 6
Gender:Female  Submitted:2011-01-21, Days after onset: 2
Location:D.C.  Entered:2011-01-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Patient has never received immunizations as a child. Besides the influenza shot as an adult, has not had any vaccinations.
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3448AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Rt deltoid swelling, large erythema, itching, pain.

VAERS ID:415769 (history)  Vaccinated:2010-10-01
Age:32.0  Onset:2010-10-03, Days after vaccination: 2
Gender:Female  Submitted:2010-11-09, Days after onset: 37
Location:Maryland  Entered:2011-01-24, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No illness at the time of vaccination. No pre-existing physician-diagnosed allergies or medical conditions. No other medications. No adverse event following prior vaccination.
Diagnostic Lab Data: Not reported
CDC Split Type: 201005871
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR  UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC3447 IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURD10871 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dry skin, Injection site reaction, Pruritus, Rash erythematous, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Case received from a healthcare professional through the MIS on 11 October 2010 under the local reference number 10-0698. A 32-year-old female patient, with no illness at the time of vaccination, no pre-existing physician-diagnosed allergies or medical conditions, no other medications and no adverse event following prior vaccination, had received her intramuscular dose of ADACEL, batch number U3298CA (C3447) in the left deltoid, her intramuscular dose of TYPHIM VI, batch number D1087-1, in the left deltoid, her dose of IPOL (batch number, route and anatomical site of administration not reported) and her dose of hepatitis A vaccine (manufacturer unknown, batch number, route and anatomical site of administration not reported) on 01 October 2010. On 03 October 2010, i.e. 2 days post-vaccination, the patient developed a red raised scaly patch on her left deltoid. Dry patches also erupted on her stomach, back, few patches. They were also itchy. The patient was seen by a physician. She received BENADRYL. The patient reported any areas being less itchy, but no improvement otherwise. Documents held by sender: none.

VAERS ID:415449 (history)  Vaccinated:2010-11-13
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2010-12-13
Location:Wisconsin  Entered:2011-01-26, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111806P1 IMUN
Administered by: Other     Purchased by: Private
Symptoms: Injection site discomfort, Skeletal injury
SMQs:, Accidents and injuries (narrow)
Write-up: Patient has been experiencing significant discomfort at the injection site. Patient thinks the problem occurred due to the pharmacist hitting bone with the needle.

VAERS ID:415473 (history)  Vaccinated:2010-10-06
Age:32.0  Onset:2010-10-06, Days after vaccination: 0
Gender:Female  Submitted:2011-01-19, Days after onset: 105
Location:Maryland  Entered:2011-01-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  IJLA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Contusion, Erythema, Fatigue, Immediate post-injection reaction, Induration, Injection site haematoma, Injection site haemorrhage, Malaise, Myalgia, Pain, Pyrexia, Swelling, Vaccination site reaction
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: 32 year old female received injectable 10/6/2010 in left arm. Immediately after the injection pt. had bleeding at the site. Patient c/o pain, swelling, erythema, bruising, and induration 4 inches in diameter that began on the day of vaccination. 4 hours later erythema developed and 8 hours later pt. had swelling and erythema. Symptoms peaked at 48 hours and pt. began experiencing mild fever, chills, malaise, myalgia and fatigue. Patient was concerned about cellulitis but symptoms improved immensely with ibuprofen and hot compresses. The induration and erythema subsided by 4 days after the injection. As of (10/18) there still remained a bruise at the site of injection which was slowly improving. Patient is a physician herself and consulted with a few physician colleagues who all ruled out cellulitis, and diagnosed her with a local vaccine reaction.

VAERS ID:415510 (history)  Vaccinated:2010-11-23
Age:32.0  Onset:0000-00-00
Gender:Male  Submitted:2011-01-26
Location:Unknown  Entered:2011-01-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Wheezing

VAERS ID:415773 (history)  Vaccinated:2009-10-21
Age:32.0  Onset:2009-10-22, Days after vaccination: 1
Gender:Female  Submitted:2011-01-29, Days after onset: 464
Location:Nebraska  Entered:2011-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98445P10IMLA
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Facial pain, Headache, Laboratory test, Muscle spasms, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Glaucoma (broad), Arthritis (broad)
Write-up: First onset consisted of severe headache, facial pain, muscle spasms in the neck and upper back. Pain moved throughout the back region and mainly settled in the face, neck and upper back. Daily ongoing headaches and pain have persisted for over 15 months. Treatment has consisted of multiple medications, physcial therapy, multiple test with multiple physicians/ specialists.

VAERS ID:416050 (history)  Vaccinated:2011-02-01
Age:32.0  Onset:2011-02-01, Days after vaccination: 0
Gender:Male  Submitted:2011-02-01, Days after onset: 0
Location:Georgia  Entered:2011-02-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF786AA0SCLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Profuse perspiration, lightheadedness, & dizziness. B/P 86/68 10 min later 144/94 30 mins later 110/70.

VAERS ID:416396 (history)  Vaccinated:2010-10-25
Age:32.0  Onset:2010-10-27, Days after vaccination: 2
Gender:Female  Submitted:2011-01-13, Days after onset: 78
Location:Florida  Entered:2011-02-08, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Vertigo
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)
Write-up: 32 y/o F vaccinated on 10/25/2010. 2 days post injection patient developed vertigo, and her hand went numb. Pt. sought treatment in the ER and was DX with vertigo. Symptoms gradually decreased each day. All symptoms resolved within 15 days. Pt states "I have seen my primary doctor twice and now am seeing an ENT. They think it might be a viral infection in my head (acoustic nerve) and I have a EMG scheduled for next week and once that test is finished we will probably do an MRI." Patient has received the flu shot 5+ times in the past with no h/o adverse reactions.

VAERS ID:416407 (history)  Vaccinated:2009-10-03
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-02-08
Location:Alaska  Entered:2011-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED07049111A0UNUN
Administered by: Unknown     Purchased by: Military
Symptoms: Abdomen scan normal, Antinuclear antibody increased, Arthralgia, Arthropathy, Blood catecholamines normal, Blood fibrinogen increased, Blood pressure increased, Cortisol free urine decreased, Echocardiogram normal, Electromyogram abnormal, Fibromyalgia, Glucose tolerance test normal, Hypoaesthesia, Intervertebral disc protrusion, Metanephrine urine normal, Myalgia, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Pain in extremity, Paraesthesia, Plantar fasciitis, Polyarthritis, Polyneuropathy, Sensorimotor disorder, Vanillyl mandelic acid urine, Vitamin B12 increased, X-ray normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: A review of the medical records and interview noted that on 15 Aug 09 she received AVA #1, Hep B #1, and Typhoid. Other than slight arm pain, she denied any problems. Then on 23 Sep 09, she received AVA and Hep B #2 and passed her medical exam. Her BP at that time was 132/90, consistent with her prior 3 yr average of 132/88. Per review, on 20 Oct 09, during her well woman exam, her BP was noted to be elevated at 164/121 with a repeat reading of 155/102. On 23 Oct during f/u for BP she reported bil great toe pain in the area between her toes. An x-ray detected no abnormalities. There were many subsequent visits for BP management without mention of toe pain. She was deployed in late Nov 09, returned in Jan 10, and reported that her feet continued to bother her. She was treated for plantar fascitis. Mar 10 increasing foot pain, given NSAIDS and a MRI was ordered, completed in Apr and noted mild disc protrusion, facet arthropathy with no neuroforaminal or central canal stenosis. In May 10 evaluated by neuro for bilateral foot pain and paresthesia with an EMG indicating a mild neuropathic process with an unclear etiology. In Jul she had a normal MRI of the brain, an elevated ANA with pos SS-A-Ab, and was evaluated by podiatry, where tarsal tunnel syndrome was ruled out. A follow up visit in Aug reported the onset of multiple joint and muscle pain that involves her neck, shoulders, hips and feet. Rheumatology dx her as having inflammatory polyarthritis, to rule out psoriatic arthritis. On 07 Dec she was evaluated by rheumatology and met the classification for fibromyalgia with no identifiable rheumatologic conditions to cause her HTN and neuropathy. She was evaluated by allergy on 08 Dec and there was no evidence of an IgE mediated event, and other than a temporal relationship to the vaccines, a causal relationship could not be identified. She was referred to internal medicine for HTN evaluation who stated that there is no current explanation for this new onset of significant HTN. She had a normal echocardiogram, U/S of abd, VMA, catecholamines. Metanephrine, GTT, but had a slightly elevated B12, and plasma rennin, and slightly low urine free cortisol. She is currently pending a renal evaluation and will follow-up with internal med. She was evaluated by neurology and was assessed as having Pedal pain and numbness. Her recent nerve conduction study suggested the presence of a mild, length-dependent, sensorimotor polyneuropathy. Extensive work-up to date revealed no symptomatic etiology for a peripheral neuropathy.

VAERS ID:416730 (history)  Vaccinated:2011-01-03
Age:32.0  Onset:2011-01-04, Days after vaccination: 1
Gender:Female  Submitted:2011-02-04, Days after onset: 31
Location:Washington  Entered:2011-02-14, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURAFLUA550BA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0932Z0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, pain, redness at injection site.

VAERS ID:416783 (history)  Vaccinated:2011-01-20
Age:32.0  Onset:2011-01-23, Days after vaccination: 3
Gender:Male  Submitted:2011-01-24, Days after onset: 1
Location:California  Entered:2011-02-14, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB807AA0UNLA
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:417383 (history)  Vaccinated:2009-10-23
Age:32.0  Onset:2009-10-23, Days after vaccination: 0
Gender:Female  Submitted:2011-02-04, Days after onset: 469
Location:Tennessee  Entered:2011-02-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Concomitant medications and relevant medical history were unknown. It was unknown if the subject had previously received influenza vaccinations.
Diagnostic Lab Data: Body temperature, Oct2009, 99-100
CDC Split Type: A0814054A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA27AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Overdose, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of sore arm in a female subject aged between 20 and 29 years old who was vaccinated with FLULAVAL (GlaxoSmithKline). On 23 October 2009, in the late afternoon, the subject received unspecified dose of FLULAVAL (5 to 6 ml, unknown, unknown arm). On 23 October 2009, less than one day after vaccination with FLULAVAL, the subject experienced sore arm, fever and overdose. At the time of reporting, the outcome of the overdose was unresolved. At the time of reporting the outcome of the sore arm and fever was unspecified. On 26 October 2009, the nurse reported that the subject allegedly received five to six ml of FLULAVAL. She experienced a sore arm and a fever. The subject consulted a health care professional regarding the event(s). Follow up information was received on 18 November 2009 via the reporting nurse (employer). The nurse reported that a 32-year-old female subject (employee) received a dose of FLULAVAL (2.5 ml (5 doses)) in the left arm. The subject had a low grade temperature of 99-100 on an unspecified day in October 2009. Approximately on 30 October 2009, the events were resolved.

VAERS ID:417387 (history)  Vaccinated:2009-10-19
Age:32.0  Onset:2009-10-19, Days after vaccination: 0
Gender:Female  Submitted:2011-02-04, Days after onset: 473
Location:Unknown  Entered:2011-02-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject had previously received influenza vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0815869A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA281AA UNRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of pain in right upper arm in a 32-year-old female subject who was vaccinated with FLULAVAL (GlaxoSmithKline). On 19 October 2009 the subject received a dose of FLULAVAL (.5 ml, unknown, right arm). On 19 October 2009, less than one day after vaccination with FLULAVAL, the subject experienced pain in right upper arm. At the time of reporting the pain in right upper arm was unresolved. The nurse reported the subject had pain in upper right arm since receiving FLULAVAL. This is one of three cases reported by the nurse; see case A0816149A and A0816150A for subjects who had pain in upper right arm following vaccination with FLULAVAL.

VAERS ID:416918 (history)  Vaccinated:2011-02-08
Age:32.0  Onset:2011-02-10, Days after vaccination: 2
Gender:Female  Submitted:2011-02-10, Days after onset: 0
Location:California  Entered:2011-02-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: During hospitalization prior to MMR Ibuprofen; Senna
Current Illness: None
Preexisting Conditions: Not disclosed
Diagnostic Lab Data: None related to reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0788Z UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Edema, erythema, and pain at right upper arm subcutaneous injection site. MD treatment: AUGMENTIN.

VAERS ID:416930 (history)  Vaccinated:2010-11-02
Age:32.0  Onset:2010-11-25, Days after vaccination: 23
Gender:Male  Submitted:2011-02-16, Days after onset: 83
Location:Delaware  Entered:2011-02-16
Life Threatening? No
Died? Yes
   Date died: 2010-12-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3486AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cardioversion, Convulsion, Death, Hypoxic-ischaemic encephalopathy
SMQs:, Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: seizure resulting in defribrilation resulting in anoxic brain injury. treated at Hospital.

VAERS ID:417164 (history)  Vaccinated:2011-01-20
Age:32.0  Onset:2011-01-22, Days after vaccination: 2
Gender:Female  Submitted:2011-02-18, Days after onset: 27
Location:Michigan  Entered:2011-02-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Viral URI
Preexisting Conditions: Allergy to sulfa; mild asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1211Z1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Cellulitis
SMQs:
Write-up: 15 cm in length x 5 cm width cellulitis in (L) upper extremity.

VAERS ID:417170 (history)  Vaccinated:2011-02-16
Age:32.0  Onset:2011-02-16, Days after vaccination: 0
Gender:Female  Submitted:2011-02-17, Days after onset: 1
Location:Connecticut  Entered:2011-02-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA; No known birth defect; No known medical cond.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB855AA2IMLA
Administered by: Public     Purchased by: Private
Symptoms: Abdominal pain, Chills, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 3 hrs after injection felt nauseated with abd. pain; mult. episodes of vomiting over 6-8 hrs; whole body aches, chills, headache; cramps in abdomen; resolved over 16-20 hrs.

VAERS ID:417208 (history)  Vaccinated:2010-09-13
Age:32.0  Onset:2010-09-14, Days after vaccination: 1
Gender:Female  Submitted:2011-02-19, Days after onset: 158
Location:West Virginia  Entered:2011-02-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: N/A
Diagnostic Lab Data: FLU AND STREPT TEST PERFORMED ON 9-14-2010. ALL RESULTS NEGATIVE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3486AA0IMRA
Administered by: Military     Purchased by: Private
Symptoms: Arthralgia, Influenza virus test negative, Myalgia, Oropharyngeal pain, Pyrexia, Streptococcus test negative, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: FEVER,SORE THROAT, SWELLING,JOINT AND MUSCLE ACHES X 3 DAYS

VAERS ID:417500 (history)  Vaccinated:2010-11-01
Age:32.0  Onset:2010-12-04, Days after vaccination: 33
Gender:Female  Submitted:2011-02-22, Days after onset: 80
Location:Massachusetts  Entered:2011-02-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported prior, but from new information received on 14 February 2011 the patient had no reported medical history, no infertility treatments and no maternal drug exposure. Obstetrical history included no prior pregnancies. Medical history for the father of the baby was reported as "perfect." The date of the patient''s last menstrual period was on 01 March 2010 with expected date of delivery on 04 December 2010.
Diagnostic Lab Data: Not reported
CDC Split Type: 201006337
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA528 UNUN
Administered by: Public     Purchased by: Private
Symptoms: Complication of pregnancy, Drug exposure during pregnancy, Hypertension, Oedema peripheral, Premature separation of placenta, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow)
Write-up: Initial report received from the patient''s spouse on 02 November 2010. A pregnant female patient (date of birth not reported) had received a first dose of ADACEL (lot number not reported) on 23 October 2010. The patient''s estimated date of delivery is 09 December 2010. At the time of this report, the patient had not experienced any adverse events since being vaccinated with ADACEL. Follow-up information received from the patient''s spouse on 14 and 18 February 2011. Upon receipt of this information, it was determined this case meets seriousness criteria and has been upgraded to serious. The patient was reported as being 34 years of age; however by calculation from the patient''s date of birth the patient was 32 years of age at the time of vaccination. Confirmation of the patient''s date of birth has been requested. The patient had received the ADACEL vaccination at "11:00 pm" on 23 October 2010. She had also received a flu shot in October 2010 of which the trade name, manufacturer name, lot number, route and site of administration were not reported. The patient had no reported medical history, no maternal drug use, and no infertility treatments. Obstetrical history included no prior pregnancies. The date of the patient''s last menstrual period was 01 March 2010 with expected date of delivery 04 December 2010. Current pregnancy history included high blood pressure (reading not provided) and swelling of face and legs with no dates of onset. Per the spouse, the patient was followed by a mid-wife and experienced pregnancy complication on 04 December 2010 when she presented with "placenta rupture and detachment" that resulted in emergency cesarean section and delivery of a single 6 pound healthy male baby. It was reported that the baby is healthy and fine and the baby had no congenital anomalies. Hospitalization was not mentioned. No other medical information was provided. At the time of this report, the patient had recovered. Documents held by sender: None.

VAERS ID:417572 (history)  Vaccinated:2011-02-22
Age:32.0  Onset:2011-02-24, Days after vaccination: 2
Gender:Female  Submitted:2011-02-25, Days after onset: 1
Location:Texas  Entered:2011-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3399DA IMUN
Administered by: Public     Purchased by: Public
Symptoms: Inflammation, Injection site discolouration, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: At site of injection - large slightly raised pink area 25mm x 25mm - warm to touch c/o of pain in shoulder & upper arm. Tx - ice pk and ibuprofen 400mg q 3- 4 hours for pain & inflammation.

VAERS ID:417578 (history)  Vaccinated:2011-01-18
Age:32.0  Onset:2011-02-11, Days after vaccination: 24
Gender:Male  Submitted:2011-02-22, Days after onset: 11
Location:D.C.  Entered:2011-02-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Troponin I''s = <0.01, 0.04, and 0.29 - positive, neg troponin T''s, neg CK/CKMB. Negative Cardiac cath, ECHO and Cardiac MRI; Normal UA, CBC, lipids, magnesium, Chem 24, CRP High Sens Neg EKG, neg Cardiac cath- vessels totally clear, Neg CT chest for PE, negative MRI with gadolinium of the heart.; Normal Cardiac cath; Normal Echocardiogram.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.UH183AA IN 
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Military
Symptoms: Blood creatine phosphokinase MB normal, Blood creatine phosphokinase normal, Blood magnesium normal, C-reactive protein normal, Catheterisation cardiac normal, Chest discomfort, Chest pain, Computerised tomogram normal, Computerised tomogram thorax normal, Echocardiogram normal, Electrocardiogram normal, Full blood count normal, Laboratory test normal, Lipids normal, Nuclear magnetic resonance imaging normal, Troponin I increased, Troponin T, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Patient is 32 y/o who received FLUMIST on Jan 18 and AVA#1, HepB, and Typhoid vaccinations on Jan 25th. Patient presented to ER with substernal chest pain/pressure radiating to left arm on 11 Feb. Pain lasted 45-60 minutes only. Pos fam hx for MI - GF had MI at age 30.

VAERS ID:417610 (history)  Vaccinated:2011-02-16
Age:32.0  Onset:2011-02-18, Days after vaccination: 2
Gender:Female  Submitted:2011-02-23, Days after onset: 5
Location:Oklahoma  Entered:2011-02-25, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1113Z1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Erythema, Pain, Secretion discharge, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Given shot on 2/16/11, on 2/18/11 had area approx. 6cm x 5cm of redness appear. On 2/20/11 blisters started forming area is painful to touch, weeping, and red today. Has had pain and warmth in area since 2/18/11.

VAERS ID:417613 (history)  Vaccinated:2011-01-04
Age:32.0  Onset:2011-01-25, Days after vaccination: 21
Gender:Male  Submitted:2011-02-25, Days after onset: 31
Location:Unknown  Entered:2011-02-25
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 31 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111797P12IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: Called by county to report that above patient is being treated for poss. Guillain-Barre syndrome at hospital. Pt history of INFLUENZA given 1/4/11.

VAERS ID:417645 (history)  Vaccinated:2011-02-23
Age:32.0  Onset:2011-02-23, Days after vaccination: 0
Gender:Female  Submitted:2011-02-25, Days after onset: 2
Location:Florida  Entered:2011-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB944CA0UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.111Z0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3819AA0UNLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Injection site warmth, Pyrexia, Rash macular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Fever, redness to arm, site hot, red blotches on inner aspect of arm.

VAERS ID:417717 (history)  Vaccinated:2011-02-12
Age:32.0  Onset:2011-02-13, Days after vaccination: 1
Gender:Male  Submitted:2011-02-26, Days after onset: 13
Location:Unknown  Entered:2011-02-28, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2011FR13469
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS360379 IJUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Chills, Decreased appetite, Delirium, Dizziness, Gait disturbance, Hallucination, Headache, Hot flush, Influenza like illness, Myalgia, Nausea, Percussion test, Tongue coated, Urine analysis normal, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: Initial report received from a consumer on 16 Feb 2011: The patient had no medical history and no allergy. The patient did not smoke, drink and did not take illicit substance and practiced regularly body building. The patient''s vaccination status was up to date and had scheduled DTP vaccine before the end of 2011. The patient was vaccinated with MENVEO (meningoccal groups A, C, W135 and Y conjugate vaccine, batch number: 360379-1) on 12 Feb 2011. On 13 Feb 2011, the patient experienced hot flushes, nausea, vomiting, headache, coated tongue and loss of appetite. At 3.00 pm the patient developed severe chills with chattering teeth, and the body temperature increased to 38.8 and then at 39 degree Celsius. During fever, the patient also experienced delirium and hallucinations, the patient developed muscular pains on thighs, calves, loin and back and flu like symptoms that lead to walking difficulty. At 9.00 pm, the patient went to emergency room. The tension was normal, fever was 40 degree Celsius and urinary tests were normal. Thoracic and abdominal percussions, knees/feet control were done (no details provided). The patient was treated with paracetamol every six hours. The outcome for muscular pain in thighs, calves, loin and back, flu like symptoms, walking difficulty, nausea, headache and dizziness was reported as condition improving whereas the outcome for increased body temperature, delirium and hallucinations was reported as recovered, the outcome for loss of appetite was reported as condition unchanged and the outcome for nausea was not reported.

VAERS ID:418027 (history)  Vaccinated:2010-10-12
Age:32.0  Onset:2010-10-14, Days after vaccination: 2
Gender:Male  Submitted:2011-03-04, Days after onset: 141
Location:New York  Entered:2011-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: cpk/tsh-normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA531BA IM 
Administered by: Public     Purchased by: Private
Symptoms: Blood creatine phosphokinase normal, Blood thyroid stimulating hormone normal, Muscular weakness, Paraesthesia, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Tingling, progressive weakness of legs. Seen 11/11/10 by neurologist that felt it was not Guillain Barre, but a strange reaction to flu vaccine. Resolved on own.

VAERS ID:418064 (history)  Vaccinated:2010-09-15
Age:32.0  Onset:2010-09-16, Days after vaccination: 1
Gender:Female  Submitted:2010-09-30, Days after onset: 14
Location:Virginia  Entered:2011-03-04, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501038P3IN 
Administered by: Military     Purchased by: Military
Symptoms: Body temperature increased, Chills, Hot flush, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow)
Write-up: On 16 Sept 2010, patient broke out with a rash on forearms around 11AM. She started having hot flashes, chills. Temperature was 99.1F. Patient noticed bumps on face, neck and arms. By the afternoon, bumps increased and were on chest and legs. Temp retaken 99.9 F. Patient took BENADRYL around 2pm and itchiness subsided. BENADRYL taken again around 1730 and she continued to do so all weekend every 3-4 hours. Resolved 20 Sept 2010.

VAERS ID:418602 (history)  Vaccinated:2011-03-04
Age:32.0  Onset:2011-03-05, Days after vaccination: 1
Gender:Female  Submitted:2011-03-08, Days after onset: 3
Location:Wisconsin  Entered:2011-03-14, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3487AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness at injection site began Sat (3/5/11) afternoon. Sunday increased redness, hard in center, warm to touch increasing in size. Temp 99.5 degrees. Seen in clinic 3/7/11 treated with Clindamycin 300mg TID x 7 days.

VAERS ID:418848 (history)  Vaccinated:2011-02-16
Age:32.0  Onset:2011-02-17, Days after vaccination: 1
Gender:Female  Submitted:2011-03-16, Days after onset: 26
Location:Louisiana  Entered:2011-03-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU2969AA0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Axillary pain, Lymph node pain, Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling and pain under the arm, took liquid Motrin. Pain lasted until Sat. AM. She states that it felt like swollen/tender lymph nodes.

VAERS ID:418950 (history)  Vaccinated:2003-12-10
Age:32.0  Onset:2003-12-30, Days after vaccination: 20
Gender:Female  Submitted:2011-03-17, Days after onset: 2633
Location:Wisconsin  Entered:2011-03-17
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 24 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES765497  UN
Administered by: Public     Purchased by: Private
Symptoms: Abasia, Headache, Hypoaesthesia, Malaise, Musculoskeletal stiffness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Headache, very stiff, felt sick, hands and feet went numb, then lost the ability to walk on my own.

VAERS ID:419867 (history)  Vaccinated:2011-03-26
Age:32.0  Onset:2011-03-27, Days after vaccination: 1
Gender:Female  Submitted:2011-03-28, Days after onset: 1
Location:Texas  Entered:2011-03-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abscess - Back
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3554BA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right deltoid - redness, swelling, warm to touch & tenderness (22 mm).

VAERS ID:420457 (history)  Vaccinated:2011-04-05
Age:32.0  Onset:2011-04-06, Days after vaccination: 1
Gender:Female  Submitted:2011-04-07, Days after onset: 1
Location:Connecticut  Entered:2011-04-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, redness, soreness at injection site, hard lump at injection site

VAERS ID:420528 (history)  Vaccinated:2011-04-01
Age:32.0  Onset:2011-04-01, Days after vaccination: 0
Gender:Female  Submitted:2011-04-08, Days after onset: 7
Location:Minnesota  Entered:2011-04-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Unknown     Purchased by: Other
Symptoms: Injection site pain, Injection site reaction, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe pain in muscle where shot was given. Still incredibly painful 1 week later. Lifting and lowering arm causes major aching and pain in shoulder.

VAERS ID:420679 (history)  Vaccinated:2011-04-08
Age:32.0  Onset:2011-04-08, Days after vaccination: 0
Gender:Female  Submitted:2011-04-11, Days after onset: 3
Location:North Carolina  Entered:2011-04-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR    
Administered by: Unknown     Purchased by: Private
Symptoms: Chills, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: Fever of about 103, aches, chills, pain in arm. Lasted 48 hours.

VAERS ID:420798 (history)  Vaccinated:2011-03-29
Age:32.0  Onset:2011-04-06, Days after vaccination: 8
Gender:Female  Submitted:2011-04-11, Days after onset: 5
Location:California  Entered:2011-04-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: EE states PCN
Diagnostic Lab Data: Neg Titer Varicella 8/29/06
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3554AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0756Z0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Antibody test negative, Injection site pain, Injection site rash, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Seen on 4/11 for Varicella Vaccine given on 3/29/11. Last week noticed pain at site; local rash at site & also sev. spots on face. Noticed "itchy" areas other places as well. Afebrile. ? dev. chickenpox.

VAERS ID:420944 (history)  Vaccinated:2011-03-08
Age:32.0  Onset:2011-03-09, Days after vaccination: 1
Gender:Female  Submitted:2011-04-13, Days after onset: 34
Location:Missouri  Entered:2011-04-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History of low blood sugar and low iron.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB211AA   
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURE02041 IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.M1607Y SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness postural, Fatigue, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient states "felt very tired all evening. The next morning dizzy upon rising, passed out". Husband drove her to emergent care. States they adm. Epipen and inst. to report if symptoms recurred.

VAERS ID:421055 (history)  Vaccinated:2011-03-30
Age:32.0  Onset:2011-04-06, Days after vaccination: 7
Gender:Female  Submitted:2011-04-14, Days after onset: 8
Location:California  Entered:2011-04-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3874BA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythematous 10x4 cm patch (L) upper arm. Warm to touch.

VAERS ID:421483 (history)  Vaccinated:2010-09-27
Age:32.0  Onset:2010-09-27, Days after vaccination: 0
Gender:Female  Submitted:2011-04-20, Days after onset: 205
Location:Florida  Entered:2011-04-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gestational Diabetes; Gestational Hypertension
Preexisting Conditions: No adverse events were reported following receipt of prior immunizations. The subject has no history of tobacco or alcohol use. The subject has a history of 3 normal, full term births. She additionally has a history of two pre-term pregnancies, one reported to be a spontaneous abortion and the other due to pregnancy-induced hypertension.
Diagnostic Lab Data: It was noted that no defects were evident from prenatal tests.
CDC Split Type: A0884584A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B058BA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Caesarean section, Drug dispensing error, Drug exposure during pregnancy, Laboratory test normal, Pregnancy with contraceptive device, Premature delivery
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: This prospective pregnancy case was reported by a healthcare professional and described the occurrence of vaccine exposure during pregnancy in a 32-year-old female subject who was vaccinated with BOOSTRIX (GlaxoSmithKline) during pregnancy. Concurrent medical conditions included gestational diabetes and gestational hypertension. Concurrent medications included Prenatal vitamins. On 27 September 2010 the subject received a dose of BOOSTRIX (.5 ml, unknown, left arm). Her last menstrual period was on an unspecified date and estimated date of delivery was on 30 January 2011. The subject was exposed to BOOSTRIX during an unknown trimester. On 27 September 2010, at the time of vaccination with BOOSTRIX, the subject experienced vaccine exposure during pregnancy and prescription dispensing error. The healthcare professional reported that a pregnant subject received a BOOSTRIX inadvertently. The subject received this vaccination in error due to it not being prescribed for her (prescription dispensing error). At the time of the report, no other adverse events occurred. The outcome of the pregnancy was unknown. Follow-up information was received via the patient''s physician on 26 October 2010. It was reported that the patient''s date of last menstrual period was 25 April 2010 and that conception was normal. She receives prenatal vitamins with DHA. The subject''s gestational age at the time of vaccination was 22 weeks. The pregnancy was an intrauterine pregnancy with an intrauterine device (IUD) in place. The IUD was removed on 23 June 2010. Follow-up information was received via a nurse on 13 April 2011. It was reported that conception was normal. The subject experienced a premature delivery on 28 November 2010, at 31 weeks gestation. The male neonate was delivered via cesarean section and weighed 4 pounds and 2 ounces. APGAR scores at 1 and 5 minutes were 08 and 09. No defect were noted, however, the neonate was sent to the neonatal intensive care unit due to the pre-term delivery. The event was not considered to be serious although premature delivery is considered medically serious by GSK.

VAERS ID:421571 (history)  Vaccinated:2011-03-16
Age:32.0  Onset:2011-04-15, Days after vaccination: 30
Gender:Male  Submitted:2011-04-22, Days after onset: 7
Location:Virginia  Entered:2011-04-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: 1. Rhabdomyolysis - Pt''s CK on presentation was just under 20K (lab had to be sent to an outside facility as lab here can only read up to values less than 5000). We were unable to trend his CK levels here due to limited lab capability, and his levels were $g5000 at the time of discharge. Follow labs will be obtained as an outpatient in 3 days to ensure resolution. His Cr improved from 1.4 on admission to 1.0 on day of discharge with aggressive IVF resuscitation, and his urine output was excellent. His potassium was near the upper limits of normal and he was advised to avoid potassium rich foods and Gatorade. His chest swelling resolved and he was asymptomatic on the day of discharge. He was seen by ortho and thought to have no evide
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2650IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B067EA0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin normal, Blood creatine phosphokinase increased, Blood potassium increased, Chills, Gamma-glutamyltransferase normal, Hepatitis B test negative, Hepatitis C test negative, Myositis, Nausea, Pyrexia, Rhabdomyolysis, Swelling, Transaminases increased, Ultrasound chest, Ultrasound scan abnormal, Urine output, Vomiting
SMQs:, Rhabdomyolysis/myopathy (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (narrow), Myocardial infarction (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad)
Write-up: He was lifting weights 4 days ago, states he did chest press of 135lbs, 4 sets of 15 reps. He stated this was lighter than his usual work out, but noted he noted no chest wall pain during or after work out. Of note, pt did receive anthrax vaccination 2-3 weeks prior in left arm on March 21, 2011

VAERS ID:421625 (history)  Vaccinated:2011-04-20
Age:32.0  Onset:2011-04-21, Days after vaccination: 1
Gender:Female  Submitted:2011-04-22, Days after onset: 1
Location:Florida  Entered:2011-04-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis resolved; Asthma
Preexisting Conditions: Asthma; Allergic rhinitis; Heart murmur; Allergy to erythromycin --$g hives
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1157Z0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Erythema, Injection site urticaria, Oedema, Skin plaque
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Hives/urticaria left bicep muscle, 4 erythematous plaque w edema present, worsen since yesterday. No angioedema. Prescribed antihistamines, H1 and H2 and also oral prednisone.

VAERS ID:421861 (history)  Vaccinated:2007-07-11
Age:32.0  Onset:2007-08-15, Days after vaccination: 35
Gender:Female  Submitted:2011-04-28, Days after onset: 1352
Location:South Carolina  Entered:2011-04-28
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Just given birth on 7/9/2007.
Preexisting Conditions: None
Diagnostic Lab Data: Diagnosed with Rheumatoid Arthritis.
CDC Split Type:
Vaccination
Manufacturer
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Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Private
Symptoms: Rheumatoid arthritis
SMQs:, Arthritis (narrow)
Write-up: Arthritis.

VAERS ID:421990 (history)  Vaccinated:2010-11-16
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2010-12-21
Location:North Carolina  Entered:2011-04-29, Days after submission: 128
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of 2 previous miscarriages. Allergy to CIPRO. No illness at time of vaccination.
Diagnostic Lab Data:
CDC Split Type: 201006506
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DECAVAC)SANOFI PASTEURU3422DA IDLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug exposure during pregnancy, Erythema, Feeling abnormal, Injection site erythema, Vaccination site swelling, Vaccination site warmth, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (broad)
Write-up: Initial case received from a nurse on 17 November 2010. This involves a case of misuse, i.e. wrong vaccine administered; it is also a pregnancy case. The patient is 1 of a cluster of 5 patients who experienced adverse events following intradermal administration of DECAVAC. A 32-year-old pregnant female patient received a left forearm intradermal injection of DECAVAC (lot number U3422DA) instead of TUBERSOL 5TU on 16 November 2010. The patient was 11 weeks pregnant at the time of vaccination, and medical history included CIPRO allergy. She had a history of 2 previous miscarriages. Following vaccination, the patient developed a 6 cm x 7 cm area around the vaccination site which was red, hot, and raised. She also complained of a 6 cm x 7 cm lighter red streak going up the arm towards the elbow, and noted that her left 5th finger "feels like it wants to contract". She was not taking any medications, and was not ill at the time of vaccination. The event was ongoing at the time of the report. The events for the other patients in this cluster are captured in case numbers 2010-06503, 2010-03604, and 2010-03608.

VAERS ID:421963 (history)  Vaccinated:2011-04-26
Age:32.0  Onset:2011-04-27, Days after vaccination: 1
Gender:Female  Submitted:2011-04-30, Days after onset: 3
Location:Arizona  Entered:2011-04-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain upper, Arthralgia, Chills, Diarrhoea, Fatigue, Headache, Injection site pain, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: Fever, Chills, Nausea, sore joints, pain at injection site, stomach ache, diarrhea, tiredness, headache,

VAERS ID:421967 (history)  Vaccinated:2011-04-27
Age:32.0  Onset:2011-04-28, Days after vaccination: 1
Gender:Female  Submitted:2011-05-01, Days after onset: 3
Location:Utah  Entered:2011-05-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Type 1 Diabetic, Thyroid replacement, Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Confusional state, Injection site erythema, Injection site infection, Injection site swelling, Injection site warmth, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Chills, muscle weakness, nausea, mental confusion. 9:00 AM (4/29/2011) site of injection is swollen and red and hot to touch. Benadryl taken @ 6:00 pm after trip to clinic due to still suffering from symptoms. Dr gave perscription for antibiotic due to concern of infection at site of injection.

VAERS ID:422233 (history)  Vaccinated:2008-01-22
Age:32.0  Onset:2008-01-22, Days after vaccination: 0
Gender:Male  Submitted:2011-05-02, Days after onset: 1195
Location:Georgia  Entered:2011-05-04, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Military
Symptoms: Decreased appetite, Dyspnoea, Lymphadenopathy, Nausea, Pharyngeal oedema, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Developed nausea, cervical and axillary LAD, fever, swelling in throat, difficulty breathing, anorexia x 3 ds. Sxs began soon after receiving vaccines. No prior rx from anthrax 1 except local rx and nodule that persisted 3 months.

VAERS ID:422703 (history)  Vaccinated:2008-01-22
Age:32.0  Onset:2008-01-22, Days after vaccination: 0
Gender:Female  Submitted:2008-01-24, Days after onset: 2
Location:Washington  Entered:2011-05-11, Days after submission: 1202
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Contact PMD
CDC Split Type: WA080012
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2230AA1UNLA
Administered by: Public     Purchased by: Private
Symptoms: Musculoskeletal stiffness, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Tues vaccine. Symptoms Tues pm 8:00pm. Stiff neck, nausea, vomit, fever 101. Thurs vomit, fever 101.

VAERS ID:422928 (history)  Vaccinated:2011-05-06
Age:32.0  Onset:2011-05-06, Days after vaccination: 0
Gender:Female  Submitted:2011-05-09, Days after onset: 3
Location:California  Entered:2011-05-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: PCN; CIPRO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3487CA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Erythema, Fatigue, Injection site swelling, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad)
Write-up: Pt had TDAP 5/6/11 felt she had not had tetanus for many years - had fever, body aches, joint pains, fatigue, redness, swelling at site.

VAERS ID:423113 (history)  Vaccinated:2009-08-30
Age:32.0  Onset:2010-10-15, Days after vaccination: 411
Gender:Male  Submitted:2011-05-18, Days after onset: 215
Location:Unknown  Entered:2011-05-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Possible Multiple Sclerosis.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED05649111A9IJRA
Administered by: Military     Purchased by: Military
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Woke up with numbness on thorax region of torso. Still present today.

VAERS ID:424133 (history)  Vaccinated:2010-10-11
Age:32.0  Onset:2010-10-11, Days after vaccination: 0
Gender:Female  Submitted:2011-05-19, Days after onset: 220
Location:Colorado  Entered:2011-05-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2010026663
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDM519080IMAR
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This medically confirmed spontaneous report (initial receipt 12-OCT-2010) concerns a 32-year-old female. On 11-OCT-2010 10:30, the patient received AFLURIA (Lot# M51908) at a dose of 0.5 cc intramuscularly for immunization. On 11-OCT-2010 11:00, thirty minutes after AFLURIA was administered, the patient developed inflammation around the injection site. The site was red, swollen and painful. The area was warm to the touch. On 14-OCT-2010, the patient was considered to have recovered from the events. The reporter considered events non serious. Follow up 1 (07-DEC-2010): additional adverse events, event outcome, listedness changed to unlisted, narrative added.

VAERS ID:424148 (history)  Vaccinated:2011-05-23
Age:32.0  Onset:2011-05-24, Days after vaccination: 1
Gender:Female  Submitted:2011-05-27, Days after onset: 3
Location:Georgia  Entered:2011-05-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF805AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Dysphonia, Headache, Hyperhidrosis, Oropharyngeal pain
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: On the afternoon of May 24, I began having a headache and a sore throat. On May 25th, my sore throat became worse, I began sweating off and on, and I started becoming hoarse. On May 26, my sore throat was more noticeable in the early morning and late at night, but my voice was not as hoarse as it was on May 25. On May 27th, my voice was hoarse again and my sore throat was very painful. I called the County Health Dept. at 10:30AM and spoke with Nurse, who administered my vaccine. She told me that strep throat was going around and she didn''t think my symptoms had anything to do with receiving the yellow fever shot. As of 10:40 AM on May 27, I have not gone to the emergency room or doctor''s office about my symptoms. If they last over a week, I will seek medical attention.

VAERS ID:424232 (history)  Vaccinated:2011-05-18
Age:32.0  Onset:2011-05-28, Days after vaccination: 10
Gender:Female  Submitted:2011-05-29, Days after onset: 1
Location:California  Entered:2011-05-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Moderate rush over the face and chest area. Mild rash over the abdominal and dorsal area.

VAERS ID:424612 (history)  Vaccinated:0000-00-00
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-05-26
Location:New Jersey  Entered:2011-06-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Serum mumps Ab, mumps test
CDC Split Type: WAES1007USA03365
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Mumps antibody test negative
SMQs:
Write-up: Information has been received from a registered nurse concerning an approximately 32 year old female patient with penicillin allergy who in "27-MAY-198-" (last digit of date is unknown because it is illegible in chart) was vaccinated with a dose of MMR II (Lot# not reported). The nurse reported that the patient did not have titers to mumps after receiving MUMPSVAX II in June 1982. The patient was also administered ATTENUVAX on 27-APR-1982 and MERUVAX II on 06-MAY-1982. The nurse reported that the patient had immunity to measles and rubella. The patient sought unspecified medical attention. At the time of the report, the patient''s outcome was unknown. Additional information has been requested.

VAERS ID:424727 (history)  Vaccinated:0000-00-00
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-05-26
Location:Unknown  Entered:2011-06-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Laboratory test, negative antibody titer to measles, mumps and rubella
CDC Split Type: WAES1004USA00514
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Measles antibody negative, Mumps antibody test negative, Rubella antibody negative
SMQs:
Write-up: Information has been received from a 32 year old female who in 1980 was vaccinated with 2 doses of MMR II at age 2 and at age 28 (in 2006), had a negative antibody titer to measles, mumps, and rubella. The patient sought unspecified medical attention. At the time of report the patient had not recovered. No further information is available.

VAERS ID:424919 (history)  Vaccinated:0000-00-00
Age:32.0  Onset:0000-00-00
Gender:Male  Submitted:2011-06-06
Location:Unknown  Entered:2011-06-07, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Animal bite; Unprovoked bite by a stray dog causing a penetrating, lacerated wound on his right calf and thigh, and bleeding from the site of wound.
Preexisting Conditions:
Diagnostic Lab Data: Fibrin D dimer, 5131 ng/ml, High
CDC Split Type: PHHY2011IN44349
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABIPUR)NOVARTIS VACCINES AND DIAGNOSTICS  IJUN
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody negative, Antiphospholipid antibodies negative, Anxiety, C-reactive protein normal, Cardiolipin antibody negative, Cellulitis, Coagulation test normal, Deep vein thrombosis, Dyspnoea, Fibrin D dimer increased, Homans' sign positive, International normalised ratio, Laboratory test abnormal, Muscle injury, Oedema peripheral, Pain, Pain in extremity, Palpitations, Protein C, Protein S normal, Prothrombin time, Pulmonary embolism, Restlessness, Sepsis, Tachycardia, Tachypnoea, Tenderness, Ultrasound Doppler abnormal, Venous occlusion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Akathisia (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad)
Write-up: Case number PHHY2011IN44349 is an initial literature report received on 24 May 2011. The authors discussed a rare case of calf muscle injury due to dog bite leading to deep vein thrombosis. This report refers to a 32 year old man presented with a history of unprovoked bite by a stray dog causing a penetrating, lacerated wound on his right calf and thigh, and bleeding from the site of wound. He was treated with local antiseptic and was vaccinated with rabies virus vaccine (manufacturer and batch number: unknown). Two days later, the patient experienced a swelling of the right calf which was ignored. Over the next 10 days, the swelling worsened and progressed from the calf to the thigh and was associated with pain in the right leg while walking. He also had acute onset of breathlessness, uneasiness, restlessness, palpitations and intolerable pain in the right leg for which he was hospitalized. On examination, the patient was restless and writhing in pain. His vital parameters were normal except for tachycardia and tachypnoea. No other abnormality was found on chest and cardiovascular examination. Local examination revealed swelling and tenderness over the right calf and thigh. Pratt sign and the Homan''s test were positive. A differential diagnosis of deep vein thrombosis (DVT) with pulmonary embolism and cellulitis with septicemia were made. The patient was investigated and a Doppler of the right leg showed total occlusion of the right common femoral vein below the saphno-femoral junction by a thrombus with partial occlusion above the junction. His D-dimer level was 5131 ng/ml which was significantly raised. no evidence of pulmonary embolism was found on further investigations. The patient was treated with low molecular weight heparin and then shifted over to oral warfarin after overlapping the treatment for 4 days. The pain, swelling and dyspnoea improved during hospital stay and he was discharged with a target international normalized ratio (INR) between 2 and 3. On follow up, his symptoms, prothrombin time (PT) and INR were monitored. No contributory thrombophilic factors (cardiolipin antibody, C-reactive protein, lupus anticoagulant, factor V Leiden, anti-thrombin, antinuclear antibody (ANA), protein C and protein S) were found during the 6 months post-injury examinations. The author commented that the patient''s only identifiable major thrombotic risk factor was the traumatic injury due to the dog bite.

VAERS ID:425171 (history)  Vaccinated:2011-06-08
Age:32.0  Onset:2011-06-09, Days after vaccination: 1
Gender:Male  Submitted:2011-06-10, Days after onset: 1
Location:California  Entered:2011-06-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PCN, shellfish
Diagnostic Lab Data: Referred to allergist and prescribed antibiotics.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2815IMRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Oedema peripheral, Pain, Paraesthesia, Skin induration, Skin warm
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)
Write-up: Swelling on front and back of shoulder, bicep, tricep. 5 in by 5 in. Redness and warm to touch on entire area. Pain with movement and tingling and in forearm and hand- radiating to fingers. Skin leathery- 4 in height by 5 in.

VAERS ID:425426 (history)  Vaccinated:2011-05-18
Age:32.0  Onset:2011-05-25, Days after vaccination: 7
Gender:Female  Submitted:2011-06-15, Days after onset: 21
Location:Ohio  Entered:2011-06-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0665Z1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0747Z1SCLA
Administered by: Public     Purchased by: Private
Symptoms: Rash erythematous, Rash pruritic, Scratch, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Red, raised itchy rash that spreads when scratched.

VAERS ID:425554 (history)  Vaccinated:2011-06-04
Age:32.0  Onset:2011-06-04, Days after vaccination: 0
Gender:Female  Submitted:2011-06-16, Days after onset: 12
Location:Florida  Entered:2011-06-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURE0950 IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0743Z SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURV3492CA IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site pain, Pain, Paraesthesia, Swelling
SMQs:, 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)
Write-up: Pt states soreness and swelling within hours of injection. Has had mild constant dull nonradiating pain in arm (Left) at site of injection. Has had intermittent tingling sensation in entirety of forearm and hand involving all fingers. Unresolved at this time.

VAERS ID:425799 (history)  Vaccinated:2011-06-08
Age:32.0  Onset:2011-06-08, Days after vaccination: 0
Gender:Female  Submitted:2011-06-13, Days after onset: 5
Location:Illinois  Entered:2011-06-21, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3898BA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Palpitations, Pharyngeal hypoaesthesia
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: Vaccine given 0800 & experienced symptoms of palpitations, abdominal cramping, diarrhea. Treated in ER with BENADRYL IV for HR 150''s. Also c/o "numbness" in back of throat. No further symptoms after ER visit.

VAERS ID:426133 (history)  Vaccinated:2011-06-03
Age:32.0  Onset:2011-06-06, Days after vaccination: 3
Gender:Female  Submitted:2011-06-23, Days after onset: 17
Location:Maine  Entered:2011-06-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Td Adsorbed (no brand name)~1~25.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B062AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Joint range of motion decreased, Myalgia, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Muscle pain, tender to touch, Limited range of motion x 4 weeks. Treating with Ibuprofen and gentle stretching.

VAERS ID:426356 (history)  Vaccinated:2011-03-09
Age:32.0  Onset:2011-06-01, Days after vaccination: 84
Gender:Male  Submitted:2011-06-28, Days after onset: 27
Location:Washington  Entered:2011-06-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None present
Preexisting Conditions: None presented
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER   AR
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER   AR
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:
Write-up: lymphadenopathy (swollen lymphnodes in neck)

VAERS ID:426779 (history)  Vaccinated:2011-06-28
Age:32.0  Onset:2011-06-28, Days after vaccination: 0
Gender:Female  Submitted:2011-06-29, Days after onset: 1
Location:Oregon  Entered:2011-07-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No
Diagnostic Lab Data: No
CDC Split Type: OR201118
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B056AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncope event after receiving Tdap. Client had momentary fainting spell. No obvious injury to head or body. Pt denies hitting head. Able to speak and move right after incident. C/o lightheadedness. Was assisted to clinic room for further eval. Neuro check & VS monitored. Clts BP remained low, so given liquids & rest until stable.

VAERS ID:426739 (history)  Vaccinated:2011-06-30
Age:32.0  Onset:2011-06-30, Days after vaccination: 0
Gender:Female  Submitted:2011-07-05, Days after onset: 5
Location:Illinois  Entered:2011-07-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies: Bees, iodine, shrimp/seafood, pcn, pertussis, potatoes, pineapple, strawberries. Medical hx: fibromyalgia
Diagnostic Lab Data: pt to try topical cortisone treatment. if no relief will see pcp for further follow-up.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU3870AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Injection site erythema, Injection site pruritus, Injection site rash, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Coughing, low grade fever 99.0, red itchy rash at injection site (Benadryl).

VAERS ID:427254 (history)  Vaccinated:2010-10-08
Age:32.0  Onset:2010-10-09, Days after vaccination: 1
Gender:Female  Submitted:2010-10-22, Days after onset: 13
Location:California  Entered:2011-07-11, Days after submission: 262
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no illness at the time of vaccination. She had no pre-existing physician-diagnosed allergies, birth defects or medical conditions. She did not experience adverse event following prior vaccination.
Diagnostic Lab Data: None
CDC Split Type: 201005900
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3491AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site haemorrhage, Injection site pain, Injection site vesicles, Wound secretion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Case received from a Healthcare Professional on 12 October 2010 under the reference number 10-0706. A 32-year-old female patient, with no relevant medical history and no illness at the time of vaccination, had received an intramuscular dose of ADACEL (batch number C3491AA) in the left deltoid on 08 October 2010. The patient had received an intramuscular dose of FLUVIRIN (other manufacturer, batch number not reported) in the left deltoid on 23 September 2010. She had received concomitantly prenatals vitamins. The patient had no pre-existing physician-diagnosed allergies, birth defects or medical conditions. She did not experience adverse event following prior vaccination. On 09 October 2010, the left deltoid was sore. Two days post-vaccination, the patient noticed two open blister like areas on the left deltoid posterior to the injection site. "By sunday", blisters were oozing and bloody. The patient was seen by a physician who recommended hydrocortisone cream. The patient had not recovered at the time of reporting, symptoms improving slowly. Documents held by sender: none.

VAERS ID:427749 (history)  Vaccinated:2009-07-24
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-07-18
Location:Oregon  Entered:2011-07-20, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No- Routine office visit.
Preexisting Conditions: Depression and Latex allergy
Diagnostic Lab Data: Vit D deficiency & Anemia- No other tests known by pt.
CDC Split Type: OR201120
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3247AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Fibromyalgia, Laboratory test, Muscle spasms, Pain, Vitamin D
SMQs:, Dystonia (broad)
Write-up: Tdap given 7/24/2009. During routine office visit because she was due for update. Later that week she had muscle spasm in back. Went to urgent care in state. Started physical therapy went 3 times & major spasm went away. Still has constant pain. Dx: Fibromyalgia. Never told doctor she questioned vaccine as cause.

VAERS ID:428379 (history)  Vaccinated:2011-07-28
Age:32.0  Onset:2011-07-28, Days after vaccination: 0
Gender:Female  Submitted:2011-07-29, Days after onset: 1
Location:Colorado  Entered:2011-07-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Chills, Feeling of body temperature change, Headache, Insomnia, Migraine, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Started with headache and sore arm, some nausea. By 12:30 AM, was shaking uncontrollably (like severe chills), especially jaw and legs. That continued for over an hour. After putting extra covers on top of me, shaking calmed down and I fell asleep, but frequently woke up feeling very hot, then very cold. Headache got worse, as did nausea. Next morning, sore all over from shaking, still had migraine.

VAERS ID:433627 (history)  Vaccinated:2011-05-11
Age:32.0  Onset:2011-05-12, Days after vaccination: 1
Gender:Male  Submitted:2011-07-29, Days after onset: 78
Location:Tennessee  Entered:2011-08-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Multiple sclerosis
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES1105USA02480
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1157Z IMRA
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site rash, Malaise, Myalgia, Oedema peripheral, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a licensed practical nurse and a nurse practitioner, concerning a 32 year old male patient with multiple sclerosis and no drug reactions or allergies reported, who on 11-MAY-2011 was vaccinated intramuscularly in the right deltoid, with a 0.5 ml dose of PNEUMOVAX 23 (Lot #: 668008/1157Z) (It was unknown if it was the first or the second dose). Concomitant vaccination included: a tetanus vaccine (manufacturer unknown) in his left arm. Concomitant therapy included REBIF, 44mcg in 0.5 ml subcutaneous syringe 1/2 ml, 3 times per week and oxycodone/acetaminophen, one 5mg/325 as needed. Licensed Practical Nurse reported that patient developed a reaction to the PNEUMOVAX 23. Nurse practitioner reported that on 12-MAY-2011, the patient noted that his right arm was "red, swollen, and painful to touch''. He had a rash at the injection site that continued to spread over the next few days. Nurse also reported that patient''s temperature was 102.6 F up to 103 F and that he had muscle aches and malaise. She stated that patient also experienced discomfort with movement of his right arm. Nurse reported that the fever continued into 13-MAY-2011, and on 14-MAY-2011 patient was feeling better. His fever had subsided and his arm pain improved. His rash, however, had become worse. TYLENOL and STERAPRED DS 10 mg tab in a dose pack for 6 days, were given as treatment for the events. No lab/diagnostic studies were performed. Patient sought medical attention through office visit. At the time of the report the patient was recovering. Additional information has been requested.

VAERS ID:429179 (history)  Vaccinated:2011-06-14
Age:32.0  Onset:2011-06-15, Days after vaccination: 1
Gender:Male  Submitted:2011-08-09, Days after onset: 55
Location:Mississippi  Entered:2011-08-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy: Penicillin PMH: chronic headaches, anxiety, restless leg syndrome, neck pain, concussions, insomnia, chronic GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site erythema, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: aching all over body, erythema extremities, right shoulder

VAERS ID:429542 (history)  Vaccinated:2011-08-03
Age:32.0  Onset:2011-08-07, Days after vaccination: 4
Gender:Male  Submitted:2011-08-10, Days after onset: 3
Location:Mississippi  Entered:2011-08-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Healthy you
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3539AA UNRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness, hot to touch, itching. Taking BENADRYL.

VAERS ID:429622 (history)  Vaccinated:2011-08-13
Age:32.0  Onset:2011-08-13, Days after vaccination: 0
Gender:Male  Submitted:2011-08-13, Days after onset: 0
Location:Pennsylvania  Entered:2011-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B069AA1IMRA
Administered by: Military     Purchased by: Military
Symptoms: Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Small red rash appearing on RT side of face, about 2 inches in length and width.

VAERS ID:429847 (history)  Vaccinated:2011-08-12
Age:32.0  Onset:2011-08-13, Days after vaccination: 1
Gender:Female  Submitted:2011-08-15, Days after onset: 2
Location:Minnesota  Entered:2011-08-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0929Z1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Reddened, tender to touch area 80 x 80 cm - raised area in center 30 cm at longest.

VAERS ID:430255 (history)  Vaccinated:2011-08-10
Age:32.0  Onset:2011-08-10, Days after vaccination: 0
Gender:Female  Submitted:2011-08-18, Days after onset: 8
Location:Arizona  Entered:2011-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB204BA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3927BA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Feeling abnormal, Injection site pain, Injection site swelling, Injection site warmth, Neck pain
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Deltoid area of left arm which received Tdap vaccine began to swell and become very painful, there was mild warmth of the area. After another 10 minutes, patient reported ache in back of neck and mental "cloudiness". Medical attention was not required. She was feeling better after about 3 hours. After one week her left arm is still sore.

VAERS ID:430729 (history)  Vaccinated:2011-08-12
Age:32.0  Onset:2011-08-13, Days after vaccination: 1
Gender:Female  Submitted:2011-08-23, Days after onset: 10
Location:North Carolina  Entered:2011-08-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Fatigue, Influenza like illness, Myalgia, Pyrexia, Sinus congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Flu like symptoms with low grade fever, sinus congestion, myalgias and fatigue lasting for at least 12 days.

VAERS ID:430914 (history)  Vaccinated:2011-08-18
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-08-23
Location:Pennsylvania  Entered:2011-08-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH442AB0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: Pt got cellulitis per ER Dr 3 days after the shot. Pt is receiving antibiotics: sxs are resolved after 24 hours.

VAERS ID:431092 (history)  Vaccinated:2011-08-22
Age:32.0  Onset:2011-08-22, Days after vaccination: 0
Gender:Male  Submitted:2011-08-24, Days after onset: 2
Location:Florida  Entered:2011-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No known allergies, etc., but advised us when reported reaction that he thought he may have had the Tdap vaccine a few months earlier at another location.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3979CA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site pain, Injection site reaction, Injection site warmth, Skin tightness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, tightness, heat, some pain right upper arm.

VAERS ID:431249 (history)  Vaccinated:2011-08-22
Age:32.0  Onset:2011-08-22, Days after vaccination: 0
Gender:Female  Submitted:2011-08-25, Days after onset: 3
Location:Kentucky  Entered:2011-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Metabolic syndrome; GAD; migraines; positive PPD 2006 INH x 9 months
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR04090BA IMLL
Administered by: Private     Purchased by: Unknown
Symptoms: Local reaction
SMQs:
Write-up: Local reaction.

VAERS ID:432252 (history)  Vaccinated:2011-08-04
Age:32.0  Onset:2011-08-10, Days after vaccination: 6
Gender:Male  Submitted:2011-08-30, Days after onset: 20
Location:Unknown  Entered:2011-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNKNOWN.
Preexisting Conditions: UNKNOWN.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04003AA0 LA
Administered by: Military     Purchased by: Unknown
Symptoms: Blister, Erythema, Generalised vaccinia
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Patient presented with generalized vaccinia patches (approx 4x4cm) with 2-4mm vesicles with surrounding erythema on L.arm/chest wall/back.

VAERS ID:432907 (history)  Vaccinated:2011-08-31
Age:32.0  Onset:2011-09-01, Days after vaccination: 1
Gender:Female  Submitted:2011-09-02, Days after onset: 1
Location:Colorado  Entered:2011-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Sulfa Drugs allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen, red, itchy, and painful at injection site. Affected area roughly 6 inches by 3 inches.

VAERS ID:433521 (history)  Vaccinated:2011-09-08
Age:32.0  Onset:2011-09-08, Days after vaccination: 0
Gender:Male  Submitted:2011-09-08, Days after onset: 0
Location:Ohio  Entered:2011-09-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA618AB5IMLA
Administered by: Private     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient had syncopal episode shortly after receiving vaccine

VAERS ID:433928 (history)  Vaccinated:2011-07-13
Age:32.0  Onset:2011-07-18, Days after vaccination: 5
Gender:Male  Submitted:2011-09-10, Days after onset: 54
Location:Ohio  Entered:2011-09-10
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1709Y1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Hypersensitivity, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives/intense itching/allergic reaction

VAERS ID:433996 (history)  Vaccinated:2011-08-09
Age:32.0  Onset:2011-08-10, Days after vaccination: 1
Gender:Female  Submitted:2011-09-12, Days after onset: 33
Location:Michigan  Entered:2011-09-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to Cephalosporins
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0442Z SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0091AA SCLL
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pruritus, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow)
Write-up: Redness to the elbow, welts, itching, and burning all the way to the fingertips. Left arm.

VAERS ID:434161 (history)  Vaccinated:2011-09-02
Age:32.0  Onset:2011-09-02, Days after vaccination: 0
Gender:Female  Submitted:2011-09-12, Days after onset: 10
Location:Virginia  Entered:2011-09-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: environmental allergies, asthma, GERD, endometriosis
Diagnostic Lab Data: Going to orthopedic doctor on 09/13/2011 for evaluation.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED 10IJLA
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Incorrect route of drug administration, Insomnia, Mobility decreased, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)
Write-up: I knew when the needle hit my body, it was in the wrong place-it had entered my shoulder joint, instead of my deltoid muscle! Within just a few moments, I had severe pain in my shoulder such that I couldn''t even lift my arm to do simple tasks-to put on my seatbelt to drive home, for example. Since then, it has been extremely difficult even to sleep, as I cannot even pull a sheet up over my body because I cannot lift my arm at all. I have been taking Aleve all day long but it doesn''t even make the pain bearable. Even putting on deodorant is beyond painful and brings tears to my eyes. I am going to see a doctor tomorrow because I haven''t been able to sleep through the night since this happened and my daytime life activities are so painful and impaired.

VAERS ID:434348 (history)  Vaccinated:2011-09-13
Age:32.0  Onset:2011-09-13, Days after vaccination: 0
Gender:Female  Submitted:2011-09-14, Days after onset: 1
Location:Virginia  Entered:2011-09-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH469AB0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Asthenia, Chest discomfort, Chills, Cough, Decreased appetite, Dysphonia, Dyspnoea, Dysstasia, Fatigue, Headache, Ocular hyperaemia, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad)
Write-up: Coughing at 4:45 PM, Hoarseness worsening for next hour. Chest tightness and shortness of breath starting at 5:00 PM. No appetite for dinner. Chills & fatigue starting at ~7:30 PM. Red eyes noticed at 8:00 PM. Severe weakness, chills, and inability to stand and function at ~8:30. Vomiting at 8:30. Felt somewhat better after vomiting 3 times. Fever of 102.2 and severe weakness/chills at 10 pm. Slept through night, severe headache, fatigue, and weakness in the morning but fever down. No medication taken. Was at store during vomiting and weakness. Ambulance was going to be called b/c I couldn''t stand up to check out or even use phone to call family, but was able to drive home after vomiting. Still feeling weak with headache at 11:40 on 9/14/2011 - stayed home from work.

VAERS ID:434448 (history)  Vaccinated:2011-09-13
Age:32.0  Onset:2011-09-13, Days after vaccination: 0
Gender:Female  Submitted:2011-09-15, Days after onset: 2
Location:Indiana  Entered:2011-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: not to our knowledge
Diagnostic Lab Data: Being evaluated at the time this report is being submitted and I do not know what diagnostic tests will be ordered at this time.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11053P3IMUN
Administered by: Unknown     Purchased by: Other
Symptoms: Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: bilateral leg weakness

VAERS ID:434697 (history)  Vaccinated:0000-00-00
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-09-16
Location:Washington  Entered:2011-09-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PCN - anaphylaxis; joint pain - hip/knees from military
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB986AA1IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1483Z SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3561CA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Headache
SMQs:
Write-up: 1430 Client called to say she got a HA about 15 min after leaving our dept. She says she took MOTRIN 600 mg at 11:30 with no relief. History 2 migraines in lifetime - feels like same thing at 15:40 says getting better.

VAERS ID:434623 (history)  Vaccinated:2011-09-13
Age:32.0  Onset:2011-09-13, Days after vaccination: 0
Gender:Female  Submitted:2011-09-17, Days after onset: 4
Location:Michigan  Entered:2011-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Levaquin, okra, green peppers
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4104AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Tenderness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Severe swelling at injection site with pain and subsequent overlying hives and axillary tenderness.

VAERS ID:434743 (history)  Vaccinated:2011-08-29
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-08-29
Location:Florida  Entered:2011-09-19, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1100501 IMAR
Administered by: Other     Purchased by: Private
Symptoms: Needle issue, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)
Write-up: Patient said needle got stuck in her arm, and RPH had a hard time getting it out. Now patient says she has blood clot in her arm 2 week later.

VAERS ID:435067 (history)  Vaccinated:2011-09-13
Age:32.0  Onset:2011-09-14, Days after vaccination: 1
Gender:Female  Submitted:2011-09-21, Days after onset: 7
Location:Maryland  Entered:2011-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to penicillin, vancomycin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0387AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3927AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Dizziness, Erythema, Movement disorder, Pain in extremity, Pyrexia, Skin warm, Toxicity to various agents
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Received 3 injections - experienced fever, chills, dizziness that night. Also very red, hot (R) arm requiring dr''s visit on 9/16 though no treatment rendered. Dx "toxic" reaction to shots. Painful to touch, hard to move arm in general. Redness spread from baseball sized 9/15 - patchy redness all over 9/16. Dr took pictures of arm.

VAERS ID:435456 (history)  Vaccinated:2011-09-19
Age:32.0  Onset:2011-09-20, Days after vaccination: 1
Gender:Female  Submitted:2011-09-22, Days after onset: 2
Location:Louisiana  Entered:2011-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None specified by patient
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH453AC0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Erythema, edema, warmth at injection site 2 days post (9/21) and surrounding (about baseball size). Reports muscle soreness, especially when moving arm. Warm compress and ADVIL provided; BENADRYL encouraged also.

VAERS ID:435636 (history)  Vaccinated:2011-09-06
Age:32.0  Onset:2011-09-07, Days after vaccination: 1
Gender:Female  Submitted:2011-09-19, Days after onset: 12
Location:Indiana  Entered:2011-09-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH446AA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Gait disturbance, Local swelling, Oedema peripheral, Pain, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Slight swelling in (R) underarm - fever, rash - started new medication at same time - swelling moved to (L) groin - golf ball sized but better - was having pain and difficulty walking d/t swelling.

VAERS ID:435917 (history)  Vaccinated:2011-09-22
Age:32.0  Onset:2011-09-27, Days after vaccination: 5
Gender:Female  Submitted:0000-00-00
Location:Virginia  Entered:2011-09-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Morphine allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11002010IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: FLUVIRIN vaccine was given in right arm. The patient developed a rash all the way down the right arm. Md gave Rx for STERAPRED if rash worsened.

VAERS ID:436037 (history)  Vaccinated:2010-10-20
Age:32.0  Onset:2010-11-18, Days after vaccination: 29
Gender:Female  Submitted:2011-09-28, Days after onset: 313
Location:Washington  Entered:2011-09-28
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Multiple Sclerosis
Diagnostic Lab Data: MRI - no findings of abnormality CAT - no findings of abnormality
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Computerised tomogram normal, Diplegia, Dyspnoea, Hypoaesthesia, Intensive care, Mechanical ventilation, Mobility decreased, Muscular weakness, Nuclear magnetic resonance imaging normal, Paralysis, Pneumonia, Respiratory arrest, Respiratory disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Began with numbness and muscle weakness in the right leg on 11/18/2010 at 5PM, this spread to the left leg by 6PM at which time I went to the emergency room due to inability to move my legs. Over the next 4-5 hours this spread throughout my body to include total paralysis by early 11/19/2010. I was admitted to the hospital. The evening of 11/19/2010 I began having trouble breathing and at one point was unable to breathe at all. Code blue was called and BiPap was used through the night. On 11/20/2010 an MRI was performed to rule out brain lesions and during this time I was again unable to breathe. Doctors again administered Bipap and I was moved to the ICU. Early 11/21/2010 I was unable to breathe for an extended amount of time at which I was placed on a ventilator. I remained on a ventilator until 11/23/2011 at which time it was removed and I suffered from ventilator aquired pneumonia. I left the hospital on 11/25/2010 and returned on 11/27/2010 where I was admitted again due to weakness and similar breathing issues and was released on 12/2/2010. Recovery was [[name]] and slow requiring months of physical and speech therapy to regain strength.

VAERS ID:436898 (history)  Vaccinated:2011-10-03
Age:32.0  Onset:2011-10-04, Days after vaccination: 1
Gender:Male  Submitted:2011-10-05, Days after onset: 1
Location:South Carolina  Entered:2011-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CONFIRMATORY TESTING REGARDING HODGKINS/LEUKEMIA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER1101901  LA
Administered by: Unknown     Purchased by: Public
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: SWELLING, RED, WARM TO TOUCH-BENADRYL 50MG

VAERS ID:436961 (history)  Vaccinated:2011-09-28
Age:32.0  Onset:2011-09-28, Days after vaccination: 0
Gender:Female  Submitted:2011-10-06, Days after onset: 8
Location:North Dakota  Entered:2011-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Headache, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Difficulty breathing, wheezing, fever, headache, tightness in chest.

VAERS ID:436994 (history)  Vaccinated:2011-09-10
Age:32.0  Onset:2011-09-12, Days after vaccination: 2
Gender:Male  Submitted:2011-10-06, Days after onset: 24
Location:West Virginia  Entered:2011-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: mild case Guillain Barre~Measles + Mumps + Rubella (no brand name)~2~30.00~Patient
Other Medications: Pt takes PRILOSEC QD
Current Illness: None
Preexisting Conditions: Allergies: MMR
Diagnostic Lab Data: MRI brain and spine; EMG scheduled; Heavy metals - Neg; B12, CBC - normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED14549121A9IMLA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Blood heavy metal normal, Full blood count normal, Hypoaesthesia, Nuclear magnetic resonance imaging, Nuclear magnetic resonance imaging brain, Paraesthesia, Vitamin B12 normal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: 9/21/11 2100 - went to ER for tingling, numbness, weakness starting in feet, moving upward to hands and elbows. MRI obtained and EMG scheduled. No treatment provided.

VAERS ID:437009 (history)  Vaccinated:2011-09-25
Age:32.0  Onset:2011-09-25, Days after vaccination: 0
Gender:Female  Submitted:2011-09-27, Days after onset: 2
Location:Ohio  Entered:2011-10-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLU627CA UNRA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: 9-25-11 at 1920 I received the flu shot (R) upper arm. At 1945 while driving, became tachycardic & short of breath. All symptoms resolved within 90 seconds. No symptoms since.

VAERS ID:437251 (history)  Vaccinated:2011-09-27
Age:32.0  Onset:2011-09-27, Days after vaccination: 0
Gender:Male  Submitted:2011-09-27, Days after onset: 0
Location:California  Entered:2011-10-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hx of anxiety with similar sx
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH463AB1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 32 y/o male, c/o itching to forearm, lips, 6 hours after receiving flu iz, no SOB, without wheezing. No localized rxn at site. Lungs clear. BP 118/64, P 84, O2 sat 100%.

VAERS ID:437272 (history)  Vaccinated:2011-09-22
Age:32.0  Onset:2011-09-22, Days after vaccination: 0
Gender:Female  Submitted:2011-09-23, Days after onset: 1
Location:Ohio  Entered:2011-10-06, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA627CA1UNUN
Administered by: Public     Purchased by: Public
Symptoms: Chest discomfort, Nausea, Palpitations, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Received flu vaccine at 9:00 AM on 9-22-11. At 9:15 am she developed symptoms (nausea, vomiting, chest tightness, palpitations). Went to ED about 11:20 am for evaluation.

VAERS ID:437283 (history)  Vaccinated:2011-10-05
Age:32.0  Onset:2011-10-06, Days after vaccination: 1
Gender:Female  Submitted:2011-10-07, Days after onset: 1
Location:Oklahoma  Entered:2011-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR6H505AA0IJLA
Administered by: Unknown     Purchased by: Other
Symptoms: Diarrhoea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: vomiting, diarrhea, achiness

VAERS ID:437303 (history)  Vaccinated:2011-09-21
Age:32.0  Onset:2011-09-22, Days after vaccination: 1
Gender:Female  Submitted:2011-10-07, Days after onset: 15
Location:New York  Entered:2011-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NYC1100031
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0104AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0162Z1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, warmth and tenderness at injection site (left arm) on 9/22 after receiving MMR and VZV on 9/21. 2 inch in size.

VAERS ID:437362 (history)  Vaccinated:2011-10-05
Age:32.0  Onset:2011-10-06, Days after vaccination: 1
Gender:Female  Submitted:2011-10-08, Days after onset: 2
Location:Missouri  Entered:2011-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Neck pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: I woke up with major pain in my shoulder and neck on the side of my body that the shot was administered. It is still very painful two days later. I can not raise my arm above my shoulder without extreme pain!

VAERS ID:437463 (history)  Vaccinated:2011-09-16
Age:32.0  Onset:2011-09-18, Days after vaccination: 2
Gender:Male  Submitted:2011-10-10, Days after onset: 22
Location:Ohio  Entered:2011-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Possible urinary tract infection, but test came up negative for it.
CDC Split Type:
Vaccination
Manufacturer
Lot
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HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0 AR
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER 0 AR
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Public     Purchased by: Public
Symptoms: Culture urine negative, Micturition urgency, Pain, Sensory loss
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)
Write-up: The feeling of always having to urinate and soreness and loss of feeling in the gluteus and with erection. Lasted over a week from that date.

VAERS ID:437539 (history)  Vaccinated:2011-10-05
Age:32.0  Onset:2011-10-05, Days after vaccination: 0
Gender:Female  Submitted:2011-10-10, Days after onset: 5
Location:Georgia  Entered:2011-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Flagyl
Diagnostic Lab Data: Ongoing Administered Prednisone pack to counteract swelling and inflammation. Alternating between heat and cold compresses. Medications alternately taken include Ibuprofen, Tylenol and Naproxen...working minimally.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT472AA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Hypoaesthesia, Inflammation, Injected limb mobility decreased, Injection site swelling, Lymph node pain, Lymph node palpable, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site swelling, left arm and axillary swelling, palpable and painful lymph nodes. Left arm numbness comes and goes. Difficult to reach above head at times. Monday 10/10/2011 right arm lymph nodes are painful, not as swollen.

VAERS ID:437911 (history)  Vaccinated:2011-10-04
Age:32.0  Onset:2011-10-04, Days after vaccination: 0
Gender:Female  Submitted:2011-10-12, Days after onset: 8
Location:Florida  Entered:2011-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Allergic reaction to flu shot
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11055P1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Hypersensitivity, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Generalize pruritis

VAERS ID:437929 (history)  Vaccinated:2011-10-10
Age:32.0  Onset:2011-10-10, Days after vaccination: 0
Gender:Female  Submitted:2011-10-12, Days after onset: 2
Location:Nebraska  Entered:2011-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: unknown
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED04649211A IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and edema and warmth at injection sight on right deltoid.

VAERS ID:438392 (history)  Vaccinated:2010-09-24
Age:32.0  Onset:2010-09-24, Days after vaccination: 0
Gender:Female  Submitted:2011-09-19, Days after onset: 360
Location:Florida  Entered:2011-10-12, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy to BIAXIN; Codeine allergy
Preexisting Conditions: No concomitant medications. No adverse events were reported with previous vaccinations. It was indicated that the subject drinks alcohol and that she smokes a pack of cigarettes a day.
Diagnostic Lab Data: UNK
CDC Split Type: A0884082A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB185BA UNUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B051BB0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case was reported by a healthcare professional and described the occurrence of swelling injection site in a 32-year-old female subject who was vaccinated with BOOSTRIX (GlaxoSmithKline). Concurrent medical conditions included allergy to BIAXIN and codeine allergy. Previous and/or concurrent vaccination included TWINRIX (GlaxoSmithKline); unknown; unknown given on 24 September 2010. On 24 September 2010 at 11:00 the subject received 1st dose of BOOSTRIX (.5 ml, unknown right arm). On 24 September 2010, 30 minutes after vaccination with BOOSTRIX, the subject experienced an injection site reaction described as raised and swollen at injection site, injection site warmth, injection site pruritus and injection site redness. At the time of reporting the swelling at injection site, injection site warmth, injection site pruritus and injection site redness were worse. The healthcare professional considered the events were probably related to vaccination with BOOSTRIX. Follow-up information received on 02 November 2010 noted that the events resolved.

VAERS ID:438058 (history)  Vaccinated:2011-09-23
Age:32.0  Onset:2011-09-23, Days after vaccination: 0
Gender:Female  Submitted:2011-09-23, Days after onset: 0
Location:Unknown  Entered:2011-10-13, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; Allergy to PCN & Naproxen
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH453AC1IMRA
Administered by: Other     Purchased by: Military
Symptoms: Dyspnoea, Immediate post-injection reaction, Injection site pruritus
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Patient received influenza vaccine around 0930 in the morning and reported immediate pruritis around injection site along with difficulty breathing. Was given oral BENADRYL which decreased symptoms.

VAERS ID:438123 (history)  Vaccinated:2011-09-12
Age:32.0  Onset:2011-09-12, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2011-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB204BA2UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Decreased appetite, Headache, Nausea, Oropharyngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Fever, nausea, loss of appetite, sore throat, headache.

VAERS ID:438360 (history)  Vaccinated:2011-09-27
Age:32.0  Onset:2011-09-27, Days after vaccination: 0
Gender:Male  Submitted:2011-10-14, Days after onset: 17
Location:Texas  Entered:2011-10-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT481AA0IMRA
Administered by: Public     Purchased by: Other
Symptoms: Chills, Hyperhidrosis, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Awoke the night with fever, chills, sweats, nauseated and achy.

VAERS ID:438362 (history)  Vaccinated:2011-10-05
Age:32.0  Onset:2011-10-05, Days after vaccination: 0
Gender:Female  Submitted:2011-10-14, Days after onset: 9
Location:Texas  Entered:2011-10-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Disclosed
Preexisting Conditions: None Disclosed
Diagnostic Lab Data: None here at clinic. However patient returned same day after ER D/C and stated she was told her "electrolytes were low and they put some magnesium in my IV then let me go home".
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2940IMRA
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB211AA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURD04120IMRA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Blood electrolytes decreased, Cold sweat, Convulsion, Cyanosis, Depressed level of consciousness, Erythema, Feeling abnormal, Immediate post-injection reaction, Injection site erythema, Loss of consciousness, Pallor, Posturing, Tonic clonic movements, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hyponatraemia/SIADH (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Patient had just received required immunizations of Anthrax and Typhoid in Right deltoid, then immediately following injection of TwinRix (HepA with HepB in one) in Left deltoid, patient stated "I''m starting to not feel so good after those first two shots", and was immediately noted to have facial and bilateral full arm erythema, with lips slightly bluish tinged and decreasing LOC. Code Blue was called immediately, and prior to the swift arrival of Code Blue staff, patient immediately aroused with the ammonia wafted beneath her nose. Awake and alert, color pale, but erythema dissipating rapidly, and lips pale pink, saying "oh my goodness, what just happened?". No hives, no angioedema. Just a few seconds later, she again appeared to have decreasing LOC, and developed tonic-clonic type movements X4 along with decorticate type posturing noted of her upper extremeties. Aroused again and seizing/posturing stopped concurrent with ammonia pledget wafting again. No urinary incontinence. No post ictal phase. Drs. along with Code Blue staff here at chairside. V/S taken and recorded on Code Blue sheet, IV started in Left AC, and O2 given via blow -by then nasal cannula. NAS FW Fire Department arrived. 09:58 Contacted patient''s husband at her request, and she spoke with him briefly. Then, he was given information on location of ED of patient''s choosing. 10:01Report called to Emergency Department . Spoke with RN. Transported by Ambulance to hospital, awake, alert, oriented, conversing, skin only slightly pale now, eupneic respirations. No further seizure activity. Code Blue Record Sheet: Oct, 5 2011. 0952 32 yo well developed, well nurished female reported feeling weak after receiving 3 immunization shots. (Anthrax, Typhoid and Twin rx) 0953 A Code Blue was called by Rn in Imms. Drs., RNs responded to Code. Along with several corp men. The Crash cart was brought to Imms. 0953 Pt started to have a seizure, she passed out, unresponsive, pale and clammy. She was layed back in the chair and was out for 5 seconds. Attempts were made to arouse her successfully. 0954 O2 was started via Nasal Cannula. 0954 RN began to start an IV. and other RN Spiked LR and primed the tubing. 0956 RR=20, HR= 59, BP=71/38, 0958 RN confirmed placement of a #18g iv to the left FA, secured with tegaderm. Good blood return noted. She then started 1 liter of Lactated Ringers solution wide open. 0958 EMS arrived, pt was Alert and Orientated x4, she was still pale and clammy. She was assisted to a standing position and walked to the EMS stretcher. 1000 HR=59 Bp 74/34 , pt left the clinic via stretcher with EMS staff.

VAERS ID:438522 (history)  Vaccinated:2011-10-06
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-10-14
Location:California  Entered:2011-10-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH469AA0IMUN
Administered by: Other     Purchased by: Private
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: N/A. No adverse event. Would like to report and document administration of FLUZONE MDI (w/ preservative) when patient requested FLUZONE preservative-free formulation. Pt. has been contacted.

VAERS ID:438838 (history)  Vaccinated:2010-06-29
Age:32.0  Onset:2010-06-29, Days after vaccination: 0
Gender:Male  Submitted:2010-06-29, Days after onset: 0
Location:Oregon  Entered:2011-10-18, Days after submission: 476
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Not ill
Preexisting Conditions: None
Diagnostic Lab Data: Venipuncture done for Hep B titer.
CDC Split Type: OR201125
Vaccination
Manufacturer
Lot
Dose
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Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3029BA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Hepatitis B antibody, Syncope, Unresponsive to stimuli, Urinary incontinence, Vomiting
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After completion of venipuncture, stated he felt "lightheaded", then fainted, was incontinent of urine. Was unresponsive for +/- 30 seconds, roused, vomited x2.

VAERS ID:439150 (history)  Vaccinated:2011-10-18
Age:32.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Male  Submitted:2011-10-19, Days after onset: 0
Location:Missouri  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IJLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Dyspnoea, Lip swelling, Rash, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: tightness in throat, hard to breathe then extreme chills then hives/ rashes /facial swelling on lip

VAERS ID:439174 (history)  Vaccinated:2011-10-18
Age:32.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:California  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Nausea, Photopsia, Tunnel vision
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad)
Write-up: nausea, dizziness, tunnel vision and flashing lights

VAERS ID:439232 (history)  Vaccinated:2011-09-28
Age:32.0  Onset:2011-10-08, Days after vaccination: 10
Gender:Female  Submitted:2011-10-16, Days after onset: 8
Location:Unknown  Entered:2011-10-20, Days after submission: 4
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Just have High Blood Pressure, and this has made my Medical condition feel worsen and very depressing.
Diagnostic Lab Data: 10/11/2011 labs x-rays antibiotics; MUCINEX; iv fluids; ultrasounds; lung specialist; respiratory ABGs; blood cultures; heart monitor
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501088P IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood culture, Blood gases, Cardiac monitoring, Chest pain, Chills, Condition aggravated, Depression, Dyspnoea, Heart rate increased, Hyperhidrosis, Laboratory test, Pyrexia, Ultrasound scan, X-ray
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow)
Write-up: Employer made Flu Shot Mandatory for employee to get the flu vaccine that has caused alot of reaction and complications! I started to experience high fever, chills and sweats on 10/08/2011 and on 10/11/2011 symptoms became worsening and I was rushed to hospital were I was admitted with Shortness of Breath, Chest Pain, Fast Heart Rate, and placed on 6 liters of oxygen. I was seen by a pulmonologist - lung doctor- who stated that these symptoms occurred from the live vaccine called the FLUMIST, which I had received and became very ill. Almost dying on 10/11/2011! I think this FLUMIST should be removed from the market as it almost took a mother of two and at the age of 32 life away by doing what the employer suggest the employees should have if they want to work, this vaccine could''ve took my life!

VAERS ID:439400 (history)  Vaccinated:2011-10-19
Age:32.0  Onset:2011-10-19, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 2
Location:Pennsylvania  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: No known allergies No medical history
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Chills, Headache, Influenza like illness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: I experienced flu like symptoms including fever (103.0), headache, extreme body aches and chills. This lasted about 24 hours and then just went away as quickly as it came on. It resulted in me missing a day of work. I could not get out of bed.

VAERS ID:439997 (history)  Vaccinated:2011-07-14
Age:32.0  Onset:2011-07-14, Days after vaccination: 0
Gender:Male  Submitted:2011-08-23, Days after onset: 40
Location:Unknown  Entered:2011-10-21, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2011US63992
Vaccination
Manufacturer
Lot
Dose
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MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA00151 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect route of drug administration, No adverse event
SMQs:
Write-up: Case number PHHY2011US63992 is an initial spontaneous report received from a health care professional (pharmacist) on 14 Jul 2011. This report refers to a 32 year old male patient. He was vaccinated with MENVEO (batch number: A00151, expiry date: Jan 2013) 0.5 ml, subcutaneously on 14 Jul 2011. No adverse reaction was reported following this incorrect route of administration.

VAERS ID:439516 (history)  Vaccinated:2009-11-01
Age:32.0  Onset:2009-11-02, Days after vaccination: 1
Gender:Female  Submitted:2011-10-22, Days after onset: 718
Location:Virginia  Entered:2011-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. Unsure of date vaccine was given.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LA
Administered by: Public     Purchased by: Other
Symptoms: Injection site rash, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Swelling of arm and rash at site and down arm.

VAERS ID:439545 (history)  Vaccinated:2011-10-13
Age:32.0  Onset:2011-10-14, Days after vaccination: 1
Gender:Female  Submitted:2011-10-23, Days after onset: 9
Location:North Carolina  Entered:2011-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Allergic to aspirin, Wellbutrin, and erythromycin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1IJLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, 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)
Write-up: Fever - 24 hours chills - 24 hours severe swelling at injection site - 96 hours body aches - 120 hours

VAERS ID:439782 (history)  Vaccinated:2011-10-10
Age:32.0  Onset:2011-10-11, Days after vaccination: 1
Gender:Female  Submitted:2011-10-13, Days after onset: 2
Location:Maryland  Entered:2011-10-24, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: anemia; depression
Diagnostic Lab Data: EKG performed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Electrocardiogram, Fatigue, Hypoaesthesia, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient to office on 10/11/11 c/o fatigue, nausea, vomiting, numbness in bilateral hands, syncope at work. Received flu vaccine on 10/10/11 at a separate facility.

VAERS ID:439864 (history)  Vaccinated:2011-10-04
Age:32.0  Onset:2011-10-05, Days after vaccination: 1
Gender:Male  Submitted:2011-10-24, Days after onset: 19
Location:Texas  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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Dose
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNLA
Administered by: Military     Purchased by: Military
Symptoms: Activities of daily living impaired, Cough, Influenza like illness, Injected limb mobility decreased, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dementia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Flu like symptoms started (cough) took THERAFLU, severe shoulder pain, unable to move left arm took TYLENOL but did not help. Went to doctor on 10/17 no guidance given. Went to another doctor on 10/24 who is referring to orthopedic doctor for testing. Specified that might be issues with administration. Pain has diminished a bit over time but still not able to use arm. Needs help dressing and other activities that require use of arm (driving).

VAERS ID:440201 (history)  Vaccinated:2011-10-18
Age:32.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 8
Location:Pennsylvania  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Allergic to aspirin--Hives
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA631BA1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash to arms, neck, chest, back face

VAERS ID:440251 (history)  Vaccinated:2011-10-20
Age:32.0  Onset:2011-10-20, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 1
Location:Maryland  Entered:2011-10-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Have experienced allergic reaction to VISINE use in eyes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT425AA IMLA
Administered by: Public     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)
Write-up: Within 1/2 a day of injection patient experienced soreness, redness and swelling over an area with a 2 in diameter below the site of injection.

VAERS ID:440262 (history)  Vaccinated:2011-10-24
Age:32.0  Onset:2011-10-24, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 3
Location:Unknown  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Claritin & Hydrocortisone cream was given. Allergic reaction was diagnosed.
CDC Split Type:
Vaccination
Manufacturer
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501096P0IN 
Administered by: Military     Purchased by: Military
Symptoms: Hypersensitivity, Pruritus, Rash erythematous, Rash generalised
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Rash over entire body, severe itching. Raised red bumps, first symptoms started 2 hrs after receiving the vaccination.

VAERS ID:440642 (history)  Vaccinated:2011-10-21
Age:32.0  Onset:2011-10-21, Days after vaccination: 0
Gender:Female  Submitted:2011-10-25, Days after onset: 4
Location:Pennsylvania  Entered:2011-10-27, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Degenerative disk disease of lower back
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AC0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Patient came to pharmacy days after vaccine was given - stated she had numbness/tingling on outside of her right hand (from wrist to small finger) that felt as if her had was about to "fall asleep". It started during administration and lasted till today. Will follow up with her next week. Has not gotten worse/stayed the same.

VAERS ID:440694 (history)  Vaccinated:2011-10-26
Age:32.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Oregon  Entered:2011-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0337AA0SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient received Varicella vaccine on 10/26/11 at 7:58am. Patient noticed very large red lump at site of injection next morning while taking a shower. 5 1/2 cm x 4 cm.

VAERS ID:440591 (history)  Vaccinated:2011-10-28
Age:32.0  Onset:2011-10-28, Days after vaccination: 0
Gender:Female  Submitted:2011-10-29, Days after onset: 1
Location:North Carolina  Entered:2011-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: allergic to cephalexin aka: Keflex and sensitive to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Low grade fever, shivering violently, headache, intense full body ache. treated with Tylenol.

VAERS ID:440764 (history)  Vaccinated:2011-10-24
Age:32.0  Onset:2011-10-24, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 7
Location:Wisconsin  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LA
Administered by: Public     Purchased by: Other
Symptoms: Chills, Cough, Dyspnoea, Headache, Malaise, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Shortness of breath, cough, wheezing at 1930, fever at 11:00, rigors, chills, malaise, head ache from 0100 until 1630ish. Continued malaise, headache, and fevers until 10/26. Felt normal on 10/27.

VAERS ID:440780 (history)  Vaccinated:2011-10-12
Age:32.0  Onset:2011-10-21, Days after vaccination: 9
Gender:Male  Submitted:2011-10-31, Days after onset: 10
Location:Texas  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Doctor visit/tests
CDC Split Type:
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501107P0  
Administered by: Military     Purchased by: Military
Symptoms: Cough, Ear infection, Laboratory test, Ocular hyperaemia, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad)
Write-up: Red eyes, sore throat, cough, body aches, fever to 101.5 for 2 days on and off, ear infection requiring Azithromycin (Z-Pac) and Solumedrol IV x 1.

VAERS ID:440898 (history)  Vaccinated:2011-10-19
Age:32.0  Onset:2011-10-20, Days after vaccination: 1
Gender:Male  Submitted:2011-11-01, Days after onset: 12
Location:California  Entered:2011-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA693AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3899AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Induration, Injection site pain, Lymphadenopathy, Musculoskeletal pain, Neck pain, Pain, Subcutaneous nodule
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient recieved a flu shot (GSH AFLLA693AA exp. 6/12 administered IM on left shoulder) and a Tdap (SP C3899AA exp. 11/9/13 administered IM on left shoulder) on 10/19/11. Shortly after recieving the injections patient felt considerable soreness in the shoulder. On 10/20/11 awoke and discovered pain above they left clavicle near the base of the neck that increased when moving head especially to the right. It felt also as though patient was stretching the skin when moving the neck. Had a large bump at this location and also a hard nodule under the skin that was not movable. This pain and swelling continued for about 5 days. The pain decreased each day, but the swelling and nodule continued to be present. It appeared as though patient had a swollen Virchow''s lymph node. Pain was also associated with the injection site for about a week. It is November 1st and the swelling and the nodule (possibly swollen lymph node) are still present, though the nodule has reduced in hardness and size somewhat.

VAERS ID:441155 (history)  Vaccinated:2011-10-28
Age:32.0  Onset:2011-10-28, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 0
Location:Colorado  Entered:2011-11-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Antibiotic Allergies (multiple); Chronic Sinusitis; Allergic Rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH467AB IMUN
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 0.1cc IM partial dose administered. Within minutes pt complained of throat tightness & breathing difficulty. Administered Epinephrine 1:1000 0.5cc IM x 1, BENADRYL, ZANTAC & prednisone. Sx slowly resolved & pt was discharged in good condition without rest of flu shot.

VAERS ID:441166 (history)  Vaccinated:2011-10-06
Age:32.0  Onset:2011-10-06, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Missouri  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11064P0IMAR
Administered by: Public     Purchased by: Unknown
Symptoms: Eye pain, Headache, Migraine with aura, Optic neuritis, Photopsia
SMQs:, Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (narrow), Ocular infections (broad)
Write-up: Received vaccine 10/6/11 approx 6 hr late had very bad headache next morning noticed flashing light out of corner of (R) eye. Headache and flashes continued so I called eye dr after 3 eye appt in 3 day determined optic nerve was inflamed and optic migraines prescribed NSAID follow up 6 mth. Headache 15 day still have eye pain.

VAERS ID:441404 (history)  Vaccinated:2011-11-03
Age:32.0  Onset:2011-11-03, Days after vaccination: 0
Gender:Female  Submitted:2011-11-04, Days after onset: 1
Location:Tennessee  Entered:2011-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJRA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Cough, Dizziness, Nausea, Ocular hyperaemia, Productive cough, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Wheezing, coughing, eyes were blood shot, coughing up mucus, chest hurting, nausea, dizziness.

VAERS ID:441503 (history)  Vaccinated:2011-10-30
Age:32.0  Onset:2011-10-30, Days after vaccination: 0
Gender:Female  Submitted:2011-10-30, Days after onset: 0
Location:Indiana  Entered:2011-11-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: (Patient states allergies to aspirin, codeine & tramadol); asthma
Diagnostic Lab Data: (Patient said E.R. gave her a shot of BENADRYL & sent her home. She said E.R. said they didn''t think it was from the flu shot.)
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AD0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Asthma, Condition aggravated, Diarrhoea, Feeling hot, Pruritus
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: About 3 1/2 hours after receiving the FLUZONE, the patient called & said that she had diarrhea, & felt hot & itchy, & said her asthma was acting up...she didn''t think the nebulizer was helping, so advised to go to E.R. if nebulizer not helping.

VAERS ID:441578 (history)  Vaccinated:2011-10-31
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-07
Location:Indiana  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: Pregnant
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS    
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Public     Purchased by: Private
Symptoms: Maternal exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: No adverse symptoms reported- Client pregnant at time of vaccine given. However, client did not report she was pregnant.

VAERS ID:441617 (history)  Vaccinated:2011-11-01
Age:32.0  Onset:2011-11-01, Days after vaccination: 0
Gender:Male  Submitted:2011-11-07, Days after onset: 6
Location:Indiana  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Otitis Media - Bilateral
Preexisting Conditions: Hyperglycemia; Diverticulosis
Diagnostic Lab Data: None
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT441AA IMRA
Administered by: Private     Purchased by: Other
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Feeling abnormal, Pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Patient stated a few hours after receiving he started feeling "bad". He states he woke up the next morning with chest tightness and slight dyspnea. He sated he was dizzy and had body aches. They resolved by afternoon with rest.

VAERS ID:441926 (history)  Vaccinated:2011-11-04
Age:32.0  Onset:2011-11-08, Days after vaccination: 4
Gender:Female  Submitted:2011-11-09, Days after onset: 1
Location:Ohio  Entered:2011-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives all over body.

VAERS ID:441981 (history)  Vaccinated:2011-10-25
Age:32.0  Onset:2011-10-25, Days after vaccination: 0
Gender:Male  Submitted:2011-10-25, Days after onset: 0
Location:Rhode Island  Entered:2011-11-09, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CECLOR; CIPRO; Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLUA67AP UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Dizziness, Injection site pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: (1) Tightness in chest. (2) Slight soreness at injection site. (3) Slight lightheadedness. BP: 140/90 recheck 120/96 no wheezing audible.

VAERS ID:442336 (history)  Vaccinated:2011-11-09
Age:32.0  Onset:2011-11-13, Days after vaccination: 4
Gender:Female  Submitted:2011-11-14, Days after onset: 1
Location:North Carolina  Entered:2011-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
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DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3828AA IMLA
Administered by: Military     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large swelling of L deltoid, heat and pain in L deltoid. No bruising or hematoma noted.

VAERS ID:442424 (history)  Vaccinated:2011-11-09
Age:32.0  Onset:2011-11-10, Days after vaccination: 1
Gender:Female  Submitted:2011-11-14, Days after onset: 4
Location:California  Entered:2011-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH470AD IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Hyperhidrosis, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: PATIENT CALLED THE OFFICE THIS MORNING AROUND 10AM STATING SHE STARTED TO FEEL SICK ON THE EVENING OF 9/10/11 AND THOUGHT THIS WAS A REACTION TOWARDS THE FLU SHOT. SHE SPOKE WITH THE NURSE PRACTITIONER AND TOLD THE PT TO TALK TO ME, THE MEDICAL ASSISTANT TO GET ALL DETAILS, AND ALL SYMPTOMS SO WE CAN REPORT THIS TO VAERS. SHE VOMIT FOR 2 STRAIGHT DAYS, SOME SWEATS, WEAKNESS, FEVER, BUT NO OTHER SYMPTOMS. TODAY SHE ONLY FEELS SOME WEAKNESS AND HAS NOT VOMIT ANYTHING ELSE. WE WILL CALL PT TOMORROW TO SEE HOW SHE IS DOING.

VAERS ID:442579 (history)  Vaccinated:2011-11-01
Age:32.0  Onset:2011-11-03, Days after vaccination: 2
Gender:Female  Submitted:2011-11-03, Days after onset: 0
Location:D.C.  Entered:2011-11-15, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZEOSA
Current Illness:
Preexisting Conditions: NKDA
Diagnostic Lab Data: None
CDC Split Type:
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HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB492CA1UNRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURE05760UNLA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUH139AA0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Petechial rash on chest. No itch. Prednisone tapering dose & BENADRYL.

VAERS ID:442667 (history)  Vaccinated:2011-11-02
Age:32.0  Onset:2011-11-02, Days after vaccination: 0
Gender:Female  Submitted:2011-11-16, Days after onset: 14
Location:Illinois  Entered:2011-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Penicillin allergy Opiates allergy
Diagnostic Lab Data: