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Case Details (Sorted by Age)

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VAERS ID:414586 (history)  Vaccinated:2010-07-16
Age:40.0  Onset:2010-07-17, Days after vaccination: 1
Gender:Female  Submitted:2010-12-27, Days after onset: 163
Location:Wisconsin  Entered:2011-01-12, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB891CA1UNRA
Administered by: Public     Purchased by: Public
Symptoms: Pain in extremity
SMQs:
Write-up: When patient returned today 12-27-10 for her last HEP B vaccine she reports her (R) arm has pain if she presses deep ever since her last HEP B in July 2010 (6 mo. ago).

VAERS ID:414636 (history)  Vaccinated:2010-11-12
Age:40.0  Onset:2011-01-09, Days after vaccination: 58
Gender:Male  Submitted:2011-01-13, Days after onset: 4
Location:Texas  Entered:2011-01-13
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Immune deficiency - Common variable
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111805P1 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0632Y IMRA
Administered by: Private     Purchased by: Private
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: Diagnosed with GUILLAIN-BARRE Syndrome on 1/12/11.

VAERS ID:414876 (history)  Vaccinated:2009-06-12
Age:40.0  Onset:2009-06-12, Days after vaccination: 0
Gender:Female  Submitted:2011-01-06, Days after onset: 573
Location:Illinois  Entered:2011-01-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy to yeast
Preexisting Conditions: Concomitant medications and relevant medical history were unknown. No information was provided regarding previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0871204A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB583AA0UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Allergy to vaccine
SMQs:, Hypersensitivity (narrow)
Write-up: This case was reported by a healthcare professional and described the occurrence of allergy to vaccine in a 40-year-old female subject who was vaccinated with ENGERIX B (GlaxoSmithKline). Concurrent medical conditions included allergy to yeast. Previous and/or concurrent vaccination included TDAP vaccine (non-gsk); Merck; unknown given on 12 June 2009. On 12 June 2009 and 27 July 2009 the subject received 1st dose and 2nd dose of ENGERIX B (20 mcg, unknown route). On 12 June 2009, less than one day after the 1st vaccination with ENGERIX B, the subject experienced allergy to vaccine. After the next vaccination with ENGERIX B the events recurred. On 27 July 2009, less one than day after the 2nd vaccination with ENGERIX B, the subject experienced allergy to vaccine. At the time of reporting the outcome of the events was unspecified. The healthcare professional reported that the subject on both occasions experienced "seasonal allergy like type of symptoms". The subject believed it may be attributable to the yeast component as she stated she had found out she is allergic to baker''s yeast. The subject was due to attend the office to provide more details regarding medical history and specific symptoms.

VAERS ID:414759 (history)  Vaccinated:2011-01-14
Age:40.0  Onset:2011-01-14, Days after vaccination: 0
Gender:Female  Submitted:2011-01-16, Days after onset: 2
Location:Texas  Entered:2011-01-16
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: Wolff Parkinson White, endometriosis, uterine fibroid, ovarian cyst
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IJLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Severe and constant pain in left arm at injection sight. Unable to move arm without significant pain. Also chills at 9:00PM (no fever).

VAERS ID:414779 (history)  Vaccinated:2010-10-11
Age:40.0  Onset:2010-10-11, Days after vaccination: 0
Gender:Female  Submitted:2010-10-12, Days after onset: 1
Location:Virginia  Entered:2011-01-17, Days after submission: 97
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 - Rash; Celiac Disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3656AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest discomfort, Cough, Dysphonia
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad)
Write-up: 1 hour after cough 2 hours after cough, hoarse, tightness chest with breathing. Took 50mg BENADRYL PO. 1 hour after BENADRYL/severe tightness relieved. Tightness x 20 hours.

VAERS ID:414783 (history)  Vaccinated:2010-12-15
Age:40.0  Onset:2010-12-15, Days after vaccination: 0
Gender:Female  Submitted:2011-01-13, Days after onset: 29
Location:Georgia  Entered:2011-01-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sulfa medications
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1116891P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Vaccination site pain
SMQs:
Write-up: Approximately 2 hrs after receiving the vaccine she developed severe pain in the upper arm area where vaccine was given. This pain has continued and causes the patient to seek treatment from her orthopedic doctor. She is scheduled for MRI on 1/13/11.

VAERS ID:414865 (history)  Vaccinated:2011-01-03
Age:40.0  Onset:2011-01-04, Days after vaccination: 1
Gender:Female  Submitted:2011-01-18, Days after onset: 14
Location:Nevada  Entered:2011-01-18
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left arm had swelling, redness, heat and pain. This has lasted for two (2) weeks and 2 days. Visited the doctor 01/12/2011 and treatment was medication for pain, inflation and infection.

VAERS ID:414882 (history)  Vaccinated:2011-01-11
Age:40.0  Onset:2011-01-12, Days after vaccination: 1
Gender:Male  Submitted:2011-01-18, Days after onset: 6
Location:D.C.  Entered:2011-01-18
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: no
Preexisting Conditions: hypertension, hypothyroidism, migraine headaches and post concussion syndrome (s/p motorcycle accident)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1067Z0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Confusional state, Headache, Injection site erythema, Local reaction, Lumbar puncture normal, Pyrexia, Vaccination site swelling
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient was admitted from the Emergency Room for a reaction to a Pneumovax vaccine given on 11JAN2011. He had fever to 102 degrees, headache, confusion, and swelling and redness on the upper right arm at the site of the vaccination. Analysis of cerebrospinal fluid taken during lumbar puncture in the Emergency Room was negative for signs of acute infection (meningitis). Patient received one prophylactic dose of ceftriaxone in the ER before the results of the lumbar puncture were available. Patient''s temperature and headache improved with acetaminophen, naproxen, and intravenous fluids. His confusion also resolved rapidly as his fever was controlled. By the afternoon of the day of admission (13JAN2011), patient had improved significantly and was feeling well. His case was discussed with Dr of allergy/immunology who felt this was a vaccine large local reaction. He was discharged home with instructions to continue acetaminophen for fever, and naproxen and ice for pain.

VAERS ID:415765 (history)  Vaccinated:2010-05-04
Age:40.0  Onset:2010-05-04, Days after vaccination: 0
Gender:Female  Submitted:2010-08-26, Days after onset: 114
Location:North Carolina  Entered:2011-01-24, Days after submission: 151
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 known drug allergies, asthma, and COPD (chronic obstructive pulmonary disease). Follow-up information received 16 August 2010 corrected that the patient had no medical history of COPD. It was confirmed that the patient had asthma and Crohns disease.
Diagnostic Lab Data: Not reported
CDC Split Type: 201004005
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB387AA UNLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURE02141 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dysgeusia, Immediate post-injection reaction, Pain in extremity
SMQs:, Taste and smell disorders (narrow), Hypersensitivity (narrow)
Write-up: Initial report received from a nurse practitioner on 23 July 2010. A 41-year-old female patient, who has no known drug allergies, asthma, and COPD (chronic obstructive pulmonary disease) had received an intramuscular left deltoid injection of TYPHIM Vi (lot number E0214-1), and a left deltoid dose of HAVRIX (manufacturer GlaxoSmithKline, lot number AHAVB387AA) on 04 May 2010. Immediately post-vaccination the patient experienced a 5 second metallic taste in her mouth and a sore arm that lasted 2 days. The patient required medical attention; however it was not reported whether the patient received any treatments. At the time of this report, the patient had recovered. Follow-up information received from a health care professional on 16 August 2010 clarified that the patient did not have COPD. The patient''s medical history confirmed she had asthma and also included Crohn''s disease. The patient used the concomitant medications of fluticasone and ADVAIR and VENTOLIN inhalers as needed (PRN). The patient did not received medical attention and none was given. The outcome for the event remained recovered. Documents held by sender: None.

VAERS ID:415369 (history)  Vaccinated:2010-10-24
Age:40.0  Onset:2010-10-26, Days after vaccination: 2
Gender:Female  Submitted:2011-01-16, Days after onset: 82
Location:Florida  Entered:2011-01-25, 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: Allergies to PPD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3616AA IMUN
Administered by: Unknown     Purchased by: Other
Symptoms: Erythema, Hypersensitivity, Oedema peripheral, Rash, Reaction to preservatives, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Allergy to thimersol rash, swelling red, hot arm 2 day after shot.

VAERS ID:415507 (history)  Vaccinated:2010-09-28
Age:40.0  Onset:2010-09-28, Days after vaccination: 0
Gender:Male  Submitted:2011-01-26, Days after onset: 120
Location:Oklahoma  Entered:2011-01-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Chest pain, Dyspnoea, Hypersensitivity
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: PT CALLED STATES HE GOT A PNEUMOVAX INJECTION YESTERDAY, STATES ON HIS WAY HOME HE STARTED HAVING CHEST PAIN, SOB, FELT LIKE SOMEONE WAS STABBING HIM WITH A KNIFE. SAYS HIS CHEST IS REALLY SORE NOW, FELT LIKE HE WAS HAVING AN MI SAYS THE ENTIRE THING ONLY LASTED A COUPLE OF MINUTES. STATES HE IS FINE TODAY EXCEPT FOR THE SORENESS IN HIS CHEST. Pt probably had allergic type reaction. Will have pt come pick up medrol dose pak and get EKG.

VAERS ID:415700 (history)  Vaccinated:2011-01-25
Age:40.0  Onset:2011-01-27, Days after vaccination: 2
Gender:Female  Submitted:2011-01-28, Days after onset: 1
Location:Virginia  Entered:2011-01-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sennocides with Docusate Soduim Diphenhydramine Ibuprofen Oxycodone and APAP Had received in previous 2 days: MGSo4, Oxytocin, Cefazolin
Current Illness: Also received vaccines on 01/25/2011
Preexisting Conditions: No known allergies to medications or food Post Cesarean Section, Gestational Diabetes, HELLP Syndrome
Diagnostic Lab Data: CBC-WBC''s 14.4-16.9, Bands to 14, CXR showed cardiomegaly and vascular congestion. Abd/chest CT showed fatty liver and enlarged right atrium and ventricle, Doppler of left upper extremity pending.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3666BA IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.11582 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Angiopathy, Band neutrophil count increased, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram abnormal, Computerised tomogram thorax abnormal, Erythema, Hepatic steatosis, Injection site erythema, Injection site pain, Injection site pruritus, Pain in extremity, Pyrexia, Ultrasound Doppler, White blood cell count increased
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Night of 01/26/2011 fever to 101.6 F. Morning of 01/27/2011 noted redness itching and pain in upper left arm where she had received 2 vaccinations. By morning of 01/28, redness and pain extended to near left wrist. Treated with antibiotics, steroids and antihistamine.

VAERS ID:415714 (history)  Vaccinated:2010-12-23
Age:40.0  Onset:2010-12-23, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2011-01-28
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 DIAGNOSTICS111811P10UNLA
Administered by: Other     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient said injection site has remained sore since it was given and now has trouble lifting it over her head. Concerned.

VAERS ID:416040 (history)  Vaccinated:2010-11-19
Age:40.0  Onset:0000-00-00
Gender:Male  Submitted:2011-02-02
Location:Ohio  Entered:2011-02-02
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
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111809P10UNRA
Administered by: Other     Purchased by: Private
Symptoms: Pain in extremity
SMQs:
Write-up: Patient states that they have had arm pain since injection.

VAERS ID:417007 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-01-26
Location:Unknown  Entered:2011-02-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1008USA00370
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Nonspecific reaction
SMQs:
Write-up: Information has been received from a registered nurse concerning a now 40 year old daughter who was vaccinated with ATTENUVAX as a child and experienced a reaction (not specified). It was unknown if the patient sought medical attention. At the time of reporting, the patient''s status was unknown. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:416397 (history)  Vaccinated:2010-10-01
Age:40.0  Onset:2010-10-03, Days after vaccination: 2
Gender:Female  Submitted:2011-01-12, Days after onset: 101
Location:Maryland  Entered:2011-02-08, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 4IJLA
Administered by: Private     Purchased by: Other
Symptoms: Hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 40 year old female received injectable 10/01/2010. 2 days after vaccine pt. developed hives, which started on the stomach and spread to legs and arms, and were dime sized. Pt. sought care with internal medicine and an allergist 2 weeks post symptom onset. Subject did not tell the allergist or internal medicine doctor about receiving the vaccine 2 days prior to onset of hives. Pt. was diagnosed with idiopathic allergy. Pt. was prescribed 60 mg of fexofenadine 1-2 times per day. Medication has decreased the symptoms of the hives, but the hives still persist 1 month post vaccination. if patient does not take prescription hives will become larger, itchier, and spread to legs/arms.

VAERS ID:416415 (history)  Vaccinated:2011-02-01
Age:40.0  Onset:2011-02-02, Days after vaccination: 1
Gender:Female  Submitted:2011-02-08, Days after onset: 6
Location:Washington  Entered:2011-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0834Z0SCLA
Administered by: Military     Purchased by: Military
Symptoms: Abdominal discomfort, Arthralgia, Influenza like illness, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Rash, fever, achy joints, upset stomach, flu-like symptoms

VAERS ID:416510 (history)  Vaccinated:2010-10-11
Age:40.0  Onset:2010-10-17, Days after vaccination: 6
Gender:Female  Submitted:2011-02-10, Days after onset: 116
Location:Minnesota  Entered:2011-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data: erythema nodosum
CDC Split Type: MN
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111805P1 UNLA
Administered by: Other     Purchased by: Private
Symptoms: Abasia, Asthenia, Circulatory collapse, Contusion, Erythema nodosum, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Weakness, edema, unable to walk, loss of circulation, bruising,

VAERS ID:416635 (history)  Vaccinated:2011-02-09
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-02-11
Location:Unknown  Entered:2011-02-11
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
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Lymphangitis
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient presented to ER with redness and swelling below the injection site and runs to the axilla almost similar to a lymphangitis.

VAERS ID:416703 (history)  Vaccinated:2011-02-08
Age:40.0  Onset:2011-02-08, Days after vaccination: 0
Gender:Male  Submitted:2011-02-10, Days after onset: 2
Location:Idaho  Entered:2011-02-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADHD - adult; (R) shoulder pain
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU3059AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pallor, Rash, Rash generalised, Rash macular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: 12 hours from vaccination developed diffuse rash to trunk - has progressed in 36 hours to full body macular, beefy red blanching erythema with several hive like lesions to shoulders and neck - involves palm & plantar aspects of feet & given MEDROL dose pak; hydroxyzine pamoate.

VAERS ID:417128 (history)  Vaccinated:2010-10-27
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-02-04
Location:New Hampshire  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: No concomitant medications or relevant medical history.
Diagnostic Lab Data: UNK
CDC Split Type: A0890085A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA602AB UNLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia facial, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of jaw numbness in a female subject of unspecified age who was vaccinated with FLULAVAL (GlaxoSmithKline). On 27 October 2010 at 10:30 the subject received unspecified dose of FLULAVAL (unknown, left arm); lot number reported as" ASLLA602AB". At an unspecified time after vaccination with FLULAVAL, the subject experienced jaw numbness, arm pain and arm tingling. The healthcare professional reported that the subject was administered FLULAVAL vaccine and experienced left jaw numbness and pain and tingling in the left arm. No additional details were provided because the vaccine was administered at a separate location. At the time of reporting the jaw numbness, arm pain and arm tingling were improved. The healthcare professional reported another case regarding FLULAVAL, see case A0890086A.

VAERS ID:416919 (history)  Vaccinated:2011-01-24
Age:40.0  Onset:2011-01-27, Days after vaccination: 3
Gender:Female  Submitted:2011-02-07, Days after onset: 11
Location:Colorado  Entered:2011-02-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seizure disorder
Diagnostic Lab Data: Thrombocytopenia at Medical Center labs
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1036Y0SCUN
Administered by: Private     Purchased by: Unknown
Symptoms: Myalgia, Pyrexia, Thrombocytopenia, Vaginal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Fever - up to 105 degrees myalgia vaginal bleeding went to Medical Center labs - thrombocytopenia.

VAERS ID:416942 (history)  Vaccinated:2011-02-03
Age:40.0  Onset:2011-02-13, Days after vaccination: 10
Gender:Female  Submitted:2011-02-16, Days after onset: 3
Location:Georgia  Entered:2011-02-16
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: No Known Drug Allergies No general allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0998Z1SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 2"x 2" reddened area. Very itchy appeared 10 days at injection site. Alavert 1 tablet given po for itchy feeling.

VAERS ID:416963 (history)  Vaccinated:2011-02-14
Age:40.0  Onset:2011-02-16, Days after vaccination: 2
Gender:Female  Submitted:2011-02-16, Days after onset: 0
Location:California  Entered:2011-02-16
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Peripheral edema and hives on same arm as injection but not directly at injection site.

VAERS ID:417003 (history)  Vaccinated:2010-12-21
Age:40.0  Onset:2011-01-24, Days after vaccination: 34
Gender:Male  Submitted:2011-02-15, Days after onset: 22
Location:Kansas  Entered:2011-02-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Spinal tap - increased CSF protein, in return w/u, all neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B067GA0IMAR
Administered by: Private     Purchased by: Private
Symptoms: Areflexia, Asthenia, CSF protein increased, Guillain-Barre syndrome, Laboratory test normal, Lumbar puncture abnormal, Neuropathy peripheral, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Weakness, areflexic paralysis, neuropathy consistent with Guillain-Barre Syndrome.

VAERS ID:417023 (history)  Vaccinated:2010-07-08
Age:40.0  Onset:2010-12-01, Days after vaccination: 146
Gender:Male  Submitted:2011-02-17, Days after onset: 78
Location:Wisconsin  Entered:2011-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Not right away. He was hospitalized 2 different times in December and 3 doctors said it was more than likely due to the vaccine received 7/2010 because he had been tested for every other cause.
Preexisting Conditions: None
Diagnostic Lab Data: Colonoscopy, Endoscope. 2 doctors at medical center, were quizzing us as to the possibilites of "gut damage." After having this for many days, I told him well he had a DPT vaccine months earlier and they both said that was the likely cause because nothing else explained his symptoms. A Third doctor at another Hospital, said that was likely also.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3382AA1IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Bacterial test, Colonoscopy abnormal, Diarrhoea, Endoscopy abnormal, Gastrointestinal disorder, Hypersensitivity, Nausea, Parasite blood test, Viral test, Vomiting
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Nausea, vomitting, severe diahhrea. The diahrrea was for 25 days and was minimum 12 bouts per day. 2 different hospitals tested him for all known viruses, food borne illnesses, bacteria, parasites. They did an endoscope and colonoscopy. What they reported was "an allergy in the gut." He had damage in his gut.

VAERS ID:417427 (history)  Vaccinated:2011-01-29
Age:40.0  Onset:2011-02-03, Days after vaccination: 5
Gender:Female  Submitted:2011-02-23, Days after onset: 20
Location:Puerto Rico  Entered:2011-02-23
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: HTN, STROKE, COAGULATION DEFECT
Diagnostic Lab Data: MRA WITH AND WITHOUT CONTRAST IN FEBRUARY 11, 2011
CDC Split Type: PR1104
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFFLA677AA1IMUN
Administered by: Public     Purchased by: Other
Symptoms: Angiogram, Dizziness, Scan with contrast, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)
Write-up: PATIENT REFERS EXPERIENCING VERTIGO/DIZZINESS.

VAERS ID:417455 (history)  Vaccinated:2011-02-15
Age:40.0  Onset:2011-02-16, Days after vaccination: 1
Gender:Female  Submitted:2011-02-17, Days after onset: 1
Location:Pennsylvania  Entered:2011-02-23, 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: Asthma
Preexisting Conditions: Eggs; Iodine; Peanuts; Seafood
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1622Z0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pyrexia, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Fever, raised localized area of erythema & tenderness.

VAERS ID:417497 (history)  Vaccinated:2011-02-23
Age:40.0  Onset:2011-02-23, Days after vaccination: 0
Gender:Male  Submitted:2011-02-24, Days after onset: 1
Location:Puerto Rico  Entered:2011-02-24
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CARDIOVASCULAR DISEASE
Diagnostic Lab Data:
CDC Split Type: PR1105
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3783AC0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Feeling hot, Generalised erythema, Pruritus, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: PATIENT PRESENTED WITH GENERALIZED REDNESS WITH RED SWELLINGS IN NECK, BODY, FACE AND BOTH UPPER LIMBS. PATIENT REFERS RASH AND ITCH IN THE BODY AND FELT HOT. THEY PROCEDED TO INJECT EPIPEN (EPINEPHRINE) IN THE RIGHT TIGH BUT THE PATIENT CONTINUED WITH THE REDNESS AND RASH (15 MINUTES LATER). HE WAS TAKEN TO THE EMERGENCY ROOM (HOSPITAL).

VAERS ID:417646 (history)  Vaccinated:2011-02-22
Age:40.0  Onset:2011-02-22, Days after vaccination: 0
Gender:Female  Submitted:2011-02-25, Days after onset: 3
Location:Texas  Entered:2011-02-25
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: Negative for influenza
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3728AA0IMAR
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Headache, Influenza virus test negative, 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)
Write-up: Received TDAP 2/22/11 in am, a few hours later developed body aches, T 101, headache. Experienced redness/swelling at site of admin. Fever as high as 103 evening of 2/24/11. Started on abx 2/24 to cover for possible cellulitis.

VAERS ID:418521 (history)  Vaccinated:2010-05-04
Age:40.0  Onset:2010-05-04, Days after vaccination: 0
Gender:Female  Submitted:2011-02-28, Days after onset: 300
Location:North Carolina  Entered:2011-03-04, 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: Allergy to horses; asthma
Preexisting Conditions: Crohn''s disease. The subject had not experienced adverse events following previous vaccinations. The subject was a non-smoker. Alcohol intake was unknown.
Diagnostic Lab Data: UNK
CDC Split Type: A0871932A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB387AA0UNLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURE021410UNLA
Administered by: Private     Purchased by: Private
Symptoms: Dysgeusia, Immediate post-injection reaction, Injected limb mobility decreased, Injection site pain
SMQs:, Taste and smell disorders (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: This case was reported by a healthcare professional and described the occurrence of metallic taste in mouth in a 40-year-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), ENGERIX B and typhoid vaccine (non-gsk). The subject''s medical history included Crohn''s disease. Concurrent medical conditions included allergy to horses and asthma. Previous and/or concurrent vaccination included TDAP; GlaxoSmithKline; unknown; unknown given on 22 July 2010. Concurrent medications included VENTOLIN and ADVAIR. On 4 May 2010 the subject received 1st dose of HAVRIX (1 ml, unknown route, left arm), and 1st dose of Typhoid vaccine (Non-GSK) (details unknown). On 4 May 2010, less than one day after vaccination with HAVRIX and Typhoid vaccine (Non-GSK), the subject experienced metallic taste in mouth. On 5 May 2010, the subject experienced injection arm pain (left arm) and unable to move arm. On 8 May 2010, the events were resolved. On 22 July 2010 at 11:45 the subject received unspecified dose of ENGERIX B (1 ml, unknown route and site). On 22 July 2010, immediately after vaccination with ENGERIX B, the subject experienced metallic taste in mouth, lasting for about 5 seconds. On 22 July 2010, the event was resolved. The healthcare professional considered the events were probably related to vaccination with HAVRIX, ENGERIX B and Typhoid vaccine (Non-GSK). Follow-up information received from the healthcare professional on 06 August 2010: Typhoid vaccine (0.5 cc) was administered in the left arm on 04 May 2010. The subject experienced injection arm pain on 04 May 2010, the same day after vaccination with HAVRIX and Typhoid vaccine. The subject received 1st dose of ENGERIX B in her left arm and BOOSTRIX (0.5 cc) in her right arm on 22 July 2010. The dose of BOOSTRIX administered on 22 July 2010 was also considered a suspect product for the event of metallic taste in mouth that occurred the same day.

VAERS ID:418736 (history)  Vaccinated:2011-02-11
Age:40.0  Onset:2011-02-12, Days after vaccination: 1
Gender:Female  Submitted:2011-02-25, Days after onset: 13
Location:Minnesota  Entered:2011-03-15, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit C. 500mg po prn
Current Illness: None
Preexisting Conditions: Chronic neck pain; tobacco use; no allergies
Diagnostic Lab Data: WBC 10; ESR 40
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3641CA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0738Z UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3553CA UNRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Influenza, Oedema peripheral, Pain in extremity, Pyrexia, Red blood cell sedimentation rate increased, White blood cell count normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Was given 3 immunizations while in for her physical on Friday 2/11/11. Developed flu symptoms, low grade elevated temp, & chills, left arm pain & swelling on 2/12/11 Sat. Went to medical center where she was started on KEFLEX 500mg PO BID x 7 days and BENADRYL 12.5 mg/5ml elixir 25mg po prn. Returned to clinic on 2/14/11- LA arm feeling better, still quite swollen. Returned began to cinic 2/16/11 Lt arm still swollen & having pain, increased KEFLEX to qid. Recommend f/u in 2 days - no f/u appt occurred.

VAERS ID:418810 (history)  Vaccinated:2011-03-14
Age:40.0  Onset:2011-03-15, Days after vaccination: 1
Gender:Female  Submitted:2011-03-16, Days after onset: 1
Location:Pennsylvania  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: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB880AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3489AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site induration, Injection site mass, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt called on 3/16/11 concerned about site reactions. They include hot to touch, hard bump and soreness. Suggested pt continue to take ibuprofen and hot/cold compresses.

VAERS ID:418971 (history)  Vaccinated:2011-03-11
Age:40.0  Onset:2011-03-12, Days after vaccination: 1
Gender:Female  Submitted:2011-03-14, Days after onset: 1
Location:New Jersey  Entered:2011-03-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Puncture wound
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABA035A0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Induration, Local reaction, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large local reaction, induration, warmth 13 x 13cm.

VAERS ID:418975 (history)  Vaccinated:2011-03-09
Age:40.0  Onset:2011-03-09, Days after vaccination: 0
Gender:Female  Submitted:2011-03-11, Days after onset: 2
Location:Ohio  Entered:2011-03-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin; HCTZ; Metoprolol; FLEXERIL; Amitriptyline; KLONOPIN
Current Illness:
Preexisting Conditions: Diabetes; Anxiety
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.9104510 SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3517AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site urticaria, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on (R) shoulder, large wheal at site of injection, began day of vaccination, BENADRYL prn for itch.

VAERS ID:419083 (history)  Vaccinated:2011-03-11
Age:40.0  Onset:2011-03-15, Days after vaccination: 4
Gender:Female  Submitted:2011-03-18, Days after onset: 3
Location:North Carolina  Entered:2011-03-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergic rhinitis, hypothyroidism, eczema
Diagnostic Lab Data: multiple labs including: UA, CBC with diff, Magnesium, CMP, TSH all checked --normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Other     Purchased by: Other
Symptoms: Blood magnesium normal, Blood thyroid stimulating hormone normal, Differential white blood cell count normal, Flushing, Full blood count normal, Hypoaesthesia, Lip swelling, Metabolic function test, Paraesthesia, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: numbness and tingling to hands, arms and legs, swelling to lips and flushing

VAERS ID:419199 (history)  Vaccinated:2011-03-14
Age:40.0  Onset:2011-03-16, Days after vaccination: 2
Gender:Male  Submitted:2011-03-21, Days after onset: 5
Location:Missouri  Entered:2011-03-21
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
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER034218A IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Vaccination complication
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient was seen in the office on 3/17 for worsening of arm redness and swelling. Was given Keflex for possible cellulitis. Docotor''s option was a vaccine reaction.

VAERS ID:419783 (history)  Vaccinated:2011-03-24
Age:40.0  Onset:2011-03-24, Days after vaccination: 0
Gender:Male  Submitted:2011-03-29, Days after onset: 5
Location:Virginia  Entered:2011-03-29
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: Tree/grass/weed pollen Cats dust mites molds Asthma Keflex - only known drug allergy (itchy skin)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJRA
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Bacterial infection, Bronchitis, Nasopharyngitis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Cold symptoms progressed to asthma exasperation and full bronchitis bacterial infection by 3/26/2011.

VAERS ID:419946 (history)  Vaccinated:2011-03-28
Age:40.0  Onset:2011-03-29, Days after vaccination: 1
Gender:Male  Submitted:2011-03-30, Days after onset: 1
Location:Delaware  Entered:2011-03-30
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 (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Dizziness, Dyspnoea, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Weakness, dizziness, shortness of breath, and brief moments of loss of consciousness.

VAERS ID:420025 (history)  Vaccinated:2011-03-08
Age:40.0  Onset:2011-03-08, Days after vaccination: 0
Gender:Female  Submitted:2011-03-27, Days after onset: 18
Location:Illinois  Entered:2011-03-31, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No known meds
Current Illness: None
Preexisting Conditions: No known conditions except pregnancy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3569BA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad)
Write-up: Pregnant patient received preservative free FLUZONE. Reports sore arm after vaccination and is still sore and cannot lift arm above chest levels 16 days after vaccination. Patient aware can take acetaminophen but has not taken any. Referred to MD.

VAERS ID:420074 (history)  Vaccinated:2011-03-29
Age:40.0  Onset:2011-03-29, Days after vaccination: 0
Gender:Female  Submitted:2011-03-31, Days after onset: 2
Location:Oregon  Entered:2011-03-31
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
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1158Z0SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3540AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: PNEUMOVAX at 0830. Itchy & red at injection site with tender axillary lymph node approx 9 hr. after admin. Rx with BENADRYL, ice, ibu. Progressed to myalgias, chills, feverish that evening. Improved during day so stopped Rx. Symptoms recurred next night & injection site more swollen & red with return of myalgias.

VAERS ID:420223 (history)  Vaccinated:2010-09-18
Age:40.0  Onset:2010-09-18, Days after vaccination: 0
Gender:Female  Submitted:2011-04-04, Days after onset: 198
Location:California  Entered:2011-04-04
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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  IJRA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Other     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site pain, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: The flu shot injection was extremely painful. After receiving it I had constant pain at the injection site and limited use of that arm due to arm weakness/pain for about a month. The pain was worse at night. After about a month the pain decreased and rather than constant I would feel it occasionally throughout the day. The pain sometimes was as far as 6 inches away from the injection site near the elbow or shoulder. About two months after the vaccination, I went several days without having pain. Then the pain started occurring again several times throughout the day. It''s now been about 7 months since the vaccination and I still sometimes feel pain at or near the injection site if I lay it a certain way or after doing some exercises but now it''s more like every couple of weeks that I feel it.

VAERS ID:420404 (history)  Vaccinated:2009-09-01
Age:40.0  Onset:2009-09-01, Days after vaccination: 0
Gender:Female  Submitted:2011-04-06, Days after onset: 582
Location:Missouri  Entered:2011-04-06
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no... I was very healthy
Preexisting Conditions: none
Diagnostic Lab Data: biopsy/mri
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98437P1A IMRA
Administered by: Other     Purchased by: Public
Symptoms: Biopsy, Immediate post-injection reaction, Mass, Nuclear magnetic resonance imaging, Pain, Skin warm
SMQs:, Hypersensitivity (narrow)
Write-up: immediate pain.. immediate lump... hot to touch

VAERS ID:420625 (history)  Vaccinated:2011-04-08
Age:40.0  Onset:2011-04-08, Days after vaccination: 0
Gender:Female  Submitted:2011-04-08, Days after onset: 0
Location:Maryland  Entered:2011-04-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3539AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Dry mouth, Injection site pain, Joint range of motion decreased, Pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: severe localized inject site and regional arm pain, distal hand discomfort and decreased ROM, dry mouth, dizziness

VAERS ID:420677 (history)  Vaccinated:2011-04-01
Age:40.0  Onset:2011-04-02, Days after vaccination: 1
Gender:Female  Submitted:2011-04-11, Days after onset: 9
Location:Vermont  Entered:2011-04-11
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: Latex allergy. Takes thyroid medication.
Diagnostic Lab Data: Serologic testing after patient became ill is not available. However, serologic titer testing prior to receiving vaccination indicated that patient did not have antibodies against mumps.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.083120SCRA
Administered by: Unknown     Purchased by: Private
Symptoms: Diarrhoea, Local swelling, Mumps, Mumps antibody test negative, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: One day after vaccine administration, pt began feeling nausea/vomiting/diarrhea. Two days after vaccine administration, patient spiked a fever, swollen neck. Went to her PCP on 4/6/11 and was diagnosed with the mumps.

VAERS ID:420809 (history)  Vaccinated:2011-04-08
Age:40.0  Onset:2011-04-10, Days after vaccination: 2
Gender:Female  Submitted:2011-04-11, Days after onset: 1
Location:California  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: None
Preexisting Conditions: None
Diagnostic Lab Data: Allergic reaction to whooping cough.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC382AA1UNLA
Administered by: Private     Purchased by: Other
Symptoms: Hypersensitivity, Pain in extremity, Skin warm, Tenderness
SMQs:, Angioedema (broad), Hypersensitivity (narrow)
Write-up: Tender at touch, (L) arm hot painful 10/10, not cellulitis, allergic reaction per MD.

VAERS ID:420950 (history)  Vaccinated:2011-04-05
Age:40.0  Onset:2011-04-08, Days after vaccination: 3
Gender:Female  Submitted:2011-04-11, Days after onset: 3
Location:California  Entered:2011-04-13, 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: None
Preexisting Conditions: Pregnant
Diagnostic Lab Data: Patient sent to emergency room.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3490AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Local swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Patient came to clinic complaining of swelling of neck and face on same side as Tdap injection. Denies respiratory involvement and is breathing and swallowing without difficulty. Sent to Emergency room for further evaluation.

VAERS ID:421356 (history)  Vaccinated:2011-03-29
Age:40.0  Onset:2011-03-30, Days after vaccination: 1
Gender:Female  Submitted:2011-04-04, Days after onset: 5
Location:Pennsylvania  Entered:2011-04-19, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3794BA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0491Z SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3728AA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fatigue, Injection site induration, Pain in extremity, Sensation of heaviness, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Ache all over right arm hot very tired. Had to take pain medicine Rt arm hurt a lot. Felt very heavy & weighed down. Rt arm was also very hard where the shot was given.

VAERS ID:421700 (history)  Vaccinated:2011-04-18
Age:40.0  Onset:2011-04-18, Days after vaccination: 0
Gender:Female  Submitted:2011-04-26, Days after onset: 8
Location:Pennsylvania  Entered:2011-04-26
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, supportive treatment.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B056AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Headache, Hypoaesthesia, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: Headaches, fever (101.6 orally), chills, c/o feeling of numbess with hands, feet, body aches.

VAERS ID:421807 (history)  Vaccinated:2011-04-25
Age:40.0  Onset:2011-04-25, Days after vaccination: 0
Gender:Female  Submitted:2011-04-27, Days after onset: 2
Location:California  Entered:2011-04-27
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: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH189AB IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3516AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Fatigue
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Patient recieved Tdap in LD IM and Flu vaccine in RD IM, uneventful. Four hours after the injections felt general weakness, loss of strength, no energy and felt tired. These symptoms lasted about 48hours. Symptoms improved 04/27/2011.

VAERS ID:421976 (history)  Vaccinated:2011-04-26
Age:40.0  Onset:2011-04-26, Days after vaccination: 0
Gender:Female  Submitted:2011-04-29, Days after onset: 3
Location:Massachusetts  Entered:2011-04-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Dairy; BENADRYL
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3516A0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Body temperature increased, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt reports pain & swelling under Rt arm near breast temp 102. 4/27 feels better now. Declines ov or further treatment will call if needed for follow up.

VAERS ID:422173 (history)  Vaccinated:2011-04-18
Age:40.0  Onset:2011-04-19, Days after vaccination: 1
Gender:Male  Submitted:2011-05-04, Days after onset: 15
Location:Illinois  Entered:2011-05-04
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: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU2936CA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pain in extremity
SMQs:
Write-up: On 4/27/2011 complained he had arm pain since injection. Called again on 5/1/2011 and was seen by the APN. No signs of erythema, swelling, has not missed work.

VAERS ID:422254 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-05-04
Location:Unknown  Entered:2011-05-05, 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: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA00089
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Uterine cancer
SMQs:, Malignant tumours (narrow), Uterine and fallopian tube malignant tumours (narrow)
Write-up: Information has been received from a physician concerning an approximately 40 year old female patient who on an unspecified date was vaccinated with a dose of GARDASIL (lot# not reported). Subsequently the patient developed uterine cancer. At the time of reporting, the outcome of uterine cancer was not reported. It was unspecified if the patient sought medical attention. Upon internal review, uterine cancer was determined to be an other important medical event. Additional information has been requested.

VAERS ID:422421 (history)  Vaccinated:2011-05-03
Age:40.0  Onset:2011-05-03, Days after vaccination: 0
Gender:Female  Submitted:2011-05-06, Days after onset: 3
Location:Pennsylvania  Entered:2011-05-09, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3516AA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, 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), Arthritis (broad)
Write-up: Patient experienced pain in multiple joints, knees, hips, elbows, ankles from 10 pm on 5/3 to the evening of 5/5/11. Took Ibuprofen q 4 hours. Resolved 5/5. Onset of pain at injection site immediately after shot. Onset of redness & swelling at site - 5/6/11. Reported to FMD 5/6. Ordered ice to local site, MOTRIN and BENADRYL.

VAERS ID:422682 (history)  Vaccinated:2011-04-17
Age:40.0  Onset:2011-05-03, Days after vaccination: 16
Gender:Female  Submitted:2011-05-11, Days after onset: 8
Location:Montana  Entered:2011-05-11
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: None
Diagnostic Lab Data: Laboratory data attached
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1393Z0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Joint swelling, Laboratory test
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Pt. reported joint pain in knees started on 5/3/11. She saw MD on 5/10/11 when lab work was done. The joint pain and swelling continued and spread to other joints this started on 5/5/11 and is on-going. Pt reported some improvement on 5/10/11.

VAERS ID:423251 (history)  Vaccinated:2010-05-04
Age:40.0  Onset:2010-05-21, Days after vaccination: 17
Gender:Female  Submitted:2011-05-12, Days after onset: 356
Location:California  Entered:2011-05-18, 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: None
Diagnostic Lab Data: None
CDC Split Type: WAES1005USA03542
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Rash, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 40 year old female patient with no pertinent medical history or drug reactions who on 04-MAY-2010 was vaccinated with a standard dose of VARIVAX (Merck). Concomitant therapy included ADACEL. On 21-MAY-2010 (last Friday) the patient had rash on her neck, face, and abdomen. She had about dozen lesions. The patient sought unspecified medical attention. At the time of the report, the patient had not recovered from this event. Additional information has been requested.

VAERS ID:424237 (history)  Vaccinated:2011-05-27
Age:40.0  Onset:2011-05-30, Days after vaccination: 3
Gender:Male  Submitted:2011-05-30, Days after onset: 0
Location:Unknown  Entered:2011-05-30
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2691IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3520AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0738Z IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0969Z SCRA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF786AA1SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, 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)
Write-up: Patient received Pneumovax, and Menactra on right deltoid muscle, and Varivax on righter aspect subcutaneous area on 27May2011. Following day, Pt had swelling on right upper arm, itchiness, redness area and warm to touch, went to ER during weekend. On 31May2011, Patient showed up Immunization. Nurse measured right upper arm red, warm to touch, swelling, length 25cm, width 28cm. temp:98.0F, No itchiness anymore, but "like a muscle soreness when touching" Patient states. About the "Above Adverse Event Onset Date," since local time is ahead, I put 05/30/2011, but actual onset date is 31May2011.

VAERS ID:424331 (history)  Vaccinated:2011-05-24
Age:40.0  Onset:2011-05-24, Days after vaccination: 0
Gender:Female  Submitted:2011-05-31, Days after onset: 7
Location:Nebraska  Entered:2011-05-31
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
TDAP: TDAP (ADACEL)SANOFI PASTEURU3554BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Pain
SMQs:
Write-up: Achy and fatigued on date of injection. OTC pain relievers recommended.

VAERS ID:424414 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Male  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: Colitis ulcerative; Immunosuppression
Preexisting Conditions:
Diagnostic Lab Data: Serum measles IgG, Negative
CDC Split Type: WAES1103USA01935
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0811Z UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood immunoglobulin G, Measles antibody negative
SMQs:
Write-up: Information has been received from a Registered Nurse (R.N.) concerning a 40 year old male patient with immunosuppression and ulcerative colitis who was not sure if received the MMR II in childhood (on an unspecified date) since he could not provide any record. It was also noted that the patient informed the nurse that he was in military and was vaccinated for "everything" but could not showed the documentations either. On 10-MAR-2011 the patient was vaccinated with a dose of MMR II (lot no. 667741/0811Z, exp. 10-JUN-2012) dose and route not reported. Concomitant therapies included prednisone, balzalaside and mercaptopurine. The nurse reported that the patient showed "negative titer for measles" when tested (date unspecified). The nurse stated that on 10-MAR-2011 when the vaccine was administered the patient "might be immunosupressed" and it was found out that patient suffered from ulcerative colitis and was taking prednisone 30 mg, balsalazide and mercaptopurine. At the time of reporting, the patient was on "a 3 week burst therapy and was weaning off". The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:424564 (history)  Vaccinated:2010-06-18
Age:40.0  Onset:2010-06-18, Days after vaccination: 0
Gender:Female  Submitted:2011-05-26, Days after onset: 342
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: Hay fever
Preexisting Conditions:
Diagnostic Lab Data: Serum mumps Ab, Low titers
CDC Split Type: WAES1010USA01135
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1334Y0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Inappropriate schedule of drug administration, Mumps antibody test negative, Neurological symptom, Paraesthesia, Pruritus, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypersensitivity (broad)
Write-up: Information has been received from a medical assistant concerning a 40 year old female patient who on 18-JUN-2010 was vaccinated subcutaneously with the first 0.5ml dose of MMR II (Lot # 665797/1334Y, Expiration date 17-SEP-2011). The medical assistant reported that on 18-JUN-2010 the patient''s titers were drawn and the patient was found to have low titers to the mumps components of the vaccine. On 16-JUL-2010 a second dose of MMR II was given. On an unspecified date, titers drawn again with the same result. No adverse effects known. Follow-up information was received, which reported that the female patient with hay fever "non known to medications" was vaccinated with a dose of MMR II (Lot # 665797/1334Y), Left deltoid on 16-JUL-2010. The patient stated that several days after receiving the shot, her left leg went numb. Another odd symptom that lasted only one week was that she would feel like the skin over my kneecap had popped open and water was running down her knee; but she claimed that it was only a neurological illusion. The water sensation happened only when she squatted down, and flexed her quadricep, to pick up her dog each night and carry him to bed. She began to have further neurological reactions to the vaccine where administered. The patient would feel like someone was pinching her leg on and off all day long. The patient reported that physical activity, such as briskly walking across campus or squatting down to pick up a heavy object, seemed to aggravate it, when the muscles were being flexed or worked. At another times, she would feel pins and needles up and down her leg. At night, when she first went to bed, she would feel electrical impulses moving back and forth across her left quadricep. The range of her body affected was the upper left leg, from the kneecap to her hip. As this was healing, her leg would also get very itchy at times, but she mentioned that scabs could do this when the body is healing. So it actually encouraged her that the symptoms seemed to be healing on an internal level. The patient stated that she did a titer in an attempt to prove immunity which was low mumps reading. The patient''s doctor told her that there exists a percentage of the population who will never have a high titer reading, no matter how many injections they receive, her doctor believes that the patient was in this category of the population and had recommended that the patient did not get any more MMR II, also based on the strong negative reaction that the patient''s body had experienced. The patient claimed that since July 2010 the patient occasionally felt the symptoms, the patient stated that she assists a yoga-type stretch that she does every morning that made her squat and then sit back on her legs. Every time that she did this, only my upper left leg would be numb for one minute afterwards (and this never happened prior to the vaccination). Once in a while, she would still feel electrical impulses jumping across her leg in the evening when she went to bed. At other times, she would feel like part of her leg was drooping or when she was wearing trousers, it would feel odd because she would feel most of her clothing, but not all of it. However, she would estimate a 90-95% recovery at the time of the report. The patient did not seek medical attention. Additional information has been requested.

VAERS ID:425054 (history)  Vaccinated:2011-06-07
Age:40.0  Onset:2011-06-08, Days after vaccination: 1
Gender:Male  Submitted:2011-06-09, Days after onset: 1
Location:Unknown  Entered:2011-06-09
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: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2697IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site cellulitis
SMQs:
Write-up: cellulitis at injection site

VAERS ID:425121 (history)  Vaccinated:2011-06-01
Age:40.0  Onset:2011-06-01, Days after vaccination: 0
Gender:Male  Submitted:2011-06-10, Days after onset: 9
Location:Ohio  Entered:2011-06-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gout
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB459CB0 LA
Administered by: Private     Purchased by: Other
Symptoms: Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: After receiving a Hepatitis A immunization, the client had a vasovagal response and lost consciousness briefly. He also suffered from extreme nausea for approximately an hour. We were concerned primary because most patients receiving this particular vaccine/lot number had at least symptoms of nausea.

VAERS ID:425402 (history)  Vaccinated:2011-06-13
Age:40.0  Onset:2011-06-14, Days after vaccination: 1
Gender:Female  Submitted:2011-06-14, Days after onset: 0
Location:Unknown  Entered:2011-06-14
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: latex allergy, asked how patient reacts to latex, patient stated "rash only to the place contacted to latex product"
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2690IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0738Z0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Due to the site the date is set as 06/14, however actual onset date is 06/15/2011. Nurse in ER called, and notified Patient visited ER this morning, left deltoid swollen, rash around the left deltoid area and radiated. No fever. Patient given Benadryl and some antibiotics and left.

VAERS ID:425406 (history)  Vaccinated:2011-06-07
Age:40.0  Onset:2011-06-07, Days after vaccination: 0
Gender:Female  Submitted:2011-06-14, Days after onset: 7
Location:California  Entered:2011-06-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0956Z0SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3488AA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURE0442 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Skin warm, Vaccination site erythema, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Developed erythema, swelling warmth and pain on the left triceps area where Pneumococcal vaccine was given earlier in the day. 48 hours after the vaccination the erythema, swelling, warmth began expanding rapidly, went below the elbow. I was hospitalized and given IV Vancomycin.

VAERS ID:426068 (history)  Vaccinated:2011-06-17
Age:40.0  Onset:2011-06-18, Days after vaccination: 1
Gender:Male  Submitted:2011-06-23, Days after onset: 5
Location:Massachusetts  Entered:2011-06-23
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 BENADRYL & morphine; Hx U.C.; Hx GERD; Hx chronic steroid use; osteoporosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA560BA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1490Z IMRA
Administered by: Private     Purchased by: Private
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: (1) Pt. had a fever of 103.5 degrees the morning following day vaccines rec. Pt. self medicated with TYLENOL - fever resolved same day. (2) Redness & swelling x 3 days at PNEUMOVAX inj. site.

VAERS ID:426264 (history)  Vaccinated:2011-06-17
Age:40.0  Onset:2011-06-27, Days after vaccination: 10
Gender:Male  Submitted:2011-06-28, Days after onset: 1
Location:Unknown  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
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04003A0OTLA
Administered by: Military     Purchased by: Military
Symptoms: Lymph node pain, Lymphadenopathy
SMQs:
Write-up: Sore lymphoids and looks like a golf ball is under skin.

VAERS ID:426411 (history)  Vaccinated:2011-06-24
Age:40.0  Onset:2011-06-26, Days after vaccination: 2
Gender:Female  Submitted:2011-06-29, Days after onset: 3
Location:New Jersey  Entered:2011-06-29
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC004AA3IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3921AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Axillary mass, Diarrhoea, Injection site pain, Nausea, Pain, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: 6/26/11 Developed body aches & tenderness at site. No redness 6/27/11 had nausea, diarrhea. Cont with nausea, 6/28/11 notice lg lump in (L) axilla area a (R) side facial swelling and body aches.

VAERS ID:426517 (history)  Vaccinated:2011-06-28
Age:40.0  Onset:2011-06-29, Days after vaccination: 1
Gender:Female  Submitted:2011-06-30, Days after onset: 1
Location:Nebraska  Entered:2011-06-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: annual physical
Preexisting Conditions: All: AMBIEN; Med. Conditions: Migraines, Insomnia, Tobacco abuse
Diagnostic Lab Data: CBC WNL except: WBC= 14; Neutrophil: 84; ANC: 11.7; Lymphocyte = 9
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0882Z IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3838BA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Full blood count abnormal, Lymphadenopathy, Lymphocyte count, Neutrophil count, Type III immune complex mediated reaction, Vasculitis, White blood cell count
SMQs:, Haematopoietic leukopenia (broad), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: W/i 12 hrs of getting vaccine, patient developed an arthus reaction (local vasculitis) & swollen lymph nodes. Urgent Care treated w/KEFLEX for possible cellulitis. Dr. gave Prednisone 20 mg BID x 5 days.

VAERS ID:426658 (history)  Vaccinated:2011-07-05
Age:40.0  Onset:2011-07-05, Days after vaccination: 0
Gender:Male  Submitted:2011-07-05, Days after onset: 0
Location:North Carolina  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: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURERA0282 LA
Administered by: Public     Purchased by: Public
Symptoms: Cold sweat, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Per patient, he felt dizzy outside of waiting area while making appointment for I 693. He said that he had not slept or eaten prior to coming for his vaccinations. Patient felt clammy to touch. He was aao x 3 and with family. He was assisted to a wheelchair and brought to an exam room and was seen by the clinic Nurse Practitioner. Patient denies any medical history during this time of visit. Patient was offered Ensure to drink and allowed to rest until recovered. He was instructed to go to ER or urgent care when symptoms persist. Vital signs stable. BP 120/79 and HR 80. Patient verbalized understanding of instructions.

VAERS ID:427076 (history)  Vaccinated:2011-07-05
Age:40.0  Onset:2011-07-06, Days after vaccination: 1
Gender:Female  Submitted:2011-07-11, Days after onset: 5
Location:Oklahoma  Entered:2011-07-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CLIENT STATES, "NO"
Preexisting Conditions: CLIENT STATES, "NO"
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1024Z1SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3828AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1611Z0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Pain in extremity, Pain of skin
SMQs:, Arthritis (broad)
Write-up: ACHING PAIN IN FEET, ANKLES, LEGS, JOINTS ACHED IN KNEES & ANKLES, SKIN UNCOMFORTABLE TO TOUCH, NO FEVER, NO RASH, AND MUCH IMPROVED TODAY 7/11/2011. CLIENT HAS DOCTOR VISIT ON 7-12-2011.

VAERS ID:427358 (history)  Vaccinated:2011-03-22
Age:40.0  Onset:2011-03-23, Days after vaccination: 1
Gender:Female  Submitted:2011-04-14, Days after onset: 22
Location:Iowa  Entered:2011-07-11, Days after submission: 88
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: The patient had no medical history and no concomitant medications. The patient had no illness at the time of vaccination.
Diagnostic Lab Data: The patient had no laboratory or diagnostic testing performed.
CDC Split Type: 201102076
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC36610IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Cheilitis, Lip exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Initial report received from a health care professional on 06 April 2011. A 40-year-old female patient received on 22 March 2011 at right deltoid intramuscular injection of ADACEL, sanofi pasteur Ltd. lot number C3661 and sanofi pasteur Inc. lot number U3554CA. The patient has no medical history and no concomitant medications. The patient had no illness at the time of vaccination. On 23 March 2011, the patient developed peeling and red lips "like when a child is licking his lips and they peel". She had no other complaints. The patient was to see her physician. The outcome was reported as not recovered. Documents held by sender: None.

VAERS ID:427342 (history)  Vaccinated:2011-07-11
Age:40.0  Onset:2011-07-11, Days after vaccination: 0
Gender:Female  Submitted:2011-07-13, Days after onset: 2
Location:Kentucky  Entered:2011-07-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Depression, HTN. NKDA
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3921AA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Headache, Nausea, Oedema peripheral
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: nausea, headache, swollen arm

VAERS ID:427515 (history)  Vaccinated:2011-07-17
Age:40.0  Onset:2011-07-17, Days after vaccination: 0
Gender:Male  Submitted:2011-07-17, Days after onset: 0
Location:Illinois  Entered:2011-07-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: SEASONAL ALLERGIES
Diagnostic Lab Data:
CDC Split Type: FAV269
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2691IMLA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Hot flush, Hypoaesthesia, Pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: HEADACHE, PAIN SCALE 4; PAIN RADIATING DOWN LEFT ARM, FINGERS TINGLING AND NUMB, HOT FLASHES

VAERS ID:427746 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-07-20
Location:Massachusetts  Entered:2011-07-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.169470SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash macular, Rash papular, Scab, Skin lesion
SMQs:, Hypersensitivity (narrow)
Write-up: Developed pruritic lesions - (3) erythematous, macule/papule - ok - then scabs on (R) forearm, left upper arm & left thighs - 17 days after varicella vaccine.

VAERS ID:427874 (history)  Vaccinated:2011-07-18
Age:40.0  Onset:2011-07-20, Days after vaccination: 2
Gender:Female  Submitted:2011-07-21, Days after onset: 1
Location:Tennessee  Entered:2011-07-21
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: Allergic to Sulfa drugs
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC004AA1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Malaise, Pyrexia, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Coughing, Sneezing, fever of 103, general malasie. Treatment - Tynenol, orange juice & water.

VAERS ID:427927 (history)  Vaccinated:2011-06-30
Age:40.0  Onset:2011-07-01, Days after vaccination: 1
Gender:Female  Submitted:2011-07-22, Days after onset: 21
Location:Montana  Entered:2011-07-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humara, Methotrexate, Vitamin D, Xanax, Flexeril, Nexium
Current Illness: No
Preexisting Conditions: Rheumatoid Arthritis
Diagnostic Lab Data: MRI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC002AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.137520IMLA
Administered by: Public     Purchased by: Private
Symptoms: Nausea, Neuralgia, Nuclear magnetic resonance imaging, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Employee had aches,nausea, vomitting, fever of 100 starting approx 24 hrs later. Over course of next 3 weeks, sxs worsened, temp up to 102.9, and then hospitalized July 12-16 for fever, pain, neuralgia, possible encephalopathy. Continues on steroids and acyclovir.

VAERS ID:428122 (history)  Vaccinated:2011-07-22
Age:40.0  Onset:2011-07-23, Days after vaccination: 1
Gender:Female  Submitted:2011-07-25, Days after onset: 2
Location:Oregon  Entered:2011-07-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUH138AA0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (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: Had swelling, warmth, tenderness (L) upper arm 7/23/11. 7/25/11 feels drowsy, has some nausea, seen by Dr. Advised rest and continue to observe.

VAERS ID:428092 (history)  Vaccinated:2011-07-21
Age:40.0  Onset:2011-07-22, Days after vaccination: 1
Gender:Female  Submitted:2011-07-26, Days after onset: 4
Location:Massachusetts  Entered:2011-07-26
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: Food allergies, to plums, peaches, apples, cherries, walnuts, chick peas, melon. Allergic to Sulfa meds-rash. Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTIPV: DT + IPV (NO BRAND NAME)UNKNOWN MANUFACTURER  IJRA
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Hypoaesthesia, Injection site erythema, Injection site induration, Injection site mass, Injection site pain, Injection site warmth, Lethargy, Nausea, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (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), Vestibular disorders (broad)
Write-up: Pain at site, the first day of injection. On day 2 developed redness at site which has increased daily to a 6cm all around. HOT to the touch, now there is a firm mass at injection site. Increased pain at site. Since 7/23, increased lethargy, nausea, dizziness. Throbbing at site, and slight numbing of rt hand felt last night for the first time. Warm compresses to the site were applied, with mild relief. Ibuprofen for pain and to decrease swelling, with minor relief. Called MD this am to request antibiotic therapy for a possible cellulitis.

VAERS ID:428268 (history)  Vaccinated:2011-07-18
Age:40.0  Onset:2011-07-18, Days after vaccination: 0
Gender:Male  Submitted:2011-07-21, Days after onset: 3
Location:Oregon  Entered:2011-07-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3872CA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site induration, Injection site pain, Injection site warmth, Local reaction, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Fever 104, NV within 24 hrs of vaccine. Local reaction 8cm. Tenderness, induration, & warmth at injection site.

VAERS ID:428510 (history)  Vaccinated:2011-07-11
Age:40.0  Onset:2011-07-11, Days after vaccination: 0
Gender:Female  Submitted:2011-08-01, Days after onset: 21
Location:Texas  Entered:2011-08-01
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:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3898BA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm itchy, swollen and painful two weeks after receiving vaccine.

VAERS ID:428642 (history)  Vaccinated:2011-07-20
Age:40.0  Onset:2011-07-21, Days after vaccination: 1
Gender:Female  Submitted:2011-07-25, Days after onset: 4
Location:Virgin Islands  Entered:2011-08-03, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None; history migraine (not active)
Preexisting Conditions: NKDA; No birth breast defects; migraine
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB944BB1IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B062AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1344Z0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Body temperature increased, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: VS. BP 124/80 Pulse 56 T=98.2 RR 18 Bilateral arm swelling worst on left but improving, (L) axillary area. No increased warm & nontender. Hx of headaches but hx of migraine. Breast pain but none now. Tx with TYLENOL without ADVAIR for pain or return to clinic or ER.

VAERS ID:429405 (history)  Vaccinated:2011-04-13
Age:40.0  Onset:2011-04-13, Days after vaccination: 0
Gender:Female  Submitted:2011-07-19, Days after onset: 97
Location:Texas  Entered:2011-08-03, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Neuropathy; Depression; Thyroid disorder; Gastric disorder; Drug hypersensitivity; Allergic reaction to antibiotics; Food allergy; Pollen allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES1104USA02430
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site erythema, Injection site reaction, Injection site warmth, Oedema peripheral, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a 40 year old female patient with neuropathy, depression, thyroid problem and stomach problem and who was allergic to aspirin, erythromycin, clindamycin; some food allergies as oysters and allergic to pollen; who "last Wednesday" (on 13-APR-2011) was vaccinated at the back of the right arm with a dose of ZOSTAVAX (Merck) (lot# not specified). Concomitant therapy included NEURONTIN, Mirtazapine (MSD), levothyroxine Na and "Platonix". The patient reported that the same afternoon after receiving the dose of ZOSTAVAX (Merck) (on 13-APR-2011), she experienced injection site reaction. Her right arm became swollen and really puffy, was itchy and red hot to touch. She stated she showed her Dad, who was pharmacist, and he told her to use cortisone cream (unspecified). The patient stated her arm was still swollen but she thought the cream was starting to help since the swelling had decreased somewhat, and the site was not as hot. She stated that she still had a ring of red at the site. No lab diagnostic studies were performed. Follow up information has been received from a female business staff from the physician''s office who stated that original patient''s adverse event could not be located. She had no new information about the patient''s adverse event. She also stated the patient did not get ZOSTAVAX (Merck) in the physician''s office. No further information is available.

VAERS ID:433821 (history)  Vaccinated:2010-08-30
Age:40.0  Onset:2010-08-31, Days after vaccination: 1
Gender:Female  Submitted:2011-07-29, Days after onset: 332
Location:Unknown  Entered:2011-08-04, 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: Brain neoplasm; Immunodeficiency
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1010USA00041
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IMLA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received concerning an "around 40 year old" female with no drug allergy and immunocompromission and a tumor in her brain who "a month ago", on approximately 30-AUG-2010 was vaccinated intramuscularly into the left arm with a first dose of PNEUMOVAX 23 (lot # not reported). At the same time the patient also vaccinated into the left arm with a dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). The "day after receiving the injection", on approximately 31-AUG-2010, the patient had a lot of swelling, itching and fever that lasted 2 to 3 weeks. The patient sought unspecified medical attention. "Sometime this week", in September 2010, the patient recovered. No further information is available.

VAERS ID:428914 (history)  Vaccinated:2011-06-08
Age:40.0  Onset:2011-07-12, Days after vaccination: 34
Gender:Female  Submitted:2011-08-05, Days after onset: 24
Location:Maryland  Entered:2011-08-05
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Chills, Erythema, Headache, Injection site reaction, Joint swelling, Myalgia, Pain, Pruritus, Pyrexia, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Fever over 100, chills, body aches, headache. After 1 week this was joined by redness of the skin which spread and itched intermittently. After 2 weeks, the chills stopped, but fever, aches, headache and red "rash" (no bumps) continued. On 07/29/2011 the body aches turned into severe muscle and joint pain in arms and shoulder, legs, feet, neck, jaw, and back (though not all at the same time--one day leg and arms, two days later leg pained lessened but intensified in wrists and elbow, then that lessened and moved to feet, and so on). In the joints was severe swelling with the pain. As of 08/05/2011, a low grade fever, headache, muscle and joint pain and rash (though not as severe as before) still continue. As an aside, I had muscle pain/soreness at the site of the injection for 3 days after the injection.

VAERS ID:428953 (history)  Vaccinated:2000-05-07
Age:40.0  Onset:2000-10-08, Days after vaccination: 154
Gender:Female  Submitted:2011-08-07, Days after onset: 3955
Location:Wisconsin  Entered:2011-08-07
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: none
Diagnostic Lab Data: Mononucleosis, Lyme disease, CBC count
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEUR177AA0PO 
Administered by: Public     Purchased by: Private
Symptoms: Borrelia test, Full blood count, Headache, Influenza like illness, Mononucleosis heterophile test, Myalgia, Orthostatic hypotension, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Severe, pounding headache, fever, muscle aches - severe flu-like symptoms. Movement made headache worse, at times orthostatic hypotension. These symptoms have occurred every 2 - 3 years since the inoculation, with no other apparent medical cause.

VAERS ID:429371 (history)  Vaccinated:2011-08-08
Age:40.0  Onset:2011-08-08, Days after vaccination: 0
Gender:Female  Submitted:2011-08-09, Days after onset: 1
Location:New Hampshire  Entered:2011-08-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions:
Diagnostic Lab Data: Checking Lyme titer
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3898BA1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Borrelia test, VIIth nerve paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: (R) Bell''s Palsy <12 hrs post vaccine on ipsilateral side.

VAERS ID:429955 (history)  Vaccinated:2011-08-12
Age:40.0  Onset:2011-08-13, Days after vaccination: 1
Gender:Female  Submitted:2011-08-16, Days after onset: 3
Location:Oregon  Entered:2011-08-16
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: Sulfa; PCN; CIPRO; LYRICA; KEFLEX; terbutaline; CHANTIX; morphine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.06234A0SCUN
Administered by: Other     Purchased by: Public
Symptoms: Injection site infection, Myalgia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: Pt experiencing swelling and muscle pain. Went to PCP and confirmed as "injection site infection".

VAERS ID:430787 (history)  Vaccinated:2011-08-22
Age:40.0  Onset:2011-08-22, Days after vaccination: 0
Gender:Female  Submitted:2011-08-23, Days after onset: 1
Location:Tennessee  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: hooked to dialysis machine
Preexisting Conditions: lupus end stage kidney disease RA Raynauds Sjogrens
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJRA
Administered by: Other     Purchased by: Other
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: sudden vomiting

VAERS ID:431509 (history)  Vaccinated:2011-08-08
Age:40.0  Onset:2011-08-18, Days after vaccination: 10
Gender:Male  Submitted:2011-08-22, Days after onset: 4
Location:Maryland  Entered:2011-08-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Pre vaccine lab: normal CBC; HIV (-); varicella titer (+)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04003A0IDUN
Administered by: Private     Purchased by: Private
Symptoms: Influenza like illness, Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Multiple vesicular lesions over arms, neck, face & back starting day 9 of initial vaccinia immunization. Mild FLS. BP 102/70 P 56 T 97.8. CDC does not feel that vaccinia IgG indicated. But lesions progressing to hands & wrist 8/22/11. Last Td 1/1/09.

VAERS ID:431780 (history)  Vaccinated:2011-08-09
Age:40.0  Onset:2011-08-11, Days after vaccination: 2
Gender:Female  Submitted:2011-08-15, Days after onset: 4
Location:Wisconsin  Entered:2011-08-29, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3958BA1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Influenza like illness, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Vaccine Tdap (ADACEL) given in split dose with 0.25ml on 8-8-11 (R) deltoid & 0.25ml given on 8-9-11 (L) deltoid. No Rxn after each shot. Patient woke up on 8-11-11 with flu like sx and afternoon of same day (L) arm became red & swollen. Used BENADRYL and Ibuprofen.

VAERS ID:432643 (history)  Vaccinated:2011-08-08
Age:40.0  Onset:2011-08-08, Days after vaccination: 0
Gender:Male  Submitted:2011-08-18, Days after onset: 10
Location:California  Entered:2011-09-01, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B065AA UNRA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Seen for cough, wheezing started on the same day he received injection.

VAERS ID:433218 (history)  Vaccinated:2011-08-23
Age:40.0  Onset:2011-08-23, Days after vaccination: 0
Gender:Female  Submitted:2011-08-26, Days after onset: 3
Location:Pennsylvania  Entered:2011-09-06, 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: None
Preexisting Conditions: K-DUR; DILANTIN; KEPPRA; NOVAHISTINE; Primidone; NIASPAN
Diagnostic Lab Data: Mantoux 8/23/11, (Neg) (LFA)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injected limb mobility decreased, Injection site induration, Injection site swelling, Injection site warmth, Laboratory test normal, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen area of (L) upper arm, 10cm x 9cm. Firm & warm to touch. Pt c/o soreness & inability to lift her (L) arm. Injection site is intact with no swelling, redness or drainage.

VAERS ID:433681 (history)  Vaccinated:2011-06-28
Age:40.0  Onset:2011-06-28, Days after vaccination: 0
Gender:Male  Submitted:2011-09-08, Days after onset: 72
Location:Illinois  Entered:2011-09-08
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
Preexisting Conditions: History of Seizures. None recently. Under control with medication.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU3051CA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Diet refusal, Lethargy, Pneumonia aspiration, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: In the evening of 6/28, patient started vomiting with fever present. Vomiting and fever continued into 6/29. Diarrhea started later that day and patient not eating and became more lethargic. Taken to hospital and recieved diagnosis of aspiration pneumonia.

VAERS ID:434215 (history)  Vaccinated:2011-09-13
Age:40.0  Onset:2011-09-13, Days after vaccination: 0
Gender:Male  Submitted:2011-09-13, Days after onset: 0
Location:Massachusetts  Entered:2011-09-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Lymph swelling.~Pneumo (no brand name)~1~39.00~Patient
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 PASTEURUH438AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Immediate post-injection reaction, Local reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Local reaction to vaccine caused instant swelling about the size of a grape. We gave the patient ice and observed him for 30 minutes. No other reaction occurred. Told him to go directly to ER if other symptoms occur.

VAERS ID:434240 (history)  Vaccinated:2011-09-12
Age:40.0  Onset:2011-09-12, Days after vaccination: 0
Gender:Female  Submitted:2011-09-13, Days after onset: 1
Location:Georgia  Entered:2011-09-13
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: Sulfa allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT425AA IMRA
Administered by: Public     Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Approximately 1 1/2 hrs. after receiving FLUZONE client began to feel SOB, tightness in her chest, & throat edema. Her symptoms worsened & she went to an Urgent Care clinic. She was given epinephrine, prednisone, ZYRTEC & an inhaler.

VAERS ID:434358 (history)  Vaccinated:2011-09-12
Age:40.0  Onset:2011-09-12, Days after vaccination: 0
Gender:Male  Submitted:2011-09-14, Days after onset: 2
Location:Missouri  Entered:2011-09-14
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: GERD TAKEN NEXIUM 20MG RX BY DOCTOR.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501096P0IN 
Administered by: Military     Purchased by: Military
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: MODERATE SYSTEMIC ITCHING. PT GIVE 50MG OF BENADRYL STAT WHICH RELIEVED SX''S

VAERS ID:434617 (history)  Vaccinated:2011-09-15
Age:40.0  Onset:2011-09-15, Days after vaccination: 0
Gender:Male  Submitted:2011-09-16, Days after onset: 1
Location:Minnesota  Entered:2011-09-16
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: No Acute illness
Preexisting Conditions: Allergies to Penicillins, Peanuts, Morphine
Diagnostic Lab Data: None noted
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA688AA0IMRA
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB223CA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B072AA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Patient had received Flu vaccine, Twinrix, and TDAP at 5:10pm, was in waiting area and was having a hard time breathing. Patient was brought back to an exam room and his breathing continued to get worse, was given Benadryl IM, Epipen, Nebulizer, and oxygen. Patient was seen in our on site Emergency room and transported to hospital and was discharged in less than 24 hours.

VAERS ID:434814 (history)  Vaccinated:2011-06-24
Age:40.0  Onset:0000-00-00
Gender:Male  Submitted:2011-09-19
Location:California  Entered:2011-09-19
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
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Limb discomfort, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Sore right arm, aching, discomfort. Lose of strength in right arm.

VAERS ID:435237 (history)  Vaccinated:2009-11-30
Age:40.0  Onset:2009-12-11, Days after vaccination: 11
Gender:Female  Submitted:2011-09-22, Days after onset: 649
Location:Massachusetts  Entered:2011-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No. I was pregnant when given the H1N1 vaccine.
Preexisting Conditions: Hashimoto''s disease, Rheumatoid Arthritis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER1009394PA0UNGM
Administered by: Private     Purchased by: Other
Symptoms: Abortion induced, Foetal disorder, Maternal exposure during pregnancy, Placental disorder, Ultrasound antenatal screen normal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: At about six weeks pregancy, my doctor''s office recommended that I get the H1N1 vaccine. So I did on/about 12/09/2009. Three days later, I started bleeding. I bled steadily for one month. I had repeated ultrasounds and was told there was no problem. During a CVS at about 16 weeks, I was told that it seemed that my son had a cerebellar abnormality. I was forced to terminate the pregnancy. It was found that I had a placental blood clot that measured 7cm. I have since corresponded with another woman who had the exact same history with regard to the vaccine and her pregnancy; which she had to terminate.

VAERS ID:435753 (history)  Vaccinated:2011-09-19
Age:40.0  Onset:2011-09-22, Days after vaccination: 3
Gender:Female  Submitted:2011-09-27, Days after onset: 5
Location:Missouri  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:
Current Illness: NO
Preexisting Conditions: Allergic to penicilin, sulfa and ceclor
Diagnostic Lab Data: chest xray
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Chest X-ray, Chills, Dizziness, Feeling abnormal, Nausea, Pain, Pyrexia, Respiratory tract congestion, Sinus headache
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Started with chills and body aches, then high fever 103. All lasted for 3 days. Then fever went to 100 and chest started getting congested along with sinus headache. Minor stomach pain and nausea were also present. 5th day fever went to 99.7. On 6th day just feeling chest congestion, sinus pain, dizziness and all over icky.

VAERS ID:435860 (history)  Vaccinated:2011-09-13
Age:40.0  Onset:2011-09-13, Days after vaccination: 0
Gender:Male  Submitted:2011-09-26, Days after onset: 13
Location:Unknown  Entered:2011-09-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus
Preexisting Conditions: Cortisone
Diagnostic Lab Data: 09/13/2011, Blood glucose increased, High, 530
CDC Split Type: PHEH2011US04310
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101201 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood glucose increased, Increased insulin requirement
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Lipodystrophy (broad)
Write-up: Case number PHEH2011US04310 is an initial spontaneous report received from a consumer who is also a health care professional on 15 Sep 2011: This report refers to an adult male patient. His medical history included diabetes and concomitant medications included insulin shots. He had received three to four cortisone shots in the past that brought his blood sugar level high. When he got the cortisone shots he would adjust his basal insulin two to two and a half times higher and adjusted his bolus insulin up to two to three times higher than normal. He had received flu shots every year in the past and it had never affected his blood sugar level. He was vaccinated with FLUVIRIN (batch number, 1101201) intramuscularly on 13 Sep 2011. After the FLUVIRIN shot he adjusted his bolus insulin lower than usual and later that evening he experienced high blood sugar of 530 (units and normal range not reported) which persisted all day on 14 Sep 2011 as well. He then had another bolus shot and his blood sugar was still not normal. On 14 Sep 2011, he was taken to the emergency room (ER) where the nurse recommended to change everything on the pump and to switch the site. He was on his third bolus shot at the time of reporting and did another site switch. The sugar fluctuations after the cortisone shots usually lasted for three days and this was the second day after FLUVIRIN shot, he was not back to normal yet. But he was taking more insulin now. No further information about the final outcome and causality was reported.

VAERS ID:435922 (history)  Vaccinated:2011-09-26
Age:40.0  Onset:2011-09-27, Days after vaccination: 1
Gender:Female  Submitted:2011-09-27, Days after onset: 0
Location:New York  Entered:2011-09-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Raynaud''s; asthma
Preexisting Conditions: Raynaud''s; asthma; latex allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDN55306 IMUN
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Dizziness, Dyspnoea, Eye pruritus, Headache, Ocular hyperaemia, Tremor, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Vaccine given at approximately 8 pmon 9-26-11. Pt experienced stomach pain, wheezing/gasping at 3 am 9-27-11, pt took PEPTO and vomited. In am of 9-27-11 had itchy, red eyes, headache, dizziness, & shakiness (did not call her MD or seek treatment).

VAERS ID:436084 (history)  Vaccinated:2011-09-20
Age:40.0  Onset:2011-09-20, Days after vaccination: 0
Gender:Male  Submitted:2011-09-26, Days after onset: 6
Location:Virginia  Entered:2011-09-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pre-existing allergy to some component of KENALOG
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AC IMRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dysphonia, Injection site erythema, Injection site induration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Approximately 1.5 hours following vaccine administration, client reported feeling faint, lightheaded. Noted raspiness in voice. Pulse, blood pressure WNL client conscious, responsive. Epinephrine given, 0.3 mg IM via auto injection. Additional care provided at hospital ER - epinephrine and BENADRYL. 12 hours after injection, client noticed induration and erythema at injection site.

VAERS ID:436042 (history)  Vaccinated:2011-09-23
Age:40.0  Onset:2011-09-25, Days after vaccination: 2
Gender:Female  Submitted:2011-09-28, Days after onset: 3
Location:North Carolina  Entered:2011-09-28
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: cbc with diff normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11011010IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Chest pain, Chills, Cough, Differential white blood cell count normal, Eye irritation, Eye pain, Full blood count normal, Ocular hyperaemia, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Arthritis (broad)
Write-up: Fever 99.5-101.5, chills, body and joint pain, sore throat, chills, cough, chest congestion and pain, sore, red, irritated eyes.

VAERS ID:436304 (history)  Vaccinated:2011-09-27
Age:40.0  Onset:2011-09-27, Days after vaccination: 0
Gender:Male  Submitted:2011-09-29, Days after onset: 2
Location:Utah  Entered:2011-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11007010IMUN
Administered by: Other     Purchased by: Private
Symptoms: Burning sensation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Patient had some throat tightness and explained it as he thought "his veins were on fire".

VAERS ID:436465 (history)  Vaccinated:2011-09-30
Age:40.0  Onset:2011-10-01, Days after vaccination: 1
Gender:Female  Submitted:2011-10-02, Days after onset: 1
Location:Unknown  Entered:2011-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Around
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 13IJLA
Administered by: Other     Purchased by: Other
Symptoms: Chest discomfort, Fatigue, Oropharyngeal pain, Pain, Pain in extremity, Paraesthesia, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Evening. Shooting pain down arm got flu shot. To wrist. Transient, severe pain. Tingling in both hands as well as lips tingling. Sore throat and chest feels heavy. Increased fatigue.

VAERS ID:436599 (history)  Vaccinated:2011-09-30
Age:40.0  Onset:2011-09-30, Days after vaccination: 0
Gender:Female  Submitted:2011-10-03, Days after onset: 3
Location:New Mexico  Entered:2011-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: I have reactions to the following medications: sulfa drugs, penicillin, erythromycin, Bactrim, Keflex I have asthma that is maintained by a daily treatment of Pulmicort.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUNKNOWN0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Chest discomfort, Chills, Cough, Dyspnoea, Eye irritation, Eye swelling, Headache, Ocular hyperaemia, Pain, Pyrexia, Sinus headache
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Hypersensitivity (narrow)
Write-up: Initially I began to have what felt like a sinus headache. Within another hour my chest felt tight and it was harder to breathe, almost like a small asthma attack. As my breathing got worse I began to cough some. Within another hour my head was throbbing, my eyes were burning and blood shot, and I was experiencing back pain. By 7:30pm that night I had a fever of over 100 degrees and was having chills and body aches. The following morning both eyes were swollen almost shut. I took Ibuprofen (400 mg) around 7:30pm on 9/29 and an additional dose around 9:00am on 9/30. It seemed to help. By 8pm on 9/30 I was feeling much better.

VAERS ID:436718 (history)  Vaccinated:2011-09-26
Age:40.0  Onset:2011-10-02, Days after vaccination: 6
Gender:Female  Submitted:2011-10-04, Days after onset: 2
Location:Connecticut  Entered:2011-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: DVT
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, swollen area at injection site of rt. arm. Put on cephalexin & BACTRIM (onset day #6 after vaccine).

VAERS ID:437323 (history)  Vaccinated:2011-10-06
Age:40.0  Onset:2011-10-06, Days after vaccination: 0
Gender:Male  Submitted:2011-10-07, Days after onset: 1
Location:D.C.  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: None Known
Preexisting Conditions: Allergy to Penicillin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AC0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Hyperhidrosis, Oedema peripheral, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Body aches, Joint soreness, fever, Body sweats, swelling in lower extremities

VAERS ID:437737 (history)  Vaccinated:2011-10-10
Age:40.0  Onset:2011-10-10, Days after vaccination: 0
Gender:Female  Submitted:2011-10-11, Days after onset: 1
Location:Colorado  Entered:2011-10-11
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED04649221A0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Body temperature increased, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Severely swollen, tender lymph nodes (approx 2 inches in diameter) in neck/clavical area and axillary area both on same side as injection was given. Injection site warm, swollen; Temperature around 100 degrees Fahrenheit.

VAERS ID:437744 (history)  Vaccinated:2011-10-11
Age:40.0  Onset:2011-10-11, Days after vaccination: 0
Gender:Female  Submitted:2011-10-11, Days after onset: 0
Location:New Jersey  Entered:2011-10-11
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  IMLA
Administered by: Other     Purchased by: Private
Symptoms: Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad)
Write-up: Bloodshot left eye, no irritation

VAERS ID:437811 (history)  Vaccinated:2011-10-06
Age:40.0  Onset:2011-10-06, Days after vaccination: 0
Gender:Female  Submitted:2011-10-12, Days after onset: 6
Location:Illinois  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
Preexisting Conditions: Allergic to Sulfa
Diagnostic Lab Data: No testing done Did not seek medical attention
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11009011IMLA
Administered by: Public     Purchased by: Other
Symptoms: Breast swelling, Burning sensation, Immediate post-injection reaction, Muscle spasms, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Injection received at 10:45 AM on 10-6-11 in Left deltoid. Immediately started burning and burning sensation ran up arm and down her back. On Friday 10-7-11 had swelling of left axillary area and left side of chest including breast. Swelling of breast has subsided but still having some swelling of axillary region. Had some muscle spasms under left arm for about 3 days.

VAERS ID:437871 (history)  Vaccinated:2011-09-30
Age:40.0  Onset:2011-09-30, Days after vaccination: 0
Gender:Female  Submitted:2011-10-07, Days after onset: 7
Location:Montana  Entered:2011-10-12, 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: None
Preexisting Conditions: Hx of reactions to vaccinations (MMR)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB942CB1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Malaise, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Client had received her second Hepatitis B on 9/30/11. Had reaction 15 min. after shot - headache that immediately made her sick - blurred vision. Felt "ill" for 2-3 days.

VAERS ID:437965 (history)  Vaccinated:2011-10-06
Age:40.0  Onset:2011-10-07, Days after vaccination: 1
Gender:Female  Submitted:2011-10-10, Days after onset: 3
Location:North Carolina  Entered:2011-10-12, 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: Paronychia; hypothyroidism; anemia; vertigo
Preexisting Conditions: (Allergic PCN, sulfa, e-mycin, LEVAQUIN); PSVT; hypothyroidism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AC2IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1011AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Injected limb mobility decreased, Injection site erythema, Malaise, Nausea, Respiratory tract congestion
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: 10-5-11 received flu vaccine Lt deltoid & Rt pneumonia vaccine. 10-6-11 came by clinic Rt upper arm, area red & pt states cannot raise her arm. Feels sick, dizzy & stopped up. Dr informed, instructed to apply ice & take IBU, can call back tomorrow. AM 10/7/11 called & checked on pt. Arm better, still stopped up. Dizziness no better. Nausea. Asked pt if she needed to be seen, felt like she would be OK. 10/7/11 (pm) husband called requested something for nausea. PHENERGAN called in & to take TYLENOL q 4-6 hours.

VAERS ID:438037 (history)  Vaccinated:2011-08-26
Age:40.0  Onset:2011-08-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-01, Days after onset: 36
Location:South Carolina  Entered:2011-10-13, Days after submission: 12
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) (FLUZONE)SANOFI PASTEURUT445AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Pain, Pain in extremity
SMQs:
Write-up: Arm very sore to raise it up.

VAERS ID:438284 (history)  Vaccinated:2011-09-01
Age:40.0  Onset:2011-09-01, Days after vaccination: 0
Gender:Female  Submitted:2011-10-03, Days after onset: 32
Location:Indiana  Entered:2011-10-13, 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: Allergies - dust, tree pollen; Hypothyroid
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA628BA IMAR
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Heart rate increased, Heart rate irregular, Malaise, Nausea, Syncope, Vaccine positive rechallenge
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Rapid, irregular heart rate; dizziness; syncope; malaise; headache; nausea. Symptoms started about 2h post-dose and remained intense overnight for about 12h; subsided 48h post dose.

VAERS ID:438358 (history)  Vaccinated:2011-10-12
Age:40.0  Onset:2011-10-12, Days after vaccination: 0
Gender:Female  Submitted:2011-10-14, Days after onset: 2
Location:Connecticut  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: no
Preexisting Conditions: seasonal allergies
Diagnostic Lab Data: Not applicable
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501044F0IN 
Administered by: Public     Purchased by: Private
Symptoms: Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: After individual received a dose of FluMist, she began to sneeze every 3 -4 minutes. This persisted throughout the day. Individual contacted her Primary Care Practitioner and was told to take OTC Claritin. Next day individual noted decrease in frequency of sneezing but every 20 minutes would sneeze 8 - 10 times. States history of severe seasonal allergies in the past with similar symptoms..none for several years.

VAERS ID:438581 (history)  Vaccinated:2011-10-14
Age:40.0  Onset:2011-10-15, Days after vaccination: 1
Gender:Female  Submitted:2011-10-17, Days after onset: 2
Location:Michigan  Entered:2011-10-17
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
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA638AA IMRA
Administered by: Unknown     Purchased by: Other
Symptoms: Nausea, Paraesthesia, Sensation of heaviness, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Am of 10/15/11 emp felt nauseous Rt. leg with tingling and prickling along with rt. arm. Feel swollen. On 10/17/111 attempted to walk stairs at work and legs buckled and felt heavy.

VAERS ID:438584 (history)  Vaccinated:2011-09-21
Age:40.0  Onset:2011-09-22, Days after vaccination: 1
Gender:Male  Submitted:2011-10-17, Days after onset: 25
Location:Florida  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No. Just more bleeding than usual.
Preexisting Conditions:
Diagnostic Lab Data: Doctor told me not to get flu shot again but I have had one every year without any problem. No signs on outside of arm of swelling. I was given cortisone shot and prednisone. After taking prednisone for 4 days and stopping pain went from level 1 to level 2-3 everyday and exists today.
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11004011IMRA
Administered by: Other     Purchased by: Private
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad)
Write-up: At first just mild but by 09/23/2011 I could not lift my arm lateral of my body. Pain level was 9. I contacted pharmacy and 13 days later I went to doctor and received a cortisone shot. Pain level went down to 2 within 6 hours. I still feel pain in arm. Level 2 to 3 all the time.

VAERS ID:438930 (history)  Vaccinated:2011-09-23
Age:40.0  Onset:2011-10-15, Days after vaccination: 22
Gender:Female  Submitted:2011-10-18, Days after onset: 3
Location:Minnesota  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Recovering from URI
Preexisting Conditions: None
Diagnostic Lab Data: None other than equivocal rubeola titer 9/7/11.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0046AA SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth, Measles antibody, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: MMR - admin. 9/23/11. Pain at site starting 10/15/11. Subseq. developed redness, warmth and induration. No fever, headache or myalgias. Note - called in on 9/29 stating had "fever". Not confirmed in clinic.

VAERS ID:439021 (history)  Vaccinated:2011-10-17
Age:40.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-19, Days after onset: 2
Location:Ohio  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: Allergy to sulfa and iodine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal discomfort, Dizziness, Fatigue, Influenza like illness, Migraine, Nasopharyngitis, Pain, Pruritus, Rhinorrhoea, Sneezing, Visual field defect
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: On the evening of the vaccination I started experiencing migraine symptoms. I experienced blind spots in my vision. The following morning I awoke with flu-like symptoms (upset stomach, dizziness, sneezing, aches and extreme fatigue). Now, the morning following the day after the vaccination, I have fatigue and mild cold symptoms (itchy, running nose, sneezing)

VAERS ID:439233 (history)  Vaccinated:2011-10-19
Age:40.0  Onset:2011-10-19, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 0
Location:Nevada  Entered:2011-10-20, 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
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1158AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Blood pressure increased, Dyspepsia, Heart rate increased, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow)
Write-up: Increase heart rate, BP increased, heart urn, indigestion. Left arm tingling numb.

VAERS ID:439337 (history)  Vaccinated:2011-10-11
Age:40.0  Onset:2011-10-11, Days after vaccination: 0
Gender:Female  Submitted:2011-10-20, Days after onset: 9
Location:Connecticut  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zipsor, Opana ER, Norco, Ambien CR, Claritin, BeneFiber
Current Illness: None
Preexisting Conditions: Mild seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Fatigue, Headache, Injection site swelling, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling injection site, headache (almost migraine), fever 103, vomiting, tiredness, chills, body aches. Symptoms subsided after approximately 24-36 hours.

VAERS ID:439365 (history)  Vaccinated:2011-10-04
Age:40.0  Onset:2011-10-06, Days after vaccination: 2
Gender:Male  Submitted:2011-10-20, Days after onset: 14
Location:Unknown  Entered:2011-10-20
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: ALLERGY TO PCN
Diagnostic Lab Data: LABS ORDERED, MRI SCHEDULED. SYMPTONS TREATED.
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2893IMRA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501096P1IN 
Administered by: Military     Purchased by: Military
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: NUMBNESS AND TINGLING TO FACE, HEAD, BILATERAL HANDS AND FEET.

VAERS ID:439554 (history)  Vaccinated:2011-10-19
Age:40.0  Onset:2011-10-21, Days after vaccination: 2
Gender:Male  Submitted:2011-10-23, Days after onset: 2
Location:Wisconsin  Entered:2011-10-23
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Bronchospasm, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Hard to breathe Bronchospasm. Took 1200mg Mucinex with lots of water throughout day. Took 80mg prednisone at 20 mg intervals until was able to breathe enough to sleep for a few hours. Saturday contacted ER doctor and was told I was following the correct protocol given the symptoms. I haven''t had an asthma event like this in several years. Diagnosed in 1977. Still hard to breath as of Sunday night 10:23 pm, but better than on Friday.

VAERS ID:439832 (history)  Vaccinated:2011-10-17
Age:40.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 7
Location:California  Entered:2011-10-24
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: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT499AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Dyspnoea, Headache, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: Day of vaccination: muscle aches, dizziness. Next day headache, sweating, shortness of breath. Patient went to ER. She was given steroids and other medications. She recovered and left ER in 2 hours.

VAERS ID:440001 (history)  Vaccinated:2011-10-11
Age:40.0  Onset:2011-10-11, Days after vaccination: 0
Gender:Female  Submitted:2011-10-25, Days after onset: 14
Location:California  Entered:2011-10-25
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
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   AR
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Pain in extremity, Poor quality sleep
SMQs:, Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)
Write-up: Sore arm where shot was administered. It has progressed from sore to painful. It has been 2 weeks of constant pain. Pain increases at night to the point it wakes me up at night.

VAERS ID:440069 (history)  Vaccinated:2011-10-06
Age:40.0  Onset:2011-10-12, Days after vaccination: 6
Gender:Female  Submitted:2011-10-21, Days after onset: 9
Location:Virginia  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:
Preexisting Conditions: The patient had a history of left temporal pain, tinnitus and facial tingling paraesthesia after receiving an influenza vaccination in 2010.
Diagnostic Lab Data: Not reported
CDC Split Type: 201109964
Vaccination
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Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT447AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eye pruritus, Headache, Influenza like illness, Paraesthesia, Paraesthesia oral, Rhinorrhoea, Similar reaction on previous exposure to drug, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hearing impairment (narrow)
Write-up: Initial report was received 13 October 2011 from a health care professional. A 40-year-old female patient who had a history of left temporal pain, tinnitus, and facial tingling and paraesthesia in 2010 following an Influenza vaccination, had received an intramuscular left deltoid injection of FLUZONE No Preservative 2011-2012, lot number UT447AA on 06 October 2011 and one day later, she developed a runny nose, itchy eyes, and flu-like symptoms. On 12 October 2011, six days after vaccination, she developed left temporal pain, increased ringing in her ears, and tingling and paraesthesia of the face and lower lip. The event required a doctor''s visit; it was not reported if treatment was required. The patient had been taking TOPRAMAX concomitantly. According to the reporter, the patient''s neurologist approved vaccination. Outcome was unknown. Documents held by sender: None.

VAERS ID:440191 (history)  Vaccinated:2011-10-07
Age:40.0  Onset:2011-10-16, Days after vaccination: 9
Gender:Female  Submitted:2011-10-26, Days after onset: 10
Location:Nebraska  Entered:2011-10-26
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: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501107P0IN 
Administered by: Public     Purchased by: Private
Symptoms: Abasia, Dehydration, Fall, Vertigo, Vestibular neuronitis, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: 10/17 deveoped vertigo and advanced in severity on 10/18/11 was unable to walk with out falling due to vertigo also deveoped vomiting. 10/19/11 went to the Emergency Department due to continued symptoms and dehydration given Meclazine and Levequin. No improvment in symptoms and on 10/24 went to ENT doctor due to vertigo and diagnosed with vestibular neuronitis thought may have been induced by viral infection from Flu Mist. Treated with prednisone, Zofran and Valium. Reported 10/25 to Employee health continued symptoms but some improvement.

VAERS ID:440400 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Male  Submitted:2011-10-27
Location:Unknown  Entered:2011-10-27
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: Epidural hematoma post trauma; traumatic skull fracture; zygoma arch fracture
Preexisting Conditions:
Diagnostic Lab Data: CSF WBC, 1 units; Cerebrospinal fluid protein, 790mg/dL; Nerve conduction studies, See text; Nuclear magnetic resonance ima, Unremarkable; Vital capacity decreased, 1.4L
CDC Split Type: B0757656A
Vaccination
Manufacturer
Lot
Dose
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Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Areflexia, Bulbar palsy, CSF protein increased, CSF white blood cell count negative, Facial paresis, Guillain-Barre syndrome, Hypoaesthesia, Hyporeflexia, Immunoglobulin therapy, Motor dysfunction, Muscular weakness, Nerve conduction studies abnormal, Neurological examination normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Paraesthesia, Sensory loss, Vital capacity decreased, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow)
Write-up: This case was reported in a literature article and described the occurrence of Guillain Barre syndrome in a 40-year-old male subject who was vaccinated with BOOSTRIX (GlaxoSmithKline). Concurrent medical conditions included small temporal epidural hematoma, nondisplaced right temporal skull fracture and zygomatic arch fracture due to a fall from a secondary story roof. His neurological examination was normal. On an unspecified date, the subject received unspecified dose of BOOSTRIX (route and injection site unknown). One week after vaccination, he was discharged home. Less than one month after vaccination with BOOSTRIX, few days after his discharged, the subject experienced weakness and numbness in his legs which progressed to involve his arms. The subject was hospitalised 3 weeks after his initial fall. The subject''s examinations showed muscle strength was 2/5 in his lower extremities and 3/5 in his upper extremities. His deep tendon reflexes were absent at his ankles and knees and were diminished in his upper extremities. There was bilateral peripheral facial paresis, bulbar weakness and impaired gag reflex. He had diminished touch and pin prick sensation in a stocking glove distribution. His vital capacity was reduced to 1.4 liters. Magnetic resonance imaging of his brain and spinal cord were unremarkable. A lumbar puncture revealed a cerebrospinal fluid protein of 790mg/dL and one white blood cell. Guillain-Barre Syndrome was diagnosed. Nerve conduction studies revealed prolongation of the upper and lower motor action potential latencies, reduced motor conduction velocities and reduced amplitude. Median and ulnar nerves sensory action potentials were absent. The subject was treated with normal immunoglobulin and his muscle strength improved. 3 months later he continued to have tingling in his hands and feet and use a walker. At the time of reporting, limb weakness was improved and the outcome of the other events was unspecified.

VAERS ID:440596 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-30, Days after onset: 3
Location:Maryland  Entered:2011-10-30
Life Threatening? Yes
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
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURUH455AC IMRA
Administered by: Public     Purchased by: Other
Symptoms: Dysarthria, Pharyngeal oedema, Swelling face, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow)
Write-up: SWELLING FACE; THROAT SWELLING AND CONSTRICTION. HIVES speech effected slurred since injection, prescribed BENADRYL and prednisone.

VAERS ID:440768 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 4
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:
Diagnostic Lab Data:
CDC Split Type: TX20110076PU
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1110Z1 LA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Oedema peripheral, Rash, Rash erythematous, Rash pruritic, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: SIGNS/SYMPTOMS - SWOLLEN, RED, ITCHY, WARM, RASH ON ARM. SHE IS FEELING WARM, TOOK MOTRIN 30 MINUTES BEFORE SHOT. SHE HAS HAD THIS SHOT BEFORE AND HAD NO REACTIONS. SHE WENT TO HER PCP TO HAVE IT CHECKED OUT.

VAERS ID:441040 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-01
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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101601 IJUN
Administered by: Public     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: TST administered using flu vaccine (inactivated) Lot # 1101601.

VAERS ID:441044 (history)  Vaccinated:2009-10-18
Age:40.0  Onset:2009-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 739
Location:Georgia  Entered:2011-11-01, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hashimoto''s thyroiditis; allergic to PCN; thimerosal
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3171AA0IJRA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Chills, Decreased appetite, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Starting approx. 16 hrs post-injection, I developed whole body joint & muscle aches, chills, sweats, loss of appetite. This resulted in my being bed or couch ridden for 3 days. Ibuprofen helped some. Remained afebrile throughout.

VAERS ID:441080 (history)  Vaccinated:2011-10-26
Age:40.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2011-11-02, Days after onset: 4
Location:Florida  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB204BA1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG108310SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3828AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: CLIENT STATED SHE NOTICED RAISED AREA TO RIGHT UPPER ARM WHICH SPREAD AND ALSO HAD ITCHING TO THE AREA. STATED IT WAS RELIEVED WITH TOPICAL CORTISONE. STATED SHE HAD NOT STARTED TYPHOID PO YET.

VAERS ID:441262 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-03, Days after onset: 7
Location:Illinois  Entered:2011-11-03
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: BACTRIM, LATEX
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501088P IN 
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: ITCHY NOSE, MOUTH & FOREHEAD WITH REDNESS.

VAERS ID:441444 (history)  Vaccinated:2011-10-11
Age:40.0  Onset:2011-10-11, Days after vaccination: 0
Gender:Male  Submitted:2011-11-05, Days after onset: 25
Location:Wyoming  Entered:2011-11-05
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: no
Diagnostic Lab Data: EKG, B/P, scedule for Cardio Stress echo
CDC Split Type:
Vaccination
Manufacturer
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B044CA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Blood pressure increased, Chest pain, Dizziness, Electrocardiogram, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Numbness in extremities, dizziness, chest pain, raised B/P.

VAERS ID:441877 (history)  Vaccinated:2011-10-28
Age:40.0  Onset:2011-10-28, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 0
Location:Arkansas  Entered:2011-11-09, 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:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4178BA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pruritus, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: After being injected with vaccine, area around injection site started to itch, the spread to arm, shoulder, neck, chest, & back. Within 1 hour of injection.

VAERS ID:441921 (history)  Vaccinated:2011-10-21
Age:40.0  Onset:2011-10-21, Days after vaccination: 0
Gender:Female  Submitted:2011-11-09, Days after onset: 19
Location:North Carolina  Entered:2011-11-09
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: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA694AA1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Ear pain, Neck pain, Pain in extremity, Pain in jaw
SMQs:, Osteonecrosis (broad), Arthritis (broad)
Write-up: Pain down arm, radiating to neck, ear and jaw. Pain in neck continues nearly 3 weeks later, pain in jaw and ear intermittent.

VAERS ID:442130 (history)  Vaccinated:2011-11-09
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-10
Location:Unknown  Entered:2011-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad)
Write-up: Bilateral Red eyes.

VAERS ID:442286 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 0
Location:North Carolina  Entered:2011-11-11, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD; RLS; Hiatal hernia; Irritable colon; Migraine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AC IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3947BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Flushing, Headache, Lip oedema, Myalgia, Oedema peripheral, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Symptoms occurred several hours after receiving the flu vaccine. Symptoms included low-grade fever, facial flushing, headache, edema of lower lip and hands, chest tightness, and myalgia. Symptoms improved with administration of BENADRYL.

VAERS ID:442298 (history)  Vaccinated:2011-10-18
Age:40.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-11-10, Days after onset: 22
Location:Washington  Entered:2011-11-11, 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: None
Preexisting Conditions: Seasonal allergic rhinitis; (R) carpal tunnel syndrome
Diagnostic Lab Data: MRI if sx persist beyond reasonable time frame.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH463AB IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Bursitis, Injected limb mobility decreased
SMQs:, Arthritis (broad)
Write-up: Day after flu vaccine administration in (L) deltoid, pt developed pain in (L) shoulder joint & decreased ROM, consistent with bursitis. Sx persisted for 2 wks before she came in for evaluation. Ortho MD eval already scheduled day after our ofc eval.

VAERS ID:442323 (history)  Vaccinated:2011-11-10
Age:40.0  Onset:2011-11-11, Days after vaccination: 1
Gender:Female  Submitted:2011-11-12, Days after onset: 1
Location:Colorado  Entered:2011-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: p
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3984AA SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: A hard red area formed around the site of injection.

VAERS ID:442302 (history)  Vaccinated:2011-10-04
Age:40.0  Onset:2011-10-11, Days after vaccination: 7
Gender:Male  Submitted:2011-11-14, Days after onset: 34
Location:Connecticut  Entered:2011-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 45 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: No allergies; exercise induced asthma - rare
Diagnostic Lab Data: Hospitalized presently
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1100901 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Respiratory tract infection
SMQs:
Write-up: Respiratory illness 1 week after vaccine. Transported to hospital 10/31/11. Remains hospitalized to date.

VAERS ID:442343 (history)  Vaccinated:2011-11-10
Age:40.0  Onset:2011-11-10, Days after vaccination: 0
Gender:Female  Submitted:2011-11-14, Days after onset: 4
Location:Georgia  Entered:2011-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Prozac
Current Illness: NO
Preexisting Conditions: No
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Other     Purchased by: Other
Symptoms: Dysphagia, Feeling cold, Headache, Nausea, Sensation of foreign body, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (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 (narrow), Hypersensitivity (broad)
Write-up: At about 5:30 PM patient''s throat starting feeling like it had a lump in it which made it hard to swallow. About 10 minutes later started feeling nauseous and began vomiting. That was followed by shaking and feeling very cold and a headache. Vomited several times until patient''s stomach was empty and then continued to feel nauseous. Did not have a fever but was shaking from feeling cold. The nausea and vomiting subsided around 11:00 PM. The feeling of tightness in throat also stopped at the same time as the nausea.

VAERS ID:442351 (history)  Vaccinated:2011-10-13
Age:40.0  Onset:2011-10-13, Days after vaccination: 0
Gender:Female  Submitted:2011-11-14, Days after onset: 32
Location:Michigan  Entered:2011-11-14
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
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11020010IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Flushing, Headache, Increased upper airway secretion, Nasal congestion, Oropharyngeal pain, Pain, Productive cough, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Felt tickle in the back of throat and throat clearing which turned into a productive cough and felt like was "drowning". Atrovent nebulizer given and an Albuterol inhaler--3 puffs. Axid and Zyrtec were given orally. Began ''flushing'', but lasted only 45 minutes and throat clearing continued to be productive. 6-14 hours after injection nasal congestion started along with headache, feeling achy, and a sore throat. All symptoms resolved 24 hours after injection and patient felt fine.

VAERS ID:442604 (history)  Vaccinated:1996-05-05
Age:40.0  Onset:2011-11-10, Days after vaccination: 5667
Gender:Male  Submitted:2011-11-16, Days after onset: 6
Location:California  Entered:2011-11-16
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: Serologically negative for varicella exposure at time of inoculation.
Diagnostic Lab Data: Evaluation of rash by doctor confirmed shingles diagnosis.
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNRA
Administered by: Unknown     Purchased by: Private
Symptoms: Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Onset of shingles symptoms. Only previous exposure to varicella virus was from Varivax immunizations given in 1996.

VAERS ID:442648 (history)  Vaccinated:2011-11-14
Age:40.0  Onset:2011-11-14, Days after vaccination: 0
Gender:Female  Submitted:2011-11-16, Days after onset: 2
Location:Pennsylvania  Entered:2011-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: RAD Hx
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA052BA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Heart rate decreased, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad)
Write-up: Given vaccine, returned within one hour tachycardia 150 AP. Observation 1.5 hour pulse decreased 106.

VAERS ID:442662 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-16, Days after onset: 20
Location:Texas  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: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Initially it was typical soreness at injection site but the pain has become progressively worse and has impacted range of motion in left shoulder currently 3 weeks post immunization.

VAERS ID:442789 (history)  Vaccinated:2011-09-28
Age:40.0  Onset:2011-09-28, Days after vaccination: 0
Gender:Female  Submitted:2011-11-16, Days after onset: 49
Location:Washington  Entered:2011-11-16
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: TENDINITIS, SHOULDER, LEFT (ICD-726.10) following immunization, will treat with heat two times daily, range of motion three times daily, naprosyn, and see PCP or return here if symptoms persist over next 1-2 week. If symptoms persist may obtain MRI of shoulder as well.
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA618AB IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Injected limb mobility decreased, Injection site joint pain, Pain, Paraesthesia, Rotator cuff syndrome
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: No radiation of pain, but does have weakness to range of motion of the shoulder, and occasional paresthesias to hand. Left shoulder with diffuse tenderness in subacromial region to palpation and range of motion, with decreased flexion and abduction due to pain, nontender elsewhere, no erythema, edema or ecchymosis, left arm nontender, with grossly normal strength and sensation.

VAERS ID:442914 (history)  Vaccinated:2011-09-27
Age:40.0  Onset:2011-09-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-17, Days after onset: 51
Location:North Carolina  Entered:2011-11-17
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: High blood pressure, herniated disc C5-6 neck, allergic clindamycin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11012011IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Back pain, Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Approximately 5 days after the shot had general body aches, severe pain to lower back that has not stopped, and legs are very shaky when walking down stairs. Legs feel like they are having tremors when weight bearing descending stairs and has not resolved. Pain to lower back continues, but not as severe as within the first two weeks following the injection.

VAERS ID:443001 (history)  Vaccinated:2011-10-26
Age:40.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Male  Submitted:2011-11-18, Days after onset: 20
Location:California  Entered:2011-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2814IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Dizziness.

VAERS ID:443276 (history)  Vaccinated:2011-11-17
Age:40.0  Onset:2011-11-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-18, Days after onset: 1
Location:Ohio  Entered:2011-11-21, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AD UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Chest discomfort, Dyspnoea, Laryngitis, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Fever/aches pains/SOB/chest pressure/sore throat/laryngitis. Symptoms started in evening - vaccine administered at approx 5pm. Pt took APAP then Ibuprofen. Fever broke about 5:30 am.

VAERS ID:443441 (history)  Vaccinated:2011-11-21
Age:40.0  Onset:2011-11-21, Days after vaccination: 0
Gender:Female  Submitted:2011-11-23, Days after onset: 2
Location:Ohio  Entered:2011-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Neurontin Singulair Zyrtec
Current Illness: none
Preexisting Conditions: Allergy to Pollen, shingles, sensitivity to peanuts, tree nuts and wheat.
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA690AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dysphonia, Lip swelling, Rash erythematous, Swelling face, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Tongue swelling, hoarseness, red rash on face, arms, chest, face swelling, lips swelling, tight throat. Treated at ER with epi, Benadryl, steroids, Pepcid. Symptoms returned gradually over the next 24 hours. Second visit to ER 6:00pm next day, same symptoms, however, tongue swelling not present. Treated with Benadryl, steroids, and Pepcid.

VAERS ID:443481 (history)  Vaccinated:2011-11-21
Age:40.0  Onset:2011-11-21, Days after vaccination: 0
Gender:Female  Submitted:2011-11-23, Days after onset: 2
Location:California  Entered:2011-11-23
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: Mild occasional asthma via animal dander.
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDOU849221A3IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chest discomfort, Dysphonia, Dyspnoea, Hypopnoea
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: By 9:30 pm realized had a voice changes and was hoarse. By 10:15/10:30 I realized I was having a hard time breathing. It felt like a strong band was cinched around my chest and pulled real tight. It came in a "spasm"/ "wave" style. Not a familiar experience I have ever had. In a course of an hour, I found and took puffs about every 15/20 minutes of an inhaler I rarely need (unless playing with my rabbit) and found no relief. It became almost scarry by 11pm to 12pm ish as I feel I lost most of my breath and was very shallow in breathing. I do not have medical as we are currently unemployed, so I just held on and hoped it to get better. Stayed awake through the night. The next day, I felt "weird" in my chest. Best I can describe is a slight tightening with a minor shortness of breath. Today, 11/23, I feel better. Called Costco to tell them, they advised seeking advice from my doctor. Well, i don''t have one. So I assume getting shots for a previously paid for trip will not be in my future. I will hope for the best. I do have to take Yellow Fever and worry very very much about this. If you can advise as to a safer way to get this done, I would GREATLY appreciate any advice or recommendations :-)

VAERS ID:443512 (history)  Vaccinated:2011-11-14
Age:40.0  Onset:2011-11-14, Days after vaccination: 0
Gender:Female  Submitted:2011-11-25, Days after onset: 11
Location:New Jersey  Entered:2011-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: In box 13, step 3, the other shot given was a PPD, manufacturer PMC. Another PPD was placed on the opposite forearm and a negative 0 mm reaction was noted.
Current Illness: n/a
Preexisting Conditions: n/a
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV294 SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Incorrect route of drug administration, Nodule, Tenderness, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Had an unexpected and unusual reaction to the PPD test. Symptoms included increased erythema, tenderness, and a nodule. It is suspected that a 0.1 ml of anthrax vaccine was erroneously administered to the patient instead of the standard PPD solution.

VAERS ID:443519 (history)  Vaccinated:2011-10-26
Age:40.0  Onset:2011-11-01, Days after vaccination: 6
Gender:Female  Submitted:2011-11-25, Days after onset: 24
Location:Maine  Entered:2011-11-25
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: CT Neck, various blood tests
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Public     Purchased by: Other
Symptoms: Activities of daily living impaired, Blood test, Chills, Computerised tomogram, Dysphagia, Laryngitis, Lymph node pain, Lymphadenopathy, Pharyngitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Unable to swallow, lymph nodes on the same side as injection huge, swollen and painful, fever/chills, vomiting. DX: Acute Pharyngitis, Laryngitis ... missed 2 weeks of work, still sick following 2 weeks.

VAERS ID:443690 (history)  Vaccinated:2011-11-18
Age:40.0  Onset:2011-11-19, Days after vaccination: 1
Gender:Female  Submitted:2011-11-28, Days after onset: 9
Location:Wisconsin  Entered:2011-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medication given at the time of the vaccine. Unknown if other medication were taken by employee earlier the day of the vaccine.
Current Illness: No illness reported at the time of immunization.
Preexisting Conditions: Reports that she reacts to everything. Headache and hives.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEURC4008BA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Reports itching and slight headache. Note pink blotching areas on forearms.

VAERS ID:443704 (history)  Vaccinated:2011-10-24
Age:40.0  Onset:2011-10-24, Days after vaccination: 0
Gender:Female  Submitted:2011-11-28, Days after onset: 35
Location:Illinois  Entered:2011-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Magnesium oxide oral tabs, Topamax oral tab, Zanaflex caps, Zyrtec caps
Current Illness: None known
Preexisting Conditions: No Known Drug Allergies, Allergies to Lilacs, Lillies, and perfumes -personal history of anaphylaxis manifesting as tightness in throat and SO, without urticaria or hypotension when exposed to certain perfumes, lilacs, or lilies -migraines
Diagnostic Lab Data: CSF fluid collection, CXR
CDC Split Type:
Vaccination
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH493AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: CSF test, Chest X-ray, Dysphonia, Dyspnoea, Rhinorrhoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Developed runny nose and hoarseness in throat as well as pressure in throat like her airway was "shutting off" and some S.O.B. No rash, itching, cough, or swelling of tongue or lips.

VAERS ID:443725 (history)  Vaccinated:2011-11-23
Age:40.0  Onset:2011-11-25, Days after vaccination: 2
Gender:Female  Submitted:2011-11-28, Days after onset: 3
Location:New Jersey  Entered:2011-11-28
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: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH453AB0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Cellulitis, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling to area and heat generated. When went to hospital diagnosed with cellulitis.

VAERS ID:443863 (history)  Vaccinated:2011-09-08
Age:40.0  Onset:2011-09-10, Days after vaccination: 2
Gender:Male  Submitted:2011-11-29, Days after onset: 80
Location:Pennsylvania  Entered:2011-11-29
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: Penicillin
Diagnostic Lab Data: An EMG test is scheduled, but the nerve damage is progressing rapidly.
CDC Split Type:
Vaccination
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TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
Administered by: Unknown     Purchased by: Other
Symptoms: Neuralgia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)
Write-up: Initial symptoms were mild, sporadic, and infrequent (i.e. tingling in my feet only when I biked). Symtoms were limited to my feet and then over a month''s time migrated to include tingling in my hands, and eventually to tingling throughout my body, and now, two months after the vaccine, I have full body nerve pain and began taking Neurontin. I have not officially been diagnosed with MS, but the symptoms are classic to MS.

VAERS ID:444317 (history)  Vaccinated:2011-10-10
Age:40.0  Onset:2011-10-13, Days after vaccination: 3
Gender:Female  Submitted:2011-12-02, Days after onset: 50
Location:California  Entered:2011-12-02
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: unknown
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA688AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Decreased appetite, Fatigue, Headache, Injection site pain, Injection site warmth, Neck pain, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Site is warm, pain in arm down to elbow. Pain in neck goes up to head. Bad headache. Scattered pain throughout. No appetite, stomach aches for 3 days. Overall tiredness.

VAERS ID:444329 (history)  Vaccinated:2011-11-28
Age:40.0  Onset:2011-11-28, Days after vaccination: 0
Gender:Female  Submitted:2011-12-02, Days after onset: 4
Location:New York  Entered:2011-12-02
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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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA652AA IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Developed pain and erythema at injection site increasing to 15cmx15cm region of erythema in right upper arm.

VAERS ID:444550 (history)  Vaccinated:2011-10-31
Age:40.0  Onset:2011-10-31, Days after vaccination: 0
Gender:Female  Submitted:2011-12-05, Days after onset: 35
Location:Texas  Entered:2011-12-05
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
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101401 IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1200AA0IMLA
Administered by: Other     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: Left arm sore, red and swollen at injection site. Went to Urgent Care twice and Dr. once for pain. Antibiotics and Benadryl.

VAERS ID:444691 (history)  Vaccinated:2011-12-01
Age:40.0  Onset:2011-12-02, Days after vaccination: 1
Gender:Female  Submitted:2011-12-06, Days after onset: 4
Location:Washington  Entered:2011-12-06
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: Allergy to Sulfa
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA636AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Diarrhoea, Headache, Nausea, Oral herpes, Pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Nausea, Headache, body aches, cold sore started, diarrhea - started approx 1130 on 12/2/11 and all symptoms gone 12/3/11 at 0700.

VAERS ID:444745 (history)  Vaccinated:0000-00-00
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-12-02
Location:Indiana  Entered:2011-12-07, 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: Unknown
Preexisting Conditions: NKDA; medical conditions unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11161P0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Joint range of motion decreased, Pain in extremity
SMQs:, Arthritis (broad)
Write-up: Sore arm limiting range of motion. Pt has seen dr.

VAERS ID:444752 (history)  Vaccinated:2011-11-08
Age:40.0  Onset:2011-11-13, Days after vaccination: 5
Gender:Male  Submitted:2011-12-01, Days after onset: 18
Location:Illinois  Entered:2011-12-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Ulcerative colitis
Diagnostic Lab Data: Surgical Pathology Report (attached)
CDC Split Type:
Vaccination
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JEV1: JAPANESE ENCEPHALITIS (IXIARO)INTERCELL AGJEV10F54E1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Appendicectomy, Appendicitis
SMQs:
Write-up: Acute appendicitis / appendectomy see attached surgical pathology report.

VAERS ID:444790 (history)  Vaccinated:2011-12-04
Age:40.0  Onset:2011-12-04, Days after vaccination: 0
Gender:Female  Submitted:2011-12-04, Days after onset: 0
Location:Indiana  Entered:2011-12-07, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ICD 9 codes: 397.0; 427.0; 785.1; 401.1
Diagnostic Lab Data: CT & labs were normal
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED04849211A IMLA
Administered by: Military     Purchased by: Military
Symptoms: Computerised tomogram normal, Dizziness, Laboratory test normal, Malaise, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: Complains of dizziness, trouble focusing, and feeling ill. 1205 BP 120/80, pulse 83. 1214 BP 140/40, pulse 94. Provided O2 via nasal cannula. Transported to emergency department.

VAERS ID:445024 (history)  Vaccinated:2011-02-04
Age:40.0  Onset:2011-02-18, Days after vaccination: 14
Gender:Male  Submitted:2011-08-18, Days after onset: 180
Location:Unknown  Entered:2011-12-09, Days after submission: 113
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline; NASONEX; NEXIUM; ALLEGRA
Current Illness: None
Preexisting Conditions: Seasonal Allergies; Occasional acid reflux
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2571UNRA
Administered by: Military     Purchased by: Other
Symptoms: Chills, Neck pain, Pain, Salivary gland disorder, Tenderness
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad)
Write-up: 13Feb - No fever, had chills & aches after Anthrax vac on 4Feb11. Neck tenderness under ears. 25Feb - No fever, neck pain under ears. 6Mar - No fever, neck pain under ears, submandibular gland irritation.

VAERS ID:445068 (history)  Vaccinated:2011-12-01
Age:40.0  Onset:2011-12-09, Days after vaccination: 8
Gender:Female  Submitted:2011-12-09, Days after onset: 0
Location:Georgia  Entered:2011-12-09
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
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Dose
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YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER  SYR 
Administered by: Private     Purchased by: Private
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: There is a large red oval shaped circle around the injection site. It is tender, raised, and itchy.

VAERS ID:445530 (history)  Vaccinated:2011-10-06
Age:40.0  Onset:2011-10-10, Days after vaccination: 4
Gender:Female  Submitted:2011-12-05, Days after onset: 56
Location:Unknown  Entered:2011-12-15, 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: lisinopril; citalopram
Current Illness:
Preexisting Conditions: hypertension
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Inflammation, Injection site erythema, Injection site pain, Injection site swelling, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 40 yo presented to Emergency Room with tetanus vaccine ADR. Inflammatory response due to tetanus vaccine: Received tetanus vax in Rt shoulder 4 days ago - on 10/6/2011 - 3 days - 10/7/2011 - ago developed pain, swelling, redness near immunization site along with chills and nausea. Discharged from ED with rxs for cephalexin and prednisone.

VAERS ID:445604 (history)  Vaccinated:2011-11-18
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-12-15
Location:Texas  Entered:2011-12-15
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: cellulitis infection & reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
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TDAP: TDAP (ADACEL)SANOFI PASTEURU3868GA UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Cellulitis, Dizziness, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Time course 3.5 weeks and counting severe dizziness, right side of body numb and.

VAERS ID:445670 (history)  Vaccinated:2011-08-16
Age:40.0  Onset:2011-08-17, Days after vaccination: 1
Gender:Female  Submitted:2011-12-09, Days after onset: 114
Location:Texas  Entered:2011-12-16, 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: AMOUR THYROID
Current Illness:
Preexisting Conditions: Lyme 20 yr ago; previous PE; Alpha-1-antitrypsin def
Diagnostic Lab Data: No evidence PE on testing
CDC Split Type:
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB223CA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Chills, Headache, Hypoaesthesia, Laboratory test normal, Musculoskeletal stiffness, Oropharyngeal pain, Vertigo
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Arthritis (broad)
Write-up: Chills, sore throat, chest pain, vertigo, headache, neck stiffness, (L) facial numbness.

VAERS ID:445897 (history)  Vaccinated:2011-12-06
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-12-20
Location:Illinois  Entered:2011-12-20
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
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TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC5280708DA SYRLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injected limb mobility decreased
SMQs:
Write-up: Patient called and stated she has been having problems lifting arm where vaccine was given. No swelling itching or redness at sight of injection.

VAERS ID:445967 (history)  Vaccinated:2011-09-23
Age:40.0  Onset:2011-09-26, Days after vaccination: 3
Gender:Female  Submitted:2011-12-20, Days after onset: 85
Location:Ohio  Entered:2011-12-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AC IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.09332 IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Abscess sterile, Inflammation, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Doctor described her condition as a sterile abscess. Her entire arm from wrist to shoulder was swollen and inflamed. Her doctor prescribed antibiotics.

VAERS ID:445995 (history)  Vaccinated:2011-10-04
Age:40.0  Onset:2011-10-10, Days after vaccination: 6
Gender:Female  Submitted:2011-12-21, Days after onset: 72
Location:Florida  Entered:2011-12-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A - will be headed to the doctor to determine cause as well as solution.
CDC Split Type:
Vaccination
Manufacturer
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DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRRA
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  JETLA
HEPAB: HEP A + HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRRA
Administered by: Unknown     Purchased by: Private
Symptoms: Activities of daily living impaired, Back pain, Injection site joint pain, Insomnia, Musculoskeletal pain, Neck pain, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Arthritis (broad)
Write-up: I had shots for the flu, Hep, Tetanus and MMR. Three shots in right arm and one in left arm. Extreme pain continued in right arm/shoulder. Can not lift heavy items, very difficult to dry hair, get dressed, pick up groceries. Arm "pops" or "cracks" when moved to certain positions. Difficult to sleep at night - continuous throbbing pain, starting in arm going into shoulder, back, neck and sometime leg.

VAERS ID:446231 (history)  Vaccinated:2011-11-30
Age:40.0  Onset:2011-12-02, Days after vaccination: 2
Gender:Female  Submitted:2011-12-23, Days after onset: 21
Location:D.C.  Entered:2011-12-23
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: referred to her private MD
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDN 569070IMLA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Injected limb mobility decreased, Injection site pain, Joint range of motion decreased, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Experienced initial pain with injection of medicine that resolved shortly after;woke two days later with +8-9/10 pain LT deltoid at injection site; intermittent pain radiation to posterior aspect of LT forearm;at no time was there any swelling and/or discoloration;denies any tingling and/ or numbness;decreased ROM and strength of LT arm and cannot raise LT arm above her waist without assistance of other arm; minimal improvement over last three weeks; has done no self treatment e.g. NSAIDS or cold or heat application;feels fatigued and "run down"; pt was referred to her private MD for further evaluation

VAERS ID:446794 (history)  Vaccinated:2011-11-08
Age:40.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:New Mexico  Entered:2012-01-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT424AA1IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Arm especially sore at shot site after flu for 3 days.

VAERS ID:446847 (history)  Vaccinated:2011-12-08
Age:40.0  Onset:2011-12-11, Days after vaccination: 3
Gender:Male  Submitted:2011-12-21, Days after onset: 10
Location:Pennsylvania  Entered:2012-01-05, Days after submission: 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: The patient had no illness at the time of vaccination, allergies or past medical history. The patient did not take any concomitant medications. No other vaccinations were given within four weeks prior to 08 December 2011. The patient''s wife had shingles.
Diagnostic Lab Data: None reported
CDC Split Type: 201112191
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4249AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Initial report was received from a health care professional on 12 December 2011. A 40-year-old male patient received an intramuscular injection (dose 1) in the left deltoid of MENACTRA, sanofi pasteur Inc., lot number U4249AA on 08 December 2011 at 2:30 PM. On 11 December 2011 at 6:00 AM, the patient vomited one time and had numbness from the tip of the tongue to the right ear and from the right hand to the forearm and elbow. The patient had no illness at the time of vaccination, allergies or past medical history. The patient did not take any concomitant medications. No other vaccinations were given within four weeks prior to 08 December 2011. The patient''s wife had shingles. No further information was available at the time of the report. The patient''s outcome was unknown. Documents held by sender: none.

VAERS ID:446851 (history)  Vaccinated:2011-10-23
Age:40.0  Onset:2011-10-24, Days after vaccination: 1
Gender:Female  Submitted:2011-12-10, Days after onset: 47
Location:Kentucky  Entered:2012-01-05, Days after submission: 26
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) (AFLURIA)CSL LIMITED13749121A0UNLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Patient called pharmacy 12-10-11 to report muscle and joint pain that started on day after vaccination and has continued since then.

VAERS ID:447026 (history)  Vaccinated:2011-12-05
Age:40.0  Onset:2011-12-05, Days after vaccination: 0
Gender:Male  Submitted:2011-12-08, Days after onset: 3
Location:Washington  Entered:2012-01-09, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril; ASA; PLAVIX; LIPITOR; amlodipine; CERVIDIL; clonidine; VICODIN
Current Illness: F/up for chronic med issues
Preexisting Conditions: HTN; CAD; hyperlipidemia; prior MI
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0813AA0SYRLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site induration, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Injection site became very indurated warm, tender.

VAERS ID:447113 (history)  Vaccinated:2011-12-19
Age:40.0  Onset:2011-12-19, Days after vaccination: 0
Gender:Female  Submitted:2012-01-10, Days after onset: 22
Location:California  Entered:2012-01-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURLU4122AA1UNLA
Administered by: Public     Purchased by: Other
Symptoms: Dry eye, Hypoaesthesia, Muscle twitching, VIIth nerve paralysis
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow)
Write-up: Employee reported experiencing (L) facial numbness 1 hour after administration of flu vaccine on 12-19-11. Followed by facial twitching & (L) eye dryness. Went to urgent care after shift ended, diagnosed "Bell''s Palsy". Steroids prescribed.

VAERS ID:447114 (history)  Vaccinated:2011-09-01
Age:40.0  Onset:2011-09-03, Days after vaccination: 2
Gender:Female  Submitted:2011-09-15, Days after onset: 12
Location:New York  Entered:2012-01-10, Days after submission: 117
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ranitidine 50mg BID; Calcium + Vit. D
Current Illness:
Preexisting Conditions: TD 2008
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AC IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Glossodynia, Oral pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Mouth/tongue painful.

VAERS ID:447139 (history)  Vaccinated:2011-10-01
Age:40.0  Onset:2011-10-01, Days after vaccination: 0
Gender:Female  Submitted:2012-01-10, Days after onset: 101
Location:Michigan  Entered:2012-01-10
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: ZYRTEC as needed
Current Illness: None
Preexisting Conditions: BENADRYL; penicillin; sulfa; LEVAQUIN; latex; polycystic ovarian syndrome
Diagnostic Lab Data: MRI 10/24/11
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1100121 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Drug administered at inappropriate site, Immediate post-injection reaction, Inflammation, Injected limb mobility decreased, Injection site pain, Nuclear magnetic resonance imaging, Surgery
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Shot given too high in shoulder - extreme pain while receiving. Could not move arm or use arm immediately after shot. Doctor visit 10/3 & 10/17 - referred to orthopedic surgeon. Surgeon - 10/20, MRI 10/24, & surgeon f/u 10/31 - Surgery 11/1/11 due to extreme inflammation. PT f/u.

VAERS ID:447319 (history)  Vaccinated:2012-01-09
Age:40.0  Onset:2012-01-13, Days after vaccination: 4
Gender:Female  Submitted:2012-01-13, Days after onset: 0
Location:New York  Entered:2012-01-13
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: Unknown
Diagnostic Lab Data: HIV testing performed (negative)
CDC Split Type:
Vaccination
Manufacturer
Lot
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0784AA0SCLA
Administered by: Private     Purchased by: Private
Symptoms: HIV test negative, Pyrexia, Varicella post vaccine
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: (1/9/12) Patient was seen in MD office for Physical. She was given Varicella at the time of visit. On 1/13/2012 to pick up forms and physician discovered patient had chicken pox. No other illness - temperature 99.3 - pt instructed for home isolation, counseled on fever, TYLENOL, ER if symptoms worsen.

VAERS ID:447348 (history)  Vaccinated:2012-01-11
Age:40.0  Onset:2012-01-12, Days after vaccination: 1
Gender:Male  Submitted:2012-01-16, Days after onset: 4
Location:Maine  Entered:2012-01-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen 600 mg; LOTRIMIN 1 % cream
Current Illness: None
Preexisting Conditions: Red dye sensitivity
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1297AA0SYRLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4015AA SYRRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Incoherent, Injection site erythema, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient developed chills, body aches, mild fever (didn''t take actual temp) and local redness & swelling at site of injection, left deltoid. Pt said he felt incoherent for awhile. He also received Tdap same day.

VAERS ID:447510 (history)  Vaccinated:2011-08-10
Age:40.0  Onset:2011-08-12, Days after vaccination: 2
Gender:Male  Submitted:2012-01-13, Days after onset: 154
Location:Pennsylvania  Entered:2012-01-18, 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: Rash - itching
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB185AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt. not available to speak. Wife stated two days after last injection, pt. started rash and itching which became worse. Did go through ER for treatment, received steroids started up in one month. No long term effects. Physician instructed not to receive any more TWINRIX.

VAERS ID:447787 (history)  Vaccinated:2012-01-20
Age:40.0  Onset:2012-01-21, Days after vaccination: 1
Gender:Female  Submitted:2012-01-23, Days after onset: 2
Location:Georgia  Entered:2012-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Extensive swelling, severe pain, and redness of the arm where the shot was given. Chills and Fever.
Preexisting Conditions: Citrus Acid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1SYRRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Injection site erythema, Injection site pain, 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: Severe extensive redness, pain, swelling at the injection site. I have had chills and fever of 101.

VAERS ID:447924 (history)  Vaccinated:2011-07-20
Age:40.0  Onset:0000-00-00
Gender:Female  Submitted:2011-12-20
Location:New York  Entered:2012-01-23, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: There were no concomitant vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0948003A
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB846AA2UNLA
Administered by: Private     Purchased by: Private
Symptoms: Alopecia
SMQs:
Write-up: This case was reported by a healthcare professional and described the occurrence of hair loss in a 40-year-old female subject who was vaccinated with ENGERIX B (GlaxoSmithKline). On 20 July 2011 at 15:45 the subject received 3rd dose of ENGERIX B (1 ml, unknown route, left arm). On an unspecified date in 2011, approximately 1 month after vaccination with ENGERIX B, the subject experienced hair loss. The subject was treated with unspecified medications under dermatologist care. At the time of reporting the event was worse.

VAERS ID:447926 (history)  Vaccinated:1992-07-24
Age:40.0  Onset:2010-03-03, Days after vaccination: 6431
Gender:Female  Submitted:2011-12-20, Days after onset: 657
Location:Florida  Entered:2012-01-23, Days after submission: 34
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: Concomitant medications were unknown. The subject had not relevant medical history that would contraindicate receiving vaccinations. The healthcare professional reported that the subjects were not required to provide medical history or concomitant medications when vaccinations were administered. The subject had not experienced adverse events following previous vaccinations.
Diagnostic Lab Data: Hepatitis B surface antibody, 03Mar2010, 0.26mIU/mL, 0.99; Hepatitis B surface antibody, 08Aug2011, 0.53mIU/mL, 0.99
CDC Split Type: A0947241A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hepatitis B surface antibody negative, No therapeutic response, Product quality issue
SMQs:, Lack of efficacy/effect (narrow)
Write-up: This case was reported by a healthcare professional and described the occurrence of not responding to therapy in a female subject of unspecified age who was vaccinated with Hep B (manufacturer unspecified) and ENGERIX B (GlaxoSmithKline). Concurrent vaccination included tdap vaccine (non-gsk); non-GSK manufacturer given on 21 January 2010. On 24 July 1992, 25 August 1992 and 28 January 1993 the subject received 1st dose, 2nd dose and 3rd dose of Hep B (1ml, unknown route, unknown deltoid). On an unknown date the subject experienced not responding to therapy. The subject''s titers were drawn and were negative. On 12 July 2007, 21 August 2007 and 21 January 2010 the subject received 1st dose, 2nd dose and 3rd dose of ENGERIX B (1 ml, unknown route, unknown deltoid). On 3 March 2010, 41 days after 3rd vaccination with ENGERIX B, 2 years after 2nd vaccination with ENGERIX B, 3 years after 1st vaccination with ENGERIX B, 17 years after 3rd vaccination with Hep B, 18 years after 2nd and 1st vaccination with Hep B, the subject experienced not responding to therapy. The subject''s titers were drawn on 3 March 2010 and were 0.2 (units not provided). The subject received a booster dose (or 4th) dose of ENGERIX B on 5 March 2010 (1mL, unknown route, unknown deltoid). Repeat titer was drawn on 10 August 2011, 17 months after the booster dose of ENGERIX B and the subject experienced not responding to therapy. The titer was less than 0.1 (units not specified). This case involves a pharmaceutical product complaint. The healthcare professional reported that she had seen an increase in non-responders to vaccination with ENGERIX B and was concerned about the vaccine. It was noted that all the vaccines are monitored by several methods for temperature excursions. The healthcare professional reported 7 cases of not responding to therapy following Hep B vaccination. This is case 4 of 7 (see case IDs A0947199A, A0947239A, A0947240A, A0947242A-A0947244A for details of the other reports). Follow-up received from the reporting healthcare professional on 18 October 2011: On 03 March 2010, the subject''s hepatitis B surface antibody was 0.26 mIU/mL (immunity was noted by the healthcare professional as greater than 0.99). On 08 August 2011, the subject''s hepatitis B surface antibody was 0.53 mIU/mL. All doses of Hep B and ENGERIX B were administered intramuscularly. All doses of Hep B and the 1st and 4th doses of ENGERIX B were administered in the left deltoid. The 2nd and 3rd doses of ENGERIX B were administered in the right deltoid.

VAERS ID:447860 (history)  Vaccinated:2012-01-23
Age:40.0  Onset:2012-01-23, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2012-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic to Ibuprofen
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS110404 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Pruritus, Rash erythematous, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: 1-2 hrs following vaccination noticed red bumps, face itchy - transient and periodic itching scalp, scratchy throat. BENADRYL 25 at 3 PM.

VAERS ID:447941 (history)  Vaccinated:2011-10-31
Age:40.0  Onset:2011-11-05, Days after vaccination: 5
Gender:Male  Submitted:2012-01-24, Days after onset: 80
Location:Georgia  Entered:2012-01-24
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 46 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Lorazapam, Zoloft
Current Illness: none
Preexisting Conditions: developmentally delayed
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA6801UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1420AA0UNUN
Administered by: Unknown     Purchased by: Public
Symptoms: Abasia, Communication disorder, Enuresis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Found my son in bed at 8:00 am. Had urinated in bed, not responsive, could not walk, or communicate with me.

VAERS ID:448407 (history)  Vaccinated:2011-11-21
Age:40.0  Onset:2011-12-05, Days after vaccination: 14
Gender:Female  Submitted:2012-01-31, Days after onset: 57
Location:Tennessee  Entered:2012-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 300 mg
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11134P0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Arm was still painful at injection site 2 weeks after vaccine given. Pharmacist recommended OTC ibuprofen.

VAERS ID:448586 (history)  Vaccinated:2011-02-03
Age:40.0  Onset:2011-02-10, Days after vaccination: 7
Gender:Female  Submitted:2012-02-01, Days after onset: 356
Location:New Jersey  Entered:2012-02-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline 100 mg daily; SYNTHROID 100 mcg daily
Current Illness: None
Preexisting Conditions: Dx''d with hypothyroidism in 2003; around the same time developed bilateral CTS; she started SYNTHROID and CTS symptoms resolved.
Diagnostic Lab Data: None.
CDC Split Type:
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SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURV04003  LA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Circadian rhythm sleep disorder, Dermatitis acneiform, Erythema, Eschar, Fatigue, Headache, Injection site erythema, Lymphadenopathy, Macule, Malaise, Papule, Rash pustular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Received smallpox vaccine in (L) posterior deltoid on 03Feb2011. Beginning on 10-11Feb, patient developed lymphadenopathy in (L) axilla and erythema in entire (L) deltoid/axilla region; these sxs resolved after two days. She arrived abroad on 12Feb and on that day developed numerous pustules on her chest. Evaluation on 15 Feb noted headache, fatigue, joint pain and swelling (described in separate VAERS). Rash described as erythematous "spots" on chest, back and a few on abdomen. Exam noted: Tamp 98.2, HR 70, BP 130/79, RR 18, normal exam except skin noted to have macules, papules and pustules to trunk and back, with acneiform eruption on face and back. Eschar on arm. Assessment included: 1) Arthralgias, c/w possible low-grade, concurrent viral prodrome - Naprosyn. 2) Headache - Acetaminophen two tabs twice daily. 3) Malaise, c/w hypothyroidism and jet lag and possible concurrent, mild viral prodrome. Patient reports rash and headache resolved within 3-5 days and fatigue gradually resolved over 2-3 weeks.

VAERS ID:448634 (history)  Vaccinated:2011-08-18
Age:40.0  Onset:2011-08-18, Days after vaccination: 0
Gender:Male  Submitted:2011-08-22, Days after onset: 4
Location:New York  Entered:2012-02-02, Days after submission: 164
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TUBERSOL
Current Illness:
Preexisting Conditions: No known allergies. Denied concurrent illness, past medical history any receipt of any other vaccinations within four weeks of TYPHIM Vi and TUBERSOL.
Diagnostic Lab Data: Not reported
CDC Split Type: 201107268
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURE0549 IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Fatigue, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Initial report was received 19 August 2011 which consisted of a cluster of two patients who experienced adverse events after receiving TYPHIM Vi, lot number E0549. This case represents one of the two patients. The other patient has been captured in case number 2011-07269. A 40-year-old male patient who had no concurrent illness and no past medical history had received an intramuscular right deltoid injection of TYPHIM V, lot number E0549 and an intradermal left forearm injection of TUBERSOL 5 TV, lot number C3761AA on 18 August 2011 and later that evening, he complained of a headache, dizziness and fatigue. The patient had not received any other vaccines within four weeks of TYPHIM Vi and TUBERSOL 5 TV. Outcome was not recovered. Documents held by sender: None.

VAERS ID:448832 (history)  Vaccinated:2012-01-29
Age:40.0  Onset:2012-01-29, Days after vaccination: 0
Gender:Female  Submitted:2012-02-05, Days after onset: 7
Location:Pennsylvania  Entered:2012-02-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZARAH; cyclobenzaprine
Current Illness: No
Preexisting Conditions: High CPK
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3490AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chest pain, Injection site pain, Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Side effects were arm pain, hand pain, chest pain, shoulder blade pain in addition to pain at injection site. Injection was given on Sunday, 1/29/12 and pain lasted until Thursday, Feb. 2nd, 2012.

VAERS ID:449199 (history)  Vaccinated:2012-01-25
Age:40.0  Onset:2012-02-06, Days after vaccination: 12
Gender:Male  Submitted:2012-02-09, Days after onset: 3
Location:California  Entered:2012-02-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04003A0OTRA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: HEADACHE, NAUSEA, DIZZINESS.

VAERS ID:449255 (history)  Vaccinated:2012-01-26
Age:40.0  Onset:2012-01-27, Days after vaccination: 1
Gender:Female  Submitted:2012-01-30, Days after onset: 3
Location:Washington  Entered:2012-02-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4041AA1IMUN
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Headache, Injection site erythema, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Patient complained of 2 day fever, headache, joint pain, arm pain & redness at injection site.

VAERS ID:449298 (history)  Vaccinated:2011-12-16
Age:40.0  Onset:2011-12-17, Days after vaccination: 1
Gender:Female  Submitted:2012-02-10, Days after onset: 55
Location:Maryland  Entered:2012-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: minocycline 100mg/d
Current Illness: None
Preexisting Conditions: Sulfa
Diagnostic Lab Data: No testing done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073BA0SYRLA
Administered by: Private     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Received her TDAP vaccine on 12/16/11. No initial pain at injection site. 12/17/11 am began to have pain in upper left arm. Pain continued to be present. Week after Christmas she was unable to lift arm and pain continued. She saw her PCP 1/31/12 after being advised to by our office. Was treated with NSAIDS. Seen again 2/9/12 and pain is achy to sharp. Still unable to raise left arm over head. Now treated with steroids and physical therapy.

VAERS ID:449791 (history)  Vaccinated:2012-02-08
Age:40.0  Onset:2012-02-13, Days after vaccination: 5
Gender:Female  Submitted:2012-02-17, Days after onset: 4
Location:Washington  Entered:2012-02-17
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
TDAP: TDAP (ADACEL)SANOFI PASTEURU3872BA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pain, redness, swelling for the first 2-3 days, then hot to the touch at the injection site 5 days after injection given.

VAERS ID:449811 (history)  Vaccinated:2012-02-11
Age:40.0  Onset:2012-02-14, Days after vaccination: 3
Gender:Male  Submitted:2012-02-19, Days after onset: 5
Location:Michigan  Entered:2012-02-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: codeine
Diagnostic Lab Data: Cat Scan, Complete blood count
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEUR 0SYRLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS    
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Computerised tomogram, Fatigue, Full blood count, Headache, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe tingling in back arms, legs neck with pain in head and back with nasuea and fatigue. Went to ER and ambulatory car three time for these symptoms.

VAERS ID:449925 (history)  Vaccinated:2010-10-01
Age:40.0  Onset:2010-10-01, Days after vaccination: 0
Gender:Female  Submitted:2012-02-03, Days after onset: 490
Location:North Carolina  Entered:2012-02-20, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI
Current Illness: Allergy to sulfa drugs; Contrast media anaphylaxis; Seasonal allergy; Skin ulcer
Preexisting Conditions: No concomitant vaccinations. The subject reported anaphylaxis to contrast media and sulfa drugs cause burns. the subject had previously received influenza vaccinations and no adverse events were reported. No adverse events were reported following receipt of prior immunizations.
Diagnostic Lab Data: UNK
CDC Split Type: A0948278A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA616AA0UNRA
Administered by: Public     Purchased by: Other
Symptoms: Dysphonia, Injection site erythema, Injection site pain, Injection site swelling, Lymph node pain, Lymphadenopathy, Malaise, Pain, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: This case was reported by a consumer and described the occurrence of swollen axillary lymph nodes in a 40-year-old female subject who was vaccinated with FLULAVAL (GlaxoSmithKline). A physician or other health care professional has not verified this report. Concurrent medical conditions included allergy to sulfa drugs, contrast media anaphylaxis, seasonal allergy and skin ulcer. Concurrent medications included MVI, Antihistamine and Calcium. On an unspecified date in October 2010 the subject received 1st dose of FLULAVAL (unknown, right arm). On an unspecified date in October 2010, less than one day after vaccination with FLULAVAL, the subject experienced localized pain (injection site pain). One day after vaccination with FLULAVAL, the subject experienced facial swelling, axillary left swollen lymph nodes and inguinal right swollen lymph nodes that was tender to touch. At an unspecified time after vaccination with FLULAVAL, the subject experienced swelling injection site, injection site redness, hoarseness, malaise and swelling of face. At the time of reporting the outcome of the swelling of face and swollen axillary lymph nodes resolved within 24 hours; injection site pain injection site redness and injection site swelling resolved within 36 hours. The swollen inguinal lymph node that was tender to touch resolved in March 2011. The events of malaise, hoarseness were unspecified. The subject reported that she receive last year''s seasonal FLULAVAL in October 2010 at the health department. She stated that she had a localized pain, swelling and redness at the injection site. She also developed systemic reactions of hoarseness, malaise, facial swelling, swollen left axillary lymph nodes and right inguinal lymph nodes. The inguinal lymph node continued to be tender to the touch until March 2011 when it seemed to completely resolve. The localized reactions seemed to resolve after 36 hours. The subject took BENADRYL and the facial swelling and swollen axillary lymph node resolved. The consumer reported another case, see A0948347A.

VAERS ID:449962 (history)  Vaccinated:2011-12-19
Age:40.0  Onset:2011-12-19, Days after vaccination: 0
Gender:Male  Submitted:2011-12-19, Days after onset: 0
Location:Tennessee  Entered:2012-02-21, 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: SINGULAIR; Albuterol; ADVAIR; ZANTAC; PROVENTIL
Current Illness: None
Preexisting Conditions: Hypoglycemia; Asthma
Diagnostic Lab Data: None
CDC Split Type: TN11025
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0352AA0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Hypoaesthesia oral, Hypoglycaemia, Paraesthesia oral, Tremor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Vaccine given at approx 1pm, at approx 1:05 pt complains of numbness and tingling in lips. Denies difficulty breathing, no itching, no rash, BP 138/92 Dr. notified - Monitor and complete forms. While monitoring pt complains of feeling "sugar drop" and hands shaking. Wife gives food and drink, after eating pt states he feels much better - adds it was not vaccine, but his sugar dropping.

VAERS ID:450016 (history)  Vaccinated:2012-02-10
Age:40.0  Onset:2012-02-12, Days after vaccination: 2
Gender:Female  Submitted:2012-02-17, Days after onset: 5
Location:Colorado  Entered:2012-02-21, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA; Asthma; hypothyroid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3984AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Axillary pain, Injection site erythema, Injection site induration, Injection site pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Erythema, tenderness & induration 2cm x 2cm at site left deltoid. Also c/o tenderness, swelling left axilla. BENADRYL / ice.

VAERS ID:450154 (history)  Vaccinated:2012-02-23
Age:40.0  Onset:2012-02-23, Days after vaccination: 0
Gender:Male  Submitted:2012-02-23, Days after onset: 0
Location:Virginia  Entered:2012-02-23
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
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4104AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt. deltoid muscle swelled immediately after Tdap injected to approximately 50 mm in diameter. Deltoid muscle was red. Ice was applied. Pt. reported no pain, 50mg oral BENADRYL given. Dr. evaluated pt.

VAERS ID:450548 (history)  Vaccinated:2011-09-15
Age:40.0  Onset:2011-09-17, Days after vaccination: 2
Gender:Female  Submitted:2011-10-27, Days after onset: 40
Location:South Carolina  Entered:2012-02-23, Days after submission: 119
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions: Mild reaction to cat dander. No known allergies.
Diagnostic Lab Data:
CDC Split Type: MEDI0013782
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A non-serious spontaneous report of itchy scalp, palm and feet, red palms, red feet and hives on forearms, legs, ears and trunk has been received from a consumer concerning a 40-year-old female, subsequent to FLUMIST. The patient''s past medical history included mild reaction to cat dander. No concomitant medications have been reported for this patient. The patient received FLUMIST on 15-Sep-2011. On 17-Sep-2011, the patient experienced itchy scalp. Days later patient had very itchy and red palms and feet, which lasted a week. It stopped for one day. Then patient had red and itchy hives on forearms, legs, ears and trunk of the body. The outcome of events red palms and red feet were recovered and the outcome of events itchy scalp, palm and feet and hives on forearms, legs, ears and trunk was unknown.

VAERS ID:450291 (history)  Vaccinated:2012-02-21
Age:40.0  Onset:2012-02-21, Days after vaccination: 0
Gender:Female  Submitted:2012-02-24, Days after onset: 3
Location:Maryland  Entered:2012-02-24
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 (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Itching and redness at site with increasing redness and swelling for past two days, with body aches and low-grade fever.

VAERS ID:450372 (history)  Vaccinated:2012-02-20
Age:40.0  Onset:2012-02-21, Days after vaccination: 1
Gender:Female  Submitted:2012-02-23, Days after onset: 2
Location:Vermont  Entered:2012-02-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; Allergic rhinitis; Hypotension
Diagnostic Lab Data: WBC - 11.1; 82% poly; 7% bands; CRP = 92.5
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.11070AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Band neutrophil percentage increased, C-reactive protein increased, Erythema, Feeling hot, Headache, Myalgia, Neutrophil percentage increased, Oedema peripheral, Pain, Pyrexia, Swelling, White blood cell count increased
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 (broad)
Write-up: Fever - headache - body aches - red - hot swollen arm. Administered 2/20/12 went to ER 2/22/12 seen in MD office 2/23/12. Reaction started 2/21 - swelling, pain, redness, then fever, myalgias, HA.

VAERS ID:450540 (history)  Vaccinated:2011-11-14
Age:40.0  Onset:2011-11-15, Days after vaccination: 1
Gender:Female  Submitted:2012-02-27, Days after onset: 104
Location:Washington  Entered:2012-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Balance disorder, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)
Write-up: Vertigo, disequalibrium that is ongoing more than three months later. Daily at first with severe symptoms on November 24, 2011. By January 2012, had three- and then five-day stretch with no symptoms, but they continue.

VAERS ID:450807 (history)  Vaccinated:2011-08-24
Age:40.0  Onset:2011-08-24, Days after vaccination: 0
Gender:Female  Submitted:2012-02-29, Days after onset: 189
Location:Virginia  Entered:2012-02-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; NEXIUM; IMITREX; ULTRAM; ZOFRAN; TYLENOL; multi vitamins; prn ZYRTEC
Current Illness: None
Preexisting Conditions: Drug allergies: PCN; ASA; sulfa; TORADOL (rash); vancomycin (difficulty breathing, swelling); Food allergies; green peppers; saffron (rash, severe GI distress); seasonal/environmental: mold; dust (rash, itchy watery eyes, nasal drainage); chemical: formaldehyde (rash); contact dermatitis; eczema; post surgical hypothyroidism; varicose veins; GERD; migraine w/aura; TMJ; right shoulder SLAP; right knee arthroscopy
Diagnostic Lab Data: 2/10/2012 RAST gelatin and gentamycin negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Military     Purchased by: Military
Symptoms: Dermatitis atopic, Radioallergosorbent test negative, Rash macular, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Annual FLUMIST on 8/24/2011 with onset of pruritic, red raised patchy macular rash to torso and legs on 8/26/2011 (day 2) that spread to her legs, neck, and face by 8/28/2011 (day 4). She denied any current or prior illness within last 2 weeks or exposure to. She advised prior side effects from 2/5/2007, 10/11/2007, 9/5/2008, 9/11/2009, and 10/26/2010 FLUMIST consisted of body aches and post nasal drip 24 hours later. These symptoms resolved within a day or two; however she denied PND or body aches with 8/24/2011 FLUMIST. She presented to medical on 9/2/2011 for persistence of pruritic macular rash (as above) advising NAFTIN and ketoconazole (prescribed meds for prior skin eczema-contact dermatitis) were effective. She described the difference with this rash vs prior rashes was that this rash was more confluent and hive like in appearance covering more surface area than usual and was to parts of her body not affected by past reactions (face, neck). This macular rash also began to weep on her chest; however she had been scratching this area. There were no papules, pustules or vesicle formations to the affected areas. She denied any headaches, fevers, chest pain, shortness of breath, lymph node swelling, or other systemic symptoms. She denied any new clothing, environmental, food or chemical contacts, soaps, detergents, animal contact, or other known triggers. Providers documented skin with angry appearing red, raised plaques to bilateral cheeks, neck, chest, shoulders, left side torso and right thigh. Suspected diagnosis was atopic dermatitis and was treated with MEDROL dose pack, triamcinolone 0.1% cream, and oral BENADRYL with full resolution of reaction about 5 days later.

VAERS ID:451035 (history)  Vaccinated:2012-02-21
Age:40.0  Onset:2012-02-21, Days after vaccination: 0
Gender:Female  Submitted:2012-02-21, Days after onset: 0
Location:Idaho  Entered:2012-03-02, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB223DA2IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Injection site pain, 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: Nauseated, light head, pain in arm (left) U arm.

VAERS ID:451650 (history)  Vaccinated:2011-08-15
Age:40.0  Onset:2011-08-15, Days after vaccination: 0
Gender:Female  Submitted:2012-03-06, Days after onset: 204
Location:Unknown  Entered:2012-03-09, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: serum hepatitis B, ?/?/06, did not develop adequate titers to RECOMBIVAX
CDC Split Type: WAES1109USA01706
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0869AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Hepatitis B core antibody negative, Injection site nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 40 year old female patient who in 2006 was administered a series of RECOMBIVAX HB (dose unknown, lot # not provided), and on 15-AUG-2011 the patient was vaccinated with RECOMBIVAX HB, intramuscularly (Lot number 0869AA is an invalid lot number for RECOMBIVAX HB, EXP 01-NOV-2013). The nurse noted this patient "did not develop adequate titers to a previous series of RECOMBIVAX HB in 2006". Nurse reported the patient developed a "pea-sized knot" where RECOMBIVAX HB was administered on 15-AUG-2011. The nurse did not know when this "pea-sized knot" developed. The patient sought unspecified medical attention and had not recovered from "pea-sized knot" at the time of the report. Out come of "did not develop adequate titers to a previous series of RECOMBIVAX HB in 2006" was unknown at the time of reporting. Additional information has been requested.

VAERS ID:451516 (history)  Vaccinated:2012-03-09
Age:40.0  Onset:2012-03-09, Days after vaccination: 0
Gender:Female  Submitted:2012-03-12, Days after onset: 2
Location:Ohio  Entered:2012-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trazodone, glyburide, tiotropium bromide, aspirin EC, Prilosec, Zocor, iloperidone, Lexapro,
Current Illness: schizoaffective disorder, suicidal ideations.
Preexisting Conditions: acetaminophen, codeine, naproxen, oxycodone
Diagnostic Lab Data: blood work,
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1489AA0SCRA
Administered by: Military     Purchased by: Other
Symptoms: Blood test, 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: Rt upper arm red swollen, painful.

VAERS ID:452246 (history)  Vaccinated:2012-03-20
Age:40.0  Onset:2012-03-21, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Montana  Entered:2012-03-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions: Codeine, latex allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU1477AD IMRA
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