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Case Details (Sorted by Age)

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VAERS ID:324485 (history)  Vaccinated:2008-08-14
Age:36.0  Onset:2008-08-14, Days after vaccination: 0
Gender:Female  Submitted:2008-09-08, Days after onset: 25
Location:Indiana  Entered:2008-09-08
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
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB123AA IM 
TDAP: TDAP (ADACEL)SANOFI PASTEURC2966AA IM 
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF307AB SC 
Administered by: Public     Purchased by: Private
Symptoms: Nasopharyngitis, Nausea, Rhinorrhoea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: day of shots- nausea- one week later cold and runny nose

VAERS ID:325350 (history)  Vaccinated:2003-11-12
Age:36.0  Onset:2003-12-01, Days after vaccination: 19
Gender:Male  Submitted:2008-09-12, Days after onset: 1746
Location:Unknown  Entered:2008-09-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: As above, none significant
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Military
Symptoms: Activities of daily living impaired, Balance disorder, Dysphagia, Dysstasia, Electromyogram normal, Fall, Fatigue, Foot deformity, Gait disturbance, Gene mutation identification test, Grip strength decreased, Hyperreflexia, Laboratory test abnormal, Lumbar puncture normal, Muscle atrophy, Myoclonus, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Pain in extremity, Spinocerebellar ataxia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: In late 2003 or early 2004 the patient began to notice balance problems, difficulty running and foot pain. He is unsure of the exact date of onset of symptoms but they became significant enough that he sought evaluation by a podiatrist in Apr 04. Severe pes cavus and brisk reflexes were noted prompting neurologic referral. One year later he was seen by neurology. At that time symptoms included awkward running, feelings of "falling over", difficulty standing on 1 foot, myoclonic jerks, intermittent tremor, occasional dysphagia, and difficulty holding items. A brain MRI, EMG/NCS and LP were normal. A diagnosis of SCA was made when Athena diagnostic tests were sent for analysis as well as SCA panel which returned positive for SCA 8 repeat expansion. Symptoms: Gait abnormality, Weakness, Hyper-reflexia. 10/13/08-records received for DOS 8/13/08-follow-up visit after development of spinocerebellar ataxia first presenting in 2003. Balance problems in late 2003. Anthrax vaccine 11/12/03, 12/1/07 and 3/9/08, began to have foot pain with abnormal reflexes and tremors in feet. April 2005 seen by neurologist, genetic testing performed found to have SCA8. Currently condition has worsened in that now has difficulty typing and writing, gait is abnormal, tremors in hands, muscle wasting in legs, balance problems, falls, chronic fatigue.

VAERS ID:325493 (history)  Vaccinated:2008-09-09
Age:36.0  Onset:2008-09-09, Days after vaccination: 0
Gender:Female  Submitted:2008-09-11, Days after onset: 2
Location:Virginia  Entered:2008-09-18, 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: Birth Control Pill (Petibelle)
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0425U1SCRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2287CA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0098X1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, edema, and warm skin b/L arms at injection sites. Left arm $g right arm. Patient instructed to take Tylenol and apply warm compress. Also, go to ER if s/s worsen.

VAERS ID:325634 (history)  Vaccinated:2008-09-18
Age:36.0  Onset:2008-09-19, Days after vaccination: 1
Gender:Female  Submitted:2008-09-19, Days after onset: 0
Location:California  Entered:2008-09-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB555AA1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hepatitis B vaccine #2 given 9/18/08 around noon. Arrived in Employee Health at 7:30 am 9/19/08 with large raised rash to all parts of body. States has never had an allergic reaction to anything before.

VAERS ID:325842 (history)  Vaccinated:2008-09-17
Age:36.0  Onset:0000-00-00
Gender:Female  Submitted:2008-12-17
Location:North Carolina  Entered:2008-09-23, Days after submission: 85
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR3027AA0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Drug exposure during pregnancy, Inappropriate schedule of drug administration
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)
Write-up: Perinatal client acknowledged wrong name and received Tdap injection. Had Td on 8/22/08. There is an outbreak of Pertussis in our county at present.

VAERS ID:326214 (history)  Vaccinated:2008-09-03
Age:36.0  Onset:2008-09-23, Days after vaccination: 20
Gender:Female  Submitted:2008-09-25, Days after onset: 2
Location:Washington  Entered:2008-09-25
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: Trial of Medrol dose pack, PT if no improvement
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2966A1UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site anaesthesia, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Right arm (deltoid) pain/ numbness at site of injection X 20 days after injection, zero redness or warmth.

VAERS ID:326678 (history)  Vaccinated:2008-09-05
Age:36.0  Onset:2008-09-05, Days after vaccination: 0
Gender:Female  Submitted:2008-10-01, Days after onset: 26
Location:New York  Entered:2008-10-01
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: Environmental allergies and asthma
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB526AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2899AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Pruritus, Rash erythematous, Rash papular, Respiratory distress
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Reprted as "shortness of breath, a red bumpy rash that I could hardly stop itching, and I had the rash for a couple of days". Rash allegedly intermittent for three to four days. Respiratory distress continued intermittently for about five days. Used P.O. Benadryl for rash and Albuterol inhaler and nebulizer for respiratory symptoms.

VAERS ID:326686 (history)  Vaccinated:2008-09-26
Age:36.0  Onset:2008-09-27, Days after vaccination: 1
Gender:Female  Submitted:2008-10-01, Days after onset: 4
Location:Florida  Entered:2008-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none. Spoke to employee health office 9/30/2008 was told that the vaccine had nothing to do with the illness. I was not ill unti
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MU: MUMPS (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: severe joint aching the day after the injection that lasted for 3 days. Also fever x 5 days still ongoing

VAERS ID:327433 (history)  Vaccinated:2008-09-10
Age:36.0  Onset:2008-09-11, Days after vaccination: 1
Gender:Male  Submitted:2008-09-12, Days after onset: 1
Location:Minnesota  Entered:2008-10-07, Days after submission: 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS439011A1IMUN
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Raised, redness, warmth surrounding injection site about 1X1. Noticed it was smaller yesterday and has been getting larger. No other S/S. Infection. 7:00 - came in - assessed RXN. Likely infection/temp increased. Sent to ER/urgent care."

VAERS ID:327586 (history)  Vaccinated:2008-10-06
Age:36.0  Onset:2008-10-07, Days after vaccination: 1
Gender:Female  Submitted:2008-10-08, Days after onset: 1
Location:Texas  Entered:2008-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Mountain Cedar; Demerol; Codeine; Augmentin; Iodin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0126X0IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB173AA0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0890X1SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3028AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Insomnia, Pain in extremity, Peripheral coldness, Tenderness
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: At arm sore, tender on 10/6/08. Had trouble sleeping on at side. By mid morning 10/7/08 was having increase in pain + by 2:30 pm it was "excruciating" at times. 10/08/08 c/o arm being cold.

VAERS ID:327901 (history)  Vaccinated:2008-10-08
Age:36.0  Onset:2008-10-08, Days after vaccination: 0
Gender:Male  Submitted:2008-10-09, Days after onset: 1
Location:Colorado  Entered:2008-10-09
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) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA153BA UNUN
Administered by: Other     Purchased by: Private
Symptoms: Incorrect dose administered, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)
Write-up: 3cc dose adm. drug error 6 dose injection arm red, painful @ site.

VAERS ID:327923 (history)  Vaccinated:2007-11-09
Age:36.0  Onset:2007-11-09, Days after vaccination: 0
Gender:Female  Submitted:2008-10-09, Days after onset: 334
Location:Virginia  Entered:2008-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Denied
Current Illness: Denied
Preexisting Conditions: Migraines; Seasonal allergies
Diagnostic Lab Data: Unk
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.   UN
Administered by: Unknown     Purchased by: Military
Symptoms: Cough, Headache, Pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Sneezing, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 11/9/2007 - FluMist given. She received vaccine about 12 noon, then returned to wk. Approximately 8 pm she began to sneeze. The next day she had sniffles, sneezing worse and diffuse aches (like a cold). The next day, Sunday, she had a cough. She went to Urgent Care on Monday c/o temp 101, stuffy head, congestion, cough and treated for URI w/meds and given NFW for 2-3 days. Symptoms lasted 2 weeks.

VAERS ID:327990 (history)  Vaccinated:2008-09-30
Age:36.0  Onset:2008-09-30, Days after vaccination: 0
Gender:Female  Submitted:2008-10-01, Days after onset: 1
Location:Washington  Entered:2008-10-10, 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: Supplements; vitamins
Current Illness:
Preexisting Conditions: CT scan contrast fluid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED02349111A IMRA
Administered by: Public     Purchased by: Private
Symptoms: Chest discomfort, Cough, Dyspnoea, Myalgia, Pain, Pyrexia, Tension headache, Throat tightness, Upper respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: About 15 minutes after receiving flu shot. I began to feel tightness of my throat and chest and head and difficulty breathing. About 2 hours later I began to feel urgency to cough and my throat more tight about 6 hours after the shot I began having body aches, muscle pain and fever of 100. Resolving throat and head tightness and congestion.

VAERS ID:328094 (history)  Vaccinated:2008-10-09
Age:36.0  Onset:2008-10-09, Days after vaccination: 0
Gender:Female  Submitted:2008-10-11, Days after onset: 2
Location:South Carolina  Entered:2008-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: None noted, but patient complained of cold symptoms approximately 1 week prior to vaccination.
Preexisting Conditions: NSAID (ibuprofen, diclofenac)
Diagnostic Lab Data: Patient''s only drug allergies includes NSAIDS (specifically Ibuprofen and diclofenac) with no allergy to eggs and a history of influenza vaccination for at least the last 2 years. She thought this was her 3rd or 4th year for vaccination.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2754AA2IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure increased, Dizziness, Dysgeusia, Erythema, Heart rate increased, Hyperhidrosis, Palmar erythema, Palpitations, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 15 to 30 minutes after influenza vaccine administration patient complained of a ''weird taste in mouth and a tight throat." Her BP and pulse were normal at 30 minutes and 45 respectively (120/68, pulse 72 and 116/80, pulse 74) with no evidence of bronchospasm, difficulty breathing, swelling of face/tongue or redness. She was given a 50mg oral dose of diphenhydramine since she did not meet protocol criteria for epinephrine administration at this time. Approximately 50 to 60 minutes after influenza vaccination, patient''s bp and pulse were beginning to rise (136/89 with pulse 93) and she began to experience palpitations, dizziness, sweating and itchy,red palms. At 6:48pm a 0.3mg EPi-pen was administered in right outer thigh by lead immunizer, and EMS was notified. EMS arrived at approx. 7pm and took over care and monitoring of patient. They administered oxygen and continued to monitor bp, pulse and checked cardiac rhythym. At no time did patient become unconscious, stop breathing or require CPR. Paramedics noted increased bp/pulse most likely due to epinephrine administration. EMS and lead immunizer advised patient to seek follow-up care and she was released by EMS at 7:30pm after signing a release that she refused to be taken to the hospital.

VAERS ID:328410 (history)  Vaccinated:2008-10-09
Age:36.0  Onset:2008-10-09, Days after vaccination: 0
Gender:Female  Submitted:2008-10-09, Days after onset: 0
Location:Massachusetts  Entered:2008-10-14, 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: No meds
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2798EA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 hours after flu-shot - left deltoid - c/o itching skin, no fever, no oral c/o.

VAERS ID:328466 (history)  Vaccinated:2008-10-08
Age:36.0  Onset:2008-10-08, Days after vaccination: 0
Gender:Male  Submitted:2008-10-14, Days after onset: 6
Location:California  Entered:2008-10-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2572AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chills, Impaired work ability, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Had vaccine 10/8/08 at 1:00 pm. Fever set in at 7 p.m. that evening. Ranged 101-102 deg- Nausea, vomiting, chills, body ache. His PCP told him to take Ibuprofen-(vomitted). Fever down by Saturday. Missed 2 days work. Today feeling okay, but lacks energy.

VAERS ID:328999 (history)  Vaccinated:2008-10-15
Age:36.0  Onset:2008-10-15, Days after vaccination: 0
Gender:Female  Submitted:2008-10-17, Days after onset: 2
Location:Indiana  Entered:2008-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient sees an Allergist for environmental allergies. She takes Allegra D, Singulair, and Rhinocort Aqua Nasal Spray. She also takes Provigil 200mgm BID for Narcolepsy.
Current Illness: No
Preexisting Conditions: Environmental allergies - dust, mold, cockroaches. Patient also has Anemia and Narcolepsy.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURPMC-U2790BA8IMRA
Administered by: Public     Purchased by: Private
Symptoms: Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient''s lower lip began swelling about 8:00 PM on Wednesday, 10/15/08. She came to our facility on Thursday morning. We advised her to call her physician, due to large swelling on lower lip. Patient saw M.D. on Thursday, 10/16/08 and was given a benadryl type medication. Swelling was completely gone by Friday morning.

VAERS ID:329080 (history)  Vaccinated:2008-10-09
Age:36.0  Onset:2008-10-10, Days after vaccination: 1
Gender:Female  Submitted:2008-10-17, Days after onset: 7
Location:Texas  Entered:2008-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol; NEXIUM
Current Illness: None
Preexisting Conditions: PERCOCET; Hydrocodone; Splenectomy 1978
Diagnostic Lab Data: CBC; BMP; referral to infectious disease for recommendations on other immunizations in the future.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER859060IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0224X2IMLA
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Dyspnoea, Erythema, Full blood count, Laboratory test, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Shortness of breath, temp of 103 degrees, left arm deltoid with edema, redness, warm to touch, ROCEPHIN IM in ER and KEFLEX 500 mg 1 po TID x 10 days, Naproxen DS 550 mg.

VAERS ID:330667 (history)  Vaccinated:2008-07-23
Age:36.0  Onset:2008-07-23, Days after vaccination: 0
Gender:Female  Submitted:2008-10-14, Days after onset: 83
Location:Massachusetts  Entered:2008-10-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA04859
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Alopecia, Immediate post-injection reaction, Inappropriate schedule of drug administration
SMQs:, Hypersensitivity (narrow), Medication errors (narrow)
Write-up: Information has been received from a 36 year old female who on 23-JUL-2008 was vaccinated with her second dose of GARDASIL 0.5mL intramuscularly. "Immediately after dose" (on 23-JUL-2008) the patient reported hair loss. The patient''s hair loss persisted. The patient did not seek medical attention. Additional information has been requested.

VAERS ID:329200 (history)  Vaccinated:2008-01-14
Age:36.0  Onset:2008-01-15, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2008-10-20
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: Tremors, controlled with propanalol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: SM developed redness, swelling, pain in left arm, within 24 hours of receiving SC anthrax shot.

VAERS ID:329202 (history)  Vaccinated:1999-12-27
Age:36.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Unknown  Entered:2008-10-20
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
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV024 SCUN
Administered by: Military     Purchased by: Military
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: SM developed generalized myalgias within 30 minutes of receiving each of his eight anthrax shots. Muscle aches lasted approximately one week. Motrin helped to keep pain tolerable. Was on quarters only once for muscle aches.

VAERS ID:329220 (history)  Vaccinated:2008-10-10
Age:36.0  Onset:2008-10-10, Days after vaccination: 0
Gender:Female  Submitted:2008-10-20, Days after onset: 10
Location:New York  Entered:2008-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Denies
Preexisting Conditions: Denies
Diagnostic Lab Data: Treated in the Emergency room with Solumedrol and Benadryl and released
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2764AA1IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Employee states she developed itching and hives approximatley 20 minutes after receiving Influenza vaccine. Developed on hands, neck, face and was seen in the emergency room at hospital where employed.

VAERS ID:329266 (history)  Vaccinated:2008-10-17
Age:36.0  Onset:2008-10-20, Days after vaccination: 3
Gender:Male  Submitted:2008-10-20, Days after onset: 0
Location:Massachusetts  Entered:2008-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
JEV: JAPANESE ENCEPHALITIS (JE-VAX)SANOFI PASTEUREJN234A1SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: 3" diameter, itchy rash around the injection site 3 days post injection. This was his 2nd dose of J-VAX

VAERS ID:329759 (history)  Vaccinated:2008-10-15
Age:36.0  Onset:2008-10-16, Days after vaccination: 1
Gender:Male  Submitted:2008-10-17, Days after onset: 1
Location:Wisconsin  Entered:2008-10-23, 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: None
Current Illness: Left forearm contusion
Preexisting Conditions: Allergies to PCN and Sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3027BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Muscle spasms
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt. called c/o abd and bilateral bicep cramping since immunization.

VAERS ID:329760 (history)  Vaccinated:2008-10-08
Age:36.0  Onset:2008-10-08, Days after vaccination: 0
Gender:Female  Submitted:2008-10-16, Days after onset: 8
Location:Connecticut  Entered:2008-10-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: MTHFR
Diagnostic Lab Data: MRI (+) bursitis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS89975 IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2768AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Bursitis, Immediate post-injection reaction, Injection site pain, Joint range of motion decreased, Nuclear magnetic resonance imaging abnormal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Immediate excruciating pain at injection site. Persistent pain and decreased ROM of shoulder. Confirmed bursitis by MRI treated with steroids.

VAERS ID:329832 (history)  Vaccinated:2008-10-23
Age:36.0  Onset:2008-10-23, Days after vaccination: 0
Gender:Female  Submitted:2008-10-23, Days after onset: 0
Location:Texas  Entered:2008-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: daily Multi-Vitamin
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Treatment: chest xray = normal; EKG = normal sinus rhythm.
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED02649111A0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chest X-ray normal, Diplopia, Electrocardiogram normal, Hypersensitivity, Palpitations, Vision blurred
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Employee received influenza vaccination in the dept she was assigned. She stated that "within approx. one hour" she felt a sudden onset of "heart racing" and "blurred & double vision".Her co-workers put her in a wheelchair, took her BP (152/98) and took her to the ER. She was admitted & treated for allergic reaction to flu vaccination. Treatment: chest xray = normal; EKG = normal sinus rhythm. Medications given to her were: Decadron 10mg IM; Benadryl 25mg PO x 1; Zantac 150mg PO x1; Ativan 1 mg PO x1. She was discharged @ approx. 4:30PM with prescriptions for Prednisone 20mg (to take 3 /day x 5 days); Xanax 0.25 mg (1 -2 q 8hrs for anxiety); & Bendaryl OTC.

VAERS ID:329923 (history)  Vaccinated:2008-10-17
Age:36.0  Onset:2008-10-22, Days after vaccination: 5
Gender:Female  Submitted:2008-10-24, Days after onset: 2
Location:Maryland  Entered:2008-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Diagnostic Lab Data: No testing done.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURUF455BA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site pain, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: complained of some soreness then redness on 10/22/08 and increase soreness with some swelling. I told her to use heat and take tylenol. I looked at her arm on 10/23/08 and it did have some redness, arm felt tight but could not determine if it was swollen. She was still having pain in her arm and she was going to see the nurse practitioner at the doctor office. She stated the heat helped. Practitioner said it looked like cellulitis. This is Adacel Tdap vaccine unable to pick that from list below.

VAERS ID:329931 (history)  Vaccinated:2008-06-21
Age:36.0  Onset:2008-06-21, Days after vaccination: 0
Gender:Female  Submitted:2008-10-24, Days after onset: 125
Location:Florida  Entered:2008-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none- USCIS immunization vaccination
Preexisting Conditions: scoliosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)SANOFI PASTEUR    
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Back pain, Lymphadenopathy
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pain in the left hip constant for the most part. Pain is moving around- not constantly in one particular place- in the lower part of the body-mostly in joints- in knee,ankles and back-around waist line. Swollen lymph nods in both groins - left is very pronounced - about the size of an egg.Blood ( directed by gynochologist )test didn''t show an infection and no problems gynochologicly.

VAERS ID:329965 (history)  Vaccinated:2008-10-15
Age:36.0  Onset:2008-10-17, Days after vaccination: 2
Gender:Male  Submitted:2008-10-24, Days after onset: 7
Location:Ohio  Entered:2008-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: allergy injection every 3 months
Current Illness: none
Preexisting Conditions: allergies to pollen
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2768AA1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: diarrhea, vomiting, chills, fever of 103 degrees F. Went to ER for IV fluids and antipyretic.

VAERS ID:330518 (history)  Vaccinated:2008-10-23
Age:36.0  Onset:2008-10-23, Days after vaccination: 0
Gender:Female  Submitted:2008-10-23, Days after onset: 0
Location:California  Entered:2008-10-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hx of Asthma
Diagnostic Lab Data: Breast feeding - Received Thimenisol Free
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2786440UNLA
Administered by: Public     Purchased by: Public
Symptoms: Angioedema, Anxiety, Hyperhidrosis, Injection site reaction
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Local reaction at injection site. Mild symptoms of anxiety angioedema, diaphoretic.

VAERS ID:330549 (history)  Vaccinated:2008-10-21
Age:36.0  Onset:2008-10-22, Days after vaccination: 1
Gender:Male  Submitted:2008-10-29, Days after onset: 7
Location:Ohio  Entered:2008-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2756AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2633AA IMLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETH0961U0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Neck mass
SMQs:
Write-up: Pt got a Meningococcal shot in Lt Del and a FLUZONE and PNEUMOVAX in Rt Del, Pt then 7 days later came into office with lump on Rt side of neck with no redness or tenderness.

VAERS ID:330585 (history)  Vaccinated:2008-10-28
Age:36.0  Onset:2008-10-28, Days after vaccination: 0
Gender:Male  Submitted:2008-10-29, Days after onset: 1
Location:Georgia  Entered:2008-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: Allergy to Antihistamine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2831AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure decreased, Hyperhidrosis, Loss of consciousness, Malaise, Pallor, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Aproximately 1-2 minutes after receiving the Flu Vaccine Patient stated not feeling well. Assisted promptly in lying down. BP drastically dropped,( non audible) patient looked very pale and diaphoretic. Lost conciousness for at least 10- 15 second. Administered Epinephrine 0.3 mg IM. Patient responded well. BP went up to 100/60. Patient able to communicate with his wife about incident. Left to East side medical ER walking accompagned by EMT staff. FU later , patient declined going to ER as stated by wife he is doing fine but kind of shaky. Called again this AM . According to wife patient is doing fine

VAERS ID:330829 (history)  Vaccinated:2008-06-06
Age:36.0  Onset:2008-06-07, Days after vaccination: 1
Gender:Female  Submitted:2008-06-08, Days after onset: 1
Location:West Virginia  Entered:2008-10-31, Days after submission: 145
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: WV0816
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2826AA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Headache, Injection site swelling, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vomiting, Headache, Generalized weakness, fever swelling @ site of injection.

VAERS ID:331147 (history)  Vaccinated:2008-10-23
Age:36.0  Onset:2008-10-23, Days after vaccination: 0
Gender:Female  Submitted:2008-11-03, Days after onset: 11
Location:California  Entered:2008-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denies being on any meds.
Current Illness: Patient denies having any illness.
Preexisting Conditions: Patient denies.
Diagnostic Lab Data: Patient stated none were done.
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2744AA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Patient states that approx. 3 hrs. after vaccine,suffered from shortness of breath, palpitations, cough. Went to nearby walk-in clinic. States she received a "breathing treatment" that alleviated her symptoms.

VAERS ID:331664 (history)  Vaccinated:2008-10-28
Age:36.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Massachusetts  Entered:2008-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Depression with SI
Preexisting Conditions: Allergic to latex
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURB22494A IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.9722106 IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Rash, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received flu vac received 10/28/08 1912 L deltoid T max 38.5 red, warm to touch, rash that came to expand x 24 hours. PO keflex d/c, then Vancomycin x 2 doses then Bactrim DS.

VAERS ID:331842 (history)  Vaccinated:2008-10-29
Age:36.0  Onset:2008-10-30, Days after vaccination: 1
Gender:Female  Submitted:2008-11-03, Days after onset: 4
Location:Florida  Entered:2008-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA; hydrochlorothiazide; metoprolol
Current Illness: none
Preexisting Conditions: Paxil (swelling face); CVA (@33); Left Ovary teratoma (@27) & HTN (@2 )
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU28311AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Body temperature, Feeling cold, Hot flush, Injection site erythema, Injection site pain, Injection site swelling, Nausea, Pain, Pain in extremity
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), Tendinopathies and ligament disorders (broad)
Write-up: 24 hrs. after receiving flu zone 0.5ml IM. Pt presented with 3.5x2 cm swelling, redness, and pain at injection site (left deltoid). Entire arm was "sore" and felt nausea and hot/cold flashes. Had stinging pain with left arm movement and rad to left hand. Temp 98 degrees. Treated with Keflex and to follow up with PCP or ER.

VAERS ID:332258 (history)  Vaccinated:2008-08-07
Age:36.0  Onset:2008-08-07, Days after vaccination: 0
Gender:Female  Submitted:2008-10-07, Days after onset: 61
Location:Oregon  Entered:2008-11-13, Days after submission: 37
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 PASTEURC2994BA IMLA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD3001411 PO 
Administered by: Public     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site pain, Lymph node pain, Lymphadenopathy, Malaise, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client called 10-2-08 left message that besides soreness , redness at the site of vaccination she had swelling of lymph''s nodes in (L) axilla day of vaccination. She reported this to a Community telephone at a Medical Center on 8-10-08. No fever, slight malaise reported plus LA swelling and tenderness limiting range of motion. she was advised to see provider or go to ED, client did not see provider. symptoms improved after one week. Client carpolled 10-3-08. She reports __(L) lymph node again sore-about size of pea. Advised to see provider

VAERS ID:332474 (history)  Vaccinated:2008-10-30
Age:36.0  Onset:2008-11-02, Days after vaccination: 3
Gender:Female  Submitted:2008-11-14, Days after onset: 12
Location:Maryland  Entered:2008-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: depression, anxiety, neurosis, UTI, intrarenal stone, IBD. Hysterectomy, C-sec. tonsillectomy. Allergies to PCN, Demerol, Tylox, Sudafed
Diagnostic Lab Data: MRI/brain/spine; CT brain; MRA; nerve conduct; EMG; EKG; lumbar top Labs and Diagnostics: CBC and Chem WNL. CXR WNL. CT head WNL. MRI/MRA brain WNL. MRA neck WNL. MRI Thoracic/Lumbar/Cervical -spine (+) for degenerative changes. Echo (+) for mild mitral regurg. Lyme (-). CSF WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA388BA0UNLA
Administered by: Other     Purchased by: Other
Symptoms: Angiogram normal, Borrelia burgdorferi serology negative, CSF test normal, Computerised tomogram normal, Dizziness, Echocardiogram abnormal, Electrocardiogram, Electromyogram, Full blood count normal, Headache, Hemiparesis, Hypoaesthesia, Hypoaesthesia facial, Injection site pain, Laboratory test normal, Lumbar puncture, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Paraesthesia, Paraesthesia oral, Scan brain, Sensory loss
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad)
Write-up: Pain at site followed by paresthesia of arm and lip. No confirmed weakness. Abnormal nerve cond. R arm. 11/17/08 MR received for DOS 11/5-6/2008 with no specific dx. Pt presented with c/o numbness and tingling of L sided extremities, face and lips R$gL x 4 days. Similar episode in 2001 with (-) w/u. Some dizziness and H/A. Neuro consult PE (+) for give-way weakness on the L side and (-) sensation to pinprick and temp bilat.

VAERS ID:332565 (history)  Vaccinated:2008-11-06
Age:36.0  Onset:2008-11-06, Days after vaccination: 0
Gender:Male  Submitted:2008-11-14, Days after onset: 8
Location:Wisconsin  Entered:2008-11-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Crohn''s Disease, Fibromyalgia
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB128AB0IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB03470IMRA
Administered by: Other     Purchased by: Private
Symptoms: Body temperature, Dizziness, Feeling hot, Heart rate normal, Hyperhidrosis, Immediate post-injection reaction, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: 11-6-08 0920 TWINRIX 1.0 ml vaccine given IM R deltoid lot AHABB128AB, Exp. 7-18-10. Immediately became pale, c/o whole body feeling warm. Lightheaded. BP 30/42 L p.60 T 97.8 degrees. R. 16. No itchiness, no SOB, no rash. Assisted to cof. 0950 BP 100/60, p.60 6pm. Respiration nonlabored 12-16. 0935 BP 102/64 p. 60 6pm. O2 per NC @ 2-4 6pm X 5min. 0940-0945. IM sitting BP 90/60. Color pink. Skin WID. had some diaphoresis 0950. 1020 feeling fine.

VAERS ID:332600 (history)  Vaccinated:2008-11-03
Age:36.0  Onset:2008-11-05, Days after vaccination: 2
Gender:Female  Submitted:2008-11-17, Days after onset: 12
Location:Oregon  Entered:2008-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inhalor
Current Illness: I had a cough, but no fever.
Preexisting Conditions: asthma
Diagnostic Lab Data: Returned to the clinic on 11/6/08 where the doctor diagnosed the infection by looking at the injection site.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site swelling, Pain in extremity, Staphylococcal infection, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: After the vaccination, my arm was sore but I expected this. Two days after the vaccination, there was swelling around the injection site and the arm continued to be sore. Three days after the vaccination, the swelling around the injection site worsened, so I went back to the clinic. The doctor on duty identified it as a staph infection and prescribed Azithromycin. He told me to take two immediately, then continue to take 1 per day for 6 days. The arm continued to ache for about a week.

VAERS ID:332672 (history)  Vaccinated:2008-11-15
Age:36.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-11-17, Days after onset: 2
Location:Tennessee  Entered:2008-11-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPOROL (u) for BP vitamins
Current Illness: None
Preexisting Conditions: High BP
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA151AA UNLA
Administered by: Other     Purchased by: Other
Symptoms: Lip swelling, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient had vaccine at approximately 1:00pm and at 6:00pm began having top lip swelling and sore throat. Not witnessed. Patient had eaten lean Quisine for lunch around noon.

VAERS ID:332697 (history)  Vaccinated:2008-11-12
Age:36.0  Onset:2008-11-13, Days after vaccination: 1
Gender:Female  Submitted:2008-11-18, Days after onset: 5
Location:Kansas  Entered:2008-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ortho tri-cyclen, flonase nasal spray
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2765AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Feeling abnormal, Flushing, Injection site erythema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Tenderness, erythema at injection site 12 hours post adminstration. Facial flushing, lightheadedness, dizziness, just weird 40 hours post admistration, followed by itching. Patient given loratadine 10mg bid, diphenhydramine 25mg hs, hydroxyzine hcl 25mg 2 doses 72 & 96 hrs post admin. Albuterol MDI started 48 hours post admin. Symptoms resolving six days after admin, still itching.

VAERS ID:332762 (history)  Vaccinated:2008-11-18
Age:36.0  Onset:2008-11-18, Days after vaccination: 0
Gender:Male  Submitted:2008-11-19, Days after onset: 1
Location:Washington  Entered:2008-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: Migraine headaches
Preexisting Conditions: Latex; Iodine; Codine; APAP;chocolate; Nuts; Tomatoes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA178AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.087X IMRA
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Erythema, Injection site anaesthesia, Lymphadenitis, Oedema, Pain in extremity, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Edema, Erythema, warm to touch, tenderness to palp. Numbness at injection site, pain to upper right arm and back. In conjunction with Lymphadenitis.

VAERS ID:332818 (history)  Vaccinated:2008-11-13
Age:36.0  Onset:2008-11-13, Days after vaccination: 0
Gender:Female  Submitted:2008-11-19, Days after onset: 6
Location:California  Entered:2008-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2789AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2731AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Hypoaesthesia, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After receiving the full vaccine the patient experienced increased pain, swelling and numbness to right arm. Pt was seen through the ER-given IM-Benadryl and PO-Vicodin. Pt did have a fever at the time of ER visit.

VAERS ID:332823 (history)  Vaccinated:2008-10-23
Age:36.0  Onset:2008-10-31, Days after vaccination: 8
Gender:Male  Submitted:2008-11-19, Days after onset: 19
Location:Maine  Entered:2008-11-19
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: CK- normal, BUN/crea- normal, elevated LFTs
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB251BA0UNRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB034720UNLA
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Blood creatine phosphokinase normal, Blood creatinine normal, Blood urea normal, Liver function test abnormal, Myalgia, Oedema peripheral, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives, hand swelling, myalgias, joint pain.

VAERS ID:332842 (history)  Vaccinated:2008-10-23
Age:36.0  Onset:2008-10-31, Days after vaccination: 8
Gender:Male  Submitted:2008-11-18, Days after onset: 18
Location:Maine  Entered:2008-11-20, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamisil
Current Illness:
Preexisting Conditions: The patient had no illness at the time of vaccination. Concomitant medications included Lamisil.
Diagnostic Lab Data: Not reported
CDC Split Type: 200803520
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB251BA0IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB0347 IMLA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF305A SCLA
Administered by: Private     Purchased by: Private
Symptoms: Musculoskeletal pain, Neck pain, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report was received from a health care professional on 07 November 2008. A 36-year-old male patient with an unknown medical history, had received an intramuscular left deltoid injection of TYPHIM VI, lot number B0347-2, and a subcutaneous left upper arm injection of YF VAX, lot number UF305AA, and a first dose right deltoid intramuscular injection of Hepatitis A (manufactured by GSK), lot number AHAVB251BA on 23 October 2008 and eight days later, he developed widespread hives and severe pain in his neck and shoulders. The patient was evaluated in the emergency room and prescribed PREDNISONE. Concomitant medications included LAMISIL. The reporter followed-up with the patient (date not specified), at which time, the patient indicated the pain was still present to a lesser degree, however hives were still occurring. The patient''s recovery status was reported as unknown at the time of the report. Documents held by sender: none.

VAERS ID:333149 (history)  Vaccinated:2008-11-21
Age:36.0  Onset:2008-11-21, Days after vaccination: 0
Gender:Female  Submitted:2008-11-24, Days after onset: 3
Location:Texas  Entered:2008-11-24
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
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1494SCRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB04244IMRA
Administered by: Military     Purchased by: Military
Symptoms: Anxiety, Dyspnoea, Oropharyngeal pain, Palpitations, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)
Write-up: Patient received anthrax and typhoid in the Rt deltoid. Patient has a really bad anxiety of receiving shots but tolerated them well. Had nurse in the room in case of vasovagel reaction. During her 20 minute wait time patient was talking with me and was doing fine. Patient started to complain of a sore throat. Started to call nurse back into the office when the patient started to say her tongue felt funny and she was having difficulty breathing. Applied O2 at 6L with NC and hit code blue alarm. Received provider''s order to administer Epi Pen, administered Epi Pen in Rt thigh. Patient asked if her heart was supposed to be racing after that and was reassured that it was a side effect of the Epi Pen. Her symptoms started to go away shortly after receiving the Epi Pen. Monitored patient for 1 hour after event and the provider sent her home on quarter for the rest of the day.

VAERS ID:333206 (history)  Vaccinated:2008-08-25
Age:36.0  Onset:2008-09-01, Days after vaccination: 7
Gender:Female  Submitted:2008-11-18, Days after onset: 78
Location:Connecticut  Entered:2008-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Joint range of motion decreased
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 1 week after ENGERIX B injection pain (L) shoulder trouble with range of motion.

VAERS ID:333283 (history)  Vaccinated:2008-10-23
Age:36.0  Onset:2008-10-23, Days after vaccination: 0
Gender:Female  Submitted:2008-11-25, Days after onset: 33
Location:New York  Entered:2008-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: dull, aching pain in right shoulder began at time of shot and has not ceased.
Preexisting Conditions:
Diagnostic Lab Data: Only flu vaccine was administered.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2771AA1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Dull, aching, chronic pain in right shoulder where flu shot was administered. Pain has lasted since flu shot was first administered on October 23, 2008. Was seen by a medical doctor who recommended physical therapy to strengthen arm back to normal. Treatment begins next week.

VAERS ID:333440 (history)  Vaccinated:2008-10-31
Age:36.0  Onset:2008-11-11, Days after vaccination: 11
Gender:Male  Submitted:2008-11-26, Days after onset: 15
Location:New Jersey  Entered:2008-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hx of heart murmur PMH: Osgood-Schlatter disease. Heart murmur. Smoker. Allergy: iodine, anaphylaxis, percocet, stomach upset. Family hx: premature CAD, MI, Marfan''s.
Diagnostic Lab Data: 11/14/08, CRP u/s 27.0; Chol, 127; Trig 103; HDL, 35; LDL, 77; Creatine Kinase MB, 0%; Creatine Kinase, 87 U/L; Troponin I Cardiac, 0.97 (H*) ng/mL; 11/14/08, Reported normal ECG; 11/19/08, TTE: EF 55%, Normal; GXT - NL GXT exercise echo w/o exercised induced segmental wall motion abnormalities to suggest stress induced myocardial ischemia at 94% of predicted MHR for age. Note: Post exercise images are suboptimal secondary to pt imaging characteristics. 11/26/08, ECHO - showed normal LV function with no e/o pericardial effusion LABS: cardiac enzymes neg, troponin 0.03. CBC, chemistry, EKG, CXR, echocardiogram, stress test WNL.
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  SCUN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P IN 
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSA14ABB103A UNUN
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEUR   UN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA09233 IMUN
Administered by: Military     Purchased by: Military
Symptoms: Asthma, Blood cholesterol normal, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal, Blood pressure increased, Blood triglycerides normal, C-reactive protein increased, Cardiac enzymes normal, Chest X-ray normal, Chest pain, Cough, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Exercise test normal, Full blood count normal, Headache, High density lipoprotein normal, Hyperhidrosis, Laboratory test normal, Low density lipoprotein normal, Nasopharyngitis, Non-cardiac chest pain, Rhinorrhoea, Tobacco user, Troponin I increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Hypoglycaemia (broad)
Write-up: Clinic visit on 11/14/08 - Left sided chest pain since 11/11 with some radiation to left arm associated with diaphoresis and elevated BP, light headache and difficulty taking deep breath. Chest pain worse on morning of 11/13/08. Pain was worse when lying flat, cough, or deep breath. Not associated with exertion. Nonprandial. Given MOTRIN at local clinic with little relief. After enzymes (+) on 11/14/08, pt referred on 11/18/08 to hospital and admitted overnight. Discharged the following day. Since this episode, he has developed cold-like symptoms (runny nose, cough), but his chest pain has been absent. Performs ADLs w/o development of chest pain, sob, or tightness. 12/5/08 Reviewed hospital medical records of 11/18-11/19/2008. FINAL DX:noncardiac chest pain; asthma; tobacco use disorder. Records reveal patient experienced left side chest pain w/radiation down left arm x 1 week, constant x 3 days then intermittent. Evaluated at outside clinic where troponin reported to be 0.97(H). Cardiac w/u neg. D/C to home w/PCP f/u.

VAERS ID:333451 (history)  Vaccinated:2008-11-24
Age:36.0  Onset:2008-11-25, Days after vaccination: 1
Gender:Male  Submitted:2008-11-26, Days after onset: 1
Location:Texas  Entered:2008-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Local swelling~Vaccine not specified (no brand name)~UN~12~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3029BA UNLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Chills, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Tdap given on 11/24/2008- next day pt. experienced severe left deltoid pain, fever to 102F, weakness, chills.

VAERS ID:333460 (history)  Vaccinated:2008-11-04
Age:36.0  Onset:2008-11-05, Days after vaccination: 1
Gender:Female  Submitted:2008-11-26, Days after onset: 21
Location:Washington  Entered:2008-11-26
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1993CA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: arm became swollen, red, warm on top part of arm.

VAERS ID:333397 (history)  Vaccinated:2008-11-20
Age:36.0  Onset:2008-11-20, Days after vaccination: 0
Gender:Male  Submitted:2008-11-27, Days after onset: 7
Location:New Jersey  Entered:2008-11-27
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1583UNLA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Nausea, Oropharyngeal pain, Pharyngeal oedema
SMQs:, Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After receiving most recent injection throat swelled up within a couple of hours and had a headache. Next day became nauses with another headache.Throat still soar and swelled as of todays date.Injection site is still soar and red with a raised itchy bump.

VAERS ID:333760 (history)  Vaccinated:2008-11-09
Age:36.0  Onset:2008-11-16, Days after vaccination: 7
Gender:Male  Submitted:2008-12-02, Days after onset: 16
Location:Connecticut  Entered:2008-12-03, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Seasonal Allergies
Diagnostic Lab Data: MRI at hospital while patient. 1/14/09-records received-CSF protein elevated 65, nucleated cells increased 13, lymphocytes increased, monotcytes increased. CSF culture negative.MRI demonstrated disc protrustion. Treated with IVIG. MRI likely represents demyelination.
CDC Split Type: CT200814
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS892975P0IMLA
Administered by: Other     Purchased by: Private
Symptoms: CSF culture negative, CSF lymphocyte count increased, CSF monocyte count increased, CSF protein increased, Dysuria, Flatulence, Gait disturbance, Hypoaesthesia, Myelitis, Nuclear magnetic resonance imaging abnormal, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Malignant lymphomas (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: 11/16/08 developed numbness tingling" saddle area". Saw primary care Physician 11/20. Numbness, tingling progressed to lower extremities. Difficulty walking, admitted to hospital. 1/8/09-records received for DOS 11/21-11/26/08-DC DX: Acute autoimmune myelitis. Presented to ED with C/O bilateral calf pain and leg pain. Passing gas uncontrollably. Anus and penis numb, urinating problems. Calf pain and numbness. Received flu vaccine 11/9/08.

VAERS ID:333837 (history)  Vaccinated:2008-11-19
Age:36.0  Onset:2008-11-19, Days after vaccination: 0
Gender:Female  Submitted:2008-12-01, Days after onset: 12
Location:Indiana  Entered:2008-12-04, 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: ALBUTEROL
Current Illness:
Preexisting Conditions: The patient did not report any illnesses, but did have past medical history of asthma at the time of the vaccination on 19 November 2008. The patient has received several influenza vaccines in the past, and it was "unknown" if the patient had experienced any adverse events with prior vaccinations.
Diagnostic Lab Data: None reported
CDC Split Type: 200803726
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2747A IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Heart rate increased, Hyperhidrosis, Immediate post-injection reaction, Nausea, Paraesthesia, Swelling face, Tremor, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Initial report received on 24 November 2008 from a health care professional. A 36-year-old female patient (date of birth not provided), who denied any concurrent illnesses, and who has a past medical history of asthma, had received an intramuscular left deltoid injection of FLUZONE SV 2008-2009 (lot number U2747AA) on 19 November 2008 at 15:05 pm. Twenty minutes after receiving the FLUZONE vaccine, the patient experienced severe wheezing, facial swelling, increased heart rate to 155 beats/minute and she was diaphoretic and had severe nausea and vomiting. She was also shaking and felt "dizzy and tingly." The patient was evaluated by the "vaccine provider" (not identified) less than five minutes after receiving the vaccine and was given epinephrine (route not provided). Emergency Medical Team was called and the patient was transported to the hospital emergency room by ambulance. It was not reported whether any relevant diagnostic tests/laboratory data were performed. At the time of this report, the "vaccine provider" reported that the patient was recovered and back to work (dates not provided). Documents held by sender: None.

VAERS ID:334109 (history)  Vaccinated:2008-11-07
Age:36.0  Onset:2008-11-10, Days after vaccination: 3
Gender:Female  Submitted:2008-11-10, Days after onset: 0
Location:Ohio  Entered:2008-12-05, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PCOS, Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF455CA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: ADACEL administered 11/7/08, Pt arm redness, swelling, fever to 102 deg. 8x9 cm red, raised area of administration site on 11/10.

VAERS ID:334118 (history)  Vaccinated:2008-11-17
Age:36.0  Onset:2008-11-17, Days after vaccination: 0
Gender:Female  Submitted:2008-12-05, Days after onset: 18
Location:Wisconsin  Entered:2008-12-05
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
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Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERC302BA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Facial palsy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: Burning left side of face (Hot) (shot given (L) arm) Resolved 1 hr. History of Bell''s Palsy 2/08 no treatment needed. No other neuralogia signs/symptoms.

VAERS ID:334085 (history)  Vaccinated:2008-11-29
Age:36.0  Onset:2008-12-03, Days after vaccination: 4
Gender:Male  Submitted:2008-12-08, Days after onset: 5
Location:Hawaii  Entered:2008-12-08
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
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1741SCRA
Administered by: Unknown     Purchased by: Military
Symptoms: Lip swelling, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed generalized maculopapular rash and pruritus after the second dose of anthrax, no respiratory involvement. Pt had mild lip swelling after the first dose of anthrax but also received smallpox and flumist 2 weeks before the 2nd dose.

VAERS ID:334219 (history)  Vaccinated:2008-12-02
Age:36.0  Onset:2008-12-02, Days after vaccination: 0
Gender:Female  Submitted:2008-12-08, Days after onset: 6
Location:Arkansas  Entered:2008-12-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20 mg
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3029BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site with itching, edema, erythemia.

VAERS ID:334404 (history)  Vaccinated:2008-11-21
Age:36.0  Onset:2008-11-23, Days after vaccination: 2
Gender:Female  Submitted:2008-11-25, Days after onset: 2
Location:Connecticut  Entered:2008-12-09, 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: Lisinopril; LOVAZA; ZANTAC; ZORCOR
Current Illness:
Preexisting Conditions: HTN; high cholesterol; thickened LV
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site warmth, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 11/21/08, ADACEL given 3:45 pm. 11/23/08, 11:50 AM, pt. called, (L) axillary lymph node area red and very sore where injection given. Negative fever, positive erythema, warmth, tenderness.

VAERS ID:334575 (history)  Vaccinated:2008-11-07
Age:36.0  Onset:2008-11-07, Days after vaccination: 0
Gender:Male  Submitted:2008-12-09, Days after onset: 32
Location:Texas  Entered:2008-12-09
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Auto-immune encephalitis due to flu vaccine 12/11/08-records received-Lumbar puncture negative. MRI negative pathology but revealed mild arthritic changes.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Autoimmune disorder, Back pain, Encephalitis, Headache, Lumbar puncture normal, Migraine, Nuclear magnetic resonance imaging normal, Pain, Post lumbar puncture syndrome, Visual impairment
SMQs:, Retroperitoneal fibrosis (broad), Noninfectious encephalitis (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Headache following administration same day - progressively got worse; coupled with vision problems. Like no other headache/migraine - crippling pain not dulled buy ibuprofen, motrin, butalbital, or hydrocodone. 12/11/08-records received for DOS 11/18-11/20/08-DC DX:Intractable headache of two weeks duration with failure of outpaitient treatment. Severe low back pain. Recent lumbar puncture. Admitted with severe headache described occipital headache with radiation over head.

VAERS ID:334602 (history)  Vaccinated:2003-12-15
Age:36.0  Onset:2005-03-01, Days after vaccination: 442
Gender:Male  Submitted:2008-12-09, Days after onset: 1379
Location:Puerto Rico  Entered:2008-12-09
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: fever
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN2IMRA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Myalgia, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever, muscle pain,jointpain,skin rash

VAERS ID:334676 (history)  Vaccinated:2008-11-19
Age:36.0  Onset:2008-11-19, Days after vaccination: 0
Gender:Female  Submitted:2008-12-09, Days after onset: 20
Location:Georgia  Entered:2008-12-09
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: takes allergy shots
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2769AA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client had FLUZONE vaccine 11/19/08 - states she started later that evening she started with fever severe aches dizziness, labored breathing - heart rate 96 - states went to sleep and felt ok the next day. Client did not report this until today 12/08/08. Did not go physician. 1st FLUZONE vaccine.

VAERS ID:334764 (history)  Vaccinated:2008-11-24
Age:36.0  Onset:2008-11-24, Days after vaccination: 0
Gender:Female  Submitted:2008-11-26, Days after onset: 2
Location:Maryland  Entered:2008-12-09, Days after submission: 13
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: Iodine; Splenectomy; Irregular heartbeat
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0978X1UNLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Feeling hot, Gait disturbance, Pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Pt c/o red warm to touch, pain with ambulation the evening after receiving vaccine. Pt was seen by provider and given Rx for Duricef and Benadryl. Also advised to use ice to area. Pt was called by the provider the next day after tx and reported she was much better.

VAERS ID:334855 (history)  Vaccinated:2008-12-07
Age:36.0  Onset:2008-12-08, Days after vaccination: 1
Gender:Female  Submitted:2008-12-10, Days after onset: 2
Location:Pennsylvania  Entered:2008-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.HOO38870IN 
Administered by: Military     Purchased by: Unknown
Symptoms: Cough, Headache, Lymphadenopathy, Musculoskeletal pain, Nasal discomfort, Oropharyngeal pain, Pain in extremity, Pyrexia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Experienced high fever(102) x3 days, runny nose, headache, soreness in shoulders, arms, hands and nose. Day three experienced cough, sore throat and swollen lymph glands in neck.

VAERS ID:335052 (history)  Vaccinated:2008-12-03
Age:36.0  Onset:2008-12-05, Days after vaccination: 2
Gender:Female  Submitted:2008-12-11, Days after onset: 6
Location:Michigan  Entered:2008-12-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Lasix, Ultram
Current Illness: No.
Preexisting Conditions: Sluggish thyroid.
Diagnostic Lab Data:
CDC Split Type:
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A fever began 36 hours after the vaccination was administered and persisted for four days, severely for two days. Arm swelled up to the point that a lump could be seen through the clothes. Arm is still swollen, though to a much lesser extent, today (8 days later).

VAERS ID:335258 (history)  Vaccinated:2008-11-21
Age:36.0  Onset:2008-11-22, Days after vaccination: 1
Gender:Female  Submitted:2008-12-12, Days after onset: 20
Location:Texas  Entered:2008-12-12
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
CDC Split Type:
Vaccination
Manufacturer
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVBGX0BA0IMUN
Administered by: Public     Purchased by: Unknown
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash all over body- No treatment

VAERS ID:335354 (history)  Vaccinated:2007-08-17
Age:36.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2008-12-15, Days after onset: 486
Location:Georgia  Entered:2008-12-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
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Manufacturer
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB403AA1IMLA
Administered by: Military     Purchased by: Military
Symptoms: Keloid scar
SMQs:
Write-up: Keloid formation devoloped at site of smallpox vaccination given on 17 Aug 2007.

VAERS ID:335390 (history)  Vaccinated:2008-11-15
Age:36.0  Onset:2008-11-15, Days after vaccination: 0
Gender:Female  Submitted:2008-12-16, Days after onset: 31
Location:Pennsylvania  Entered:2008-12-16
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: Sulfa drugs, lanolin (contact dermatitis)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS  IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Asthma, Chills, Conjunctivitis, Eye discharge, Malaise, Photophobia, Pyrexia, Wheezing
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Malaise, fever, chills followed by slow onset of asthma (with wheezes), photophobia, conjunctivitis (with thick yellow discharge). treated with Albuterol inhaler & Advair (spaced 3 hours apart), 2 tabs of benadryl and another 2 puffs of albuterol before bed (12am). Symptoms resolved completely by the 8am. Considered visiting the emergency room, but symptoms improved by the evening. I am a medical professional- if I wasn''t I would have definitely gone to the ER.

VAERS ID:335470 (history)  Vaccinated:2008-12-09
Age:36.0  Onset:2008-12-10, Days after vaccination: 1
Gender:Male  Submitted:2008-12-12, Days after onset: 2
Location:Minnesota  Entered:2008-12-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB640BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hepatitis B administered on 12/9/08. Left side of lip significantly swollen 1 day later. Returned to clinic 12/11/08 and given diphenhydramine 50mg Q6 hrs.

VAERS ID:335509 (history)  Vaccinated:2008-12-15
Age:36.0  Onset:2008-12-15, Days after vaccination: 0
Gender:Female  Submitted:2008-12-17, Days after onset: 2
Location:North Carolina  Entered:2008-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: NA
CDC Split Type:
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0866X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed circular bumps that itched on lower back 5 hours after administration followed by hives on face that itched following day. Patient took benadryl which releaved symptoms

VAERS ID:335846 (history)  Vaccinated:2008-11-14
Age:36.0  Onset:2008-11-15, Days after vaccination: 1
Gender:Female  Submitted:2008-12-17, Days after onset: 32
Location:California  Entered:2008-12-22, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Did have prenatal vitamins
Current Illness: None
Preexisting Conditions: None PMH: SVD 10/9/08 w/o complication. Kidney stone, ruptured ovarian cyst.
Diagnostic Lab Data: Many test and studies were performed at medical center - patient does not have results. Was told the cause was told the cause of her renal failure was unknown. LABS: Creatinine 1.83, BUN 11. UA abnormal w/ketones. WBC 10.3. Anion gap 22 AST 58, ALT 104, total bilirubin 1.9. Blood, urine & GC c/s neg. US& CT abdomen/pelvis WNL. CXR WNL
CDC Split Type:
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TDAP: TDAP (ADACEL)SANOFI PASTEURUF452BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Acidosis, Alanine aminotransferase increased, Anion gap increased, Anorexia, Aspartate aminotransferase increased, Back pain, Blood bilirubin increased, Blood creatinine increased, Blood culture negative, Blood urea normal, Chest X-ray normal, Chills, Culture urine negative, Dizziness, Hyperhidrosis, Liver function test abnormal, Malaise, Myalgia, Nausea, Pyrexia, Renal failure acute, Tremor, Ultrasound abdomen normal, Urine analysis abnormal, Urine ketone body present, Vaginal discharge, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)
Write-up: Vaccine TdaP 11/14/08 - felt sick 11/15/08, shaky, sweats, chills - went medical center 11/18/08 - admitted - "acute renal failure" - antibiotics & IV - medical center said not bacterial infection - 3 days in hospital - kidney function returned. 1/26/09 Reviewed hospital medical records of 11/19-11/20/2009. FINAL DX: no d/c summary available. ER dx: acute renal failure, anion gap acidosis & elevated LFTs. Records reveal patient experienced fever, chills, myalgias, dizzy/lightheaded, abdominal & lower back pain, nausea, anorexia x 4 days. Had bloody/brown vaginal discharge. OB/GYN consult done & WNL. Tx w/IVF & antibiotics. Improved markedly overnight w/fluids & antibiotics. D/C to home. .

VAERS ID:335968 (history)  Vaccinated:2008-12-19
Age:36.0  Onset:2008-12-21, Days after vaccination: 2
Gender:Female  Submitted:2008-12-23, Days after onset: 2
Location:Indiana  Entered:2008-12-23
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: Latex
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC899AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site swelling, Injection site warmth, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness and swelling at injection site radiating to axilla. Heat in tissue involved. Augmentin PO given for 10 days.

VAERS ID:336214 (history)  Vaccinated:2008-11-16
Age:36.0  Onset:0000-00-00
Gender:Male  Submitted:2008-12-29
Location:Virginia  Entered:2008-12-29
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 LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:, Medication errors (narrow)
Write-up: RECEIVED INFLUENZA IM VACCINE VIA INTRANASAL ROUTE

VAERS ID:336563 (history)  Vaccinated:2008-09-09
Age:36.0  Onset:2008-09-09, Days after vaccination: 0
Gender:Male  Submitted:2008-12-24, Days after onset: 106
Location:Unknown  Entered:2009-01-06, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1786SCUN
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB640AA UNUN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURA03945IMUN
Administered by: Military     Purchased by: Military
Symptoms: Rash erythematous, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received ANTHRAX vaccine #7 on 9 Sep 08. A erythematous rxy followed & the size of a softball, 4" in diameter, 1/2 inch raised, warm to touch, with 101 degree fever. The arm was sore to the point that a t-shirt was uncomfortable. On day 5, the reaction started to subside.

VAERS ID:336620 (history)  Vaccinated:1999-03-01
Age:36.0  Onset:1999-03-15, Days after vaccination: 14
Gender:Female  Submitted:2009-01-06, Days after onset: 3585
Location:New Jersey  Entered:2009-01-06
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: Allergies; Arthritis; Asthma; Depression; Fatigue; Gastroesophageal reflux disease; Joint pain; Kidney stone; Knee derangement; Knee pain; Leg cramps; Low back pain; Lyme disease; Sacral contusion; Smoking; Stress urinary incontinence; Thin hair; Tubal ligation; History of "long-term " treatment of Lyme disease including ZITHROMAX and doxycycline. In approximately 1989, she began e
Diagnostic Lab Data: Antinuclear antibody, 16Mar1999, negative; Antinuclear antibody, 17Jul1999, negative; Antinuclear antibody, 06Oct1999, negative; Antinuclear antibody, 10Mar2008, negative; Erythrocyte sedimentation rate, 16Mar1999, 1mm/hr; Erythrocyte sedim
CDC Split Type: A0730257A
Vaccination
Manufacturer
Lot
Dose
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Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALSLY120A90IMUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Antinuclear antibody negative, Arthralgia, Arthritis, Autoimmune disorder, Back pain, Blood immunoglobulin G normal, Blood immunoglobulin M, Borrelia burgdorferi serology, Borrelia burgdorferi serology negative, Cognitive disorder, Condition aggravated, Crohn's disease, Eating disorder, Epicondylitis, Fall, Fatigue, Fibromyalgia, Full blood count normal, Gastrointestinal disorder, HLA marker study, Immediate post-injection reaction, Immunology test, Joint sprain, Joint swelling, Lyme disease, Muscle strain, Musculoskeletal pain, Musculoskeletal stiffness, Myalgia, Neck pain, Neurological symptom, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging normal, Oedema peripheral, Osteoarthritis, Pain, Post vaccination syndrome, Rash, Red blood cell sedimentation rate normal, Rheumatoid arthritis, Rheumatoid factor, Rheumatoid factor negative, Sleep disorder, Swelling face, X-ray abnormal, X-ray limb abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal premalignant disorders (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a lawyer and described the occurrence of rheumatological symptoms in a female subject of unspecified age who was vaccinated with LYMERIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of LYMERIX. According to the statement of injuries, at an unspecified time after vaccination with LYMERIX the subject experienced "arthralgias, myalgias, cognitive dysfunction, facial swelling, and fatigue" as well as "rashes, swollen joints, swollen feet, and gastrointestinal problems". The statement of injuries also alleged that the subject experienced "rheumatologic, neurologic, and/or cognitive impairment of an autoimmune, immune-mediated, or other mechanism all caused by vaccination with LYMERIX including but not limited to those set forth above", and that she experienced "decreased activities of daily life and decreased ability to participate in recreational activities". At the time of reporting the outcome of the events was unspecified. Follow up information was received on 29 July 2008 via medical records. The subject''s medical history included arthritis, depression, fatigue, joint pain, kidney stone, leg cramps, low back pain and Lyme disease. She also had past subcapsular syndrome treated with hydrocortisone and MARCAINE. She had been hospitalized in the past (1989) for Lyme arthralgia. She received her first dose of LYMERIX on 01 March 1999. on 15 March 1999, she experienced "supposed swelling/ rash, not confirmed" as well as aching. It was noted that the subject "swears she had Lyme disease before getting the vaccine; taken doxycycline for several years for Lyme even though never confirmed". On 10 December 2001, she was evaluated for post-Lyme vaccine syndrome and elbow epicondylitis. She was treated by a "Lyme specialist" and medications included VIOXX and ULTRAM. On 15 March 2002, she reported that "the LYMERIX injections have caused her to have a lot of symptoms". On 27 December 2002,

VAERS ID:336920 (history)  Vaccinated:2008-11-16
Age:36.0  Onset:0000-00-00
Gender:Male  Submitted:2009-01-09
Location:Virginia  Entered:2009-01-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED03149111A IN 
Administered by: Military     Purchased by: Military
Symptoms: Incorrect route of drug administration
SMQs:, Medication errors (narrow)
Write-up: SM RECEIVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE

VAERS ID:337335 (history)  Vaccinated:2008-12-05
Age:36.0  Onset:2008-12-05, Days after vaccination: 0
Gender:Male  Submitted:2009-01-14, Days after onset: 40
Location:Michigan  Entered:2009-01-14
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: Client states he takes allergy medication for environmental allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2765AA1IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Cough, Dyspnoea, Eyelid oedema, Sneezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 2 hours after received flu shot client starting sneezing and coughing. Eye lids began to swell and had difficulty breathing.

VAERS ID:337698 (history)  Vaccinated:2007-08-01
Age:36.0  Onset:0000-00-00
Gender:Male  Submitted:2008-01-25
Location:Unknown  Entered:2009-01-16, Days after submission: 357
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: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS  SC 
Administered by: Military     Purchased by: Military
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: SM developed redness, swelling and pain at injection site within 24 hrs of receiving his second ANTHRAX shot.

VAERS ID:338151 (history)  Vaccinated:2005-10-03
Age:36.0  Onset:2005-10-03, Days after vaccination: 0
Gender:Male  Submitted:2009-01-12, Days after onset: 1197
Location:Unknown  Entered:2009-01-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMIN, IBUPROFEN
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Blood glucose, 03Oct2005, 94mg/dL, 74, 106; Blood pressure, 03Oct2005, 140/100; Blood pressure, 03Oct2005, Blood pressure, 110/70; Blood pressure, 03Oct2005, 140/100; Cholesterol, 03Oct2005, 249mg/dL,80, 200; Protein total, 03Oct2005, 8.9gm
CDC Split Type: A0725646A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS  IMRL
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood cholesterol increased, Blood pressure, Blood triglycerides increased, Dizziness, Nausea, Protein total increased, Vision blurred
SMQs:, Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Lipodystrophy (broad), Hypoglycaemia (broad)
Write-up: The subject was in clinic for day 180 on 03 October 20005. Pre-injection vitals were normal with blood pressure (BP) of 114/84. The subject did not have any complaints. About 15 minutes after received the injection the subject experienced mild nausea, lightheadedness dizziness with blurred vision. He was not diaphoretic and head not experienced these or any other symptoms on earlier injection day (was previously given injections on two separate occasions for this study). The subject had not eaten since 2100 the night before (injections given at 1200). The subject was given orange juice to drink and the lightheadedness, dizziness and nausea were resolved with in a few minutes. Blurred vision was resolved within 15 minutes. He is not a known diabetic and was on no Anti-retroviral (ARV) medications. A physical exam was performed and BP was taken lying down, which was 110/710. About five minute later, while sitting it as 140/100 and standing it was 140/100. Heart sounds were normal. After speaking to the subject later that day, he remained without the above symptoms. The following day his only complaints were slight headache and sluggishness. The reporting physician (PMD) deems this was possibly related to study treatment.

VAERS ID:338291 (history)  Vaccinated:2009-01-05
Age:36.0  Onset:2009-01-06, Days after vaccination: 1
Gender:Male  Submitted:2009-01-26, Days after onset: 20
Location:Florida  Entered:2009-01-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid; Lexapro
Current Illness: Puncture wound (R) foot due to a fishing hook 2 days prior
Preexisting Conditions: Allergies: Levaquin; PMHX: Hypothyroid; Anxiety
Diagnostic Lab Data: Pt states basic lab test, viral load and thyroid evaluation by Dr.
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURC3032AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Laboratory test, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient states developed muscle and joint aches the following day after receiving a Tetanus vaccine. Stated by 4:00 PM on 1/4/09 his joints began to ache and by 7:00 PM he felt worse. He follows up with his own Physician in 2 weeks.

VAERS ID:339096 (history)  Vaccinated:0000-00-00
Age:36.0  Onset:0000-00-00
Gender:Female  Submitted:2009-02-04
Location:California  Entered:2009-02-05, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3068AA1UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Condition aggravated
SMQs:
Write-up: Unlikely time vaccine reaction. The injection triggered a flare up of pts underlying reflex sympathetic dystoptry.

VAERS ID:339196 (history)  Vaccinated:2008-09-24
Age:36.0  Onset:2008-09-29, Days after vaccination: 5
Gender:Male  Submitted:2008-10-16, Days after onset: 17
Location:North Carolina  Entered:2009-02-06, Days after submission: 113
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: Allergies: No known allergies. No birth defects. Medical conditions: 1) HTN; 2) Hypertriglyceridemia; 3) Nephrolithiasis. Birth defects: None. PMH: Nephrolithiasis. HTN. Hypertriglyceridemia. L shoulder pain 2'' to labrum tear
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Site
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER  IDUN
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Military     Purchased by: Military
Symptoms: Influenza like illness, Injection site erythema, Malaise, Pain in extremity, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: 36 y/o male with possible adverse reaction to Smallpox Vaccine. 2/10/09 Office note received from reporting MD. Pt seen 10/6/08 with c/o L arm pain and increased redness at SP vax site. Some malaise and flu-like sx. PE WNL except oval shaped smallpox lesion with central scarring. Assessment: Robust reaction from SPV-likely etiology for pt sx constellation. Tx-Motrin PRN.

VAERS ID:339200 (history)  Vaccinated:2008-05-19
Age:36.0  Onset:2008-05-20, Days after vaccination: 1
Gender:Female  Submitted:2008-05-25, Days after onset: 5
Location:North Carolina  Entered:2009-02-06, Days after submission: 257
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: 05/23/2008 Rash, oth nonspecific skin eruption (Resolved)
Diagnostic Lab Data: PPD read as "0mm" on 5-23-08. Pt. received annual PPDs and never has experienced a local reaction or a rash.
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNLA
Administered by: Military     Purchased by: Military
Symptoms: Tuberculin test negative, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 36 y/o female, spouse of retired SM presents to FBVHC with report of developing a rash "hives" on both arms and legs within 24 hrs of receipt of Tdap (left deltoid) received on 05-19-08. In addition, PPD was placed in her left forearm on same date and read as 0mm on 5-23-08. She has had annual PPDs as a WAMC IT civilian employee, but never has developed any rash or local reaction to PPD in the past. Symptoms: Rash, pruritic.

VAERS ID:339543 (history)  Vaccinated:2009-02-09
Age:36.0  Onset:2009-02-09, Days after vaccination: 0
Gender:Female  Submitted:2009-02-12, Days after onset: 3
Location:Maryland  Entered:2009-02-12
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: Previous reaction when given FLUVIRIN and Hepatitis B
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB697CA1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Headache, Pallor, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: ENGERIX B #2 administered at 11 am on 2/9/09 at noon cheeks became red and flushed then pale, severe headache.. Premedicated at 7am with TYLENOL x 5 x2. Left work at 1:30pm that evening had hives on arms, front legs and chest. Headache continued on and off till 2/12/09. On 2/9/09 in evening at temperature 101 degree F.

VAERS ID:339651 (history)  Vaccinated:2009-02-11
Age:36.0  Onset:2009-02-11, Days after vaccination: 0
Gender:Female  Submitted:2009-02-16, Days after onset: 5
Location:North Carolina  Entered:2009-02-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair, Singulair, Atenolol, Ativan prn
Current Illness:
Preexisting Conditions: Hx tachycardia, aortic valve dz post rheumatic fever, Hx asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1571X1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Immediate post-injection reaction, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Immediate onset of erythema, pruritus and edema on right upper arm after receiving MMR vaccine. VS - B/p-104/64, R-20, P-74, regular. Patient was given Benadryl 25 mg po immediately and observed for 2 hours. Was transported home by husband. Called the next day and patient reported no further problems.

VAERS ID:340397 (history)  Vaccinated:2009-01-21
Age:36.0  Onset:2009-02-09, Days after vaccination: 19
Gender:Male  Submitted:2009-02-14, Days after onset: 5
Location:New York  Entered:2009-02-23, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: VZV strain discrimination
CDC Split Type:
Vaccination
Manufacturer
Lot
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1535X0SCUN
Administered by: Private     Purchased by: Other
Symptoms: Headache, Pyrexia, Rash, Skin lesion, Varicella zoster virus serology positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2/9/09 started with rash, fever and HA. Seen on 2/11/09 counted 44 lesions (papules). Seen 2/12/09 vesicular fluid sample collected. Feels worse.

VAERS ID:340808 (history)  Vaccinated:2009-01-15
Age:36.0  Onset:2009-01-16, Days after vaccination: 1
Gender:Male  Submitted:2009-02-26, Days after onset: 41
Location:Michigan  Entered:2009-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB140AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC2773BA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site urticaria, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: One day after receiving the injection, a bump appeared at the injection site,lasting about a day. It disappeared and then retrurned about 1 week later. The arm was itchy and a raised rash appeared, lasting over a month. Application of OTC hydrocortisone cream relieved the redness and itching.

VAERS ID:348891 (history)  Vaccinated:2008-07-15
Age:36.0  Onset:2008-07-16, Days after vaccination: 1
Gender:Female  Submitted:2009-02-11, Days after onset: 210
Location:Michigan  Entered:2009-03-03, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: GERD Gastrooesophageal reflux disease; Allergies to: PCN, Keflex, Morphine, Demerol, Drug hypersensitivity
Diagnostic Lab Data: None
CDC Split Type: 08AV00436SP
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2331SCLA
Administered by: Other     Purchased by: Private
Symptoms: Feeling jittery, Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Redness at injection site at 24 hours after immunization. Redness, swelling, itching, tenderness and induration at injection site at 48 hours after immunization. Pain extended throughout entire left arm. Subject felt jittery and experienced episodes of heart racing. Subject was seen by a physician and prescribed Loratadine 10 mg daily and Topicort LP cream to site. Symptoms resolved completely as of 7/21/08, 6 days after immunization.

VAERS ID:341074 (history)  Vaccinated:2008-05-16
Age:36.0  Onset:0000-00-00
Gender:Female  Submitted:2009-03-04
Location:Illinois  Entered:2009-03-04
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2760AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)
Write-up: Patient self reported sore arm for 3 weeks. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel box and vial not marked for pediatric use at time of administration. Error found when new Daptacel box received and new box was marked pediatric.

VAERS ID:341729 (history)  Vaccinated:2009-03-10
Age:36.0  Onset:2009-03-11, Days after vaccination: 1
Gender:Female  Submitted:2009-03-13, Days after onset: 2
Location:Oklahoma  Entered:2009-03-13
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
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0980X0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Headache, Nausea, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: reddness, swelling, nausea, headache, low grade fever.

VAERS ID:341898 (history)  Vaccinated:2009-03-03
Age:36.0  Onset:2009-03-15, Days after vaccination: 12
Gender:Male  Submitted:2009-03-05, Days after onset: 9
Location:Michigan  Entered:2009-03-17, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: None~ ()~~0~Patient
Other Medications: ZOCOR
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF457CA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: lymph node in the deltoid region and lymphadenopathy in the left axillary region. Some erythema of the injection site.

VAERS ID:341930 (history)  Vaccinated:2009-03-16
Age:36.0  Onset:2009-03-16, Days after vaccination: 0
Gender:Female  Submitted:2009-03-17, Days after onset: 1
Location:Texas  Entered:2009-03-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown meds patient brought with her from Burma/Thailand for allergies and muscle pain
Current Illness: states headaches
Preexisting Conditions: hx of menorrhea
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1366X1SCRA
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)SANOFI PASTEURU2347CA2IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1401X1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Immunizations given 3/16/09. Client returned to clinic 3/17/09 stating during the evening of 3/16 her left arm was painful, w/pain radiating down to hand. On 3/17, upper left arm appeared slightly swollen; red; warm to touch. Ice packs advised.

VAERS ID:342528 (history)  Vaccinated:2009-03-14
Age:36.0  Onset:2009-03-15, Days after vaccination: 1
Gender:Male  Submitted:2009-03-15, Days after onset: 0
Location:Alabama  Entered:2009-03-24, 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: Pt discontinued allergy shots one month ago.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2768BA0IMRA
Administered by: Military     Purchased by: Unknown
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: C/o minor rash on arms & forehead within 24 hrs of receiving TDaP vaccine recommended OTC BENADRYL & hydrocortisone cream prn itching. No swelling or respiratory symptoms.

VAERS ID:342686 (history)  Vaccinated:2009-03-20
Age:36.0  Onset:2009-03-23, Days after vaccination: 3
Gender:Female  Submitted:2009-03-25, Days after onset: 2
Location:Minnesota  Entered:2009-03-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions: Allergies to penicillin and intravein dye, dx: myalgia in 2008
Diagnostic Lab Data: CBC-results pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3508AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Fatigue, Full blood count, Injected limb mobility decreased, Lymphadenopathy, Pain in extremity, Tenderness
SMQs:, Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3-20-09: Tdap left deltoid, 3-22-09: arm sore, fatigue, 3-23-09: pain in arm with movement swollen left axillary lymph node, tender to touch, 3-24-09: pain worse, swelling worse, 3-25-09: pain worse, swelling worse, CBC test results pending

VAERS ID:342810 (history)  Vaccinated:2009-03-19
Age:36.0  Onset:2009-03-19, Days after vaccination: 0
Gender:Female  Submitted:2009-03-26, Days after onset: 7
Location:Michigan  Entered:2009-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MOTRIN 600 mg
Current Illness:
Preexisting Conditions: Allergic to tetanus, DM, HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1080X1UNLA
Administered by: Public     Purchased by: Other
Symptoms: Local swelling, Pain in extremity
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Localized swelling and pain after she received a MMR vaccine on 3/19/09 in Lt. upper arm.

VAERS ID:343051 (history)  Vaccinated:2009-01-30
Age:36.0  Onset:2009-02-11, Days after vaccination: 12
Gender:Male  Submitted:2009-03-27, Days after onset: 43
Location:Mississippi  Entered:2009-03-31, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: HTN PMH: HTN, shoulder surgery. Family hx: CAD
Diagnostic Lab Data: Troponin: records say ''elevated'' but awaiting exact reading from civilian records; Cardiac Cath: 12 Feb 09 "small occlusion of distal LAD, otherwise, normal coronaries".
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTH  UNUN
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER  IDUN
Administered by: Military     Purchased by: Military
Symptoms: Blood pressure increased, Catheterisation cardiac, Catheterisation cardiac normal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Hyperhidrosis, Intensive care, Myocarditis, Oxygen supplementation, Pyrexia, Troponin increased, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Developed chest pain, SOB and diaphoresis. Admitted to clinic and diagnosed with MI. Troponins elevated, EKG normal, Cardiac cath primarily normal. Seen by military cardiologist and correctly diagnosed post vaccinia Myocarditis. 4/15/09 Received medical records of 3/26-3/30/2009. FINAL DX: post vaccinia myocarditis Records reveal patient experienced chest pain after receiving multiple vaccinations w/robust take on smallpox. Twelve days s/p vaccination, he awoke w/chest pain radiating down left arm, SOB, sweating. Pain lessened & patient had usual day. Late in same afternoon, pain exacerbated & went to aid station where he was dx w/panic attack; however, BP 160/116. Tx w/O2 & NTG & transferred to local hospital on where EKG was WNL but troponin elevated. Admitted to CCU 2/11-2/14/2009 & had normal heart cath. Transferred to step down unit & also given pneumovax. Developed fever of 103.8 within a few hours that lasted 24 hours then resolved. When seen in Cardio Clinic 3/26 for echocardiogram which was WNL, dx changed to post vaccinia myocarditis & meds changed. Not deployed & released to home.

VAERS ID:343553 (history)  Vaccinated:2008-06-03
Age:36.0  Onset:2008-06-03, Days after vaccination: 0
Gender:Unknown  Submitted:2008-10-27, Days after onset: 146
Location:Louisiana  Entered:2009-04-03, Days after submission: 158
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVIL
Current Illness:
Preexisting Conditions: None reported.
Diagnostic Lab Data: None reported.
CDC Split Type: 200801848
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)SANOFI PASTEURZ0578 UNUN
Administered by: Private     Purchased by: Public
Symptoms: Accidental exposure, Eye pruritus, Oropharyngeal pain, Paraesthesia, Pruritus, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was received from a health professional on 03 June 2008. A 36-year-old female patient was accidentally exposed to ACTHIB (lot number UE931AA, sanofi-pasteur SA lot number Z0578) via to eye. On 03 June 2008, the patient was holding an infant during vaccine administration when the needle separated from the syringe and she was splashed in the eye (according to the reporter, it was not a pre-filled syringe). Twenty minutes after exposure, the patient began complaining of eye itching, sore throat, facial tingling and itching, and runny nose. No shortness of breath or breathing difficulties were noted. The patient flushed her eyes with water; no other treatment was provided. At the time of the report, the event was still ongoing. Follow up information was received on 24 October 2008 from a health care professional. The patient was splashed in the right eye. The patient recovered from the event two hours later. No other findings were reported. List of Documents held by Sender: None.

VAERS ID:343511 (history)  Vaccinated:2009-03-14
Age:36.0  Onset:2009-03-24, Days after vaccination: 10
Gender:Male  Submitted:2009-04-05, Days after onset: 12
Location:California  Entered:2009-04-05
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
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1640IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2898FA2IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB042421IMRA
Administered by: Military     Purchased by: Military
Symptoms: Herpes zoster, Injection site pruritus, Injection site vesicles, Purulence, Skin lesion
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient was given scheduled vaccination doses of: Typhoid, Influenza, and Anthrax on 3/14/09. After about a week and a half later, the patient noticed some mild blistering and itchiness around and below the vaccination site. The blisters and itchiness continued to worsen and spread. Patient finally went to ER on 4/5/09 with purulent lesions that were on the lateral part of their right arm and extending from the deltoid to the forearm. ER diagnosed patient with, "Cutaneous reaction to Anthrax vaccine" and sent patient home with instructions to use hydrocortisone creme. After patient went to the ER, he came to see a military doctor. After our doctor saw the lesions, he commented that it could be a herpes zoster infection secondary to having the vaccines. He concurred with the hydrocortisone therapy. the patient wsa told to let the clinic know if there are any changes, to let us know right away.

VAERS ID:343561 (history)  Vaccinated:2009-03-05
Age:36.0  Onset:2009-03-06, Days after vaccination: 1
Gender:Male  Submitted:2009-03-07, Days after onset: 1
Location:New York  Entered:2009-04-06, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV1485IMRA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB697AC2IMLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Local reaction, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Small localized reaction started day after. Increase to redness, swelling. Spreading down R arm hot to touch.

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