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Case Details (Sorted by Age)

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VAERS ID: 424669 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Rubella antibody negative
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Polycystic ovaries
Preexisting Conditions:
Diagnostic Lab Data: Serum rubella IgG, Negative
CDC Split Type: WAES1005USA01626

Write-up: Information has been received from a certified medical assistant concerning a 30 year old female patient with polycystic ovary disease and no drug reactions or allergies who in the past could have been vaccinated with a dose of MMR II (Lot number not provided). The healthcare worker reported that the patient had a negative antibody titer for rubella. At the time of the report the patient''s outcome was unknown. The patient sought medical attention by an office visit. Additional information has been requested.


VAERS ID: 424733 (history)  
Age: 30.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Mumps
SMQs:, Oropharyngeal infections (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Diagnostic laboratory, mumps
CDC Split Type: WAES1105USA02672

Write-up: Information has been received from a licensed visiting nurse concerning a patient in his/her 30''s who at some point in his/her childhood was vaccinated with a dose of MMR II (lot number not reported). It was reported that the patient was a confirmed case of mumps in a local correctional facility. A laboratory test confirmed that the patient had mumps. The patient was not hospitalized. At the time of the report, the patient''s outcome was unknown. It was unknown if the patient sought medical attention. All telephone call attempts to obtain follow-up information have been unsuccessful. This is one of several reports received from the same source. Additional information has been requested.


VAERS ID: 424735 (history)  
Age: 30.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Mumps
SMQs:, Oropharyngeal infections (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Diagnostic laboratory, mumps
CDC Split Type: WAES1105USA02673

Write-up: Information has been received from a licensed visiting nurse concerning a patient in his/her 30''s who at some point in his/her childhood was vaccinated with a dose of MMR II (lot number not reported). It was reported that the patient was a confirmed case of mumps in a local correctional facility. A laboratory test confirmed that the patient had mumps. The patient was not hospitalized. At the time of the report, the patient''s outcome was unknown. It was unknown if the patient sought medical attention. All telephone call attempts to obtain follow-up information have been unsuccessful. This is one of several reports received from the same source. Additional information has been requested.


VAERS ID: 424736 (history)  
Age: 30.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Mumps
SMQs:, Oropharyngeal infections (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA02674

Write-up: Information has been received from a licensed visiting nurse concerning a patient in his/her 30''s who at some point in his/her childhood was vaccinated with a dose of MMR II (lot number not reported). It was reported that the patient was an unconfirmed case of mumps in a local correctional facility but they were pretty confident that it was going to come back positive after the lab testing. The patient was not hospitalized. At the time of the report, the patient''s outcome was unknown. It was unknown if the patient sought medical attention. All telephone call attempts to obtain follow-up information have been unsuccessful. This is one of several reports received from the same source. Additional information has been requested.


VAERS ID: 424738 (history)  
Age: 30.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Mumps
SMQs:, Oropharyngeal infections (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA02675

Write-up: Information has been received from a licensed visiting nurse concerning a patient in his/her 30''s who at some point in his/her childhood was vaccinated with a dose of MMR II (lot number not reported). It was reported that the patient was an unconfirmed case of mumps in a local correctional facility but they were pretty confident that it was going come back positive after the lab testing. The patient was not hospitalized. At the time of the report, the patient''s outcome was unknown. It was unknown if the patient sought medical attention. All telephone call attempts to obtain follow-up information have been unsuccessful. This is one of several reports received from the same source. Additional information has been requested.


VAERS ID: 424739 (history)  
Age: 30.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Mumps
SMQs:, Oropharyngeal infections (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA02676

Write-up: Information has been received from a licensed visiting nurse concerning a patient in his/her 30''s who at some point in his/her childhood was vaccinated with a dose of MMR II (lot number not reported). It was reported that the patient was an unconfirmed case of mumps in a local correctional facility but they were pretty confident that it was going to come back positive after the lab testing. The patient was not hospitalized. At the time of the report, the patient''s outcome was unknown. It was unknown if the patient sought medical attention. All telephone call attempts to obtain follow-up information have been unsuccessful. This is one of several reports received from the same source. Additional information has been requested.


VAERS ID: 424561 (history)  
Age: 30.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2011-05-23
Onset:2011-05-24
   Days after vaccination:1
Submitted: 2011-05-24
   Days after onset:0
Entered: 2011-06-02
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC002A / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3518AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1345Z / 0 RA / SC

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

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:

Write-up: Generalized papulovesicular rash face, neck, torso, arms 1 day after vaccine administered.


VAERS ID: 425017 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-06-06
Onset:2011-06-07
   Days after vaccination:1
Submitted: 2011-06-08
   Days after onset:1
Entered: 2011-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3519AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3819AA / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR E0304 / 1 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Redness on chest and slight fever per pt. (URTICARIA) per doctor.


VAERS ID: 425021 (history)  
Age: 30.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2011-06-06
Onset:2011-06-06
   Days after vaccination:0
Submitted: 2011-06-08
   Days after onset:2
Entered: 2011-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB909AB / 0 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Blood gases, Chest X-ray, Dyspnoea, Electrocardiogram, Oedema peripheral, Pruritus generalised
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergic to grass, dogs and cats. No allegies to yeast, medications or foods
Diagnostic Lab Data: Chest x-ray, EKG, Blood Gases
CDC Split Type:

Write-up: Several hours after shot developed pain in both ankles, swelling in both legs and feet and itching all over. Reported above to OBI nurse on 6/8/2011 at 11:30 AM. No rash on body but still itching all over. 12:30PM developed difficulty breathing. Taken to Medical Center by car. Physician is treating subject for possible pulmonary embolus. Lungs were clear per ER physician. 3:30 PM Subject still itching all over. ER Physican unsure if symptoms from vaccination.


VAERS ID: 425397 (history)  
Age: 30.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-06-10
Onset:2011-06-10
   Days after vaccination:0
Submitted: 2011-06-14
   Days after onset:4
Entered: 2011-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3838BA / - LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site joint pain, Injection site pain, Injection site swelling, Injection site warmth, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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:

Write-up: Significant swelling, redness, heat and pain at the injection site (left deltoid). Muscle pain in left arm. Left shoulder joint pain.


VAERS ID: 425416 (history)  
Age: 30.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2011-06-14
Onset:2011-06-14
   Days after vaccination:0
Submitted: 2011-06-14
   Days after onset:0
Entered: 2011-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0880Z / 0 LA / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; LANTUS insulin; estradiol; PROZAC; ZYRTEC; XANAX PRN; multivitamin
Current Illness: None
Preexisting Conditions: Allergies - PCN; Iodine; bees; asthma; DM; thyroid (removal 12/09)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Employee reported itching arms, ears, back, hip areas approx. 2 hours after receiving vaccine. Employee declined to go to ER only accepted BENADRYL 25-50mg dose. States alleviated somewhat.


VAERS ID: 425512 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-05-27
Onset:2011-05-29
   Days after vaccination:2
Submitted: 2011-06-16
   Days after onset:18
Entered: 2011-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB945BA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3872CA / - LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site infection, Injection site mass, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BCP ALLERGY SHOTS WEEKLY IBUPROFEN PRN TYLENOL ALLERGY AURALGAN OTIC GTT 5 BIOFREEZE TOPICAL PRN
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX20110031PR

Write-up: PT RECIEVED TDAP ON 5/27/11. STATES HER ARM STARTED GETTING RED AND PAINFUL 5/29/11 AND DID NOT GET ANY BETTER. CAME TO CLINIC 6/1/11 FOR HEP A INJECTION AND THIS NURSE NOTICED REDNESS, SWELLING AND INCREASED TEMP AT INJECTION SITE IN LEFT DELTOID. PT ALSO HAD PALPABLE LUMP AT SITE. CHECKED BY CFNP. RX FOR BACTRIM DS - PO PH BID X 10 AND RECHECK ON 6/3/11. ADVISED WMP AND NO HEP A TODAY. PT WENT TO URGENT CARE AFTER LEAVING HERE. UPDATE: PT IS TEACHER GOING OUT OF COUNTRY. REASON FOR BACTRIM, INJ. SITE LOOKED INFECTED. FOUND OUT PT WAS ALLERGIC TO SULPHA, REASON FOR URGENT CARE VISIT.


VAERS ID: 426862 (history)  
Age: 30.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2011-06-28
Onset:2011-06-30
   Days after vaccination:2
Submitted: 2011-07-05
   Days after onset:5
Entered: 2011-07-07
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3973CA / - LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Erythema, Induration, Local reaction
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin (recent); CLARITIN
Current Illness: Patient had recent sinus infection
Preexisting Conditions: Allergies to cat hair, pollen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Local reaction for 1 wk duration 10x10 cm erythema/induration OTC Ibuprofen.


VAERS ID: 426944 (history)  
Age: 30.0  
Gender: Male  
Location: Puerto Rico  
Vaccinated:2010-10-16
Onset:0000-00-00
Submitted: 2011-07-07
Entered: 2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED M51507 / 1 LA / UN

Administered by: Military       Purchased by: Military
Symptoms: Cyst, Insomnia, Musculoskeletal pain, Nuclear magnetic resonance imaging abnormal, Osteoarthritis, Pain, Tendonitis, X-ray normal
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (narrow), Tendinopathies and ligament disorders (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Shoulder pain, limited range of motion arm, loss strength arm. Burning sensation shoulder.
Preexisting Conditions: none
Diagnostic Lab Data: xrays negative, mri study compatible with degenerative joint disease in the left acromioclavicular joint with tendonitis and paralabral cyst.
CDC Split Type:

Write-up: Shoulder pain, unable to move the arm without pain in shoulder. Trouble sleeping without pills. Tx anti-inflammatories, pain relievers and physical therapy. This have persisted during a 8 months. The pain is worst but at least I can sleep.


VAERS ID: 427074 (history)  
Age: 30.0  
Gender: Female  
Location: Utah  
Vaccinated:2011-07-01
Onset:2011-07-02
   Days after vaccination:1
Submitted: 2011-07-08
   Days after onset:6
Entered: 2011-07-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB986AA / 0 LA / IJ

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Fatigue, Injection site pruritus, Injection site rash, Rash erythematous, Rash generalised
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Previous allergy to PCN & WELLBUTRIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 24 hours after vaccine, pt noticed red bumps & itchy at injection site. Progressed over body with bumps. Day 7 & 8, weak & tired. Has not experienced SOB.


VAERS ID: 427244 (history)  
Age: 30.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2010-10-26
Onset:2010-10-27
   Days after vaccination:1
Submitted: 2010-11-24
   Days after onset:28
Entered: 2011-07-11
   Days after submission:228
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3488BA / - UN / ID

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Skin test, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TUBERSOL
Current Illness:
Preexisting Conditions: The patient had no pre-existing medical conditions, was not taking any concomitant medications, and was not ill at the time of vaccination.
Diagnostic Lab Data:
CDC Split Type: 201006257

Write-up: Initial report received from a health care professional on 28 October 2010. It involves a case of misuse, i.e. wrong vaccine administered. A 30-year-old female patient received an intradermal injection of ADACEL (lot number C3488BA) instead of TUBERSOL on 26 October 2010. The patient also received an intradermal injection of TUBERSOL (lot not reported) the same day. The patient was not taking any concomitant medications, was not ill at the time of vaccination, and had no pre-existing medical conditions. One day post-vaccination, the patient complained that the ADACEL injection site was warm, red, and hard. Treatment included ice and ibuprofen. The patient returned to her physician on 28 October 2010 to have her skin test read, and at that time the ADACEL site remained warm with a large reddened area. Per the reporter, the physician was planning to prescribe antibiotics to treat the event. At the time of the report, the event was still ongoing.


VAERS ID: 427364 (history)  
Age: 30.0  
Gender: Female  
Location: Alabama  
Vaccinated:2011-03-28
Onset:0000-00-00
Submitted: 2011-04-19
Entered: 2011-07-11
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3661 / - RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Migraine, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No concurrent illnesses at time of vaccination. No other vaccinations were received within 4 weeks prior to 28 March 2011. It was unknown if the patient had any pre-existing medical history, use of other medications; or if she had experienced any adverse events with prior vaccinations.
Diagnostic Lab Data: None
CDC Split Type: 201101829

Write-up: Initial report received from a health care professional on 30 March 2011. A 30-year-old female patient with no concurrent illnesses, had received an intramuscular right deltoid injection of ADACEL (lot number U3554CA, Sanofi pasteur Ltd. lot number C3661) on 28 March 2011, and 2 hours after receiving the vaccinations she reported having a headache that progressed to a migraine, and neck stiffness that required a doctor visit. Results of doctor visit were not provided. No relevant diagnostic tests/laboratory data were performed. The patient had not received any other vaccinations within 4 weeks prior to 28 March 2011; and her pre-existing medical history and use of other medications were unknown. It was also unknown if the patient had experienced any adverse events with prior vaccinations. A the time of this report, the patient had not recovered. Documents held by sender: None.


VAERS ID: 427133 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-03-18
Onset:0000-00-00
Submitted: 2011-07-11
Entered: 2011-07-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3518A / 0 GM / IM

Administered by: Private       Purchased by: Other
Symptoms: Biopsy, Culture, Drug administered at inappropriate site, Injection site cyst, Injection site discharge, Injection site haemorrhage, Injection site rash, Skin bacterial infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of erythromycin sensitivity.
Diagnostic Lab Data:
CDC Split Type: 201104260

Write-up: Initial case received from a dermatologist on 08 July 2011. A 31-year-old female, with a history of erythromycin sensitivity, received an intramuscular right hip injection of ADACEL (lot number C3518AA) on 18 March 2011. Of note, the recommended site of vaccination for ADACEL is the deltoid; the gluteal muscle is not recommended for administration. The patient subsequently developed a rash at the injection site in March 2011. On 24 June 2011 she was noted to have a 3cm bleeding, draining cyst on her right hip. She underwent a biopsy and culture; results were pending. The patient was diagnosed with "atypical bacterial rash''. The event remained ongoing at the time of the report.


VAERS ID: 427503 (history)  
Age: 30.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-07-04
Onset:2011-07-06
   Days after vaccination:2
Submitted: 2011-07-15
   Days after onset:9
Entered: 2011-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / IJ

Administered by: Public       Purchased by: Private
Symptoms: Feeling cold, Muscle swelling, Muscle tightness
SMQs:, Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: Cellulitis in right foot. Went to ER.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/4/2011 got vaccine 7/6/2011 woke up and left calf muscle was tight and looked a little swollen 7/7/2011 left calf muscle felt tight, but didn''t look or feel tight, I had a cold sensation in the front of my lower leg, sometimes am getting it in my left upper leg, the muscles on the left side of my spine, and occassionally in my left arm as well. The muscles on the left side of my spine are tense and also have the cold sensation at times. I am not in pain, nothing is swollen or stiff, I am still exercising daily, but the cold sensation is not going away and my calf still feels tight even thought its not.


VAERS ID: 427824 (history)  
Age: 30.0  
Gender: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2011-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3900AA / - LA / UN

Administered by: Public       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated.


VAERS ID: 428031 (history)  
Age: 30.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-07-08
Onset:0000-00-00
Submitted: 2011-07-25
Entered: 2011-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3900AA / 0 LA / IJ

Administered by: Private       Purchased by: Private
Symptoms: Blood calcium normal, Blood magnesium normal, Blood phosphorus normal, Blood potassium normal, Injection site pain, Paraesthesia, Tetany
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: K, Ca, Mg, Phos: all normal
CDC Split Type:

Write-up: Pain at injection site followed days later by tingling back of hand and 3rd finger with intermittent tetany.


VAERS ID: 428446 (history)  
Age: 30.0  
Gender: Female  
Location: Idaho  
Vaccinated:2011-07-19
Onset:2011-07-20
   Days after vaccination:1
Submitted: 2011-07-25
   Days after onset:5
Entered: 2011-08-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3828AA / - LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Local swelling, Lymphadenopathy, Oedema peripheral, Pain
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)

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:

Write-up: Swelling in left arm up to neck and swollen painful gland or "lump" in neck in same arm Tdap was given on 7/19/2011.


VAERS ID: 428504 (history)  
Age: 30.0  
Gender: Female  
Location: Georgia  
Vaccinated:2011-07-27
Onset:2011-07-29
   Days after vaccination:2
Submitted: 2011-08-01
   Days after onset:3
Entered: 2011-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB986BB / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1600Z / 0 LA / SC
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052BA / 0 LA / IM

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

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

Write-up: Pt. here to report rec''d Tdap vaccine on 7/27/11 & now has a big knot where she rec''d the shot. Pt. sts had a fever of 102 degrees.


VAERS ID: 430151 (history)  
Age: 30.0  
Gender: Unknown  
Location: Wisconsin  
Vaccinated:2010-06-16
Onset:2010-06-16
   Days after vaccination:0
Submitted: 2011-07-19
   Days after onset:398
Entered: 2011-08-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1006USA04146

Write-up: Information has been received from a licensed practical nurse concerning a 30 year old patient who on 16-JUN-2010 was inadvertently vaccinated with a 0.65mL dose of ZOSTAVAX (Merck) SQ in the left arm instead of VARIVAX (Merck). No adverse event was reported. Additional information has been requested.


VAERS ID: 428774 (history)  
Age: 30.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2011-08-01
Onset:2011-08-04
   Days after vaccination:3
Submitted: 2011-08-04
   Days after onset:0
Entered: 2011-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1397Z / 0 LA / UN

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

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

Write-up: Soreness to (L) upper arm, followed by redness & warmth at injection site.


VAERS ID: 433297 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2010-10-04
Onset:2010-10-04
   Days after vaccination:0
Submitted: 2011-07-29
   Days after onset:298
Entered: 2011-08-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0823Y / - RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Inflammatory bowel disease, Malaise, Rash, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1011USA01823

Write-up: Information has been received from a registered nurse concerning a 30 year old female patient with questionable penicillin allergy and no pertinent medical history, who on 04-OCT-2010 at 15:00 was inadvertently vaccinated with less than a 0.5 ml dose of PNEUMOVAX 23 (Lot # 664654/0823Y EXP 09-MAR-2011) IM right deltoid instead of flu vaccine due to staff error. There was no concomitant medication. The nurse said that patient was not feeling well post vaccination. At 05:00 on 05-OCT-2010 the patient had diarrhea and by 14:00 a rash on her back. On this same day 05-OCT-2010 the patient went to emergency room with inflammation of bowel. The patient was given a medication to control the diarrhea and BENADRYL for the rash. The patient was not hospitalized. At the time of the report the patient was feeling much better. Additional information is not expected.


VAERS ID: 429075 (history)  
Age: 30.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2011-07-28
Onset:2011-07-28
   Days after vaccination:0
Submitted: 2011-08-08
   Days after onset:11
Entered: 2011-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3554AA / - LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Feeling hot, Headache, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: allergic Rx/hospitalized~Influenza (Seasonal) (no brand name)~~0.00~Patient
Other Medications: Flu vaccine Rx before H1N1. Unsure of date.
Current Illness: none
Preexisting Conditions: had previous allergic Rx to Tubersol (localized) and systemic allergic Rx to Influenza vaccine (thought to be egg allergy)
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Started sneezing and head felt "hot and full". Next day and for several days sneezing persisted forcefully and very frequently. (Had similar Rx when took flu vaccine but was more severe.) Self medicated with Benadryl for several days. (this rx occurred over a weekend, and I was notified on Monday of the Rx. By then, Rx was resolving)


VAERS ID: 432027 (history)  
Age: 30.0  
Gender: Female  
Location: Wyoming  
Vaccinated:2011-01-25
Onset:2011-01-25
   Days after vaccination:0
Submitted: 2011-08-04
   Days after onset:190
Entered: 2011-08-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 0 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Maternal exposure during pregnancy, No adverse event, Ultrasound antenatal screen normal, Wrong drug administered
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins (unspecified)
Current Illness:
Preexisting Conditions: Abortion spontaneous; Pregnancy
Diagnostic Lab Data: Ultrasound, 01/25/11, dating: within normal limits
CDC Split Type: WAES1101USA03064

Write-up: Information has been received from a Registered Nurse for GARDASIL, a Pregnancy Registry Product, concerning a 30 year old female patient with no pertinent medical history, or drug reactions/allergies, who on 25-JAN-2011 was vaccinated IM inadvertently with a 0.5ml dose of GARDASIL (lot#666162/0565Z) instead of an unnamed influenza vaccine. Concomitant therapy included prenatal vitamins (unspecified). A vial of the GARDASIL was misplaced in a box with the influenza vaccines. On an unspecified date, a pregnancy test ultrasound was performed. No adverse symptoms were noted. Patient''s last menstrual period was 15-NOV-2010. Expected date of delivery was 22-AUG-2011. Follow up information was received from a Registered Nurse (R.N) via pregnancy questionnaire who reported that the 30 year old female patient has a history of 3 pregnancies (2 full term deliveries) and 1 spontaneous abortion of twin fetal demise at 14 weeks in 2010. There was no defect in previous pregnancies. It was reported that on 25-JAN-2011, an ultrasound was performed which was within normal limits. The patient was scheduled for the next anatomical ultrasound on 01-APR-2011. Follow-up information was received from an initial pregnancy questionnaire from the registered nurse indicating that the patient''s 2 full term deliveries were at 39 weeks from last menstrual period. Additional information has been requested.


VAERS ID: 432066 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-08-04
Entered: 2011-08-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Smear cervix abnormal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Pap test, Abnormal
CDC Split Type: WAES1008USA03994

Write-up: Information has been received from a female consumer in her 30s, who on an unspecified dates was vaccinated with the 3 doses of GARDASIL (Lot #, routes no reported). The consumer reported that after receiving the 3 doses she had been diagnosed with an abnormal pap smears. The patient also had noticed intermittent vaginal bleeding. She had scheduled a colposcopy. At the time of the report, the patient had not recovered. The patient sought unspecified medical attention. No further information is available.


VAERS ID: 429241 (history)  
Age: 30.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2011-08-09
Onset:2011-08-09
   Days after vaccination:0
Submitted: 2011-08-10
   Days after onset:1
Entered: 2011-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV286 / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3921AA / 0 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1124 / 0 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Headache, Pyrexia, Respiratory tract congestion, Viral test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild headache
Preexisting Conditions: None. Healthy
Diagnostic Lab Data: Resp Viral Cultures via Nasal Washing
CDC Split Type:

Write-up: Fever to 102.0 and headache and mild congestion. Self medicated with Dayquil relief of fever. Seen for sick call at Flight Surgeon Office 8/10/2011.


VAERS ID: 430315 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2006-01-01
Onset:2006-01-01
   Days after vaccination:0
Submitted: 2010-09-08
   Days after onset:1710
Entered: 2011-08-15
   Days after submission:341
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Drug exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0011520

Write-up: A non-serious spontaneous report of FLUMIST administration to a pregnant female was received from a MedImmune Representative concerning a 30-year-old female. The patient''s medical history, obstetrical history and concomitant medications were not reported. On 01-Jan-2006, the patient received FLUMIST. She was in her first trimester of pregnancy, however she was unaware that she was pregnant when she received FLUMIST. On an unknown date, she delivered a healthy, full-term, female. According to the reporter, no adverse events occurred.


VAERS ID: 430443 (history)  
Age: 30.0  
Gender: Female  
Location: Georgia  
Vaccinated:2010-10-12
Onset:2010-10-18
   Days after vaccination:6
Submitted: 2010-10-25
   Days after onset:7
Entered: 2011-08-15
   Days after submission:294
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Rectal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: REMICADE; LIALDA
Current Illness: Ulcerative colitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0011666

Write-up: A non-serious spontaneous report of cramping and rectal bleeding has been received from a health professional concerning a 30-year-old female, subsequent to receiving FLUMIST. Medical history included ulcerative colitis. Concomitant medications included infliximab and mesalamine. On 12-Oct-2010, the patient received FLUMIST. The patient reported to her manager who relayed the information to the Director of Nursing, who then relayed this information to the reporter that on 18-Oct-2010, the patient began to have abdominal cramping. The next day she experienced rectal bleeding and called her physician. Hydrocortisone enemas were prescribed and her current dose of mesalamine was increased. The reporter did not believe that the patient was actually seen by her physician. However, the reporter indicated she has not spoken directly with the patient regarding these events. The outcome of the event was unknown.


VAERS ID: 431531 (history)  
Age: 30.0  
Gender: Female  
Location: Idaho  
Vaccinated:2011-01-28
Onset:2011-01-28
   Days after vaccination:0
Submitted: 2011-04-25
   Days after onset:86
Entered: 2011-08-15
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501034P / - - / IN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0012380

Write-up: A non-serious spontaneous report of administration of expired product was received from a health professional concerning a 30-year-old female subsequent to receiving FLUMIST. Neither relevant medical history nor concomitant medications were reported for this patient. The FLUMIST expired on 02-Jan-2011. The patient received the expired vaccine on 28-Jan-2011. There was no adverse event associated with this medication error; therefore, treatment and reporter causality assessments are not applicable, and the event is considered resolved. There were no late occurring adverse events. Additional information received on 25-Apr-2011 and incorporated into case: no late occurring adverse events.


VAERS ID: 430792 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:2011-05-04
Onset:2011-05-07
   Days after vaccination:3
Submitted: 2011-08-23
   Days after onset:108
Entered: 2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABIE-VAX) / SANOFI PASTEUR SPEO586 / 0 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Nuclear magnetic resonance imaging, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt. given first dose of Verorab (Sanofi Pasteur).
Current Illness: No
Preexisting Conditions: NKA
Diagnostic Lab Data: Medevaced for neurological consult and MRI.
CDC Split Type:

Write-up: Paresthesia rt. cheek, jaw and tip of tongue. Observation.


VAERS ID: 430925 (history)  
Age: 30.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2010-10-06
Onset:2011-01-13
   Days after vaccination:99
Submitted: 2011-08-11
   Days after onset:209
Entered: 2011-08-23
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA607AA / - UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypoaesthesia, Lumbar puncture abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Spinal tap revealed Guillain Barre
CDC Split Type:

Write-up: Began to feel numbness and tingling in hands and feet within 1 week could barely walk. Went to ER on Jan 16 2011 where I was diagnosed with Guillain Barre syndrome. The only thing I did different was get the flu shot. I was hospitalized and sent to rehabilitation center where I had to learn to do everything again. It''s 7 months later and I''m still recovering.


VAERS ID: 431018 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-08-09
Onset:2011-08-19
   Days after vaccination:10
Submitted: 2011-08-24
   Days after onset:5
Entered: 2011-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0919Z / - LA / IM

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

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

Write-up: Mildly pruritis pink generalized pinpoint, non-confluent rash on upper back and chest, no SOB, no dysphagia or oropharyngeal complaints, no fever, no pain.


VAERS ID: 431391 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2011-08-25
Onset:2011-08-25
   Days after vaccination:0
Submitted: 2011-08-25
   Days after onset:0
Entered: 2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1100401 / - LA / UN
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1111Z / 0 RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Dizziness, Gaze palsy, Immediate post-injection reaction, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately following PNEUMOVAX 23 shot pt stated she felt dizzy. Her eyes then rolled back but remained open and she started having a seizure in the chair. I got behind her so she wouldn''t fall and hit her head. I had the tech call 911 and another tech helped me move her to the ground. She seized about 1 min the became responsive and declined the ambulance.


VAERS ID: 431411 (history)  
Age: 30.0  
Gender: Female  
Location: Hawaii  
Vaccinated:2011-08-23
Onset:2011-08-24
   Days after vaccination:1
Submitted: 2011-08-25
   Days after onset:1
Entered: 2011-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 - / IN

Administered by: Military       Purchased by: Military
Symptoms: Body temperature increased, Dizziness, Ear pain, Malaise, Sinusitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Horrible sinus infection, dizziness, ear pain, overall malaise feeling, temps $g 100 degrees F.


VAERS ID: 431654 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2010-10-08
Onset:2010-10-09
   Days after vaccination:1
Submitted: 2011-08-26
   Days after onset:321
Entered: 2011-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown       Purchased by: Other
Symptoms: Blood test, Chills, Computerised tomogram, Feeling abnormal, Headache, Pain in extremity, Paraesthesia, Sensory loss, Ultrasound scan, Viral infection
SMQs:, Peripheral neuropathy (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Exposed to a stomach virus that both my husband and daughter had but I did not have symptoms.
Preexisting Conditions:
Diagnostic Lab Data: CT Scan, ultrasound, blood tests. Nuerologist believes I caught a virus from the vaccine.
CDC Split Type:

Write-up: I starting having pain in my left hand then I felt it tingling. By 10/13/2011 I was foggy. Had a headache and chills that night. The next day I awoke with a loss of sensation all over my body.


VAERS ID: 432390 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:2011-06-03
Onset:2011-06-20
   Days after vaccination:17
Submitted: 2011-08-29
   Days after onset:70
Entered: 2011-08-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR - / - UN / ID
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Echocardiogram normal, Electrocardiogram abnormal, Pericarditis, Troponin I
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Medical history was not available.
Diagnostic Lab Data:
CDC Split Type: 201107361

Write-up: This study case was received from the investigator on 19 August 2011. A 30-year-old male subject received on 03 June 2011 received the following vaccinations: an injection of ACAM2000 (lot number not reported), anthrax vaccine (manufacturer and lot number not reported), Tdap (manufacturer and lot number not reported) and TYPHOID Vi polysaccharide(lot not reported). Medical history was not available. On 20 June 2011, the subject had an abnormal electrocardiogram (ECG) and a normal echocardiogram. The subject''s Troponin I was not available. On 20 June 2011, the subject was diagnosed acute pericarditis, unspecified. The outcome was not reported. Additional information will be requested from the investigator. There is no reporter causality assessment as this is a safety surveillance study. Documents held by sender: None.


VAERS ID: 432410 (history)  
Age: 30.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2011-08-24
Onset:2011-08-24
   Days after vaccination:0
Submitted: 2011-08-24
   Days after onset:0
Entered: 2011-08-31
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0005AA / - LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SEASONIQUE
Current Illness: No
Preexisting Conditions: Probable PPD reaction; Endometriosis; Polycystic ovaries
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 15 minutes post MMR vaccination, rash developed forearms and progressed chest wall, back & shoulders.


VAERS ID: 432733 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-08-18
Onset:0000-00-00
Submitted: 2011-09-01
Entered: 2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Injection site infection, Injection site pain, Injection site pruritus, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Hot, itchy, and painful rash at injection site that appeared day after injection, became infected and spread, patient had to take antibiotics. Was told looked like cellulitis.


VAERS ID: 433571 (history)  
Age: 30.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2011-08-19
Onset:2011-08-20
   Days after vaccination:1
Submitted: 2011-08-25
   Days after onset:5
Entered: 2011-09-08
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0459AA / - UN / SC

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

Life Threatening? No
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:

Write-up: Vaccine taken 8-19-11; pt. states site progressively worse daily: pt took BENADRYL and used topical anti-itch cream 8-22-11 - presented at the facility 8-25-11 with raised 100mm x 50mm red/rash site - localized fever and itching. Treated with MEDROL dose pack.


VAERS ID: 433672 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-08-24
Onset:2011-08-25
   Days after vaccination:1
Submitted: 2011-09-08
   Days after onset:14
Entered: 2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT441AA / - RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B072AA / - LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Body temperature increased, Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt had a temp about 100 F. Pain at injection site not subside $g 1 week after injection. Arm feels numb and site is tender at touch.


VAERS ID: 433690 (history)  
Age: 30.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-08-25
Onset:2011-08-26
   Days after vaccination:1
Submitted: 2011-09-08
   Days after onset:13
Entered: 2011-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS A10051 / - LA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0595AA / - RA / -

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 10mg x 1 day Zyrtec 10mg x 1 day Omnicef 600mg x 1 day
Current Illness: None
Preexisting Conditions: Allergies and low immune system
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen arm at injection site, very warm and sore to the touch, and had redness where shot was given. Two doctors revealed it was a 7x8 cm cellulitis.


VAERS ID: 433934 (history)  
Age: 30.0  
Gender: Female  
Location: New York  
Vaccinated:2011-09-09
Onset:2011-09-10
   Days after vaccination:1
Submitted: 2011-09-11
   Days after onset:1
Entered: 2011-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 10 LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Borrelia test, Full blood count, Immunology test, Joint swelling, Metabolic function test normal, Urticaria, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Was seen for shoulder pain - told was a pinched nerve
Preexisting Conditions: None
Diagnostic Lab Data: Had CBC, CMP, Lyme Titer, and immune studies. WBC 11,000, CMP normal. Other tests pending.
CDC Split Type:

Write-up: Joint swelling - started in both knees, left more than right. Then progressed to wrist/elbow/ankle swelling and hives to arms and legs only. Called doctor, told to take Benadryl and Pepcid, continued to get worse without relief. Went to ER and received steroids, Benadryl, and Pepcid. Continue to have symptoms, but now improved.


VAERS ID: 434520 (history)  
Age: 30.0  
Gender: Male  
Location: Georgia  
Vaccinated:2011-09-15
Onset:0000-00-00
Submitted: 2011-09-15
Entered: 2011-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH453AB / - RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Injection site pruritus, Malaise, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Itchiness at site, some itchiness on face, malaise, mild headache. Symptoms started within 3-4 hours of vaccination.


VAERS ID: 434533 (history)  
Age: 30.0  
Gender: Female  
Location: Alaska  
Vaccinated:2011-09-13
Onset:2011-09-13
   Days after vaccination:0
Submitted: 2011-09-15
   Days after onset:2
Entered: 2011-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR - / 10 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Local swelling, Pain, Skin warm
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Swelling on shoulder, hot to the touch, pain


VAERS ID: 434537 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-09-14
Onset:2011-09-15
   Days after vaccination:1
Submitted: 2011-09-15
   Days after onset:0
Entered: 2011-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT441AA / - LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: sore throat


VAERS ID: 434562 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2011-09-09
Onset:2011-09-11
   Days after vaccination:2
Submitted: 2011-09-13
   Days after onset:2
Entered: 2011-09-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA604AA / - UN / UN
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0631AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B072AA / 0 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Arthralgia, Body temperature increased, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tuberculin 9-6-11
Current Illness: Ankylosing spondylitis
Preexisting Conditions: Fibromyalgia; Anxiety; ADD
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Achy joints all over body. Temp 101. Raised, red, hot, swollen area size of palm of hand at injection site (R) deltoid.


VAERS ID: 434622 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-09-15
Onset:2011-09-15
   Days after vaccination:0
Submitted: 2011-09-16
   Days after onset:1
Entered: 2011-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / -

Administered by: Military       Purchased by: Other
Symptoms: Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe hives and itching to forearms, groin, chest, back, neck. Lasted until 50mg of Benadryl took effect at approx 9pm on 9/15. Hives were resolved, but then returned at 5pm on 9/16. 25mg of Benadryl taken again....resolution pending.


VAERS ID: 434635 (history)  
Age: 30.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2011-09-15
Onset:2011-09-15
   Days after vaccination:0
Submitted: 2011-09-18
   Days after onset:3
Entered: 2011-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Dizziness, Headache, Nausea, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: rash fever convulsions, dizziness, nausea vomiting head ache


VAERS ID: 434736 (history)  
Age: 30.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2011-09-09
Onset:2011-09-10
   Days after vaccination:1
Submitted: 2011-09-13
   Days after onset:3
Entered: 2011-09-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH453AD / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3941AA / 0 LA / IM

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

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:

Write-up: 9-10-11 Developed redness, discomfort at injection site (L) deltoid. Clindamycin 150 1 PO TID x 7 days. Dx cellulitis.


VAERS ID: 434851 (history)  
Age: 30.0  
Gender: Male  
Location: Virginia  
Vaccinated:2011-09-19
Onset:2011-09-19
   Days after vaccination:0
Submitted: 2011-09-19
   Days after onset:0
Entered: 2011-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / IJ

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Cough, Diarrhoea, Eye pain, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, Claritin, Zyrtec, Nasonex
Current Illness: no
Preexisting Conditions: fairly bad year-round allergies to most tree and grass pollens, cat dander and saliva, peanuts chronic constipation
Diagnostic Lab Data:
CDC Split Type:

Write-up: muscle aches, fatigue, runny stool, slight cough, abdominal cramps, eye pain


VAERS ID: 434922 (history)  
Age: 30.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-09-16
Onset:2011-09-16
   Days after vaccination:0
Submitted: 2011-09-20
   Days after onset:4
Entered: 2011-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT434AA / 0 LA / IM
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB184BA / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1017Z / 1 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Injection site erythema, Lip swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Docusate calcium, cyclobenzaprine HCL, hydrocodone bit/acetaminophen, chlorthalidone, depakote, amiodipine besylate, rizatriptan benzoate, quetiapine fumarate.
Current Illness: Pt denied any illness at time of vaccination. No illness observed at time of vaccination.
Preexisting Conditions: Allergies as follows: Ace inhibitors, ASA, clarithromycin, cortisone, honey, honey bee venom, hydromorphone, iodine, ipratropium-albuterol, latex, levaquin, NSAIDs, oxymetazoline, peanut oil, PCNs, shellfish, sulfa drugs. Medical conditions as follows: Asthma, PTSD, Bipolar II disorder, Migraine, Tachycardia, HTN, Back pain.
Diagnostic Lab Data: 50mg IM Benadryl administered near injection site.
CDC Split Type:

Write-up: Patient broke out in hives with localized redness to right arm (where vaccination was administered). Patient had mild lip swelling, without difficulty breathing. Pt stated that she was very "itchy." Symptoms alleviated with administration of 50mg IM Benadryl at injection site (approximately 30 minutes from administration of vaccination).


VAERS ID: 435022 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-09-11
Onset:2011-09-18
   Days after vaccination:7
Submitted: 2011-09-20
   Days after onset:2
Entered: 2011-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / -

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

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:

Write-up: rash on hands and stomach


VAERS ID: 435075 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-09-19
Onset:2011-09-20
   Days after vaccination:1
Submitted: 2011-09-21
   Days after onset:1
Entered: 2011-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT448AA / - LA / UN

Administered by: Public       Purchased by: Private
Symptoms: Ophthalmological examination abnormal, Periorbital oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Optic nerve disorders (broad), Corneal disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Eye exam - other than edema: normal
CDC Split Type:

Write-up: Patient developed (L) periorbital edema one day after vaccine administration.


VAERS ID: 435309 (history)  
Age: 30.0  
Gender: Female  
Location: Delaware  
Vaccinated:2011-09-21
Onset:2011-09-21
   Days after vaccination:0
Submitted: 2011-09-22
   Days after onset:1
Entered: 2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH462AA / 0 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Back pain, Chills, Headache, Malaise, Nausea, Neck pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: profound malaise, nausea, vomiting, fever, chills, back, neck and head aches


VAERS ID: 435311 (history)  
Age: 30.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-08-15
Onset:2011-08-15
   Days after vaccination:0
Submitted: 2011-09-22
   Days after onset:38
Entered: 2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 1519Z / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Bursitis, Periarthritis, X-ray limb normal
SMQs:, Arthritis (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt was on Kariva, Advair and albuterol before reaction and was given Atarax for symptoms after.
Current Illness: None
Preexisting Conditions: Obesity, tobacco abuse, asthma, low back pain, molluscum
Diagnostic Lab Data: negative shoulder xrays
CDC Split Type:

Write-up: Pt had adhesive capsulitis or right shoulder bursitis from injection site of 3rd Hep B shot. Never had reaction before to this immunization.


VAERS ID: 435557 (history)  
Age: 30.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2011-09-23
Onset:2011-09-23
   Days after vaccination:0
Submitted: 2011-09-24
   Days after onset:1
Entered: 2011-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1100401 / - LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Within five minutes after receiving FLUVIRIN patient had tingling in left arm (site of shot). Patient did not report till morning of 9/24/11. Morning of 9/24 patient also noticed tingling on (L) back side and still in left arm.


VAERS ID: 435586 (history)  
Age: 30.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-09-22
Onset:2011-09-22
   Days after vaccination:0
Submitted: 2011-09-23
   Days after onset:1
Entered: 2011-09-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1100401 / 0 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0595AA / 0 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Flank pain, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SAPHRIS; SEROQUEL; SYNTHROID; AMBIEN CR; cefadroxil; chlordiazepoxide
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports pain on right side & traveling to neck. Patient has taken ALEVE & going to MD today (9/23) & will report s/sx there at office.


VAERS ID: 435638 (history)  
Age: 30.0  
Gender: Female  
Location: Indiana  
Vaccinated:2011-09-06
Onset:2011-09-07
   Days after vaccination:1
Submitted: 2011-09-08
   Days after onset:1
Entered: 2011-09-26
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH446AA / - LA / IJ

Administered by: Public       Purchased by: Private
Symptoms: Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Slight swelling upper (L) chest wall - tender to touch. No swelling, redness, or pain at vaccine entrance of (L) deltoid. After receiving vaccine - worked out at gym - next morning above symptoms appeared.


VAERS ID: 435693 (history)  
Age: 30.0  
Gender: Male  
Location: Illinois  
Vaccinated:2011-09-23
Onset:2011-09-24
   Days after vaccination:1
Submitted: 2011-09-26
   Days after onset:2
Entered: 2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Asthenia, Asthma, Diarrhoea, Dizziness, Dyspnoea, Headache, Injection site inflammation, Injection site pruritus, Myalgia, Nausea, Pyrexia, Rhinorrhoea, Sneezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Cat/dog allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: FEVER DIARRHEA INJECTION-SITE REACTION (INFLAMED AND ITCHY) SHORTNESS OF BREATH RHINORRHEA UNCONTROLLABLE BURSTS OF SNEEZING, EXCEEDING 1 HOUR IN DURATION ASTHMA ATTACK WEAKNESS HEADACHE DIZZINESS NAUSEA MUSCLE PAIN


VAERS ID: 435728 (history)  
Age: 30.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-09-23
Onset:2011-09-23
   Days after vaccination:0
Submitted: 2011-09-26
   Days after onset:3
Entered: 2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH477AC / 0 LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Dyspnoea, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins
Current Illness: No
Preexisting Conditions: Asthma; eczema
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient describes respiratory difficulty at 3:30pm. Patient had a headache, took ADVIL & used an albuterol inhaler.


VAERS ID: 435724 (history)  
Age: 30.0  
Gender: Female  
Location: Missouri  
Vaccinated:2011-09-27
Onset:2011-09-27
   Days after vaccination:0
Submitted: 2011-09-27
   Days after onset:0
Entered: 2011-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER XXX / 1 LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Eye pain, Fatigue, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~Influenza (Seasonal) (no brand name)~1~29.00~Patient
Other Medications: Adderall, Nuvaring
Current Illness: no
Preexisting Conditions: penicillin, mold, dust
Diagnostic Lab Data: n/a - still in pain.
CDC Split Type:

Write-up: nausea, low grade fever, muscle pain, exhaustion, headache, eyes sore


VAERS ID: 435835 (history)  
Age: 30.0  
Gender: Female  
Location: Iowa  
Vaccinated:2011-09-20
Onset:2011-09-21
   Days after vaccination:1
Submitted: 2011-09-22
   Days after onset:1
Entered: 2011-09-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT447AA / 0 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth, Limb discomfort, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEXA; prenatal vitamin
Current Illness: None reported
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: S: The patient is a nurse who works in recovery. She had a flu vaccine in her left arm a few days ago. She had noticed that where the immunization was given there has been warmth and erythema. It has felt firm. It has been sore. She says that the firmness and soreness have decreased. It does not hurt too much moving her left arm around. She denies fever, chills, nausea, vomiting, headache, shortness of breath, or facial or throat swelling. She took ibuprofen times one. She has used some heat on her left arm. O: Midway down the lateral posterior aspect of the left upper arm, there is approximately a 4-cm-diameter area of erythema. It is slightly warm. I detect no fluctuance here. There are no gross signs of infection. It is slightly tender to palpation. She expressed slight discomfort with resisted left upper extremity examination maneuvers but has full range of motion in the left upper extremity. Her lungs are clear. Her heart examination is normal. A: Local reaction status post influenza vaccination. P: We discussed that this is not an uncommon occurrence with ''flu vaccination. The are no overt signs of infection or any signs or symptoms that she has had an allergic reaction to the vaccine. I directed her for reference to again look at the influenza vaccination information sheet provided by the CDC. (1) We discussed physical modalities to do. (2) She should try to stretch her left arm. (3) We discussed some medication she can take for the next one to two days. (4) At this juncture, she is fine with being discharged to full duty. (5) I did want her to continue to watch the area for worsening signs of pain, redness, and swelling, as well as any allergic reaction type symptoms. (5) Otherwise, I will discharge her from the clinic today. She may return P.R.N.


VAERS ID: 435882 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-05-28
Onset:2011-07-01
   Days after vaccination:34
Submitted: 2011-09-26
   Days after onset:87
Entered: 2011-09-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS 466011A / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest X-ray normal, Chest pain, Fatigue, Neck pain, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Contraceptives
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHEH2011US04546

Write-up: Case number PHEH2011US04546, is an initial spontaneous report received from a nurse on 15 Sep 2011: This report refers to 31-year-old female patient. She received first dose of pre-exposure series RABAVERT (batch number 466011A) on 28 Apr 2011 and second dose (batch number 466011A) on 28 May 2011. She did not receive third dose. On an unspecified date in Jul 2011, she began to experienced fatigue, chest and neck pain and high white blood cell count. She also stopped taking birth control pills. Chest X-ray revealed no abnormality. The reporter stated that, investigation was going at time of this report that whether or not patient has any kind of infection. Outcome of the events was ongoing.


VAERS ID: 436130 (history)  
Age: 30.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-09-24
Onset:0000-00-00
Submitted: 2011-09-28
Entered: 2011-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED N55306 / 0 RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt received AFLURIA on 9/24/11 (Sat). Came into pharmacy Mon 9/26/11 stating that his arm was tingling & he was developing a rash & was going to ER.


VAERS ID: 436178 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-04-20
Onset:2011-04-20
   Days after vaccination:0
Submitted: 2011-09-22
   Days after onset:155
Entered: 2011-09-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MU: MUMPS (MUMPSVAX II) / MERCK & CO. INC. 0188X / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Expired drug administered, Product commingling
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES1104USA03184

Write-up: Information has been received from a registered nurse concerning a 30 year old female patient with no pertinent medical history and no drug allergies who on 20-APR-2011, was vaccinated with a dose of MUMPSVAX (route not reported) (lot number 659616/0188X, Exp. January 2010) expirated. There was a mix of medication in a carton of MMR II. 10x10 carton of MMR II contained one vial of MUMPSVAX. The MUMPSVAX vial had a teal color, the MMR II was very similar, almost exactly the same. The nurse reported that the patient who received the vaccine had not been checked on status and to made her aware of this issue. The patient did not seek medical attention. There was no treatment for the event and no laboratories were performed. At the time of the report the outcome of the patient was unknown. Product quality complaint was involved. Additional information has been requested.


VAERS ID: 436298 (history)  
Age: 30.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2011-09-20
Onset:2011-09-21
   Days after vaccination:1
Submitted: 2011-09-29
   Days after onset:8
Entered: 2011-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAV520AA / 0 LA / IM
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV10F54E / 0 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1163Z / 0 LA / SC
RAB: RABIES (RABIPUR) / NOVARTIS VACCINES AND DIAGNOSTICS 473011C / 0 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Erythema, Local reaction, Lymphocyte morphology abnormal, Lymphocyte percentage decreased, Neutrophil count, Pain in extremity, Red blood cell sedimentation rate increased, Ultrasound scan normal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Malignant lymphomas (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; h/o pneumonia; Allergy to dairy, latex, Amoxicillin
Diagnostic Lab Data: U/S (L) arm negative for fluid collection; 9/22 WBC=10.48, 69S/18L/3AtyL; 9/23 WBC=8.87, 74S/20L; B cx negative; ESR 51, CRP=127.3
CDC Split Type:

Write-up: 1 day after immunization, pt developed red area (L) arm, red & sore. The following day, she noted temp 100. Appearance more c/w local rxn 6.5 x 10 cm oval well circumscribed, but increased over next 24 hours, on Ibuprofen/ice pack. Treated 9/23 & 9/24 with IV Vanco/ceftriaxone with much improvement by 9/25. Switched to oral Dicloxacillin.


VAERS ID: 436615 (history)  
Age: 30.0  
Gender: Male  
Location: Nebraska  
Vaccinated:2011-09-30
Onset:2011-10-02
   Days after vaccination:2
Submitted: 2011-10-03
   Days after onset:1
Entered: 2011-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA628BA / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: allergic to pcn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of arm from shoulder to hand


VAERS ID: 436676 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-09-30
Onset:2011-10-01
   Days after vaccination:1
Submitted: 2011-10-03
   Days after onset:2
Entered: 2011-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA664AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3491AA / - LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Pain in extremity, Rash erythematous, Skin irritation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 3 Oct 11 1300 Pt presented with (L) arm rash, thick by 1 mm red & raised - approx 4" x 2" - pt stated that the rash occurred 24 hrs following the flu & Tdap vaccine on 30 Sept 11 --- He is currently afebrile at 97.8 degrees F - denies fever at home, N/V/D. He does c/o minimal pain & irritation when he uses the arm or when it is touched or rubbed. The pt denies any previous reactions or allergies. Plan his skin surrounding rash perimeter has marked with a body pen - the pt was instructed to monitor rash - watch for signs as listed on VIS & f/u tomorrow - VAERS reporting pending file. 4 Oct 11 1420 Pt returned for repeat check of rash - rash is no longer raised but continues to look red - redness has spread an additional 1" in length & 0.5 inch in width - pt denies fever - current temp 98.3 degrees. Now states he did have nausea & HA the day of the shot - consulted with FNP to see if he needs further eval & walk-in. Pt seen by FNP - Dx with "Arthus" rash. No treatment needed.


VAERS ID: 436864 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-10-03
Onset:2011-10-03
   Days after vaccination:0
Submitted: 2011-10-05
   Days after onset:2
Entered: 2011-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV09M40F / 0 RA / IM

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

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

Write-up: JEV (Lot # JEV09M40F) expiration Date 09/30/2011, JEV given 10/03/2011, No adverse symptoms noted to patient.


VAERS ID: 437119 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-09-23
Onset:2011-09-23
   Days after vaccination:0
Submitted: 2011-09-23
   Days after onset:0
Entered: 2011-10-06
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH455AA / 0 RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Dysphonia, Flushing, Nausea, Sensation of foreign body, Throat irritation, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

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

Write-up: 12:20p flu shot given, 12:30p N/V hoarseness feeling flush - constantly clearing her throat, states that "feels like a lump in my throat" - reported these symptoms to nurse at 12: 40pm, 1:45 Respirations WNL BP 157/91, P 65 - EMS called and arrived at 12:54. Patient refused to go to ER. Agreed to go to ER if symptoms worsen.


VAERS ID: 437290 (history)  
Age: 30.0  
Gender: Female  
Location: Florida  
Vaccinated:2011-10-07
Onset:2011-10-07
   Days after vaccination:0
Submitted: 2011-10-07
   Days after onset:0
Entered: 2011-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED N57107 / 0 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: STATES ONLY ON BIRTH CONTROL IUD. DENIES ANY OTHER MEDS.
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: FELT LIGHTHEADED NAUSEA. THEN ATE CRAKERS AND JUICE AND STATES SHE VOMITED APPROX 2 MINUTES AFTER EATING. VITAL SIGNS WERE CHECKED AND STABLE. BP 131/89, P90, TEMP 97.9.


VAERS ID: 437441 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-10-03
Onset:2011-10-05
   Days after vaccination:2
Submitted: 2011-10-07
   Days after onset:2
Entered: 2011-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 11063P / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cold sweat, Maternal exposure during pregnancy, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

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: Pregnant (33 wks, 4 days)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient felt nauseous and vomited several times through the day (10/05/11) with some diarrhea on the second day after the flu shot. Patient is afebrile and appears well at urgent appointment on 10/06/11, but felt clammy yesterday. Patient was given ZOFRAN prescription and return if worsens. Patient is pregnant (33 wks, 4d) but did not have these complaints before the shot. Patient returned from a 2 week trip earlier this week where a couple people had upset stomach and diarrhea, but none with her severity.


VAERS ID: 437487 (history)  
Age: 30.0  
Gender: Male  
Location: Washington  
Vaccinated:2011-10-04
Onset:2011-10-04
   Days after vaccination:0
Submitted: 2011-10-10
   Days after onset:6
Entered: 2011-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA625BA / - LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Full blood count normal, Induration, Local reaction, Metabolic function test normal, Pain, Pyrexia, Tenderness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: BMP, CBC: all values within normal limits.
CDC Split Type:

Write-up: Low grade fever, local reaction; erythema and induration measuring 12 cm x 6 cm, pain and tenderness.


VAERS ID: 437513 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-10-06
Onset:2011-10-06
   Days after vaccination:0
Submitted: 2011-10-10
   Days after onset:4
Entered: 2011-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IJ

Administered by: Public       Purchased by: Private
Symptoms: Cognitive disorder, Disturbance in attention, Dizziness, Injected limb mobility decreased, Injection site induration, Injection site pain, Injection site swelling, Insomnia, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take a prenatal multivitamin, garlic gel tab, Omega 3-6-9, probiotic daily.
Current Illness: no
Preexisting Conditions: Allergy to the Flu shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: The night the vaccine was given I had swelling and soreness in my L upper arm at the injection site. As the days progressed I could not extend my arm to shoulder height. There was dizziness, nausea and inability to sleep that occurred from date of administration to 10/10/11. On 10/10/11 I went back to facility to have verify there was a reaction. My L upper arm on the posterior side is swollen and hard around the muscle. Since the administration of the vaccine the site of injection could not be touched, laid on or rubbed. At night pain ranged from a 7-8 on a 10 scale. Cognitively I felt cloudy with an inability to focus and concentrate. I iced and applied Arnica topical gel to the injection site. Today, 10/10/11 my L arm still aches, sensitive to touch and pulls on the muscle when extended to the side body.


VAERS ID: 437514 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-10-09
Onset:2011-10-10
   Days after vaccination:1
Submitted: 2011-10-10
   Days after onset:0
Entered: 2011-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1102011 / 0 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness postural, Fatigue, Lymph node palpable, Lymphadenopathy, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~Influenza (Seasonal) (no brand name)~~0.00~Patient
Other Medications: diphenhydramine (taken 4 hours after vaccine)
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: swelling of left supraclavicular node (2 hrs and continuing), dizziness/syncope (upon standing or palpitation of left supraclavicular node), fatigue, nausea (upon palpitation of left supraclavicular node)


VAERS ID: 437742 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-10-05
Onset:2011-10-09
   Days after vaccination:4
Submitted: 2011-10-11
   Days after onset:2
Entered: 2011-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Disturbance in attention, Headache, Hyperhidrosis, Memory impairment, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: Aspirin, Motrin, Cold Urticaria
Diagnostic Lab Data:
CDC Split Type:

Write-up: 100.2 - 100.8 degree fever for two days which included chills, sweats, aches, headaches, difficulty concentrating and remembering


VAERS ID: 437804 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-09-29
Onset:2011-09-29
   Days after vaccination:0
Submitted: 2011-10-12
   Days after onset:13
Entered: 2011-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH493AA / 4 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Chest pain, Computerised tomogram, Dyspnoea, Eye swelling, Lip swelling, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nor QD- BCP- one daily
Current Illness: None Known
Preexisting Conditions: Congenital Narrowed ureteropelvic junction
Diagnostic Lab Data: Records from ER visit not available at this time.
CDC Split Type:

Write-up: Approx 3 hours after vaccinated c/o chest bain starting in her back then slowly wrapping around to the front, Throat tightening, swelling of eyes and lips, difficulty breathing lasted about 10 hours, required ER transport and CT for L renal Colic


VAERS ID: 437941 (history)  
Age: 30.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2011-10-12
Onset:2011-10-12
   Days after vaccination:0
Submitted: 2011-10-12
   Days after onset:0
Entered: 2011-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Private
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin Pump - Novolog Insulin
Current Illness: None
Preexisting Conditions: Type 1 Diabtetes
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anaphylaxis - taken to ER. Given epinephrine shot and Benadryl shot.


VAERS ID: 438323 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2011-02-14
Onset:2011-02-14
   Days after vaccination:0
Submitted: 2011-09-19
   Days after onset:216
Entered: 2011-10-12
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B044CA / 0 UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins, Norethisterone
Current Illness: Unknown
Preexisting Conditions: No know drug allergies. It was unknown if adverse events occurred with previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0915157A

Write-up: This case was reported by a healthcare professional and described the occurrence of swelling injection site in a 30-year-old female subject who was vaccinated with Boostrix (GlaxoSmithKline). Concurrent medications included Prenatal vitamins and Norethisterone (Nor-QD). On 14 February 2011 at 15:15 the subject received 1st dose of Boostrix (1 ml, unknown, left arm). On 14 February 2011, less than one day or on 15 February 2011 the following morning after vaccination with Boostrix, the subject experienced swelling injection site and arm pain at injection site. The swelling injection site and arm pain at injection site has continued for about nine days. The subject was treated with Advil and warm compress. At the time of reporting the swelling injections site and arm pain at injections site were unresolved. The healthcare professional considered the events were possibly related to vaccination with Boostrix. Follow-up information was received on 16 March 2011. It was reported that the events occurred the day of Boostrix administration, 14 February 2011. The outcome of the events was unknown and the causality was possible. No additional information was provided.


VAERS ID: 438395 (history)  
Age: 30.0  
Gender: Female  
Location: Kansas  
Vaccinated:2010-12-23
Onset:2010-12-26
   Days after vaccination:3
Submitted: 2011-09-19
   Days after onset:266
Entered: 2011-10-12
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B044CA / - AR / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NO concurrent medication
Current Illness: Unknown
Preexisting Conditions: There was no history of allergies or chronic health problems reported. No history of adverse events following previous vaccinations. Tetanus vaccination was received as a child.
Diagnostic Lab Data: UNK
CDC Split Type: A0906021A

Write-up: This case was reported by a healthcare professional and described the occurrence of injection site pain in a 30-year-old female subject who was vaccinated with BOOSTRIX (GlaxoSmithKline). There were no concurrent medications. On 23 December 2010 the subject received unspecified dose of BOOSTRIX (.5 ml, unknown, unknown arm). On 26 December 2010, 3 days after vaccination with BOOSTRIX, the subject spoke of injection site pain in the shoulder where the injection was given. It was noted that the pain may have started prior to 26 December 2010. The subject visit her physician in regards to the pain. At the time of reporting, the pain was unresolved and the subject was receiving ibuprofen for relief. In the reporting nurse''s opinion, the subject needed something stronger for her pain. They were speculating if the pain was due to neuritis related to tetanus immunization. The subject was treated with ibuprofen. At the time of reporting the events were unresolved.


VAERS ID: 438105 (history)  
Age: 30.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-10-03
Onset:2011-10-12
   Days after vaccination:9
Submitted: 2011-10-13
   Days after onset:1
Entered: 2011-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 0 LA / OT

Administered by: Military       Purchased by: Military
Symptoms: Acne, Chills, Pyrexia, Rash, Rash macular, Vaccination complication, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Primary vaccination site enlarged with multiple satellite lesions. Fever and chills. Diffuse macular rash to trunk and face. Sent to local emergency room with diagnosis or acne.


VAERS ID: 438107 (history)  
Age: 30.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2011-10-12
Onset:2011-10-12
   Days after vaccination:0
Submitted: 2011-10-13
   Days after onset:1
Entered: 2011-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Angina pectoris, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

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

Write-up: Chest pains. It''s a constant pain stemming from my heart that has been going on since about 2 hours after the vaccine.


VAERS ID: 438258 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-10-11
Onset:2011-10-11
   Days after vaccination:0
Submitted: 2011-10-14
   Days after onset:3
Entered: 2011-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown       Purchased by: Private
Symptoms: Chest pain, Dizziness postural, Dyspnoea, Headache, Nausea, Oedema mouth, Pharyngeal oedema, Pyrexia, Swollen tongue, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir, Sprintec
Current Illness: None
Preexisting Conditions: Allergic to Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms began at approx. 8pm with a severe headache. 2 hours later, mouth, tongue, throat very swollen. Unable to take deep breaths, wheezing and very bad chest pain. Dizziness while standing and nausea. Fever of 102.2. Very difficult to breathe, called nurse line and was instructed to go immediately to emergency. Was given an IV and administered Benadryl and Toradol. Discharged from ER at approx 2am. Arrived at 11pm.


VAERS ID: 438791 (history)  
Age: 30.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2011-09-19
Onset:0000-00-00
Submitted: 2011-10-17
Entered: 2011-10-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 04749211A / - LA / IM

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

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: Penicillin; Erythromycin; TYLENOL w/ Codeine; Fenofibrate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Achy, chills, fever 100.9 - 102.5 for 3 days.


VAERS ID: 438844 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-10-13
Onset:2011-10-15
   Days after vaccination:2
Submitted: 2011-10-17
   Days after onset:2
Entered: 2011-10-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Erythema, Feeling hot, Injection site pain, Injection site swelling, Malaise, Pain, Rash erythematous, Tenderness, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Redness, swelling~DTP (no brand name)~2~0.20~Patient|Joint pains~Measles + Mumps + Rubella (no brand name)~UN~5.00~Patient
Other Medications:
Current Illness: None reported
Preexisting Conditions: 10/17 Reports spoke with mom and learns he did have reaction to DPT age 2mo and 6 yrs; H/o reaction to MMR age 5
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: 10/17/2011 patient reported 10/15 awakened with malaise, body aches, pain (L) deltoid, wheeze. He had received TD vaccine eve 10/13. He noticed red rash and swelling left upper arm with pain at elbow. Today increased heat, redness, tenderness present.


VAERS ID: 438886 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-10-17
Onset:2011-10-17
   Days after vaccination:0
Submitted: 2011-10-18
   Days after onset:1
Entered: 2011-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IJ

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

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

Write-up: Pain and soreness at the injection site that has persisted for nearly 36 hours.


VAERS ID: 438925 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-10-18
Onset:2011-10-18
   Days after vaccination:0
Submitted: 2011-10-18
   Days after onset:0
Entered: 2011-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 110559 / - LA / IM

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

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: BP 138/82, P 74 after Epi; 198/92 P80 before
CDC Split Type:

Write-up: Pt. complaint of dizziness, itching, and difficulty breathing. Administered 0.3mg Epipen once.


VAERS ID: 439032 (history)  
Age: 30.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2011-10-11
Onset:2011-10-14
   Days after vaccination:3
Submitted: 2011-10-19
   Days after onset:5
Entered: 2011-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS 477AB / 0 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Aphasia, Blister, Dysphagia, Eating disorder, Fluid intake reduced, Pharyngeal oedema
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
CDC Split Type:

Write-up: throat swelled with blisters, could not talk; difficulty eating, drinking, swallowing Doctor visit... given antibiotics


VAERS ID: 439286 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-10-19
Onset:2011-10-19
   Days after vaccination:0
Submitted: 2011-10-20
   Days after onset:1
Entered: 2011-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA689AA / - LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Consciousness fluctuating, Cyanosis, Gaze palsy, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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: None
CDC Split Type:

Write-up: Patient looked like they were coming in and out of consciousness. Eyes rolling back, very sweaty. Lips blue.


VAERS ID: 439291 (history)  
Age: 30.0  
Gender: Female  
Location: Montana  
Vaccinated:2011-10-06
Onset:2011-10-10
   Days after vaccination:4
Submitted: 2011-10-19
   Days after onset:9
Entered: 2011-10-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 6036 / 0 UN / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Hyperaesthesia, Hypoaesthesia, Pain, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Within a few hours of the injection, (L) deltoid area became very sore, even with light tough. This soreness continued for 3-4 days. Still unable to sleep on (L) side due to pain and numbness from pressure. Prolonged weight bearing on (L) arm also causes these symptoms.


VAERS ID: 439394 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-10-13
Onset:0000-00-00
Submitted: 2011-10-19
Entered: 2011-10-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH462AA / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0985AA / 0 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Heart rate increased, Lip swelling, Local swelling, Rash, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Upper lip swelling. Rapid heart beat. Rash locally & local swelling & tenderness. Last 36 hours.


VAERS ID: 439429 (history)  
Age: 30.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-09-23
Onset:2011-09-30
   Days after vaccination:7
Submitted: 2011-10-05
   Days after onset:5
Entered: 2011-10-21
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV281 / - UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / - UN / ID

Administered by: Military       Purchased by: Military
Symptoms: Axillary pain, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal, C-reactive protein normal, Chest X-ray normal, Chest pain, Red blood cell sedimentation rate normal, Troponin T
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CELEBREX 200MG PO QDaily
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Troponin T Cardiac Site/Specimen 02 Oct 2011 2346 Units Ref Rng; Troponin T Cardiac SERUM, <0.010 ng/mL; Creatine Kinase Site/Specimen 02 Oct 2011 2346 Units Ref Rng; Creatine Kinase SERUM, 129 U/L; Creatine Kinase MB Site/Specimen 02 Oct 2011 2346 Units Ref Rng; Creatine Kinase MB SERUM, 1.5 ng/mL; C-Reactive Protein Site/Specimen 03 Oct 2011 0012 Units Ref Rng; C-Reactive Protein SERUM, 0.4 mg/dL; ESR Site/Specimen 03 Oct 2011 0012 Units Ref Rng; ESR BLOOD, 7 mm/hr; Cardiac Panel Site/Specimen 03 Oct 2011 0632 Units Ref Rng; Creatine Kinase SERUM, 117 U/L; Creatine Kinase MB SERUM, 1.5 ng/mL; Troponin T Cardiac SERUM, <0.010 ng/mL; Cardiac Panel Site/Specimen 03 Oct 2011 1241 Units Ref Rng; Creatine Kinase SERUM, 103 U/L; Creatine Kinase
CDC Split Type:

Write-up: 30 y/o female ADSM admitted to hospital Inpatient Unit for chest and axillary pain commencing 7-9 days after receipt of primary SPV, AVA, and TIV vaccines. Axillary pain commenced 9/30 and then became intertwined with achy chest pain over the weekend, leading to hospital admission on 3 Oct.


VAERS ID: 439582 (history)  
Age: 30.0  
Gender: Male  
Location: Mississippi  
Vaccinated:2011-10-19
Onset:2011-10-19
   Days after vaccination:0
Submitted: 2011-10-21
   Days after onset:2
Entered: 2011-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 13849111A / 8 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Salivary hypersecretion, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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:

Write-up: Pt reported vomiting, but having excessive salivation. Reported to work. Suggestion was to go to local ER due to the excessive salivation was a new & unknown symptom of anthrax.


VAERS ID: 439631 (history)  
Age: 30.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2011-10-17
Onset:2011-10-17
   Days after vaccination:0
Submitted: 2011-10-24
   Days after onset:7
Entered: 2011-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR UT425AA / 9 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Paraesthesia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Vomited day of vaccine. Dizziness, tingling in hands & feet, SOB, sweating intermittently. 10/18-10/24/11.


VAERS ID: 439748 (history)  
Age: 30.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2011-10-20
Onset:2011-10-22
   Days after vaccination:2
Submitted: 2011-10-24
   Days after onset:2
Entered: 2011-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U41244AA / - LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Contusion, Incision site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Pregnant
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seasonal flu vaccine administered 10/20/11 in left upper arm. Reports 10/22/11 3" red circle around incision site looks bruised and slightly itchy. Pt denied need for appt or tx.


VAERS ID: 440005 (history)  
Age: 30.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2011-10-19
Onset:2011-10-19
   Days after vaccination:0
Submitted: 2011-10-25
   Days after onset:6
Entered: 2011-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA678AA / - RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1200AA / - LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Chills, Headache, Hyperhidrosis, Injection site cellulitis, Injection site erythema, Injection site induration, Injection site streaking, Injection site warmth, Malaise, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benedryl, Nicotine patch, Methadone, Tylenol, Commit lozenges, Clonidine, Bentyl, Motrin, Doxepin, Multi-vit.
Current Illness: Withdrawal
Preexisting Conditions: None NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pneumococcal vaccine given L deltoid 10/19 approx 6am by LPN. Influenza vaccine given R deltoid 10/19 approx 10am by another LPN. At approx 6pm on 10/19 pt. c/o sore throat. During the night it progresses to chills, diaphoresis, body aches, headache, and malaise. Temp 99.6 at 6am 10/20. 12:30pm vitals 154/90-78-101.7. Motrin and clonidine ordered. Suggested pt. push fluids. 10/21 pt developed reddened area L deltoid which was hot to touch. Question of some streaking. Vitals 144/83-98.2-83-18. Dx of cellulitis of L deltoid. Bactrim DS ordered. Stil c/o sore throat, chills, sweats. 10/22/11 Low grade fever, sweats, chills. Vitals 135/82-101.0-86-18. Positive local cellulitis / erythema L deltoid. 10/23/11 Decreased fever, decreased induration L deltiod, less erythema. Vitals 112/62-96.0-85. 11/24 Minimal sweats, chills. Temp 97.9. Increased energy. Less erythema. Mild induration. Vitals 142/95-97.9-80-16. 10/25/11 L arm still painful but good range of motion. Slight erythema. Feeling better. Vitals 124/80-96.3-77-16.


VAERS ID: 440018 (history)  
Age: 30.0  
Gender: Female  
Location: Florida  
Vaccinated:2011-10-03
Onset:2011-10-03
   Days after vaccination:0
Submitted: 2011-10-25
   Days after onset:22
Entered: 2011-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH498AB / 2 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Cough, Eye discharge, Eye irritation, Fatigue, Headache, Injection site pain, Ocular hyperaemia, Pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cough. Fatigue. Body Aches. Sore Throat. Red, burning eyes with discharge. 102 degree fever for 12 hours. 99.5 degree mild fever for one week. Headache. Pain at injection site. Nasal Drainage.


VAERS ID: 440379 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-10-26
Onset:2011-10-27
   Days after vaccination:1
Submitted: 2011-10-27
   Days after onset:0
Entered: 2011-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH478AA / 0 RA / UN

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

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:

Write-up: Redness at site (R) deltoid 2.5 inches x 2 inches. No induration.


VAERS ID: 440504 (history)  
Age: 30.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-10-25
Onset:2011-10-26
   Days after vaccination:1
Submitted: 2011-10-28
   Days after onset:2
Entered: 2011-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 04849221A / 3 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1200AA / 0 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Injection site erythema, Injection site warmth, Local reaction, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Scheduled pt with an appointment with the PCM for the following day.
CDC Split Type:

Write-up: Local reaction: about a 4"red area with little red blotches toward the armpit area. Pt states that it showed up the next day, and has remained the same. Pt reports that it has not gotten bigger. Pt reports no other symptoms. The site is warm to the touch and red only.


VAERS ID: 440601 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-10-29
Onset:2011-10-30
   Days after vaccination:1
Submitted: 2011-10-30
   Days after onset:0
Entered: 2011-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / IJ

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain upper, Diarrhoea, Injection site pain, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: No
Preexisting Conditions: Seasonal allergies, hypertension
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness at site of injection began at approximately 7 pm on 10/29/2011. Nausea and stomach ache noticeable after midnight. Fainted 2 times on the way to bathroom. Experienced diarrhea. Fainted once more on the way back to bedroom. Symptons disappeared after a night''s sleep.


VAERS ID: 440885 (history)  
Age: 30.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2011-10-28
Onset:2011-10-28
   Days after vaccination:0
Submitted: 2011-10-31
   Days after onset:3
Entered: 2011-11-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3748BA / 0 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Body temperature increased, Feeling abnormal, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Seasonal allergies; asthma
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, body aches, nausea, increased temp (100.4). Reports he felt awful.


VAERS ID: 441000 (history)  
Age: 30.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-09-21
Onset:2011-10-17
   Days after vaccination:26
Submitted: 2011-11-01
   Days after onset:15
Entered: 2011-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA634AA / - RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Dysgraphia, Hypoaesthesia, Injection site pain, Movement disorder, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: Unknown
Preexisting Conditions: There was no relevant medical history. The subject had received flu shots in the past with no adverse events. She had not experienced adverse events following other previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0950657A

Write-up: This case was reported by a healthcare professional and described the occurrence of pain around injection site in a 30-year-old female subject who was vaccinated with FLUARIX (GlaxoSmithKline). Concurrent medications included Multivitamin. On 21 September 2011 at 08:00 the subject received a dose of FLUARIX (unknown route, right arm). On 17 October 2011, 26 days after vaccination with FLUARIX, the subject experienced pain around injection site. She also experienced arm pain, arm numbness and hard to move arm. The pain around injection site started the week of 17 October 2011 and had progressively worsened. The subject reported that she first noticed the pain when writing on the chalkboard. She writes on the board all day and the pain usually started later in the day. The subject noted that the pain started around the area of injection and had gotten worse so that she had difficulty writing on the board. In the later afternoon when her arm is parallel to her side, the subject reported that her arm started to go numb and the numbness extends down to her fingers. The numbness was worse when her arm was by her side. The subject reported that when she was using her right arm (arm of injection) it was hard to lift. On 25 October 2011, the subject experienced a sharp pain in her arm when lifting her arm to brush her hair, and she dropped the hairbrush. The subject had not yet consulted her physician regarding the events. The healthcare professional considered the events were disabling. At the time of reporting the events of pain around injection site, arm pain and arm numbness were worse. The outcome of the hard to move arm event was unknown.


VAERS ID: 441013 (history)  
Age: 30.0  
Gender: Female  
Location: New York  
Vaccinated:2011-10-24
Onset:2011-10-24
   Days after vaccination:0
Submitted: 2011-10-25
   Days after onset:1
Entered: 2011-11-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH442AB / 0 LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Anxiety, Chest pain, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None given
Diagnostic Lab Data: Blood pressure of 107/80
CDC Split Type:

Write-up: Patient experienced anxiety post vaccination. Chest burning, sweating, nauseated. Waited approximately 35 minutes and said she felt much better. Called patient at 10:42 and she stated all symptoms had completely resolved.


VAERS ID: 441089 (history)  
Age: 30.0  
Gender: Female  
Location: Montana  
Vaccinated:2011-10-27
Onset:2011-10-27
   Days after vaccination:0
Submitted: 2011-10-31
   Days after onset:4
Entered: 2011-11-02
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH477AD / - LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Cough, Eye discharge, Headache, Ocular hyperaemia, Pyrexia, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Inhaler prn
Current Illness: None
Preexisting Conditions: Allergy to Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: One hour after vaccinated began coughing - eyes turned bright red and began having eye discharge. Got a fever, started throwing up, headache & throat tightness. Took Albuterol Inhaler with some relief.


VAERS ID: 441296 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2011-11-01
Onset:2011-11-01
   Days after vaccination:0
Submitted: 2011-11-03
   Days after onset:2
Entered: 2011-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / -

Administered by: Other       Purchased by: Private
Symptoms: Cough, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Egg sensitivity - stomach issues with eggs
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Throat swelling, cough.


VAERS ID: 441329 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2011-10-13
Onset:2011-10-14
   Days after vaccination:1
Submitted: 2011-11-02
   Days after onset:19
Entered: 2011-11-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT443AA / - LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4056BA / - LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Chills, Neutrophil count increased, Pyrexia, Red blood cell sedimentation rate increased, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient denies
Preexisting Conditions: None
Diagnostic Lab Data: Sed rate 30 (H); WBC 11.5 (H); Absolute neutrophils 8625 (H)
CDC Split Type:

Write-up: Joint pain x 3 weeks. Began the day following vaccine injections. Initial onset also had "fever and chills -" temp on 10/31/11 99.0 degrees F.


VAERS ID: 441451 (history)  
Age: 30.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-10-21
Onset:2011-10-22
   Days after vaccination:1
Submitted: 2011-11-05
   Days after onset:14
Entered: 2011-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 66521011410 / - LA / IJ

Administered by: Other       Purchased by: Private
Symptoms: Body temperature increased, Chills, Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl, prenatal vitamin, vitamin D
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Diarrhea, nausea, vomiting, chills, 99.6 degree temperature.


VAERS ID: 441455 (history)  
Age: 30.0  
Gender: Female  
Location: Montana  
Vaccinated:2011-11-05
Onset:2011-11-05
   Days after vaccination:0
Submitted: 2011-11-05
   Days after onset:0
Entered: 2011-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 RA / -

Administered by: Other       Purchased by: Private
Symptoms: Cough, Dysphonia, Rhinitis, Swelling, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Low-Ogestrel.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Severe coughing, hoarseness, larynx swelling, feeling of fullness in throat. Within 30 minutes: Rhinitis. One Benadryl orally (25 mg Diphenhydramine HCl) at signs of serious airway symptoms.


VAERS ID: 441469 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-11-03
Onset:2011-11-03
   Days after vaccination:0
Submitted: 2011-11-06
   Days after onset:3
Entered: 2011-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Drug administered at inappropriate site, Pain, Tendon injury, Tendonitis
SMQs:, Accidents and injuries (narrow), Tendinopathies and ligament disorders (narrow), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT 100MG QHS
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: SHOULDER INJURY DUE TO VACCINE ADMINISTRATION: GIVEN TOO HIGH INJURING TENDON CAUSING TENDONITIS. IN EXTREME PAIN.


VAERS ID: 441582 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-11-02
Onset:2011-11-04
   Days after vaccination:2
Submitted: 2011-11-07
   Days after onset:3
Entered: 2011-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 04849211A / - LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Mobility decreased
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt call clinic 2 days after vaccination on 4 NOV 2011, complaining she is unable to move neck, pt was advised to present to the emergancy room.


VAERS ID: 441705 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-10-03
Onset:2011-10-03
   Days after vaccination:0
Submitted: 2011-11-07
   Days after onset:35
Entered: 2011-11-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC008AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3517AA / 0 LA / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Abdominal pain upper, Dizziness, Erythema, Headache, Injected limb mobility decreased, Oedema peripheral, Pain, Palpitations, Pruritus, Pyrexia, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 10-3-11 Client received Hep B on (R) arm and TDAP on left arm. States no redness or swelling to (R) arm. States (L) arm swelling, redness, itching, and had dizziness, and heart would race at time that same day. States on 2nd day had fever on & off, emesis, stomache, headache, and generalized body aches. Symptoms lasted x 2 wks. as per female client. Cont back page. States on same day called PMD - who informed her it was normal to have some reaction, and to go to E. R. if she has chest pain or feels like she is going to pass out. Also, common law husband called clinic and advised to go to PMD or E.R. that same day. Client did not call. States went to PMD on 10th day - was told by PMD to apply ice, heating pad, take BENADRYL, and take ibuprofen or TYLENOL - nothing also could be done. States after 2 wks - symptoms subsided, and is able to left left arm.


VAERS ID: 441835 (history)  
Age: 30.0  
Gender: Female  
Location: D.C.  
Vaccinated:2011-11-07
Onset:2011-11-08
   Days after vaccination:1
Submitted: 2011-11-09
   Days after onset:1
Entered: 2011-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zovia; generic ZYRTEC
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Quarter sized swelling-around site. Tender to touch at center. Warm/heat with redness.


VAERS ID: 441879 (history)  
Age: 30.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2011-11-02
Onset:0000-00-00
Submitted: 2011-11-04
Entered: 2011-11-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH477AH / - LA / IM

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

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:

Write-up: Site on left arm had redness, was tender and had hard knot underneath with heat associated with it.


VAERS ID: 441949 (history)  
Age: 30.0  
Gender: Female  
Location: Utah  
Vaccinated:2011-10-12
Onset:2011-10-12
   Days after vaccination:0
Submitted: 2011-11-09
   Days after onset:28
Entered: 2011-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Cognitive disorder, Dizziness, Lacrimation increased, Mydriasis, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Lacrimal disorders (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zrytec D
Current Illness: No
Preexisting Conditions: Interstitial Cystitis, Seasonal Allergies, Endometriosis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became nauseated, dizzy, could not comprehend what people were saying, eyes started to become watery and very dilated. Patient took one Benadryl pill and in two hours felt a lot better but eyes were still dilated.


VAERS ID: 442362 (history)  
Age: 30.0  
Gender: Female  
Location: D.C.  
Vaccinated:2011-11-10
Onset:2011-11-10
   Days after vaccination:0
Submitted: 2011-11-14
   Days after onset:4
Entered: 2011-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3989AA / - LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Burning sensation, Erythema, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen, burning, red, warm, painful.


VAERS ID: 442525 (history)  
Age: 30.0  
Gender: Female  
Location: Maryland  
Vaccinated:2011-10-05
Onset:2011-10-27
   Days after vaccination:22
Submitted: 2011-11-11
   Days after onset:15
Entered: 2011-11-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA652AA / 7 LA / UN

Administered by: Public       Purchased by: Other
Symptoms: Abdominal pain, Decreased appetite, Headache, Myalgia, Nausea, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Von Willebrand disease; Iron deficiency
Diagnostic Lab Data: see attached
CDC Split Type:

Write-up: Patient is a 30 y.o. female presenting with fever. Primary symptoms of the febrile illness include fever, headaches, abdominal pain, nausea and myalgias (generalized). Primary symptoms do not include cough, vomiting, dysuria or rash. The headache is not associated with weakness. The myalgias are not associated with weakness. 30 y.o. female presents to ED with c/o HA onset 1.5 ago s/p receiving flu shot, hives onset 3 days ago and fever of 102 onset 2 days ago. (+)Muscle aches and decreased appetite. Pt states that she took BENADRYL for the hives which resolved. Has been taking TYLENOL for fever without relief. Pt also c/o abd pain. Hx of iron deficiency and Von Willebrand disease.


VAERS ID: 442816 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-11-08
Onset:2011-11-09
   Days after vaccination:1
Submitted: 2011-11-17
   Days after onset:8
Entered: 2011-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1083 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3844AA / 0 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Injection site pain, Oedema, Pain, Pruritus, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin (breastfeeding)
Current Illness: n/a
Preexisting Conditions: Bi-Polar
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain noticed in Right deltoid when stretching out arms above head on 9 Nov 2011. Noticed erythema, edema, warm to touch, and pruritis larger than a 50 cent piece but smaller than my palm to begin with. Tender to touch. Erythema, edema, pruritis all larger than the size of my palm. Tender to touch. Symptoms started the day after injection (9 Nov) and progressively got worse until 13 Nov, when erythema dissipated. Edema dissipated by 15 Nov 2011.


VAERS ID: 442895 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-11-14
Onset:2011-11-15
   Days after vaccination:1
Submitted: 2011-11-17
   Days after onset:2
Entered: 2011-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3898AA / - LA / IM

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

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

Write-up: Dizziness, diaphoresis, nausea. Lasted most of morning and early afternoon. No treatment sought.


VAERS ID: 443061 (history)  
Age: 30.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2011-11-14
Onset:2011-11-14
   Days after vaccination:0
Submitted: 2011-11-18
   Days after onset:4
Entered: 2011-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV294 / - LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Local reaction, Nodule, Tenderness, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Box10, Step 3, other vaccine was PPD, Manufacturer is PMC.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had an unexpected and unusual localized reaction to the PPD test. Symptoms included increased erythema, tenderness, and a nodule (5mm). It is suspected that a 0.1 ml of anthrax vaccine was erroneously administered to the sm instead of the standard PPD solution.


VAERS ID: 443396 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-11-09
Onset:2011-11-09
   Days after vaccination:0
Submitted: 2011-11-10
   Days after onset:1
Entered: 2011-11-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1100101 / - RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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: NKDA or health conditions. Does not smoke or use alcohol.
Diagnostic Lab Data:
CDC Split Type:

Write-up: FLUVIRIN - manufacturer Novartis - Lot# 1100101 Exp. 4/12 administered 0.5ml into the right deltoid intramuscularly. The patient was not able to raise her left arm above her shoulder due to severe pain 20-30 minutes after administration. This pain limiting limb movement was in the opposite arm of the intramuscular injection.


VAERS ID: 443313 (history)  
Age: 30.0  
Gender: Male  
Location: Michigan  
Vaccinated:2011-10-16
Onset:2011-11-17
   Days after vaccination:32
Submitted: 2011-11-22
   Days after onset:5
Entered: 2011-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 1 LA / SC
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3958AA / 0 LA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: On 10/31/11 Patient received a PPD. It was read on 11/3/11 as 0 mm or negative.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythema & swelling to the injection site. 101 degree temperature. Currently the area is still itchy.


VAERS ID: 443675 (history)  
Age: 30.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2008-05-01
Onset:0000-00-00
Submitted: 2011-11-22
Entered: 2011-11-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bordetella test positive, Cough, Decreased appetite, Fatigue, Pertussis, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient denied any medical history or concomitant medications. She had no known allergies. The patient denied any illness at the time of vaccination. The patient may have possibly received hepatitis vaccine within 4 weeks prior to the ADACEL.
Diagnostic Lab Data: The patient had a blood test that was recently drawn for pertussis.
CDC Split Type: 201111279

Write-up: Initial report received from a consumer on 16 November 2011. A 31-year-old female patient received an intramuscular injection of ADACEL, sanofi pasteur Ltd. lot number not reported, on an unknown date in May 2008. The patient denied any medical history or concomitant medications. She had no known allergies. The patient denied any illness at the time of vaccination. The patient may have possibly received hepatitis vaccine within 4 weeks prior to the ADACEL. In August-September 2011, the patient developed persistent dry cough, fatigue, loss of appetite, and weight loss of eleven pounds. The patient was informed by a nurse that she had pertussis. This was following a blood test that recently was drawn. The patient had been ill for three months. The outcome was reported as not recovered. Documents held by sender: None.


VAERS ID: 444133 (history)  
Age: 30.0  
Gender: Female  
Location: Georgia  
Vaccinated:2011-10-27
Onset:2011-10-28
   Days after vaccination:1
Submitted: 2011-11-14
   Days after onset:17
Entered: 2011-11-30
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA608AA / 0 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site reaction, Injection site vesicles, Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Yellowish blister to (L) upper arm 24 hour after immunization, lasted for 5 days. Papular rash noted to site.


VAERS ID: 444080 (history)  
Age: 30.0  
Gender: Male  
Location: Illinois  
Vaccinated:2011-11-29
Onset:2011-11-29
   Days after vaccination:0
Submitted: 2011-11-30
   Days after onset:1
Entered: 2011-12-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT473AA / - RA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB493BA / 0 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1223 / - LA / SC
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G0481 / 0 LA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH283AA / 0 RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol; Fluticasone
Current Illness: Hx of Asthma - controlled.
Preexisting Conditions: Asthma.
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Vaccines for impending travel: Hepatitis A #1 of 2, Influenza 2011-12, Polio IPV, Typhoid TYPHIM VI, Yellow Fever.


VAERS ID: 444172 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-11-20
Onset:2011-11-20
   Days after vaccination:0
Submitted: 2011-12-01
   Days after onset:11
Entered: 2011-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 5010949 / - - / IN

Administered by: Other       Purchased by: Military
Symptoms: Flushing, Nausea, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

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

Write-up: Pt. c/o nausea, feeling flushed, and swelling of both hands approximately 1 hour after receiving FluMist vaccine.


VAERS ID: 444309 (history)  
Age: 30.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-11-30
Onset:0000-00-00
Submitted: 2011-12-02
Entered: 2011-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / -

Administered by: Other       Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Hypersensitivity, Hypoaesthesia oral, Injection site rash, Pharyngeal hypoaesthesia, Rash generalised
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Singulair, Metformin, Prozac
Current Illness: No
Preexisting Conditions: Seasonal allergies, some drug allergies, hypothyroidism
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately, 4 hours after the vaccination, I began developing a rash on the arm where the vaccine was administered. Within 24 hours, the rash had spread over my whole body and I began to experience tightness of the chest, shortness of breath, lip and throat numbness. I was sent to the ER and was given medications to combat the allergic reaction. I''m now on a steroid and several antihistamines to combat the allergies.


VAERS ID: 444363 (history)  
Age: 30.0  
Gender: Female  
Location: Florida  
Vaccinated:2011-10-28
Onset:2011-10-28
   Days after vaccination:0
Submitted: 2011-12-02
   Days after onset:35
Entered: 2011-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA691AA / 1 LA / IM

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

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

Write-up: Burning and soreness at injection site. Soreness lasting over 30 days.


VAERS ID: 444563 (history)  
Age: 30.0  
Gender: Female  
Location: South Dakota  
Vaccinated:2011-11-04
Onset:0000-00-00
Submitted: 2011-12-05
Entered: 2011-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / IJ

Administered by: Private       Purchased by: Other
Symptoms: Arthralgia, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Shoulder (joint) and arm pain. Shooting pain when lifting arm, or crossing the body with arm. Ongoing since time of flu shot on November 4, 2011. Starting physical therapy 12/7/11.


VAERS ID: 444591 (history)  
Age: 30.0  
Gender: Male  
Location: Hawaii  
Vaccinated:2011-11-15
Onset:2011-11-26
   Days after vaccination:11
Submitted: 2011-12-05
   Days after onset:9
Entered: 2011-12-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV294 / 0 RA / IM
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 0 LA / ID

Administered by: Military       Purchased by: Military
Symptoms: Activated partial thromboplastin time, Chest X-ray, Chills, Ecchymosis, Full blood count, Oedema, Pain in extremity, Prothrombin time, Pyrexia, Ultrasound scan, Vasculitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vasculitis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Chest X-ray, Ultrasound of lower extremities, CBC, PT, PTT.
CDC Split Type:

Write-up: PT experienced fever, chills, and pain at 8 of 10 in bilateral calves that lasted 1-2 hours then +3 pitting edema and ecchymosis of bilateral lower extrimities set in. PT was medevac''d to Hospital and spent 2 days in the hospital DX with vasculitis. Released 29 Nov 11 Fit for Full Duty Asymptomatic.


VAERS ID: 445369 (history)  
Age: 30.0  
Gender: Female  
Location: New York  
Vaccinated:2011-12-05
Onset:2011-12-05
   Days after vaccination:0
Submitted: 2011-12-12
   Days after onset:7
Entered: 2011-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH469AB / 0 LA / IM

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

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

Write-up: Swelling in upper arm area around injection site and also pain. Stated she has had this for a week.


VAERS ID: 445276 (history)  
Age: 30.0  
Gender: Male  
Location: Virginia  
Vaccinated:2011-07-10
Onset:2011-08-04
   Days after vaccination:25
Submitted: 2011-12-09
   Days after onset:127
Entered: 2011-12-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR - / - UN / -

Administered by: Military       Purchased by: Military
Symptoms: Cardiomyopathy, Electrocardiogram, Lumbar puncture, Nuclear magnetic resonance imaging, Nuclear magnetic resonance imaging brain, Troponin I
SMQs:, Cardiomyopathy (narrow)

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: Medical history was not available.
Diagnostic Lab Data: Not reported
CDC Split Type: 201111732

Write-up: This study case was received from the investigator on 30 November 2011. A 30-year-old male subject with an unknown medical history was found to have Cardiomyopathy 25 days after he had received on 10 July 2011 ACAM2000 (lot number, route and site of administration not reported). The subject had also received on 09 July 2011 ANTHRAX 1 (manufacturer, lot number, route and site of administration not reported). The subject''s Troponin I, ECG, Lumbar puncture and MRI of the brain, spinal cord and heart were not available. Treatments were not reported. The subject''s outcome was not reported. Note: There is no reporter causality assessment as this is a safety surveillance (data mining, non-interventional) study. Documents held by sender: none.


VAERS ID: 445320 (history)  
Age: 30.0  
Gender: Male  
Location: South Dakota  
Vaccinated:2011-10-24
Onset:2011-10-25
   Days after vaccination:1
Submitted: 2011-12-13
   Days after onset:49
Entered: 2011-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA692AA / - LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Musculoskeletal pain, Pain, Pain in extremity, Sensation of heaviness
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe arm pain. Feels pain in upper arm and shoulder x 6 weeks. Feels arm is very "heavy". Arm hurts when tries to lift it above his head.


VAERS ID: 445568 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2011-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB204BA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3837 / - LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: A 30 year old female was reported she was raped 2 days ago came to clinic to get checked. Client last period was X/X/11, client stated having history of regular menses. tdap and hep A/B vaccine given. Client then sent to lab for HIV/RPR test. Referral by clinician was made to another clinic after STD visit for plan B where they did a preg test which tested positive 4 wks pregnant. I then called CDC concerning giving the pt TDAP and TWINRIX. CDC reported TDAP was ok to pregnant women as of June 2011, hep B ok to give no risk factors and hep A vaccine risk to fetus very low. Spoke with CDC. Client was informed about the vaccines and its low risk via phone call and she voiced understanding. The vaccines given was TDAP .55 CC IM (LD) # C3837 by ADACEL and TWINRIX 1.0cc IM (RD) # AHABB204BA GlaxoSmithKline. There was no knowledge of client being pregnant at the time of vaccination. Client''s last period was on such a date and next menses (month later).


VAERS ID: 445589 (history)  
Age: 30.0  
Gender: Female  
Location: Iowa  
Vaccinated:2011-10-23
Onset:0000-00-00
Submitted: 2011-12-15
Entered: 2011-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH456AA / - LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Injected limb mobility decreased
SMQs:

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:

Write-up: Has no/limited range of motion in arm 6 weeks after shot administered.


VAERS ID: 445661 (history)  
Age: 30.0  
Gender: Male  
Location: Iowa  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-12-09
Entered: 2011-12-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 14549111A / - LA / UN

Administered by: Military       Purchased by: Military
Symptoms: Unevaluable event
SMQs:

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:

Write-up: None stated.


VAERS ID: 445696 (history)  
Age: 30.0  
Gender: Female  
Location: Nevada  
Vaccinated:2011-12-16
Onset:2011-12-16
   Days after vaccination:0
Submitted: 2011-12-17
   Days after onset:1
Entered: 2011-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Gait disturbance, Hyperhidrosis, Nausea, Sluggishness, Tremor, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ocella, One A Day Women''s multivitamin, flaxseed oil, vitamin D, magnesium, calcium supplements.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up shaky, weak, diaphoretic, nauseous, dizzy/vertigo (patient NOT a diabetic). In case it was low blood sugar, patient ate apple sauce, a piece of a banana, some macaroni, and drank approximately 500mL of water. The symptoms continues with new onset fatigue. After sleeping off and on for several more hours the symptoms slowly began to resolve. Current time is 12:15 AM on 12/17/11- 8 hours after onset of symptoms and nearly 16 hours after vaccination was administered- and patient is finally able to walk appropriately, the vertigo and nausea have subsided, but the patient remains feeling sluggish.


VAERS ID: 445917 (history)  
Age: 30.0  
Gender: Female  
Location: Alabama  
Vaccinated:2011-12-14
Onset:0000-00-00
Submitted: 2011-12-14
Entered: 2011-12-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH486AF / - RA / UN

Administered by: Military       Purchased by: Military
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated.


VAERS ID: 446071 (history)  
Age: 30.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-09-19
Onset:2011-09-19
   Days after vaccination:0
Submitted: 2011-11-16
   Days after onset:58
Entered: 2011-12-21
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH464AA / 1 LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Erythema, Oedema, Pruritus, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Allergy; sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given INFLUENZA vaccine. Called EHS c/o upper arm tenderness, erythema, edema, warmth and pruritus. C/O dizziness 9/19/11.


VAERS ID: 446100 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-12-05
Onset:0000-00-00
Submitted: 2011-12-22
Entered: 2011-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B078BB / - LA / IM

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

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

Write-up: Pt. reported having pain, lump, pus, edema to site a few days after Tdap. Tdap given 12-5-11. Pt. reported this to me 12/19/11. Lump, sloughing skin.


VAERS ID: 446108 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-12-20
Entered: 2011-12-22
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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: not reported
Diagnostic Lab Data: not reported
CDC Split Type: 201112312

Write-up: Initial report was received from a consumer, who was also the patient''s mother, on 13 December 2011. A 30-year-old male patient (date of birth not reported) had received an intramuscular injection in the left arm of INFLUENZA vaccine (manufacturer, lot number and exact date of administration not reported) in 2010. The patient''s left arm had been hurting since the vaccine last year and the doctor said it may be tendonitis. It was not reported if the patient had any illness at the time of vaccination, pre-existing medical conditions or took any concomitant medications. No further information was available at the time of the report. The patient''s outcome was not reported. Documents held by sender: none.


VAERS ID: 446292 (history)  
Age: 30.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2011-12-20
Onset:0000-00-00
Submitted: 2011-12-21
Entered: 2011-12-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1154AA / - LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3941AA / - LA / UN

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

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:

Write-up: On the injection schedule pt was in for hep B and Tdap. I looked on pts HMP & it said pt was due for her 2nd Hep B and Tdap. That was given when I went to put vaccines in pt was already given Tdap on 11-18-11.


VAERS ID: 446864 (history)  
Age: 30.0  
Gender: Female  
Location: Maine  
Vaccinated:2010-11-09
Onset:2011-11-29
   Days after vaccination:385
Submitted: 2011-12-28
   Days after onset:29
Entered: 2012-01-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 AR / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 AR / UN

Administered by: Private       Purchased by: Private
Symptoms: Blood thyroid stimulating hormone normal, Laboratory test abnormal, Myalgia, Nervous system disorder, Panic attack, Tremor, Vitamin B12 normal, Vitamin D decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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: TSH (normal); Vitamin D (Low); Vit. B12 (normal); Neuroscreen (not ideal)
CDC Split Type:

Write-up: Sudden crash of the nervous system - shaking, panic - muscle pain etc. Have tried anti-depressants and a battery of supplements and tinctures. Condition persists 13 months later, but definite improvement noted.


VAERS ID: 446986 (history)  
Age: 30.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-12-30
Onset:2012-01-05
   Days after vaccination:6
Submitted: 2012-01-06
   Days after onset:1
Entered: 2012-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair, Proair, Synthroid, Loestrin
Current Illness: None
Preexisting Conditions: Asthma, hypothyroidism, allergic to penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body aches, joint pain, stomach cramps, diarrhea, fatigue.


VAERS ID: 447061 (history)  
Age: 30.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-01-27
Onset:2011-01-27
   Days after vaccination:0
Submitted: 2012-01-09
   Days after onset:347
Entered: 2012-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV269 / 4 - / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR E04421 / 2 - / IM

Administered by: Military       Purchased by: Military
Symptoms: Dizziness, Dyspnoea, Nausea, Pallor, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: "High fever, dizziness, paleness and mild difficult breathing as well as nausea. Was seen at urgent care and treated with IV fluids and ibuprofen for high temperature."


VAERS ID: 447080 (history)  
Age: 30.0  
Gender: Male  
Location: Hawaii  
Vaccinated:2012-01-04
Onset:2012-01-08
   Days after vaccination:4
Submitted: 2012-01-09
   Days after onset:1
Entered: 2012-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA622AA / - RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1138AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4015AA / 0 LA / IM

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

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:

Write-up: Swelling, redness & discomfort (R) deltoid were pneumococcal polysaccharide vaccine was administered & influenza.


VAERS ID: 447100 (history)  
Age: 30.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2011-12-28
Onset:2011-12-28
   Days after vaccination:0
Submitted: 2011-12-28
   Days after onset:0
Entered: 2012-01-10
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA672AA / - LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Paraesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt "felt dizzy throat and tongue tingling" epinephrine per epipen (L) upper thigh - transported to ER via EMS in stable condition.


VAERS ID: 447292 (history)  
Age: 30.0  
Gender: Male  
Location: California  
Vaccinated:2012-01-10
Onset:2012-01-11
   Days after vaccination:1
Submitted: 2012-01-12
   Days after onset:1
Entered: 2012-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / SYR
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / SYR
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / SYR

Administered by: Unknown       Purchased by: Private
Symptoms: Disorientation, Dizziness, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Yes. Checked into urgent care for a cough lasting longer than 7 days.
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Disoriented, dizzy, headache, body aches, extremely sore and fever all day and over night of 101-103 degrees.


VAERS ID: 447386 (history)  
Age: 30.0  
Gender: Female  
Location: Virginia  
Vaccinated:2012-01-16
Onset:2012-01-16
   Days after vaccination:0
Submitted: 2012-01-16
   Days after onset:0
Entered: 2012-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4114DA / - - / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Feeling hot, Nervousness, Palpitations, Tunnel vision, Weight loss diet
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt reported feeling light-headed/dizziness, vision changes (tunnel vision) and shaky, also reported palpitations (she attributed all symptoms to insufficient caloric intake), felt feverish but no fever, temp was 97.3F. Hands were stable, no rash or difficulty breathing.


VAERS ID: 447618 (history)  
Age: 30.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2009-11-24
Onset:2009-11-24
   Days after vaccination:0
Submitted: 2012-01-19
   Days after onset:786
Entered: 2012-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV219 / 0 UN / UN
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 102040P1A / 0 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR - / 0 UN / ID
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UF317AA / 0 UN / SC

Administered by: Military       Purchased by: Military
Symptoms: Alanine aminotransferase normal, Amnesia, Anti-cyclic citrullinated peptide antibody negative, Antibody test normal, Antinuclear antibody negative, Arthralgia, Aspartate aminotransferase normal, Asthenia, Basophil count decreased, Basophil percentage increased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood cholesterol increased, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone, Blood thyroid stimulating hormone normal, Blood triglycerides normal, Blood urea normal, Bone scan normal, C-reactive protein increased, Complement factor C3 increased, Complement factor C4, Complement factor decreased, Depression, Disturbance in attention, Eosinophil count decreased, Eosinophil percentage decreased, Fatigue, Feeling abnormal, Fibromyalgia, Gait disturbance, Haematocrit normal, Haemoglobin normal, Headache, High density lipoprotein normal, Impaired work ability, Influenza like illness, Insomnia, Low density lipoprotein normal, Lymphocyte count normal, Lymphocyte percentage, Malaise, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume decreased, Memory impairment, Monocyte count normal, Monocyte percentage, Myalgia, Nerve conduction studies normal, Neutrophil count normal, Neutrophil percentage, Nuclear magnetic resonance imaging brain abnormal, Pain, Platelet count normal, Protein total normal, Red blood cell count normal, Red blood cell sedimentation rate increased, Red cell distribution width normal, Rheumatoid factor negative, Scan normal, Sleep disorder, Thyroxine free decreased, Total cholesterol/HDL ratio normal, Vaccine positive rechallenge, White blood cell count decreased, White blood cell count normal, Whole body scan, X-ray normal
SMQs:, Rhabdomyolysis/myopathy (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (narrow), Lipodystrophy (broad), Arthritis (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: 6/14/10 CCP 2; WBC 6.29; RBC 4.69; HGB 12.4: HCT 37.8; PLT 291; Albumin 4.2; Alk phos 55; SGPT 11; SGOT 13; BUN 12; Ca 9.3; Chloride 105; Total protein 7.4; Creat. 0.9; Glucose 88; K+ 3.9; Na 138; Total bili 0.3; ESR 23; CRP 1.14; RF <5.00; ANA neg; TSH 4.0; 14 Dec 2010 Thyrotropin Sensitive 2.36 mcIU/mL; Cholesterol 227 (H) mg/dL; Triglyceride 75 mg/dL; HDL Cholesterol 62; LDL Cholesterol 150 (H) mg/dL; Cholesterol/HDL Cholesterol 3.7; WBC 4.24 (L) x 10 (3)/mcL; RBC 4.72 x 10(6); Hematocrit 38.6%; MCV 81.7 fL; MCHC 33.4 g/dL; RDW CV 12.3%; Platelets 283 x10(3); MPV 6.1 (L) fL; Lymphocytes 32.4%; Monocytes 6.7%; Neutrophils 58.3%; Eosinophils 1.6%; Basophils 1.0%; Lymphocytes 1.4 x10(3); Monocytes 0.3 x10(3); Neutrophils 2.5 x10(3); Eosinop
CDC Split Type:

Write-up: Pt received multiple vaccines in preparation for a job and initial had flu-like symptoms that progressed to chronic fatigue, myalgias, arthralgias, weakness, memory loss and headaches. She was seen by rheumatology in June 2010 and diagnosed with fibromyalgia. On 11/24/09 she received AVA #1, H1N1, yellow fever and primary SPV in preparation for a job in Jan. Within 4-8 hrs, she felt she had come down with the flu (body aches, malaise, fatigue). Stayed in bed the next day because she continued to feel poorly. Discussed with MD and was told it would resolve in a month''s time and to treat symptomatically. Into December noticed increase of symptoms including muscle and joint aches, increasing fatigue, generalized weakness, disruption to sleep pattern, mental fog (forgetfulness, poor concentration) HA on R side of head. Left for job in Jan 2010. She continued to have symptoms at time of job, feeling like she a really bad case of the flu, had to force herself to go to work, couldn''t sleep at night, hard time working due to poor concentration and forgetfulness, difficulty walking due to muscle and joint pain and weakness. Pt received AVA #2 on 1/30/10 and she felt as if she had a worsening of her symptoms, especially increasing joint and muscle pain and fatigue, more disruption to her sleep cycle. She was sent back from job in Feb 1010 because she was unable to function at her job. Was told at one time that her symptoms were due to depression. Saw a rheumatologist in June and was diagnosed with fibromyalgia. Has seen neurology for HA, which got progressively worse.


VAERS ID: 447673 (history)  
Age: 30.0  
Gender: Female  
Location: Georgia  
Vaccinated:2011-11-22
Onset:2011-11-23
   Days after vaccination:1
Submitted: 2012-01-14
   Days after onset:52
Entered: 2012-01-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1102601 / 0 LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TRILEPTAL; Paroxetine
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: After flu shot, patient has had sharp pain in arm. She is unable to lift arm all the way. Patient has tried to give nerve time to heal but is still having pain in left arm.


VAERS ID: 447881 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-03-01
Onset:2011-12-09
   Days after vaccination:283
Submitted: 2012-01-23
   Days after onset:45
Entered: 2012-01-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Caesarean section, Maternal exposure before pregnancy, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Chickenpox
Diagnostic Lab Data: Beta-human chorionic, pregnant
CDC Split Type: WAES1105USA03201

Write-up: Information has been received from a consumer for VARIVAX (Merck), a Pregnancy Registry Product, concerning his 30 year old wife with a history of chicken pox "as a child" and no drug allergies or reaction who on 01-MAR-2011 was vaccinated with a 0.5 ml dose of VARIVAX (Merck). There was no concomitant medication. On 17-MAY-2011 the patient found out she was pregnant. There was no AE reported. The patient was seeing her OB/GYN on Tuesday. The patient sought unspecified medical attention and the patient''s pregnancy had been confirmed by pregnancy test. Her last LMP was on 08-MAR-2011. Expected date of delivery was 13-DEC-2011. Follow up information was received from the consumer in regards to his wife''s pregnancy outcome. He reported that his wife, the patient, gave birth to a healthy baby boy on 09-DEC-2011 that was full term. The baby weighed 8 lbs, 2 oz.; length was 22 inches. He stated his son had no difficulties or anomalies. He reported the delivery was a C-section. When asked why his wife had a C-section, he stated that he did not really know. His wife and baby suffered no complications of the cesarean birth. He verified that his wife only had one dose of VARIVAX (Merck) and that she did have chickenpox as a child. He did not know if VARIVAX (Merck) titers were done on his wife. Upon internal review, cesarean section delivery was determined to be an other important medical event. No further information is available.


VAERS ID: 448080 (history)  
Age: 30.0  
Gender: Female  
Location: Virginia  
Vaccinated:2012-01-24
Onset:2012-01-25
   Days after vaccination:1
Submitted: 2012-01-26
   Days after onset:1
Entered: 2012-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B071CA / 0 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Poor quality sleep, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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 known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine administered approximately 345 pm on 1/24/12. Pt. called 1/25/12 in A.M. & stated she developed hives & itching during "middle of night (woke her up from sleep)". Symptoms improved over course of day. No other symptoms.


VAERS ID: 448111 (history)  
Age: 30.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2012-01-11
Onset:2012-01-11
   Days after vaccination:0
Submitted: 2012-01-26
   Days after onset:15
Entered: 2012-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH271AA / 1 UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Chest discomfort, Lip swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Less than 1 hr after vaccination, pt experienced swelling of upper lip, itching and chest tightness. Aid station administered Benadryl, Cimetidine and Prednisone. Pt then went to EC where he was assessed by physician. Administered Decadron and sent home with Prednisone to complete treatment.


VAERS ID: 448162 (history)  
Age: 30.0  
Gender: Female  
Location: Indiana  
Vaccinated:2012-01-26
Onset:2012-01-26
   Days after vaccination:0
Submitted: 2012-01-26
   Days after onset:0
Entered: 2012-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT55DDAB / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1418AA / 0 RA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Injection site pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Lovenox, Methimazole, Metoprolol, Nicotine patch
Current Illness: No.
Preexisting Conditions: Allergic to codeine. History of Afib, HTN, Grave''s, Anemia.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was complaining of pain and tenderness to her right upper arm and arm appeared swollen.


VAERS ID: 448225 (history)  
Age: 30.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2012-01-21
Onset:2012-01-22
   Days after vaccination:1
Submitted: 2012-01-27
   Days after onset:5
Entered: 2012-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4103AA / 0 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Erythema, Headache, Induration, Local swelling, Nausea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI; Vit E
Current Illness: None
Preexisting Conditions: None other than constipation.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccinated 1/20/2012. Developed localized erythema, swelling, pain associated with HA, fever, nausea the day after vaccination 1/21. Fever, HA, nausea resolved by 1/22. Erythema, swelling with induration and pain persist to 1/26 - day of office visit. Today''s date is 1/27/2012.


VAERS ID: 448226 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:2012-01-19
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2012-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS - / - LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Unevaluable event
SMQs:

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:

Write-up: None stated.


VAERS ID: 448242 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-01-20
Onset:2012-01-25
   Days after vaccination:5
Submitted: 2012-01-27
   Days after onset:2
Entered: 2012-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G0507 / 0 LA / IM

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

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

Write-up: Fever $g 101 degrees F and chills.


VAERS ID: 448247 (history)  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:2009-05-26
Onset:2009-05-26
   Days after vaccination:0
Submitted: 2012-01-27
   Days after onset:976
Entered: 2012-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV164 / - UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Feeling hot, Hypersensitivity, Papule, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Allergies: CELEXA --$g hives, nausea; Latex --$g runny nose, nasal congestion; Hx: Anxiety disorder
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 2-3 hours after receipt of AVA (2), patient noted that her face and ears were hot and her back itched. She noted pencil sized raised non-red pruritic papules on her chest, back, arms and legs. Pt went to sick call (no documentation) and was told that she may be having an allergic reaction to the vaccine. She was treated with BENADRYL which she took sporadically. Symptoms persisted 2-3 weeks. She denies any angioedema, wheezing, lightheadedness or loss of consciousness. Patient had no reaction following first anthrax vaccine except some local erythema. She has not received any anthrax vaccines since, but has received multiple flu vaccines and typhoid vaccine. She admits to one other episode of hives many years ago with no identifier. No allergy to foods. No allergy to insect bites/stings. No allergy to animals. An allergy to latex --$g runny nose and nasal congestion. No rash, hives, wheezing. Allergic to CELEXA --$g hives, vomiting.


VAERS ID: 448346 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2012-01-30
Onset:2012-01-30
   Days after vaccination:0
Submitted: 2012-01-30
   Days after onset:0
Entered: 2012-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV304 / 4 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Hypoaesthesia, Immediate post-injection reaction, Injected limb mobility decreased, Sensation of heaviness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien 5mg daily, amitripolyn 25mg daily
Current Illness: none
Preexisting Conditions: pt states allergic to norotriptolin and Motrin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt describes immediate right arm numbness and inability to move entire right arm "feels heavy". Right arm movement resolved after 20 minutes.


VAERS ID: 448410 (history)  
Age: 30.0  
Gender: Female  
Location: Georgia  
Vaccinated:2012-01-10
Onset:2012-01-11
   Days after vaccination:1
Submitted: 2012-01-12
   Days after onset:1
Entered: 2012-01-31
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH456AB / 3 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB459AA / 2 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0750Z / 0 LA / SC

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

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:

Write-up: Client stated itching at back of Lt arm at VZV site given 1-10-12. Area warm to touch. Redness 4 inches in diameter. Advised TYL. q4r prn for pain & BENADRYL 125 mg q6hrs prn for itching. Apply hydrocortisone or BENADRYL cr prn.


VAERS ID: 448852 (history)  
Age: 30.0  
Gender: Female  
Location: Utah  
Vaccinated:2012-01-27
Onset:2012-01-27
   Days after vaccination:0
Submitted: 2012-01-30
   Days after onset:3
Entered: 2012-02-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB208AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1686Z / 0 LA / SC

Administered by: Public       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)

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

Write-up: Patient has redness, swelling, heat at varicella injection site. Does not have SOB, difficulty breathing/reaction is getting worse and has been present for 2-3 days. Referred to MD.


VAERS ID: 448928 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:2011-10-06
Onset:2012-02-03
   Days after vaccination:120
Submitted: 2012-02-06
   Days after onset:3
Entered: 2012-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 11064P / - LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Facial paresis, VIIth nerve paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Awoke 2/3/11 with sudden-onset Left-sided facial weakness/paralysis. Diagnosed by her personal physician on 2/3/11 with Bell''s Palsy; treated by her PMD with Prednisone 20mg PO BID x6 days. Individual is on day 4 of treatment, and is still currently having symptoms.


VAERS ID: 449120 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-01-16
Onset:2012-01-21
   Days after vaccination:5
Submitted: 2012-02-07
   Days after onset:17
Entered: 2012-02-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB223DA / 0 UN / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Chills, Decreased appetite, Hepatic enzyme increased, Jaundice, Nausea, Pyrexia, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Elevated liver enzymes (still following these); AST; ALT
CDC Split Type:

Write-up: According to Dr. patient has the following symptoms: lost of appetite, elevated liver enzymes, jaundice, fever & chills, nausea/vomiting.


VAERS ID: 449295 (history)  
Age: 30.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2012-02-01
Onset:2012-02-01
   Days after vaccination:0
Submitted: 2012-02-09
   Days after onset:8
Entered: 2012-02-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED N55906 / 0 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Chills, Fatigue, Malaise, Pain
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Kariva 28-day birth control
Current Illness: No
Preexisting Conditions: Sulfa medication- Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme Fatigue/Malaise (24 hours). Full body aches (24 hours). Chills (5-6 hours).


VAERS ID: 449465 (history)  
Age: 30.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2012-02-09
Onset:2012-02-10
   Days after vaccination:1
Submitted: 2012-02-13
   Days after onset:3
Entered: 2012-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0188AA / - LA / SC

Administered by: Public       Purchased by: Military
Symptoms: Arthralgia, Body temperature increased, Malaise, Myalgia, Rash erythematous, Rash papular, Rash pruritic
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPAMAX
Current Illness:
Preexisting Conditions: Allergies Penicillin; Erythromycin; ROCEPHIN; MOTRIN
Diagnostic Lab Data: No tests
CDC Split Type:

Write-up: Malaise today following vaccine. Temp 103-104 degrees F days 2 and after vaccine with myalgia, arthralgia and rash with erythema, pruritic papules over left shoulder and left upper area above scapular appears to be improved today.


VAERS ID: 449654 (history)  
Age: 30.0  
Gender: Male  
Location: Florida  
Vaccinated:2012-02-07
Onset:2012-02-08
   Days after vaccination:1
Submitted: 2012-02-15
   Days after onset:7
Entered: 2012-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Chest pain, Chills, Headache, Myalgia, Pyrexia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: (+) Troponin 1.38
CDC Split Type:

Write-up: Pt began having myalgias, fever, chills, H/A, all within 48 -72 hours after vaccination, then began having chest pain 3-5 days later.


VAERS ID: 449834 (history)  
Age: 30.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2012-02-10
Onset:2012-02-10
   Days after vaccination:0
Submitted: 2012-02-17
   Days after onset:7
Entered: 2012-02-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4023AA / - LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Musculoskeletal pain, Neck mass, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Possible secondary infection
Preexisting Conditions: CECLOR; Cephalosporins; Clindamycin; Doxycycline; Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in the left shoulder along with fevers up to 102 x 1-2 days. Noticed lump on her neck 2 days later. Also c/o tiredness tiredness and fevers lasted for 3 days. Given LEVAQUIN 500 mg for possible infection.


VAERS ID: 450198 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:2012-02-22
Onset:2012-02-22
   Days after vaccination:0
Submitted: 2012-02-23
   Days after onset:1
Entered: 2012-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / SYR

Administered by: Public       Purchased by: Private
Symptoms: Dizziness, Injection site haematoma, Injection site swelling, Nausea, Pain in extremity, Pyrexia, Vertigo
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same as listed before~Varicella (no brand name)~1~30.17~Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Light headed, fever, swelling and bruising around entire area where shot was given. Severe soreness in entire arm. Vertigo, nausea.


VAERS ID: 450676 (history)  
Age: 30.0  
Gender: Female  
Location: New York  
Vaccinated:2011-04-25
Onset:2011-05-16
   Days after vaccination:21
Submitted: 2012-02-27
   Days after onset:287
Entered: 2012-02-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0667Z / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abortion induced, Foetal disorder, Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins (unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1106USA02225B1

Write-up: Information has been received from a physician concerning a baby fetus at 14 weeks of LMP a 30 year old mother with a history of irregular menses who on 25-APR-2011 was vaccinated with a first dose of MMR II (Lot # 665427/0667Z). Concomitant therapy included vitamins (unspecified). On an unspecified date experienced an elective abortion at 14 weeks of gestation. (LMP: 16-APR-2011). It was reported that the fetus experienced Turner''s syndrome. At the time of reporting, the patient''s outcome was unknown. Turner''s syndrome was considered to be congenital anomaly by the physician The mother''s experience has been captured in WAES 1106USA02225). Additional information has been requested.


VAERS ID: 450767 (history)  
Age: 30.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2012-02-27
Onset:2012-02-27
   Days after vaccination:0
Submitted: 2012-02-28
   Days after onset:1
Entered: 2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 LA / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LA / UN

Administered by: Military       Purchased by: Military
Symptoms: Asthenia, Dizziness, Headache, Lethargy, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~Rabies (Rabie-Vax)~1~0.00~Patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Called advice nurse, and vaccine hotline.
CDC Split Type:

Write-up: Fever, severe headache, dizziness, nausea, weakness, lethargy.


VAERS ID: 450812 (history)  
Age: 30.0  
Gender: Female  
Location: Florida  
Vaccinated:2012-02-14
Onset:2012-02-14
   Days after vaccination:0
Submitted: 2012-02-14
   Days after onset:0
Entered: 2012-02-29
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH498AB / 13 AR / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness, muscle pain at the site/arm of injection.


VAERS ID: 450985 (history)  
Age: 30.0  
Gender: Female  
Location: New York  
Vaccinated:2012-02-28
Onset:2012-03-01
   Days after vaccination:2
Submitted: 2012-03-02
   Days after onset:1
Entered: 2012-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood calcium increased, Blood potassium increased, Blood test, Burning sensation, Confusional state, Dizziness, Hyperhidrosis, Hypertension, Hypoaesthesia, Insomnia, Lymphocyte count decreased, Metabolic function test abnormal, Monocyte count decreased, Nausea, Paraesthesia, Rash, Urine analysis, Viral infection, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: fading, confusion, nausea, numbness, lymphatic node enlarged left underarm~HPV (Cervarix)~UN~30.25~Patient
Other Medications:
Current Illness: no
Preexisting Conditions: allergy on dust, mites, anesthesia, on some of the immunity medicine, spinal disc herniation
Diagnostic Lab Data: Patient''s WBC wnl though low monocytes and lymphocytes. BMP with slightly high K+ and Ca. Patient developed mild rash on chest. Given overall picture likely radiculopathy with either mild reaction to recent Gardasil injection or mild viral illness.
CDC Split Type:

Write-up: Woke all in sweat with two fingers numb on the right hand, all back in burning sensation, stood up from bed and went to the toilet, almost faded, was about to pass out for 40 min, had very strong nausea, started to feel burning sensation all over the body and tingling, especially on the face, head and back. Went to the emergency room, left leg felt numb, was having on and off nausea and burning sensation, felt dizzy and confused, around 4 pm in the ER started to feel burning tingling sensation very strong on chest and neck. My blood pressure was high for me. Doctors performed blood and urine tests, told me it looks like I have a virus, but overall said analysis are fine, sent me home at 12.00 AM next day. When I came home I started to have nausea and burning sensation again all over my body, couldn''t sleep till 6 a.m, still have the same symptoms.


VAERS ID: 451344 (history)  
Age: 30.0  
Gender: Female  
Location: Maryland  
Vaccinated:2012-02-29
Onset:2012-02-29
   Days after vaccination:0
Submitted: 2012-03-09
   Days after onset:9
Entered: 2012-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4009AA / - LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Chills, Mobility decreased, Musculoskeletal pain, Oedema peripheral, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same s/s chills~Influenza (H1N1) (H1N1 (MONOVALENT) (UNKNOWN))~1~27.00~Patient
Other Medications: Birth Control Pills only (Motrin)
Current Illness: no
Preexisting Conditions: NKA, no med conditions
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Arm became swollen and unable to move. Had taken 2 Motrin right after Tdap was given. Took 2 more Tdap @ 10 PM. @ approx 2 AM the next Morning, chills started and pain in left arm, shoulder and side started.


VAERS ID: 451861 (history)  
Age: 30.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-09-27
Onset:2011-09-27
   Days after vaccination:0
Submitted: 2012-02-24
   Days after onset:150
Entered: 2012-03-09
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA670AA / - LA / SYR
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB459AA / 0 LA / SYR

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Latex allergy
Preexisting Conditions: The subject''s latex allergy consisted of "itching, whelps and burning of skin". The subject had previously received influenza vaccinations and no adverse events were reported. The subject received chicken pox vaccine, VARIVAX (other manufacturer) about four years ago and experienced "red, hot, knot". The subject did not drink alcohol or use tobacco. She had not received HAVRIX in the past. The subject had no history of allergic reactions to other drugs.
Diagnostic Lab Data: UNK
CDC Split Type: A0947204A

Write-up: This case was reported by a healthcare professional and described the occurrence of possible latex allergic reaction in a 30-year-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline). Concurrent medical conditions included latex allergy. Concurrent vaccination included FLULAVAL; GlaxoSmithKline; unknown; left deltoid given on 27 September 2011. There was no concurrent medications. On 27 September 2011 at 15:00 the subject received 1st dose of HAVRIX (.5 ml, unknown, left deltoid). On 27 September 2011, two hours after vaccination with HAVRIX, the subject experienced a local reaction that included possible latex allergic reaction, injection site redness, soreness from injection, knot at injection site, fever and hot feeling injection site. The initial reason for the subject''s report was due to the latex content of the HAVRIX syringe (58160-826-48) and when it was noted that a possible latex reaction could occur, due to the tip cap containing dry natural latex rubber the subject was identified. The subject received HAVRIX and FLULAVAL in the left deltoid about two inches apart. The subject has received FLULAVAL annually in years past and had no reaction. HAVRIX immunization series was discontinued. At the time of reporting the possible latex allergic reaction, injection site redness, soreness from injection, nodule injection site, fever and hot feeling injection site were unresolved. The healthcare professional considered the injection site redness was probably related to vaccination with HAVIRX. Follow-up received from the healthcare professional on 20 October 2011: The events resolved on an unspecified date after 3 days duration. The healthcare professional confirmed that the events were not considered serious.


VAERS ID: 451946 (history)  
Age: 30.0  
Gender: Female  
Location: Oregon  
Vaccinated:2001-08-23
Onset:2001-08-23
   Days after vaccination:0
Submitted: 2012-03-06
   Days after onset:3848
Entered: 2012-03-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Hepatitis B surface antibody negative, Inappropriate schedule of drug administration, No therapeutic response
SMQs:, Lack of efficacy/effect (narrow), Medication errors (narrow)

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: None
Diagnostic Lab Data: serum hepatitis B, 05/20/11, Nonreactive; serum hepatitis B, 05/20/11, 5.48mIU/, FAB
CDC Split Type: WAES1106USA01235

Write-up: Information has been received from a medical assistant concerning a 30 year old female patient with no known drug allergies and no pertinent medical history who on 21-FEB-2011 (it was also reported that therapy started on 21-APR-2011, dose reported as 0.5 mL), was vaccinated with the first dose of RECOMBIVAX HB (route and lot number not reported). On 21-MAR-2001, the patient was vaccinated with the second dose of RECOMBIVAX HB (route and lot number not reported). On 23-AUG-2001, the patient was vaccinated with the third dose of RECOMBIVAX HB (route and lot number not reported). There was no concomitant medication. On 20-MAY-2011, the patient came into the office and the physician did blood work. The test and results were "Hepatitis B surface antibody and result was nonreactive and a Hepatitis Fab and results was 5.48 mIU/mL". The medical assistant stated that on 09-JUN-2011, the patient was vaccinated with a fourth dose of RECOMBIVAX HB (route and lot number not reported). At the time of the report the patient had not recovered. Follow-up information received on 18-JUL-2011 from a Registered Nurse who stated that the physician had nothing further to add and did not want to provide more information. No further information is available.


VAERS ID: 451981 (history)  
Age: 30.0  
Gender: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-03-06
Entered: 2012-03-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1632Z / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Hepatitis B antibody negative, Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Serum hepatitis B, ?/?/10, (-)
CDC Split Type: WAES1103USA03341

Write-up: Information has been received from a certified medical assistant concerning a female in her 30''s who in approximately 2006, reported as "5 years earlier", was vaccinated with hepatitis B vaccine. Titers were drawn in 2010 but came back negative. On 23-MAR-2011, the patient was vaccinated with, 0.5ml (lot no. 668061/1632Z, expiration date 30-MAR-2013) again, but only received one pediatric dose instead of 2. The patient did not seek medical attention. No adverse effect seen. Additional information has been requested.


VAERS ID: 451634 (history)  
Age: 30.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2012-03-02
Onset:2012-03-12
   Days after vaccination:10
Submitted: 2012-03-13
   Days after onset:1
Entered: 2012-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / - LA / OT

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

Life Threatening? No
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:
CDC Split Type:

Write-up: Rash on upper chest and upper back, feeling feverish.


VAERS ID: 451773 (history)  
Age: 30.0  
Gender: Female  
Location: New York  
Vaccinated:2012-03-06
Onset:0000-00-00
Submitted: 2012-03-09
Entered: 2012-03-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4023AA / 0 LA / UN

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well
Preexisting Conditions: Sulpha; Had anaphylactic shock, hospitalized.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, induration 2 x 2.5 inches. No fever, pain, itching or limitation in range of motion of left arm.


VAERS ID: 451993 (history)  
Age: 30.0  
Gender: Female  
Location: Puerto Rico  
Vaccinated:2012-01-20
Onset:2012-01-20
   Days after vaccination:0
Submitted: 2012-02-14
   Days after onset:25
Entered: 2012-03-16
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 1 UN / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Erythema, Pruritus, Pyrexia, Rash maculo-papular, Skin lesion, Toxic skin eruption
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Toxic erythema
CDC Split Type:

Write-up: Macular, papular skin lesion at abdomen and lower limbs, itch; erythema and fever.


VAERS ID: 452026 (history)  
Age: 30.0  
Gender: Female  
Location: Colorado  
Vaccinated:2012-01-29
Onset:2012-02-01
   Days after vaccination:3
Submitted: 2012-03-17
   Days after onset:44
Entered: 2012-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4009BA / 0 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Back pain, CSF protein increased, Cholecystectomy, Computerised tomogram, Dysuria, Facial paresis, Gallbladder non-functioning, Guillain-Barre syndrome, Hepatobiliary scan, Hypertension, Immunoglobulin therapy, Laboratory test, Lumbar puncture abnormal, Nuclear magnetic resonance imaging brain abnormal, Pain, Ultrasound abdomen
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gallbladder related disorders (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypertension (narrow), Demyelination (narrow)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, ibuprofen, stool softener
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: MRI indicated swelling around cranial nerve VII, increased protein levels in spinal fluid.
CDC Split Type:

Write-up: Started with back pain, possible kidney infection per urgent care. Went to ER multiple times for uncontrolled pain. During this time, blood pressure was extremely high and started to have difficulty urinating. Had several labs run, ultrasounds, CTs to determine possible cause of pain. On 2/10/12, PCP thought it was possible gall bladder problem, underwent HIDA scan, which indicated possible poor functioning of gall bladder causing pain. Developed bilateral facial weakness, had gall bladder removed on 2/10/12. Starting 2/13/12-2/16/12 underwent several rounds of MRIs, had lumbar puncture. Final diagnosis of Guillain-Barre syndrome. Was hospitalized for IVIG treatment on 2/17/12-2/20/12.


VAERS ID: 452137 (history)  
Age: 30.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2012-03-19
Onset:2012-03-19
   Days after vaccination:0
Submitted: 2012-03-20
   Days after onset:1
Entered: 2012-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC029CA / 0 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hypersensitivity, Oedema peripheral, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PEPCID; Birth control (unknown brand); TB skin test
Current Illness: None
Preexisting Conditions: Allergic to codeine, PCN, Sulfa, ASA, TYLENOL
Diagnostic Lab Data: Allergic reaction Dx 3/20/12 at Dr office
CDC Split Type:

Write-up: ENGERIX B given IM at approx 14:00 pm on 3/19/12. Reports swelling in Rt arm, hand & face started approx. 1030 pm.


VAERS ID: 452150 (history)  
Age: 30.0  
Gender: Female  
Location: West Virginia  
Vaccinated:2012-03-16
Onset:2012-03-16
   Days after vaccination:0
Submitted: 2012-03-20
   Days after onset:4
Entered: 2012-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B080AA / - UN / IM

Administered by: Public       Purchased by: Public
Symptoms: Fatigue, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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:

Write-up: H/A, N/V, fatigue, "body aches". No fever.


VAERS ID: 452239 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:2012-03-19
Onset:2012-03-20
   Days after vaccination:1
Submitted: 2012-03-21
   Days after onset:1
Entered: 2012-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV307 / 3 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Injection site swelling, Oedema peripheral, Pruritus
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)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Vomiting, Fevers~Anthrax (Biothrax)~3~27.00~Patient|Vomiting, Fevers~Typhoid Vi Polysaccharide (Typhim Vi)~2~27.00~Patient
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient noticed swelling at the site of injection and swelling, redness, and itching along the lateral aspect of the left arm just above the elbow. Patient took Benadryl and the rection diminished, but remained reddened and slightly edematous until 22 Mar 0900, when he reported to the clinic.


VAERS ID: 452324 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:2010-11-11
Onset:2010-12-24
   Days after vaccination:43
Submitted: 2012-03-09
   Days after onset:441
Entered: 2012-03-23
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501029P / - - / IN

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Fatigue, Grimacing, Insomnia, Narcolepsy, Panic disorder, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Convulsions (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness: Malaria; Duodenal ulcer repair
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0015165

Write-up: A serious spontaneous report of narcolepsy and non-serious dyspnoea and fatigue has been received from a health professional concerning a 30-year-old male, subsequent to FLUMIST. The patient''s medical history included malaria (2005) and surgery for duodenal ulcer (2007). No concomitant medications have been reported for this patient. On 11-Nov-2012, the patient received 0.2 ml FLUMIST nasally for influenza vaccination. After receiving FLUMIST, the patient developed fatigue and dyspnoea. On 24-Dec-2010, neuropsychiatry diagnosed the patient with narcolepsy. He still complained of panic disorder, feeling chest stuffiness, insomnia at night, narcolepsy during the daytime and facial distorting. The outcome of the events narcolepsy, dyspnoea fatigue was unknown.


VAERS ID: 452605 (history)  
Age: 30.0  
Gender: Female  
Location: Colorado  
Vaccinated:2010-11-05
Onset:2010-11-05
   Days after vaccination:0
Submitted: 2012-03-28
   Days after onset:509
Entered: 2012-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3666BA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Activities of daily living impaired, Asthenia, Back pain, Blood creatine phosphokinase normal, Full blood count normal, Hypoaesthesia, Injection site pain, Laboratory test, Muscular weakness, Neck pain, Pain in extremity, Paraesthesia, Specific gravity urine normal, Urine analysis normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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: pt reports rhabdomyolsis about one yr prior. NKDA
Diagnostic Lab Data: Urinalysis clear, specific gravity 1.005, chem profile 20 and CBC, normal and CBC wnl. skelaxin for tight muscles and h/a. No lifting greater than 5# with affected arm. Normal CK level, manual muscle testing 5/5 throughout. Impingement signs neg bilat, diffuse tenderness to palpation over the left trapezius, deltoid, biceps, and triceps. Light touch sensory intact, deep tendon reflexes 2+ throughout including bilat ankle jerks and downgoing toes bilat. distal pulses intact. From Work comp Dr and work comp physiatrist notes.
CDC Split Type:

Write-up: At first arm sore, then on 11/08/2010 began having pain, numbness, and weakness radiating down her lt arm into her fingers and up into her upper back and side of her neck. Tingling bilat feet. Lightheaded, nausea, vomiting, fatigue, feeling out of sorts, head feels pressure. Seen by physiatrist on 11/09/2010. Seen by another work comp MD on 11/11/10. Treated with skelaxin for h/a. Labs all normal. No dx of rabdo. Not Guillain-Barre, neurologically intact. may be "muscular response to even slight trauma and this will most likely self resolve. However, one is not unable to completely rule out brachial neuritis" given oral steroids one week. Light duty at work. Work comp claim denied. Last seen by WC Dr on 11/17/10. Seen by her private physician and returned to work w/o restiction 12/2/2010.


VAERS ID: 452985 (history)  
Age: 30.0  
Gender: Female  
Location: Arizona  
Vaccinated:2012-03-17
Onset:2012-03-29
   Days after vaccination:12
Submitted: 2012-04-03
   Days after onset:5
Entered: 2012-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / - LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12938A / 1 RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Lymphadenopathy, Malaise, Pain, Rash pruritic, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Sulfa allergy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: March 29: Right side of face swelling next day both sides of face and lymph nodes. Face, arm, chest, lower back; raised itchy rash. General malaise, aches, pain. Resolved 4/2/12. Residual rash, swelling. Rx: Cephalexin 500mg 3xday 7 days, Loratadine 10mg qd x 30 days, Triamcinolone 0.1% cream affected area 2x day.


VAERS ID: 453019 (history)  
Age: 30.0  
Gender: Male  
Location: Unknown  
Vaccinated:2009-08-24
Onset:2009-08-25
   Days after vaccination:1
Submitted: 2012-04-04
   Days after onset:953
Entered: 2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / SYR

Administered by: Military       Purchased by: Military
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Left arm became red, swollen, and hard around injection area. Each day the swelling and redness would grow until it encompassed my entire upper left arm. The arm had a temperature of approx 100 degrees and was still and swollen. It was very uncomfortable to move that arm.


VAERS ID: 453084 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-03-01
Onset:2012-03-01
   Days after vaccination:0
Submitted: 2012-04-06
   Days after onset:35
Entered: 2012-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / 0 LA / SYR

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOESTRIN 1/20
Current Illness: No.
Preexisting Conditions: Nickel allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: INTENSE SORENESS AT INJECTION SITE (UPPER LEFT ARM), SEVERELY LIMITING RANGE OF MOTION LASTING 4 DAYS.


VAERS ID: 453201 (history)  
Age: 30.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-04-09
Onset:2012-04-09
   Days after vaccination:0
Submitted: 2012-04-09
   Days after onset:0
Entered: 2012-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B073AC / 2 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G11241 / 1 LA / IM

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

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 noted
Preexisting Conditions: none noted
Diagnostic Lab Data: Patient has had no side effects as of this time.
CDC Split Type:

Write-up: Patient received the Tdap and Typhoid immunization on 04/05/2012 and then again on 04/09/2012.


VAERS ID: 453308 (history)  
Age: 30.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-12-21
Onset:2011-12-21
   Days after vaccination:0
Submitted: 2012-04-10
   Days after onset:110
Entered: 2012-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV297 / 2 RA / IM

Administered by: Military       Purchased by: Unknown
Symptoms: Dyspnoea, Nausea, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Pt states after a couple of hours of recieving the Anthrax vaccine he started to have nausea, shaking, and shortness of breath that lasted for a couple of hours. Pt was not seen for these symptoms.


VAERS ID: 454019 (history)  
Age: 30.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2012-04-16
Onset:2012-04-16
   Days after vaccination:0
Submitted: 2012-04-19
   Days after onset:3
Entered: 2012-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U40304AA / 0 LA / IM

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

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

Write-up: Pt broke out in large hives neck/trunk approx. 2hrs following Tdap injection. Denies difficulty breathing. Per v.o. Dr., pt to take oral Bendaryl, prednisone, and seek immediate medical attention should symptoms progress.


VAERS ID: 454034 (history)  
Age: 30.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-04-11
Onset:2012-04-12
   Days after vaccination:1
Submitted: 2012-04-19
   Days after onset:7
Entered: 2012-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4009CA / - RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chills, Injection site erythema, Injection site induration, Lymphadenopathy, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Abnormal soreness of upper extremity, chills, body aches. T 37.7, erythema 10cm x 6.5 cm with induration 5 cm x 6 cm at injection site. Right anterior cervical lymph nodes full with supraclavicular lymphadenopathy. Treated with Bactrim DS 1 by mouth twice a day for ten days.


VAERS ID: 454057 (history)  
Age: 30.0  
Gender: Male  
Location: Florida  
Vaccinated:2012-04-12
Onset:2012-04-12
   Days after vaccination:0
Submitted: 2012-04-20
   Days after onset:8
Entered: 2012-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1198AA / 0 LA / SC

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

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

Write-up: No adverse event, but administered incorrect vaccine. Requested varicella vaccine, received Zostavax.


VAERS ID: 454115 (history)  
Age: 30.0  
Gender: Male  
Location: New York  
Vaccinated:2012-04-16
Onset:2012-04-16
   Days after vaccination:0
Submitted: 2012-04-20
   Days after onset:4
Entered: 2012-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / - RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Cough, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Fever, with weakness, headache the night of administration. Next day cough, headache. Seen by provider 4 days after vaccine admin/ cough, headache.


VAERS ID: 454479 (history)  
Age: 30.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2012-04-11
Onset:2012-04-24
   Days after vaccination:13
Submitted: 2012-04-27
   Days after onset:3
Entered: 2012-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1328Z / 0 LA / SC

Administered by: Unknown       Purchased by: Private
Symptoms: Headache, Injection site rash, Malaise, Rash, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No