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Found 500157 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:339754 (history)  Vaccinated:2008-12-15
Age:50.0  Onset:2008-12-29, Days after vaccination: 14
Gender:Female  Submitted:2009-01-20, Days after onset: 22
Location:Maine  Entered:2009-02-18, Days after submission: 29
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: Inj. iron; amoxicillin; ASA; MOTRIN
Diagnostic Lab Data: Has seen PCP- Rheumatologist per work up.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU455BA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Body temperature increased, Joint swelling, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Sudden onset arthralgias 12/29/08. Pain, swelling elbows, wrists, hands, fingers,knees, ankles low grade temp initially. Seen by PCP & Rheumatologist. PREDNISONE.

VAERS ID:339997 (history)  Vaccinated:2008-12-11
Age:50.0  Onset:2008-12-11, Days after vaccination: 0
Gender:Female  Submitted:2009-02-12, Days after onset: 63
Location:Minnesota  Entered:2009-02-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to yellow dye, antibiotics, sodium phosphate
Diagnostic Lab Data: Allergic reaction causing anxiety reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2804AA1UNLA
Administered by: Public     Purchased by: Other
Symptoms: Anxiety, Blood pressure increased, Bronchospasm, Dizziness, Dyspnoea, Heart rate increased, Hypersensitivity, Nausea, Speech disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: First dizzy, increased blood pressure-racing pulse, nauseous, bronchial spasms, difficulty breathing and speaking- Taken to ER given BENADRYL and anxiety medicine by IV-Prednisone 5 days

VAERS ID:340186 (history)  Vaccinated:2009-02-09
Age:50.0  Onset:2009-02-09, Days after vaccination: 0
Gender:Female  Submitted:2009-02-13, Days after onset: 4
Location:Virginia  Entered:2009-02-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Quinapril; HCTZ; EFFEXOR XR; NIASPAN
Current Illness: None
Preexisting Conditions: SIMVASTATJN $g URTICARIA, DX: HTN, Depression, and Hyper Cholesterol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460AA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 3-4 hours after Vaccine given patient called with an intense PRURITIC Response - patient returned to office for DEPO MEDROC Injection.

VAERS ID:340198 (history)  Vaccinated:2009-02-12
Age:50.0  Onset:2009-02-12, Days after vaccination: 0
Gender:Female  Submitted:2009-02-13, Days after onset: 1
Location:Wisconsin  Entered:2009-02-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Vomiting~Influenza (Seasonal) (no brand name)~1~32.00~Patient
Other Medications: PAXIL, BUSPAR, IMITREX
Current Illness: None
Preexisting Conditions: Migraines, eggs, milk, PCN - Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB703AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Developed raised, red area at injection site used ice with relief this am. C/O severe pain to right arm - no pain medication taken by RN advised to take IBUPROFEN or TYLENOL.

VAERS ID:340530 (history)  Vaccinated:2008-09-22
Age:50.0  Onset:2008-09-23, Days after vaccination: 1
Gender:Male  Submitted:2008-09-24, Days after onset: 1
Location:Michigan  Entered:2009-02-24, Days after submission: 153
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Digoxin; ALLEGRA; LEXAPRO
Current Illness: Cervical spinal stenosis (C2-C7); Cardiac Dysrhythmia (scheduled for surgical rpr 9/28/08)
Preexisting Conditions: Ibuprofen - CHF
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVA251CA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC288BAA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain and warmth and firmness felt at injection site on upper left arm. 2 1/2 cm at area of induration felt there, no erythema

VAERS ID:340706 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Michigan  Entered:2009-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2749AA UNLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Injection administered 10-17-08, on 10-23-08 pt seen by PA-C for wide spread hives on palms and soles. Tenderness to area of injection, no swelling or signs of infection. Pt seen on 2-17-09 injection site still painful.

VAERS ID:341067 (history)  Vaccinated:2008-12-04
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-03-04
Location:Illinois  Entered:2009-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2760AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Wrong drug administered
SMQs:
Write-up: no adverse reaction Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel box and vial not marked for pediatric use at time of administration. Error found when new Daptacel box received and new box was marked pediatric.

VAERS ID:341102 (history)  Vaccinated:2008-10-13
Age:50.0  Onset:2008-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-03-04, Days after onset: 142
Location:California  Entered:2009-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUZ349AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Heart rate increased, Injection site erythema, Injection site pain, Pain, Pyrexia, Ventricular extrasystoles
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Initially redness, soreness at injection site - approx 8 hrs later increase HR with some PVC''S, severe HA and backache, low grade fever 99.6 lt headed, body aches - (L) arm redness extending injection site to elbow -10/15/08 - Dx = Severe systemic Rxn to flu vaccine per ID physician told never have another flu vaccine.

VAERS ID:341114 (history)  Vaccinated:2008-11-03
Age:50.0  Onset:2008-11-06, Days after vaccination: 3
Gender:Female  Submitted:2009-03-03, Days after onset: 117
Location:Wisconsin  Entered:2009-03-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL PM Pr; Calcium; Vitamins; GERITOL; Folic acid; ASA 81mg; LIPITOR; Metaprel; Fenofibrate; Sulfa;
Current Illness: None
Preexisting Conditions: "D" (in "SELDANE" or "CLARITIN-D" makes heart flutter); reports cervical spine narrow pathway- not a lot of fluid in my spine. HTN; Increase cholesterol; whiplash history arthritis; cervical disk degeneration; congenital defect
Diagnostic Lab Data: 12/29/08 Xray (L) shoulder; Blood work. MRI (L) shoulder/arm and neck; had a procedure to "deaden nerve"
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLU380AA UNLA
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Injection site discomfort, Injection site haematoma, Nuclear magnetic resonance imaging, Pain, X-ray limb
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Pt received flu shot at clinic on 11/3/08. States she started with discomfort to left upper arm from flu shot area to her elbow and states "it feels bruised" - the pain from (L) shoulder to (L) elbow is exactly in line where shot was given. Saw MD on 12/29 and Xray done; 1/6/09 MRI (L) arm and neck; 2/2 saw MD; 2/13/09 has procedure to deaden nerve; next MD appt 3/16/09.

VAERS ID:341737 (history)  Vaccinated:2009-03-10
Age:50.0  Onset:2009-03-11, Days after vaccination: 1
Gender:Female  Submitted:2009-03-13, Days after onset: 2
Location:North Carolina  Entered:2009-03-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none what so ever
Preexisting Conditions: none
Diagnostic Lab Data: Blood work done and showed that I had a lowWBC. I had been totally healthy before I was asked o take the flu shot at work this past TUesday. I did not want to take the flu shot because I had had a bad reaction 15 years ago to a flu shot and
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2744AA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Back pain, Blood test abnormal, Disorientation, Disturbance in attention, Fatigue, Headache, Malaise, Musculoskeletal pain, Neck pain, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad)
Write-up: terrible back, neck shoulder and head pain, Headache, and disorientation, could not concentrate, malaise, weakness, tired. Went to my family doctor who is monitoring my symptoms.

VAERS ID:343101 (history)  Vaccinated:2008-10-01
Age:50.0  Onset:2008-10-02, Days after vaccination: 1
Gender:Female  Submitted:2009-03-06, Days after onset: 155
Location:Unknown  Entered:2009-03-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide; ATIVAN; BENICAR
Current Illness: Hypertension
Preexisting Conditions:
Diagnostic Lab Data: Skin biopsy, "possible drug reaction"
CDC Split Type: WAES0812USA00053
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HEP: HEP B (FOREIGN)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Unknown
Symptoms: Biopsy skin, Hypoaesthesia, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a pharmacist concerning a 50 year old female with hypertension and no history of drug reactions/allergies, who on 1-OCT-2008, was vaccinated with HEPTAVAX. Concomitant therapy included influenza virus vaccine (unspecified), BENICAR, furosemide and ATIVAN. On 2-OCT-2008 the patient developed an itchy rash from her neck to her knees. The patient had been treated with unspecified steroids and antihistamines but the rash persisted. A skin biopsy, performed by an unspecified dermatologist, revealed "possible drug reaction". The patient also developed numbness of the fingers of her left hand. At the time of reporting, the patient has not yet recovered. The patient sought medical attention with an office visit. No product quality complaint involved. Additional information has been requested.

VAERS ID:343210 (history)  Vaccinated:2008-07-02
Age:50.0  Onset:2008-07-13, Days after vaccination: 11
Gender:Female  Submitted:2009-03-06, Days after onset: 236
Location:Unknown  Entered:2009-03-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; TAPAZOLE
Current Illness:
Preexisting Conditions: Hypothyroidism; Drug hypersensitivity
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA05683
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0398X2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Chest discomfort, Pericarditis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Chronic kidney disease (broad)
Write-up: Information has been received from a 50 year old female registered nurse with hypothyroidism and allergy to non-steroidal anti-inflammatory medications, who on 08-JAN-2008 was vaccinated with a first dose of RECOMBIVAX HB, 1 ml intramuscularly. On 28-FEB-2008 was vaccinated with a second dose of RECOMBIVAX HB (Lot # 656879/1148U) and on 02-JUL-2008 was vaccinated with a third dose of RECOMBIVAX HB (Lot # 660951/0398X). Concomitant therapy included SYNTHROID and TAPAZOLE. On 13-JUL-2008 the patient developed chest discomfort on inspiration and low-grade fever. On 20-JUL-2008, she was examined in a local emergency room and had an electrocardiogram, chest X-ray, unspecified blood work, and computerized tomography of the chest. A diagnosis of pericarditis was made, and the patient was prescribed a four day course of prednosone 40 mg daily. The symptoms resolved. On 29-JUL-2008 the chest discomfort returned and the patient was scheduled to see her physician. There was no product quality complaint. No further information is available.

VAERS ID:342997 (history)  Vaccinated:2009-03-24
Age:50.0  Onset:2009-03-27, Days after vaccination: 3
Gender:Female  Submitted:2009-03-30, Days after onset: 3
Location:Arizona  Entered:2009-03-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lanisporil HCT
Current Illness: none
Preexisting Conditions: Borderline High-Blood Pressure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2774AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site discomfort, Injection site haematoma, Injection site pain, Injection site swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Soreness and bruising noted at injection site on March 27, 2009. Noted discomfort on March 29 to injection site around 10, awoke client up, discomfort continued during the night. Did not take meds for discomfort. Right side deltoid swollen, hot to touch, and raised reddened areas noted. Bruising noted. Advised to apply ice pack 15 minutes on and 15 minutes off and to take ibuprofen and to seek PMD if gets worse.

VAERS ID:343110 (history)  Vaccinated:2009-03-28
Age:50.0  Onset:2009-03-29, Days after vaccination: 1
Gender:Female  Submitted:2009-03-31, Days after onset: 2
Location:Massachusetts  Entered:2009-03-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Zyrtek
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR3098AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Axillary pain, Injection site induration, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain, warmth and induraton at vaccine site. Tender aillary nodes.

VAERS ID:343621 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-04-06
Location:Texas  Entered:2009-04-07, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0904USA00372
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1621X UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blister, Herpes zoster, Pain, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a concerning a 50 year old nurse female who was also a nurse was vaccinated with a dose of ZOSTAVAX (Oka/Merck), lot number: 662755/1621X. The patient experienced shingles after receiving the vaccine. She developed rash on her upper neck, blisters and pain on the right side only from the back of her neck. No further information was provided. Subsequently the patient recovered. The patient sought medical attention. Shingles was considered to be disabling by the nurse. Additional information has been requested.

VAERS ID:344930 (history)  Vaccinated:2009-03-30
Age:50.0  Onset:2009-04-10, Days after vaccination: 11
Gender:Female  Submitted:2009-04-27, Days after onset: 17
Location:California  Entered:2009-04-27
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin, Xyzal, Singulair, Ventolin, Advair, Nasonex
Current Illness: Allerted to alergies
Preexisting Conditions: Asthma, allergies to food and in environment
Diagnostic Lab Data: IgE, Liver & Kidney Panels, Glucose & Chem, RA, Sed Rate, etc 5/4/09-records received Asthma control test 20 and peak flows 90%
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1198X IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood glucose, Blood immunoglobulin E, Hypersensitivity, Laboratory test, Liver function test, Peak expiratory flow rate, Red blood cell sedimentation rate, Renal function test, Respiratory distress, Rheumatoid factor, Type III immune complex mediated reaction
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Hypersensitivity (narrow)
Write-up: Diagnosed with severe arthus allergic reaction and pulmonary distress. Treated with high and prolonged dose of prednisone - ongoing at present.5/4/09-records received-office note 4/1/09-follow up with allergist after difficult winter now doing signicantly better. Routine allergy visits for follow-up care.

VAERS ID:344957 (history)  Vaccinated:2009-03-24
Age:50.0  Onset:2009-03-24, Days after vaccination: 0
Gender:Male  Submitted:2009-04-22, Days after onset: 29
Location:California  Entered:2009-04-27, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Risperidone 2mg; HYLO #3
Current Illness: HTN
Preexisting Conditions: Liquid Iodine (X-ray contrast)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA178AA UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1163X0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Joint range of motion decreased, Pain
SMQs:, Arthritis (broad)
Write-up: Received Flu and PNEUMOVAX 3/24/09 one in each deltoid. Pain since - Limited range of motion, very painful. Referred to physical therapy - Given pain meds. Last seen 4/21/09

VAERS ID:345309 (history)  Vaccinated:2009-04-27
Age:50.0  Onset:2009-04-28, Days after vaccination: 1
Gender:Male  Submitted:2009-04-30, Days after onset: 2
Location:Utah  Entered:2009-04-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0310Y IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3097AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: left arm warm to the touch and red

VAERS ID:345731 (history)  Vaccinated:2009-04-30
Age:50.0  Onset:2009-04-30, Days after vaccination: 0
Gender:Male  Submitted:2009-05-05, Days after onset: 5
Location:Oklahoma  Entered:2009-05-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1667U0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: PNEUMOVAX .5 CC GIVEN R DELTOID IM APPROX 10 A.M.. PT STATES THAT EVENING ARM TENDER, SOME SWELLING, WARMNESS AT SITE,C/O FEVER. STATES HE CALLED AN ER AND THEY TOLD HIM TO COME IN IF BREATHING DIFFICULTY. PT DENIED SOB. STATES ARM SORENESS LASTED 48-60 HOURS.

VAERS ID:345931 (history)  Vaccinated:2009-04-29
Age:50.0  Onset:2009-04-29, Days after vaccination: 0
Gender:Female  Submitted:2009-05-01, Days after onset: 2
Location:Colorado  Entered:2009-05-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
Administered by: Public     Purchased by: Private
Symptoms: Head discomfort, Headache
SMQs:
Write-up: Sever headache and feeling of inside of scull on fire - lasted 3 hr and lifted. Went to ER.

VAERS ID:346075 (history)  Vaccinated:2009-05-07
Age:50.0  Onset:2009-05-08, Days after vaccination: 1
Gender:Female  Submitted:2009-05-11, Days after onset: 3
Location:California  Entered:2009-05-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2817AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Developed fevers, malaise and headache within 24 of administration of Menactra. Now feeling somewhat better 4 days after administration. Previously received a dose of Menomume in 2002, without side effects. Patient works in a clinical microbiology laboratory and handles cultures of Neisseria meningitidis.

VAERS ID:347504 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-05-15
Location:Unknown  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: serum varicella zoster, negative
CDC Split Type: WAES0901USA01722
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Antibody test negative, No adverse event, Serology negative
SMQs:
Write-up: Information has been received from a nurse concerning a 50 year old female who in 1995 was vaccinated with one dose of VARIVAX (Oka/Merck) (lot# not provided). Subsequently the patient had a negative titer. No adverse effects noted from the negative titer. The patient sought medical attention in the office. Additional information has been requested.

VAERS ID:347452 (history)  Vaccinated:2009-05-19
Age:50.0  Onset:2009-05-19, Days after vaccination: 0
Gender:Male  Submitted:2009-05-21, Days after onset: 2
Location:New Hampshire  Entered:2009-05-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C; PREVACID; Multivitamin
Current Illness: GERD; Post nasal drip
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Weakness and pain in arm. No fever, no redness or swelling at sight of injection but tender to the touch. Weakness and pain lasting 2 days +.

VAERS ID:347928 (history)  Vaccinated:2009-05-20
Age:50.0  Onset:2009-05-22, Days after vaccination: 2
Gender:Female  Submitted:2009-05-28, Days after onset: 6
Location:Oregon  Entered:2009-05-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lipitor, advair, flonase, prilosec
Current Illness: none
Preexisting Conditions: seasonal allergies, dust and pet dander allergies
Diagnostic Lab Data: History of asthma
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.?1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Asthma, Chills, Dyspnoea, Feeling cold, Headache, Heart rate increased, Malaise, Pain, Respiratory rate increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: I received this second HB shot during a 9:30 am appointment on 5-20-09. The first HB shot I received was from the same physician a month earlier on 4-20-09. I did not have an adverse reaction to this first HB shot. I did have a reaction to the second HB shot. I began to have severe chills with body aches, aches in joints and headache at 10:30 pm on 5-22-09. My teeth were chattering very badly, I could not get warm, my pulse felt fast and my breathing felt faster and with some difficulty. These symptoms occurred over the Memorial Day weekend on a Friday night. I did not want to go to the ER. I thought I might be having a bad reaction to the shot. I took an over the counter Benedryl tablet (25 mg) and used my nebulizer with abluterol sulfate. I have severe asthma and this seemed to help my breathing get a little easier. The chills subsided by morning, but the body aches, headache and feeling of malaise persisted for the next two days. I do not want to get the third series in this set because I am afraid of the bad reaction. I have to get updated immunizations for a medical training program that I am attending. I expect that my immune system has had enough of HB. I will ask my doctor to to a titer test if possible so I can skip the third shot of HB. In retrospect, I probably should have gone to the ER. I was very sick and very frightened by this reaction. The respiratory symptoms in conjunction with my asthma was not good.

VAERS ID:348163 (history)  Vaccinated:2009-05-16
Age:50.0  Onset:2009-05-28, Days after vaccination: 12
Gender:Male  Submitted:2009-05-29, Days after onset: 1
Location:Nevada  Entered:2009-05-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BP med and DM med from the Phillipines
Current Illness: none
Preexisting Conditions: DM2 (not compliant), htn; no known allergies
Diagnostic Lab Data: None at this point
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1247X SCRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSUF455A IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0487X SCLA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash erythematous, Rash macular, Rash papular, Rash rubelliform
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pt presented 13 days s/p vaccination of MMR, TDaP & Varicella w/ rubella type rash; pink macular papular rash involving face, UE''s & torso; Pt also w/ low grade fever (subjective). Symptoms started last PM. Tx''d w/ benadryl, zyrtec & tylenol only at this point. Expect resolution in the next 3-4 days.

VAERS ID:348620 (history)  Vaccinated:2009-05-26
Age:50.0  Onset:2009-05-27, Days after vaccination: 1
Gender:Female  Submitted:2009-06-05, Days after onset: 9
Location:New York  Entered:2009-06-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Vomiting, head aches, body aches, dizziness, bad mood,~Measles + Mumps + Rubella (no brand name)~1~50~In Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Affective disorder, Arthralgia, Back pain, Dizziness, Headache, Injection site pain, Insomnia, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Psychosis and psychotic disorders (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)
Write-up: Dizziness, vomiting, headaches, pain in joints, backache, aches in the arm that was injected. Bad mood and sleepnessness.

VAERS ID:349037 (history)  Vaccinated:2009-06-13
Age:50.0  Onset:2009-06-14, Days after vaccination: 1
Gender:Male  Submitted:2009-06-14, Days after onset: 0
Location:Michigan  Entered:2009-06-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bilateral lower extremity cellulitis being treated with vancomycin and levaquin.
Preexisting Conditions: NKA prior to this incident. CAD and chronic venous stasis resulting in lower extremity cellulitis and ulcerations.
Diagnostic Lab Data: RN outlined area and will cont to follow. No further intervention needed at this time.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1577X SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt received vaccine in the hospital. Approximately 1.5 days after administration RN noticed moderate swelling and redness of right upper extremity where pt received vaccination. Pt complained of mild pain and only when blood pressure cuff was used. RN called pharmacist (myself). I asked her to outline area and alert doctor of adverse reaction in the am. I added this vaccine to the pt''s allergy list.

VAERS ID:349953 (history)  Vaccinated:2008-06-06
Age:50.0  Onset:2008-06-08, Days after vaccination: 2
Gender:Female  Submitted:2009-05-29, Days after onset: 355
Location:Texas  Entered:2009-06-17, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy; Drug hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: biopsy, 11/25?/08, it was not contagious and could be viral in nature; serum mumps Ab, 08/08/08, posit
CDC Split Type: WAES0807USA02259
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0215X0SCUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC2767AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Biopsy, Blister, Contusion, Mumps antibody test positive, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 50 year old female employee with penicillin and codeine allergies and an unspecified medical history who on 06-JUN-2008 was vaccinated SQ with the first dose of MMR II (lot # 658516/0215X). Concomitant vaccinations on the same day included a first IM dose of ADACEL (lot # C2767AA) and a first ID dose of APLISOL (lot # 62412) (also reported as being administered on 03-JUN-2008). Concomitant medication included PLAQUENIL. On 11-JUN-2008 the employee was seen for a second "TST". Subsequently, "1.5 days after vaccination" on approximately 08-JUN-2008, the patient developed blisters starting on her legs and later on one arm. The patient broke out on her legs and arms with tiny blisters that became a large quarter-size rash. The patient was seen in the ER and was given steroids and a referral to a dermatologist. The dermatologist was unable to provide a diagnosis. The patient was recently seen by the nurse who described smooth areas the size of a quarter that looked like bruised areas on her legs. The patient was told that she had been in the sun too long. However, the patient had not been outside. The patient was referred to a dermatologist. By the time the patient got her appointment, the rash was flat and there was nothing to biopsy. The dermatologist did not give her a diagnosis. There was no rash on the patient legs, but her legs were marked with areas that were round, quarter-size and at a glance appeared to be bruised, but they were not. The patient felt they were scarred, but they did not appear to be. On 08-JUN-2008 the patient had a mumps titer drawn. The results were positive. At the time of the report, the patient recovered on an unspecified date. It was noted that the patient''s legs were rash free, but there were still some faint "shadowing" where the spots were. Follow-up information has been received from a registered nurse concerning this 50 year old female employee with the same blistery rash, some in circular form came to the reporter''s office. The patient stated she had been off for seven days, came back to work and on the second night started to itch and it then developed into a rash. The reporter encouraged her to go straight to the dermatologist that she had seen the last time this had happened. The patient did and the doctor was able to take a biopsy of the blisters. The dermatologist also told the patient it was not contagious, and felt it could be viral in nature. The reporter indicated it was not related to MMR II. No further information is available. This is in follow-up report(s) previously submitted on 5/29/2009. Follow-up information has been received from a registered nurse who saw the employee on 19-JUN-2009. The nurse stated they felt the patient''s reaction was caused by Gain Detergent. The patient''s sister had recently moved in and washed some their cloths together. After the practice was stopped, there was no more rash. No further information is available.

VAERS ID:349886 (history)  Vaccinated:2009-06-16
Age:50.0  Onset:2009-06-17, Days after vaccination: 1
Gender:Female  Submitted:2009-06-19, Days after onset: 2
Location:Virginia  Entered:2009-06-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Fibromyalgia
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3248AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm where she received Tdap is red, swollen and warm to touch on Wed 6-17-09.

VAERS ID:349988 (history)  Vaccinated:2009-06-16
Age:50.0  Onset:2009-06-16, Days after vaccination: 0
Gender:Male  Submitted:2009-06-22, Days after onset: 6
Location:South Carolina  Entered:2009-06-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: facial laceration
Preexisting Conditions:
Diagnostic Lab Data: Lacerations
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3158AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Lymphadenopathy, Malaise, Myalgia, Oropharyngeal pain, Sinus congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad)
Write-up: Pt states he felt sinus congruent with sore throat, muscle aches allover, Temp, congestion (sinus), general malaise swollen lymph Glands @ neck.

VAERS ID:350145 (history)  Vaccinated:2009-06-18
Age:50.0  Onset:2009-06-24, Days after vaccination: 6
Gender:Male  Submitted:2009-06-29, Days after onset: 5
Location:Unknown  Entered:2009-06-25, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra; Lipitor 40 mg; Singulair 10mg; Atacand 16mg
Current Illness: None
Preexisting Conditions: PCN-rash, Ceclor-rash
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Immediate post-injection reaction, Injection site induration, Injection site pruritus, Injection site reaction, Joint swelling, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Immediate myalgias after injection. On 6/24/09 (6 d after inj). Woke up itchy, indurated, local injection site 4 x 8cm. (B) wrist edema. Hurt with arthralgias and myalgias. Fever 100 degrees F. orally on 6/24/09.

VAERS ID:350927 (history)  Vaccinated:2009-07-02
Age:50.0  Onset:2009-07-04, Days after vaccination: 2
Gender:Female  Submitted:2009-07-07, Days after onset: 3
Location:Wisconsin  Entered:2009-07-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPH: DTAP + HIB (TRIHIBIT)SANOFI PASTEURC2965AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Hypoaesthesia oral, Injection site pain, Lymphadenopathy, Pain, Paraesthesia, Pyrexia, Tenderness
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: On 7-3-09 came to work at 7am with temp over the next three hours of 99.8 to 99.9. At 11am fever became 100.2 and employee was sent home from work. Had pain at site at that time. On Saturday pain was in arm from site to hand and fever to 100.2 continued. On Sunday numbness and tingling from shoulder to hand began and has continued through today. Deltoid and anterior chest muscles at axilla remain achey and sore today but have been painful on Sunday and Monday. Lymph nodes from axilla toward elbow are swollen and very tender to the touch.

VAERS ID:350986 (history)  Vaccinated:2009-05-11
Age:50.0  Onset:2009-07-08, Days after vaccination: 58
Gender:Female  Submitted:2009-07-08, Days after onset: 0
Location:Minnesota  Entered:2009-07-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions:
Diagnostic Lab Data: None required.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2609AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Expired drug administered
SMQs:
Write-up: Expired vaccine given inadvertantly.

VAERS ID:351051 (history)  Vaccinated:2009-07-02
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-09
Location:New York  Entered:2009-07-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1506X IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B031AB IMLA
Administered by: Public     Purchased by: Private
Symptoms: Epistaxis, Injection site discharge, Lymphadenopathy, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)
Write-up: PINKISH DISCHARGE AT INJECTION SITE, SWOLLEN GLANDS, HEAVY NOSE BLEED, LARGE BLOOD CLOTS

VAERS ID:351063 (history)  Vaccinated:2009-06-03
Age:50.0  Onset:2009-06-04, Days after vaccination: 1
Gender:Female  Submitted:2009-07-09, Days after onset: 35
Location:California  Entered:2009-07-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hep C txn
Current Illness: none
Preexisting Conditions: Sulfa allergy, HEP C
Diagnostic Lab Data: arthritis panel pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3070AA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Arthralgia, Immediate post-injection reaction, Laboratory test
SMQs:, Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt report onset of pain in joints on injection side arm immediatly after injection, this progressed to joint pains in wrists bilaterally x 6 weeks since injection.

VAERS ID:351224 (history)  Vaccinated:2009-05-14
Age:50.0  Onset:2009-05-26, Days after vaccination: 12
Gender:Male  Submitted:2009-05-29, Days after onset: 3
Location:Georgia  Entered:2009-07-13, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: GA09021
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB711AA0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1369X0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pyrexia, Rash, Rash morbilliform
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Broke out with rash 5/26/09. Mild fever began 5/27/09. Denies any other problems. Denies difficulty breathing, swelling around lips/throat or hives. Rash is small, red bumps per pt description "measles like". Reviewed VIS form 3/98. To MD if develops moderated or severe problems.

VAERS ID:351292 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:2009-03-13
Gender:Female  Submitted:2009-06-24, Days after onset: 103
Location:Unknown  Entered:2009-07-13, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0903USA02321
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Accidental exposure, Corneal abrasion, Product quality issue
SMQs:, Accidents and injuries (narrow), Corneal disorders (narrow)
Write-up: Information has been received from a nurse practitioner concerning a 50 year old nurse female who experienced eye and face exposure to ZOSTAVAX (Merck) when the dose was being withdrawn from the vial. On 13-MAR-2009 the nurse went to the urgent care center and was diagnosed with bilateral corneal abrasions. Her eyes had been flushed with water and saline. At the time of reporting, 16-MAR-2009, the nurse''s eyes were "not so bad". There was a product quality complaint involved. Additional information was received on 16-MAR-2009. The nurse practitioner reported that the female nurse at her office suffered from bilateral corneal abrasions while reconstituting the product on 13-MAR-2009. As the nurse injected the diluent, the product "exploded" back into her eyes and face. The vial was completely empty after it exploded. It was first thought that the vial actually broke, but upon further inspection of the vial, it was completely intact. The nurse practitioner reported that the hole created by the syringe needle appeared to be enlarged due to the force of the pressure which must have ripped the hole. The nurse''s eyes were properly irrigated following the exposure and she was doing better as of 16-MAR-2009. The emergency room physician felt the abrasions were caused by the force of the product hitting her eyes and was not from glass or metal from the vial. Additional information has been requested.

VAERS ID:351999 (history)  Vaccinated:2009-07-07
Age:50.0  Onset:2009-07-07, Days after vaccination: 0
Gender:Male  Submitted:2009-07-08, Days after onset: 1
Location:Unknown  Entered:2009-07-21, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Joint range of motion decreased, Joint swelling, Pain in extremity, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad)
Write-up: 50yo male received pneumococcal vaccine in left deltoid on 7/7/09. Later that evening he called the medical center complaining of pain, warmth, and redness in the same arm. He presented to urgent care the following day, with fever of 100, and swollen, erythematous R elbow and soft tissue proximal to elbow. Was treated for cellulitis with clindamycin. Returned the following day unable to move the joint and evaluated and admitted by surgery to observe for necrotizing fasciitis (determined not to be necrotizing cellulitis). Was treated with IV vancomycin and clindamycin for two days with significant improvement and was discharged 2 days later on po BACTRIM and clindamycin. The affected vial was already completely administered by the time he presented, no other reports from other patients. The erythema and swelling started closer to the elbow than the deltoid where the injection was given.

VAERS ID:352511 (history)  Vaccinated:2009-07-11
Age:50.0  Onset:2009-07-11, Days after vaccination: 0
Gender:Female  Submitted:2009-07-22, Days after onset: 11
Location:Pennsylvania  Entered:2009-07-27, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Z PACK antibiotic; ZYRTEC; TOPROL XL; Albuterol inhaler; CARDIAZEM
Current Illness:
Preexisting Conditions: Bitten by a stray cat (date not reported). The patient had also started taking a Z-PACK antibiotic on the day of the event, an unspecified amount of time prior to the event onset. Her last tetanus vaccination had been 10-12 years prior. The patient had a past history of seasonal allergies, asthma, sinus problems, cardiac arrythmias and allergies to dust, latex, nickel, penicillin.
Diagnostic Lab Data: Blood work (not specified)
CDC Split Type: 200903122
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Blood test, Burning sensation, Erythema, Myalgia, Oedema mouth, Pain, Pharyngeal oedema, Pruritus, Throat tightness, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Initial report was received 20 July 2009 from a consumer in the country, who is also the patient. A 50-year-old female patient with a history of a stray cat bite, had received a left deltoid injection of Tetanus Toxoid (manufacturer, lot number and route not reported) at 15:00 hours on 11 July 2009 for wound management, and at approximately 18:30 hours, she became itchy on her abdomen and under her breast area. She also developed hives, and her face, mouth and hands turned red with a burning and stinging sensation. Her mouth and throat felt swollen and her throat felt like it was locked. The patient was prescribed a Z-PACK antibiotic on the day of the event, which she started taking an unspecified amount of time prior to the event onset. The patient was treated by emergency services and was taken to the hospital at which time she received BENADRYL and steroids. The patient was kept for observation and then discharged. The patient was instructed to continue taking oral BENADRYL and was prescribed a MEDROL PACK which she never had filled. Her diagnosis had been possible acute allergic reaction. The following day, on 12 July 2009, she was seen at a walk-in clinic due to persistent symptoms; no additional treatments were prescribed. On 13 July 2009, she went to the hospital with the same symptoms and left sided muscle pain that extended from her shoulder to her throat. She was given TORADOL and morphine for pain and kept for observation until 14 July 2009. The patient''s last tetanus vaccination had been 10 -12 years ago. Per the reporter, she could not remember having this kind of a reaction after receiving a tetanus vaccine in the past. The patient had a past history of seasonal allergies, asthma, sinus problems, cardiac arrythmias and allergies to dust, latex, nickel, penicillin. She had been taking ZYRTEC, TOPROL XL, Albuterol inhaler and CARDIZEM concomitantly. At the time of the report, her recovery status was reported as unknown. Documents held by sender: None

VAERS ID:352833 (history)  Vaccinated:2009-04-14
Age:50.0  Onset:2009-04-19, Days after vaccination: 5
Gender:Male  Submitted:2009-04-21, Days after onset: 2
Location:Nevada  Entered:2009-07-31, Days after submission: 101
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3070AA UNLA
Administered by: Military     Purchased by: Military
Symptoms: Axillary pain
SMQs:
Write-up: Tetanus (L) arm 6 d ago. Next AM noted disc (L) axillary this AM with discomfort about medical episode/ (L) elbow. No erythema - No fever - No systemic Sx - No neuro scan. Not taking any meds.

VAERS ID:353103 (history)  Vaccinated:2009-07-10
Age:50.0  Onset:2009-07-11, Days after vaccination: 1
Gender:Female  Submitted:2009-07-29, Days after onset: 18
Location:Minnesota  Entered:2009-08-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AZITHROMYCIN 250mg
Current Illness: None
Preexisting Conditions: Episodic annual pleurisy Sx
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF457AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Eye swelling, Eyelid oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: Patient woke up on 7-11-09 and her eyes were puffy both the top + bottom lids. No itching or burning. Eye eyes are still puffy 2 wks later.

VAERS ID:353552 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:Texas  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Diabetes
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0808USA02641
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a female in her 50''s with diabetes who "one year ago", was vaccinated with her first dose of PNEUMOVAX (Lot #, site and route not reported). One day after receiving the vaccine, the patient experienced hives, fever and a rash. The patient sought unspecified medical attention. On an unspecified date, the patient recovered from hives, fever and rash. No additional information was provided. Additional information has been requested.

VAERS ID:353713 (history)  Vaccinated:2008-10-01
Age:50.0  Onset:2008-10-01, Days after vaccination: 0
Gender:Unknown  Submitted:2009-07-30, Days after onset: 302
Location:Massachusetts  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0810USA02125
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0551X0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Burning sensation, Pain
SMQs:, Peripheral neuropathy (broad)
Write-up: Information has been received from a nurse concerning an adult in 50s, who in October 2008 ("past week") received a first dose of 0.5 ml PNEUMOVAX (lot # 660718/0551X, route and injection site unknown). It was reported that the patient had pain and burning while the injection was given. The events resolved in a minute or two. The patient sought unspecified medical attention; no treatment was required. Additional information has been requested. This is one of 3 reports from a same source.

VAERS ID:353737 (history)  Vaccinated:2008-10-01
Age:50.0  Onset:2008-10-01, Days after vaccination: 0
Gender:Male  Submitted:2009-07-30, Days after onset: 302
Location:Massachusetts  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0810USA01813
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0551X0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a nurse concerning a male adult over 50 years old, who in October ("past week") received a first dose of 0.5 ml PNEUMOVAX vaccine (lot # 660718/0551X, route and injection site unknown). The day after the injection, the patient sought medical attention in the office with pain, redness and swelling at the injection site. No treatment was required for him. The patient recovered on an unspecified day. Additional information has been requested. This is one of 3 reports from a same source.

VAERS ID:353839 (history)  Vaccinated:2008-09-26
Age:50.0  Onset:2008-09-26, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 307
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0810USA03858
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1960U IDUN
Administered by: Public     Purchased by: Public
Symptoms: Anxiety, Headache, Incorrect route of drug administration, Pain in extremity
SMQs:
Write-up: Information has been received from a physician concerning a 50 year old female who on 26-SEP-2008 was vaccinated with PNEUMOVAX (lot # 659487/1960U), mistakenly intradermally. On 26-SEP-2008 the patient experienced pain in arm, headache for a weekend, anxiety for long term effect possibility. The patient required emergency room or doctor visit. The outcome was unknown. No further information is available.

VAERS ID:353945 (history)  Vaccinated:2008-10-27
Age:50.0  Onset:2008-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 276
Location:Iowa  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Anxiety; Menopause; Rhinitis allergic
Preexisting Conditions: Irritable bowel syndrome
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0810USA05159
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2789BA IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0224X IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC3027BA IMUN
Administered by: Private     Purchased by: Private
Symptoms: Headache, Oropharyngeal pain, Pain, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Information has been received from a medical assistant concerning a female who on 28-OCT-2008 was vaccinated with PNEUMOVAX 23 (dose and route not reported). On 29-OCT-2008 the patient experienced wheezing and achiness. It was not known if this was the patient''s first dose of PNEUMOVAX 23. The patient''s wheezing and achiness persisted. Follow-up information has been received from a physician concerning a 50 year old female with anxiety, rhinitis allergic and menopause and a history of irritable bowel syndrome and no illness at the time of vaccination who on 27-OCT-2008 was vaccinated with PNEUMOVAX 23 (lot number: 660717/0224X) IM into her right upper arm. Concomitant therapy included FLUZONE and ADACEL. On 27-OCT-2008 the patient experienced wheezing, bodyaches, headache and sore throat. The patient was treated with naproxen, albuterol, QVAR, and an unspecified medication. Approximate 1 week later, the patient recovered. Additional information is not expected.

VAERS ID:353972 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:Virginia  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0811USA01068
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1021X UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a nurse concerning a 50 year old female who on 05-NOV-2008 was vaccinated with dose of PNEUMOVAX (lot number 661065/1021X) (injection site and route not reported). Subsequently the patient had a red raised spot around the injection site and experienced fever. Unspecified medical attention was sought. The outcome of the patient''s experience was unknown. This is one of several reports from the same source. No further information is available.

VAERS ID:354156 (history)  Vaccinated:2008-11-21
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:New Jersey  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FIORICET with Codeine; atenolol; desipramine hydrochloride; LEVOXYL
Current Illness: Drug hypersensitivity
Preexisting Conditions: Graves'' disease
Diagnostic Lab Data: None
CDC Split Type: WAES0811USA03950
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Erythema, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a licensed practical nurse concerning an approximately 50 year old female with drug hypersensitivity to thimerosal and a history of Graves'' disease who on 21-NOV-2008 was vaccinated IM with PNEUMOVAX 0.5ml (LOT# not reported). Concomitant therapy included atenolol, LEVOXYL, FIORICET with Codeine and desipramine. Subsequently, the patient experienced painful, red, and swollen from deltoid to elbow after administration of PNEUMOVAX. The patient experienced fever and chills. The patient was recovering from the adverse events. No lab or diagnosis studies were performed. It was reported that the patient sought medical attention: office visit. Additional information has been requested.

VAERS ID:354172 (history)  Vaccinated:2008-12-04
Age:50.0  Onset:2008-12-04, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 237
Location:Georgia  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OS-CAL, NEXIUM, SYNTHROID, PRAVACHOL
Current Illness: Hypercholesterolaemia; Hypothyroidism; Drug hypersensitivity; Food allergy
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0812USA01791
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1163X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site pain, Rash macular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a healthcare worker concerning a 50 year old female patient with hypercholesterolaemia, hypothyroidism, CODEIDING hypersensitivity and wheat allergy who on 04-DEC-2008 was vaccinated with first dose of PNEUMOVAX (Lot #....), 0.5ml, intramuscularly. Concomitant therapy included PRAVACHOL, NEXIUM, SYNTHROID and OS-CAL. On 04-DEC-2008 after the patient received PNEUMOVAX developed left arm pain in the injection and a round red blotch about the size of a half dollar on her left shoulder and the same size blotch on the left side of her neck. There were no Laboratory or Diagnostics studies performed. At the time of the report on 05-DEC-2008 the patient was recovering. The patient sought medical attention office visit. Additional information has been requested.

VAERS ID:354216 (history)  Vaccinated:2008-12-01
Age:50.0  Onset:2008-12-01, Days after vaccination: 0
Gender:Male  Submitted:2009-07-30, Days after onset: 240
Location:Georgia  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: temperature measurement, 12/10/08, 102 Degrees
CDC Split Type: WAES0812USA04696
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1163X IMUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Chills, Full blood count, Injected limb mobility decreased, Local reaction, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Information has been received from a physician concerning two patients in their 50 who on approximately 09-DEC-2008 ("last week") were vaccinated with a dose of PNEUMOVAX (663012/1163X). The physician reported that the two patients experienced a severe local reaction and a fever of 102 degrees within 24 hours of being vaccinated with PNEUMOVAX. The physician contacted the center and was told to discontinue using lot # 663012/1163X however a specific explanation for this was not available at the time of the call. The two patients sought unspecified medical attention. At the time of the report the two patients were recovered. Attempts are being made to obtain additional identifying information to distinguish the individual patients. Follow up information received from an office manager indicated that one patient was a 50 year old male. The patient received a dose of PNEUMOVAX (lot # 663012/1163X) on 10-DEC-2008. The patient was not hospitalized. Follow-up information from the office manager indicated that the 50 year old patient with no medical history or allergies received a dose of PNEUMOVAX IM, 0.5 mL (lot # 663012/1163X) on 10-DEC-2008. Concomitant therapy included "thyroid mediation" (manufacturer unspecified). Subsequently, the patient couldn''t move his arm where he received his injection and experienced chills and fever. The patient saw the physician and a complete blood count was preformed (result unknown). The patient recovered on 15-DEC-2008. This is one of two reported from the same source. A standard lot check investigation was performed. All in-process quality checks for the lot number in question were satisfactory. The lot met the requirements of the Center and was released. This is a consolidation of two reports concerning the same patient. Additional information has been requested. It has been determined that WAES # 0812USA04572 is a duplicate of WAES # 0812USA04696. Therefore, WAES # 0812USA04572 is being deleted from our files and the reports consolidated into 0812USA04696.

VAERS ID:354557 (history)  Vaccinated:2008-11-19
Age:50.0  Onset:2008-11-21, Days after vaccination: 2
Gender:Female  Submitted:2009-07-30, Days after onset: 250
Location:Florida  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: PENICILLIN allergy; Drug hypersensitivity
Preexisting Conditions: Gastrostomy tube insertion; Gastrointestinal disorder
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0901USA04143
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0868X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning a 50 year old female with PENICILLIN allergy and "a lot of medications" allergies and a history of "PEG tube" and gastrointestinal problems who on 19-NOV-2008 was vaccinated intramuscularly with first 0.5 mL dose of PNEUMOVAX (LOT # 661529/0868X). On 21-NOV-2008 the patient experienced swelling, warmth and redness at the site of injection about 8cm by 17cm. The patient was treated with TYLENOL, BENADRYL and cold compresses. Complete cell count and "CHEM14" were performed and no results were provided. Subsequently, the patient recovered from the events. The patient sought medical attention in the office. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:354596 (history)  Vaccinated:2008-12-18
Age:50.0  Onset:2008-12-18, Days after vaccination: 0
Gender:Male  Submitted:2009-07-30, Days after onset: 223
Location:California  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Bronchitis
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0902USA00853
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0555U UNLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Erythema, Induration, Injection site erythema, Injection site swelling, Malaise, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a physician concerning a patient who on unspecified date was vaccinated with a dose of PNEUMOVAX. Subsequently, the patient experienced "induration on his deltoid and erythema". It is unknown if the patient sought medical attention. At the time of reporting, the patient''s outcome was unknown. Follow up information has been received from a physician on 07-APR-2009. It was reported that the 50 year old male patient with bronchitis at the time of vaccination, who on 18-DEC-2008 was vaccinated in the left deltoid with one dose of PNEUMOVAX (Lot # 657526/055U) at 2:00 pm. On the same day, in the evening, the patient felt sick and had fever, Thursday night and Friday. The patient had chills and spot where shot was given was red, hard swollen. The patient started feeling better on 20-DEC-2008 and improved from there on. The patient had a greater than palm sized area of swelling. redness, pain and induration. This reaction was much more than physician usually see with immunization. There was no airway obstruction, no other rash/skin changes. This is one of two case from the same source. Additional information is not expected.

VAERS ID:354601 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Male  Submitted:2009-07-30
Location:Idaho  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0902USA01697
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site cellulitis, Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a physician concerning an approximately 50 year old male who was vaccinated with a dose of PNEUMOVAX vaccine. Later in the vaccination evening, the patient had pain, redness, hot to the touch and cellulitis that went from the injection site down his arm. The physician reported that the experience got progressively worse over the next couple of days. The physician reported that the patient had recovered on therapy. The physician reported that he gave this sale vial to two other patients who had a similar experience (reported in 0902USA01696 and 0902USA01706). The patient called physician for medical attention. Additional information has been requested.

VAERS ID:353523 (history)  Vaccinated:2006-09-01
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-08-07
Location:New York  Entered:2009-08-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol; XANAX; ELAVIL; FLEXERIL; ADVAIR; RELAFEN; NASACORT
Current Illness: Reflex sympathetic dystrophy; Allergic reaction to antibiotics; Sulfonamide allergy; Cystitis interstitial
Preexisting Conditions: Bronchiectasis
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0908USA00602
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Seroconversion test negative
SMQs:
Write-up: Information has been received from a female registered nurse with reflex sympathetic dystrophy, cystitis interstitial, allergic reaction to cefaclor and sulfonamide allergy and a history of bronchiectasis who on unspecified dates was vaccinated with three doses of PNEUMOVAX 23 (lot# unknown). Concomitant therapy included amitriptyline hydrochloride (MSD), XANAX, RELAFEN, albuterol, NASACORT, cyclobenzaprine HCl (MSD) and ADVAIR. Subsequently the patient did not seroconvert to all 23 serotypes after three doses of vaccination. The titers were checked 4-6 weeks after administration. Unspecified medical attention was sought. At the time of the report, the patient had not recovered. Not seroconverting to all 23 serotypes was considered to be disabling. Additional information has been requested.

VAERS ID:355324 (history)  Vaccinated:2008-09-18
Age:50.0  Onset:2008-09-18, Days after vaccination: 0
Gender:Male  Submitted:2008-10-22, Days after onset: 34
Location:Nevada  Entered:2009-08-13, Days after submission: 295
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: MEDI0007320
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Malaise
SMQs:, Arthritis (broad)
Write-up: A non-serious spontaneous report of a 50-year-old male patient who experienced arthralgia and malaise subsequent to FLUMIST has been received from a physician (patient). No relevant medical and medication history was reported. The patient received FLUMIST on 18-Sep-2008. Two days after FLUMIST administration, the patient experienced malaise and general arthralgia which lasted for about four days. At the time of report, the patient had no symptoms.

VAERS ID:355056 (history)  Vaccinated:2009-01-25
Age:50.0  Onset:2009-01-25, Days after vaccination: 0
Gender:Male  Submitted:2009-08-24, Days after onset: 210
Location:Florida  Entered:2009-08-24
Life Threatening? No
Died? Yes
   Date died: 2009-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: List includes PRN meds / standing orders over one month hospital stay:Tylenol PO, Norvasc PO, Bisacodyl PO,chlorpromazine IM, clonidine PO, Cardene IV, fentanyl IV, haldol IM, Primaxin IV, hydralazine IV, labetolol IV, levaquin IV, Ativan I
Current Illness: anaphylaxis (immediate)
Preexisting Conditions: Allergy to ace inhibitors (swollen lips, a sign of angioedema). PMH of hypertension x 14 years.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.UNKNOWN IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Abscess, Anaemia, Anaphylactic reaction, Anaphylactic shock, Anxiety, Appendicectomy, Arrhythmia, Atelectasis, Cardiac arrest, Cardiopulmonary failure, Chest tube insertion, Convulsion, Gastrooesophageal reflux disease, Haematuria, Hypercholesterolaemia, Ileus, Immediate post-injection reaction, Impaired gastric emptying, Intestinal obstruction, Leukocytosis, Nephrectomy, Pancreatitis, Psychotic disorder, Pyrexia, Renal cancer, Renal failure chronic, Respiratory distress
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Dyslipidaemia (narrow), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Convulsions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Lipodystrophy (broad), Malignant tumours (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tubulointerstitial diseases (broad)
Write-up: anaphylaxis (immediate) 9/10/09 Received hospital medical records of 12/2/08-1/24/2009. FINAL DX: Expired; malignant neoplasm of kidney; pulmonary insufficiency; HTN; hypertensive urgency; pulmonary atelectasis; acute pancreatitis; paralytic ileus; bacteremia; peritoneal abscess; pure hypercholesterolemia; GERD; anxiety; cardiac dysrhythmia; anemia; leukocytosis; psychosis; gastroparesis; hematuria; hypertensive chronic kidney disease Records reveal patient experienced progressively increasing abdominal pain & swelling x 11 mo. Nephrology, Uro, Heme/Onc, gen surgery, Cardio, Pulm, ID consults done. Taken to 12/19 OR for exp lap, radical left nephrectomy, jejunostomy & appendectomy. Developed post op HTN, fever, pancreatitis, ileus, psychosis & OBS. Taken back to OR for re-exploration of bowel obstruction requiring bowel resection & removal of massive adhesions, abdominal wound left open. Chest tube & thoracotomy. Progressed slowly & was ready for d/c to home when he received the vaccine. Patient developed immediate respiratory difficulty, had a seizure & respiratory-cardiac arrest & was unable to be resuscitated. ME refused autopsy but was done in hospital

VAERS ID:355272 (history)  Vaccinated:2009-07-14
Age:50.0  Onset:2009-07-17, Days after vaccination: 3
Gender:Female  Submitted:2009-08-14, Days after onset: 28
Location:Washington  Entered:2009-08-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB583AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site papule, Injection site pustule
SMQs:
Write-up: Received Hepatitis B vaccination (ENGERIX B) on 7-14-09. Returned for dose #2 Hep B today 8-14-09. That''s when the patient showed nurse a papule/pustule like knot on (L) arm at inj site of previous dose. No redness. Non-tender 4-5mm circumference. Elevated 2mm. Non-draining.

VAERS ID:356322 (history)  Vaccinated:2008-07-11
Age:50.0  Onset:2008-07-28, Days after vaccination: 17
Gender:Female  Submitted:2008-08-11, Days after onset: 14
Location:Ohio  Entered:2009-09-02, Days after submission: 387
Life Threatening? Yes
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURERS1148U1UNUN
Administered by: Public     Purchased by: Other
Symptoms: Activities of daily living impaired, Aphasia, Asthenia, Chest pain, Coagulopathy, Condition aggravated, Cyanosis, Dysarthria, Dyspnoea, Epistaxis, Fatigue, Gait disturbance, Gastrointestinal haemorrhage, Hemiparesis, Hypoaesthesia, Livedo reticularis, Loss of proprioception, Memory impairment, Muscular weakness, Nasal septum deviation, Nasal septum disorder, Oedema peripheral, Pain, Pain in extremity, Ulcer, Vascular cauterisation, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: I received 2 of the 3 HEPATITIS B Vaccines after the first mild achiness after the 2nd my Rt leg & arm went numb - vision disturbances. Can''t see well stumbling gait chest pain. Neuro changes, can''t feel feet and hands at times. Very weak, SOB, tired all of the time memory shot. Vision comes & goes Alzheimers & Guillain Barre like symptoms for 1 year now, can''t work! Within 2 weeks of shot. I was G.I bleeding & had a nose bleed that continues & had to be cauterized 2 times by on ENT. With no current insurance, kids in college & no job I went to ENT to avoid an Epistaxis Balloon & exorbitant high charges & we did the cauterize after. I am still getting occasional nose bleed but I have some continued bleeding & clotting problem since the swelling in Rt arm & leg with pain & just blew it off thinking it would go away but now I think it activated something & that it was actually clots in both limbs. I have color changes pain & swelling still in these 2 limbs that continues to this day. Fingers blue limbs mottled foot pads go dusky especially on Rt foot & in Rt hand. I had & still have a speaking defect expressive aphasia for speaking at times with slurred speech. I have a gait defect Rt sided weakness & if you throw a light switch off I veer drastically to the Rt side & crash into walls fall onto floor or off step porch etc. Basically cannot tell if I am upright in the dark. Vision "greys" out. Very scary.

VAERS ID:356492 (history)  Vaccinated:2009-08-25
Age:50.0  Onset:2009-08-25, Days after vaccination: 0
Gender:Female  Submitted:2009-08-26, Days after onset: 1
Location:Indiana  Entered:2009-09-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same symptom~Td Adsorbed (no brand name)~UN~30~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: PCN; Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3192AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Mobility decreased, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swollen, red, hot area - hard to move upper arm.

VAERS ID:356577 (history)  Vaccinated:2009-08-19
Age:50.0  Onset:2009-08-19, Days after vaccination: 0
Gender:Male  Submitted:2009-09-04, Days after onset: 16
Location:Kansas  Entered:2009-09-04
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: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1125 SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Feeling hot, Pallor
SMQs:, Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Vaccine administered 8/19/09 at 09:05am. Patient reported back to nurse approximately 10-15 minutes later complaining of feeling hot and red. Then patient becamse pale and cool to the touch. After 10 min of observation by nurse patient stated he felt fine and continued on to next appointment. Patient state that he had not eaten since 5:30pm the evening before.

VAERS ID:356715 (history)  Vaccinated:2009-09-05
Age:50.0  Onset:2009-09-08, Days after vaccination: 3
Gender:Female  Submitted:2009-09-08, Days after onset: 0
Location:Colorado  Entered:2009-09-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sulfa; Codeine; Quinolones; Nifedipine
Diagnostic Lab Data: Waiting for patient call-back with more information.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3190AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1296X IMRA
Administered by: Other     Purchased by: Private
Symptoms: Pain in extremity, Pneumonia, Skin striae
SMQs:, Eosinophilic pneumonia (broad)
Write-up: Patient described "pain in arm with striations." Patient was diagnosed with Pneumonia on 9/07/09.

VAERS ID:356728 (history)  Vaccinated:2009-09-02
Age:50.0  Onset:2009-09-03, Days after vaccination: 1
Gender:Female  Submitted:2009-09-04, Days after onset: 1
Location:Georgia  Entered:2009-09-08, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVAIR
Current Illness: Pharyngitis
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1296X0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site rash, Injection site urticaria, Pain of skin, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Circular raised silver-dollar sized area around injection site with 2 finger size striations on arm + 1 into side of neck. Sore to the touch.

VAERS ID:356851 (history)  Vaccinated:2009-08-08
Age:50.0  Onset:2009-08-10, Days after vaccination: 2
Gender:Male  Submitted:2009-08-30, Days after onset: 20
Location:Colorado  Entered:2009-09-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.004200IMRA
Administered by: Other     Purchased by: Private
Symptoms: Infection, Injection site erythema, Injection site inflammation, Injection site swelling, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 2 days post inj pt had large localized inflammation redness, swelling, heat. Spread to elbow. Day 5 pt went to urgent care; suspected infection however allergist suspect IgG reaction.

VAERS ID:357056 (history)  Vaccinated:2009-09-02
Age:50.0  Onset:2009-09-02, Days after vaccination: 0
Gender:Female  Submitted:2009-09-11, Days after onset: 9
Location:Massachusetts  Entered:2009-09-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sister is allergic to eggs does not take seasonal flu vaccine~ ()~NULL~~In Sibling1
Other Medications: Depakoate; aspirin; psych meds
Current Illness: none
Preexisting Conditions: Emphysema
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3188AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Fatigue, Injection site pain, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: At the time of administrtion, patient stated," My god, this hurts a real lot" She states she made that statment as the vaccine was being administered. At approximatel 6pm or 5 hours after vaccine administered, patient experienced vision problems...problem seeing, "blurry", thought I must be getting an infection in my eye, felt nauseous and even when I put on my glasses it did not help. Blurry vision started out of the blue on that evening and continued for several days until Saturday when it got better. Nausea started at the same time, was able to eat lightly; lasted until Saturday. No vomiting. Just wanted to sleep; ended up leaving work early approximately 24 hours after vaccine administered...so tired; too exhausted to work on Friday; felt better by Sunday.

VAERS ID:357209 (history)  Vaccinated:2009-09-09
Age:50.0  Onset:2009-09-10, Days after vaccination: 1
Gender:Female  Submitted:2009-09-14, Days after onset: 4
Location:Maryland  Entered:2009-09-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrica 75mg HS and Flexeril 10mg HS
Current Illness: Denied illness
Preexisting Conditions: Cervical Herniated Disk, Scleroderma(no treatment), Allergic to PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA275AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Client reported 4" X 11/2" area of induration that started near the injection site and spread distal the site. Reported area was red. Denied itching. Took Hydrochloride 10mg tables. Area was observed by Medical Director and he recommended Benadryl per client.

VAERS ID:357225 (history)  Vaccinated:2009-09-14
Age:50.0  Onset:2009-09-14, Days after vaccination: 0
Gender:Female  Submitted:2009-09-14, Days after onset: 0
Location:New York  Entered:2009-09-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR; Folic acid
Current Illness: None
Preexisting Conditions: Aspirin; ADVIL allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960301P0 LA
Administered by: Other     Purchased by: Private
Symptoms: Pruritus, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: "Throat closing" - itching, hives - Lot# 092040D exp02/2011 Westward epinephrine 5.3 cc SC @ 10:30 AM (R) forearm- 11:15 AM spoke to Doctor''s office - to see Pt @ 1:45 PM

VAERS ID:357376 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:2009-09-11
Gender:Female  Submitted:2009-09-15, Days after onset: 4
Location:Michigan  Entered:2009-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: swelling, formation of clots~Pneumo (Pneumovax)~1~38.50~Patient
Other Medications: Prednisone, Plaquenil, Warfarin, Lyrica, Ultram, Provigil, Zoloft, Boniva, Ambien, Calcium, multi-vitamin
Current Illness: Slight flare of left ankle
Preexisting Conditions: Antiphospholipid Syndrome, mixed connective disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  SYR 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Herpes simplex, Immediate post-injection reaction, Joint swelling, Nausea, Pain, Pyrexia, Skin lesion, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Immediate significant swelling and exquisite pain around the injection site, fever lasting more than 48 hours (5 days), significant nausea, aggravation of joint swelling, herpes simplex infection on the side of the nose, lesions extending up inside the left nostril.

VAERS ID:357552 (history)  Vaccinated:2009-09-09
Age:50.0  Onset:2009-09-11, Days after vaccination: 2
Gender:Female  Submitted:2009-09-11, Days after onset: 0
Location:New York  Entered:2009-09-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3058AA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045CA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site cellulitis
SMQs:
Write-up: Positive cellulitis on vaccine site.

VAERS ID:357604 (history)  Vaccinated:2009-09-15
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-09-17
Location:Alabama  Entered:2009-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure increased, Dizziness, Dysphagia, Erythema, Lymphadenopathy, Pain, Presyncope, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (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 (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Redness, puffed or swollen, about size of a baseball, soreness, difficulty swallowing, glands in the neck swollen, almost Blacked out, continued dizziness, and elavated blood pressure.

VAERS ID:357688 (history)  Vaccinated:2009-09-18
Age:50.0  Onset:2009-09-18, Days after vaccination: 0
Gender:Female  Submitted:2009-09-18, Days after onset: 0
Location:New Mexico  Entered:2009-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P2 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Patient felt lighthead and needed to sit down. Paramedics called, patient evaluated.

VAERS ID:357810 (history)  Vaccinated:2009-09-21
Age:50.0  Onset:2009-09-21, Days after vaccination: 0
Gender:Unknown  Submitted:2009-09-21, Days after onset: 0
Location:California  Entered:2009-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Public     Purchased by: Unknown
Symptoms: Chest discomfort, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: tingling in back of throat, tightening of chest

VAERS ID:357887 (history)  Vaccinated:2009-09-10
Age:50.0  Onset:2009-09-11, Days after vaccination: 1
Gender:Female  Submitted:2009-09-14, Days after onset: 3
Location:Ohio  Entered:2009-09-22, Days after submission: 8
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: Emphazema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97850PL0UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0037Y0UNRA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Oedema peripheral, Pain in extremity, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Headache, Fever, Arm Swollen, Arm Pain, Rash.

VAERS ID:357980 (history)  Vaccinated:2009-09-18
Age:50.0  Onset:2009-09-20, Days after vaccination: 2
Gender:Female  Submitted:2009-09-22, Days after onset: 2
Location:California  Entered:2009-09-22
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 12/08/09 PHM Hypothyroidism 12/11/09 PMH: Impetigo; Allergic to sulfa, PCN, egg yolks
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3184AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Herpes simplex, Lip blister, Lip swelling, Lymphadenopathy, Oral herpes, Pain, Pallor, Scar, Swelling face, Tenderness, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: I was injected with the flu vaccine on Friday, September 18, 2009 at approximately 2:30 pm. I woke up on Sunday morning with a big bump on my top lip which got worse throughout the day and night. On Monday morning, I woke up at 4:30 am with a cluster of blisters on my lip, upper respiratory wheezing and heaviness, and the left side of my neck felt like I had a swollen gland. As yesterday progressed, my lip (the left side)got bigger and more infectious looking. I called the doctor and she apologized for my reaction, and said she didn''t know I might be allergic to egg yolks. I never signed a release form at her office. This morning, my lip looks even worse and the left side of my face is swollen and tender. The doctor isn''t in until tomorrow, so I am going to my dermatologist to have my lip examined. I am in pain and scared that I am getting worse, not better. 12/08/09 Medical records received for DOS 11/17/04-9/23/09 Pt called PCP to notify of lip swelling and tenderness and plan to see dermatologist. DX: HSVI cold sore 12/11/09 Dermatology medical records received for DOS 10/11/2000-9/22/2009. DX: Herpes Simplex Virus, flaring (9/22/09)

VAERS ID:358037 (history)  Vaccinated:2009-09-15
Age:50.0  Onset:2009-09-17, Days after vaccination: 2
Gender:Female  Submitted:2009-09-22, Days after onset: 5
Location:Virginia  Entered:2009-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: None
Preexisting Conditions: Hx blood clots, clotting deficiency
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA449BA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Joint range of motion decreased, Neck pain, Pain in jaw
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Arthritis (broad)
Write-up: Seen in clinic 9/17/09 with L arm injection site swollen, red, hot, 25 x 50 mm. C/o pain radiating to post neck and jaws bilaterally increasing with hand movements. Full ROM, sensation, the ROM limited by pain with movement. Recheck 9/18/09. Referred to PCP. Initial rec. ice packs, observe.

VAERS ID:358197 (history)  Vaccinated:2009-09-17
Age:50.0  Onset:2009-09-17, Days after vaccination: 0
Gender:Female  Submitted:2009-09-21, Days after onset: 4
Location:Nebraska  Entered:2009-09-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2007~Influenza (Seasonal) (no brand name)~UN~48.00~Patient|2008~Influenza (Seasonal) (no brand name)~UN~49.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions: NSAIDS (all); pollens; weeds, grasses, trees
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3202AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Dizziness, Dyspepsia, Fatigue, Headache, Hot flush, Myalgia, Nausea, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: Headache, dizziness, naseua, fever, food stayed in stomach for 24 hours, chills, hot flashed, muscle aches, fatigue no reactions prior to 2007. However 2007, 2008, 2009 same reaction-2007 worse, 2008 not as bad, 2009 moderate.

VAERS ID:358218 (history)  Vaccinated:2009-09-17
Age:50.0  Onset:2009-09-17, Days after vaccination: 0
Gender:Female  Submitted:2009-09-21, Days after onset: 4
Location:Oregon  Entered:2009-09-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA448BA15IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Laryngospasm
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Hypersensitivity (narrow)
Write-up: Moderately severe Laryngospasm 1 hr after vaccination. Rx with EPI in ER.

VAERS ID:358251 (history)  Vaccinated:2009-09-21
Age:50.0  Onset:2009-09-22, Days after vaccination: 1
Gender:Female  Submitted:2009-09-24, Days after onset: 2
Location:Maryland  Entered:2009-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: wellbutrin
Current Illness: No other illness
Preexisting Conditions: Penicillin
Diagnostic Lab Data: N/a
CDC Split Type:
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DTP: DTP (NO BRAND NAME)SANOFI PASTEURC3355AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Erythema, Malaise, Myalgia, Pyrexia, Swelling, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Local redness, swelling and tenderness x 8 cm, fever, myalgias, arthralgias all lasting over 48 hours following vaccine, still feels sick

VAERS ID:358397 (history)  Vaccinated:2009-09-23
Age:50.0  Onset:2009-09-24, Days after vaccination: 1
Gender:Unknown  Submitted:2009-09-26, Days after onset: 2
Location:California  Entered:2009-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vesicare, Detrol, Omeprazole, multivitamin, fish & flaxseed oil
Current Illness: None
Preexisting Conditions: No known drug allergies previously. Has hyperlipidemia, goiter, overactive bladder, degenerative disc disease of the C-spine
Diagnostic Lab Data: CBC, BUN, Cr, ESR all normal. Mild hyponatremia (Na 132) but electrolytes otherwise unremarkable.
CDC Split Type:
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IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD0052 SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF486BA IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB11470IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Blood urea normal, Erythema, Full blood count normal, Oedema peripheral, Red blood cell sedimentation rate normal
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient was vaccinated with IPV, typhoid vaccine, and TdAP all in the left deltoid on 9/23/09 by RN at nursing clinic. On the following day (9/24/09) she developed left shoulder redness, swelling & blisters and was seen in the ER. She received steroids & underwent bullae drainage, with improvement in the ER, and she was discharged to home with a steroid taper, and recommendations to take Benadryl.

VAERS ID:358410 (history)  Vaccinated:2009-09-22
Age:50.0  Onset:2009-09-23, Days after vaccination: 1
Gender:Female  Submitted:2009-09-26, Days after onset: 3
Location:New Hampshire  Entered:2009-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin, ambien, omeprazole, proair, flonase, lisinopril, HCTZ
Current Illness: none
Preexisting Conditions: Latex, levaquin, tetracycline, amitriptyline
Diagnostic Lab Data: NOne
CDC Split Type:
Vaccination
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Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU 3186AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Musculoskeletal pain, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Induration, erythema 3.5 cm around, tenderness, pain entire shoulder region. Self limited symptoms

VAERS ID:358509 (history)  Vaccinated:2009-09-09
Age:50.0  Onset:2009-09-09, Days after vaccination: 0
Gender:Female  Submitted:2009-09-16, Days after onset: 7
Location:Florida  Entered:2009-09-28, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED06549111A0UNUN
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling at injection site. Tender to touch, and slightly warm.

VAERS ID:358713 (history)  Vaccinated:2009-09-23
Age:50.0  Onset:2009-09-24, Days after vaccination: 1
Gender:Female  Submitted:2009-09-29, Days after onset: 5
Location:Missouri  Entered:2009-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, metoprolol, wellbutrin, reservatol
Current Illness: none
Preexisting Conditions: none known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960312P IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient recieved flu shot on 9/23/09. Noted swelling of the arm day after flu shot given. Was seen on 9/25/09 by Dr. Dr. noted swelling and erythema in the area where the shot was given. Patient was advised to utilize ice and over the counter medications and to follow up if no expected resolution of symptoms.

VAERS ID:358798 (history)  Vaccinated:2009-09-28
Age:50.0  Onset:2009-09-28, Days after vaccination: 0
Gender:Female  Submitted:2009-09-28, Days after onset: 0
Location:Oregon  Entered:2009-09-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none.
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED07949111A   
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Conjunctival hyperaemia, Conjunctival oedema, Fatigue, Hyperhidrosis, Laryngitis, Pyrexia, Rhinorrhoea
SMQs:, Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: 2 hrs after vaccine: red edematous conjunctivae with arthragias, sweats, fever 100.5, fatigue,laryngitis, rhinnorhea. Improved in less than 24 hours. Treated with ibuprofen, benadry and 40 mg prednisone.

VAERS ID:359000 (history)  Vaccinated:2009-09-24
Age:50.0  Onset:2009-09-25, Days after vaccination: 1
Gender:Female  Submitted:2009-09-30, Days after onset: 5
Location:Utah  Entered:2009-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICSH842P20IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt started with rash at inner arm on elbow joint and behind knee on the day after she got the shot. Rash getting worse for 5 days after shot. She had taken BENADRYL for last 36 hours.

VAERS ID:359075 (history)  Vaccinated:2009-09-29
Age:50.0  Onset:2009-09-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-01, Days after onset: 2
Location:Ohio  Entered:2009-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 10 mg po daily; Zyrtec 10 mg po daily;
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR63300AA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest pain, Cough, Dysphonia, Dyspnoea, Eye pruritus, Lacrimation increased, Palpitations, Pyrexia, Sinus congestion, Stridor, Throat irritation, Tremor
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Lacrimal disorders (narrow), Hypersensitivity (broad)
Write-up: SX: Fever with violent shaking, cough, throat burning and felt like unable to breathe, stridor, severe eye itching/watering, sinuses with copious mucus drainage, voice very hoarse. Heart racing to the point of chest pain. Symptoms began about 4 hours after injection. TRX: Zyrtec 10 mg. po, Nasocort nasal spray 2 to each nostril, Tylenol 625 mg PO, Zicam 1 tablet dissolved in mouth all taken about 45 minutes after symptoms started and symptoms started to abate about 40 minutes after that.

VAERS ID:359079 (history)  Vaccinated:2009-09-23
Age:50.0  Onset:2009-09-23, Days after vaccination: 0
Gender:Female  Submitted:2009-10-01, Days after onset: 8
Location:California  Entered:2009-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
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Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR3186AA2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dysphonia, Eye swelling, Ocular hyperaemia, Oropharyngeal pain, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: Approximately 2 hours post vaccination patient experienced sore throat, hoarseness, and her tongue felt slightly swollen. In addition, she complained of bilatteral eye swelling and redness.

VAERS ID:359134 (history)  Vaccinated:2009-09-28
Age:50.0  Onset:2009-09-28, Days after vaccination: 0
Gender:Female  Submitted:2009-10-01, Days after onset: 3
Location:Kentucky  Entered:2009-10-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRAMIDOL; KLONIPIN; SYMBICORT; PROVENTIL; PREMARIN; SYNTHROID; SPIRIVA; THEOPHYLLINE; ASTHMANEX;
Current Illness: None
Preexisting Conditions: COPD; Asthma; Emphysema; Thyroid; (PCN, Keflex, Librium, Bee Stings; iodine)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR93AA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0509Y1UNRA
Administered by: Public     Purchased by: Other
Symptoms: Dyspnoea, Injection site pain, Injection site swelling, Local swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Rec''d flu and pneumonia shot on 9/28/09. In PM had increased pain and swelling in L arm flu shot given (double in size down to wrist). L side neck swollen & SOB. Called ER - took BENADRYL. Called doc and PCP. Hx anaphylaxis in past form medicine.

VAERS ID:359154 (history)  Vaccinated:2009-09-21
Age:50.0  Onset:2009-09-22, Days after vaccination: 1
Gender:Male  Submitted:2009-09-23, Days after onset: 1
Location:Virginia  Entered:2009-10-02, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seizures
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA257CA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Dizziness, Headache, Influenza, Neck pain, Pain, Urinary retention
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Chills, HA, body aches, dizzy, pain in neck....On 9/23/09 pt went to ER and DX flu then returned 9/25 with urinary retention and required indwelling cath.

VAERS ID:359242 (history)  Vaccinated:2009-10-03
Age:50.0  Onset:2009-10-04, Days after vaccination: 1
Gender:Female  Submitted:2009-10-04, Days after onset: 0
Location:Texas  Entered:2009-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to Sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2501AA11IMRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Musculoskeletal pain, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Received Anthrax booster IM in right deltoid am of 10/03/2009. Patient awoke at 0100 with severe pain in right shoulder radiating up toward neck and down into right arm. She also experienced a localized redness (which she has experienced with past injections). She required narcotic pain medication to aleviate pain. Movement increased pain to shoulder so at 10:00 AM 10/04 pt placed arm in sling. Patient stated she may see her physician if pain is not better by Monday 10/05.

VAERS ID:359381 (history)  Vaccinated:2009-09-19
Age:50.0  Onset:2009-09-19, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Arizona  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: None
Preexisting Conditions: Penicillin; Valve replacement
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97847P2 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Dry mouth, Flushing, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Dry mouth, heart palpitations, pt stated BP feels like its going up. Became flushed, pink cheeks paramedics took her to hospital.

VAERS ID:359469 (history)  Vaccinated:2009-10-02
Age:50.0  Onset:2009-10-05, Days after vaccination: 3
Gender:Female  Submitted:2009-10-05, Days after onset: 0
Location:Iowa  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: Fine
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97215014IMLA
Administered by: Public     Purchased by: Private
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: The trotts

VAERS ID:359600 (history)  Vaccinated:2009-09-15
Age:50.0  Onset:2009-09-15, Days after vaccination: 0
Gender:Male  Submitted:2009-09-28, Days after onset: 13
Location:New Hampshire  Entered:2009-10-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURM31877AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Employee states high fever and body aches approximately 10 hours after vaccine. Symptoms lasted approximately 1 day.

VAERS ID:359635 (history)  Vaccinated:2009-09-15
Age:50.0  Onset:2009-09-16, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 20
Location:New Mexico  Entered:2009-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA456BA1IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Fatigue, Headache, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Headache,Lymphadenopathy,Fatigue,Muscle Aches lasting 2 weeks duration

VAERS ID:359636 (history)  Vaccinated:2009-10-02
Age:50.0  Onset:2009-10-03, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 3
Location:Minnesota  Entered:2009-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Twelve hours after injection patient reported symptoms of:"fever,uncontrollable shaking,all over body pain,weakness and disorien
Preexisting Conditions: Migraine,depresson,genital herpes,Lupus,mitral valve disorder
Diagnostic Lab Data: None
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3200AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1296X IMRA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Disorientation, Lymph node pain, Lymphadenopathy, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: See last screen for symptoms

VAERS ID:359928 (history)  Vaccinated:2009-10-07
Age:50.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 0
Location:Illinois  Entered:2009-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97850P119UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1315Y0UNLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Warm and bulging around injection site within 2 1/2 hours later. No trouble breathing, itching none. Gave EPIPEN shot at 18:50 by 19:30 pain gone.

VAERS ID:360099 (history)  Vaccinated:2009-10-03
Age:50.0  Onset:2009-10-03, Days after vaccination: 0
Gender:Female  Submitted:2009-10-08, Days after onset: 5
Location:Texas  Entered:2009-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: asthma, seasonal allergies, allergies to dander, mold, etc., migraine, fibromyalgia, hypertension
Diagnostic Lab Data: none-Saturday pm - doctor not available
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA257AA IJUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Facial nerve disorder, Facial paresis, Fatigue, Feeling hot, Hypoaesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (broad)
Write-up: About 15 minutes after injection, began having numbness, warm sensation, and itching starting at my left jaw and going into distinct areas of my left side of my face. Was unable to fully wrinkle my forehead and it felt very strange, could not close my left eye completely, could not purse my lips or drink from a straw. My ear and jaw kept itching deeply. It began to resolve within about 2 hours, but I still will have some residual weakness when I am fatigued. I did not see a doctor that day because it was Saturday PM and I did not think it was an emergency. (seemed to be facial nerve irritation-precursor of Bell''s palsy?)

VAERS ID:360148 (history)  Vaccinated:2009-10-05
Age:50.0  Onset:2009-10-06, Days after vaccination: 1
Gender:Female  Submitted:2009-10-08, Days after onset: 2
Location:Tennessee  Entered:2009-10-08
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: History breast cancer; Left mastectomy; CAD; Allergies: Codeine, latex, tape
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3195AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0509Y1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Dizziness, Injection site erythema, Injection site induration, Injection site pain, Injection site warmth
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: Patient reports onset weakness, intermittent dizziness with redness and warmth of injection site on 10/6/09 no fever. Rt arm (injection) sore. States area is approximately 5 1/2 " long x 2 1/2 " wide red, firm and warm to the touch. She called her MD. No treatment. Did not want to come to office. Pt has history feels better today.

VAERS ID:360171 (history)  Vaccinated:2009-09-29
Age:50.0  Onset:2009-09-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 8
Location:New York  Entered:2009-10-09, Days after submission: 2
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:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA259AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Injection site rash, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Patient c/o localized rash at injection site, fever of 102.5, headache and nausea at 7pm the evening same day vaccine administered, treated with MOTRIN and BENADRYL - no SOB, cough, CP follow up with MD on 10/06/2009.

VAERS ID:360558 (history)  Vaccinated:2009-10-10
Age:50.0  Onset:2009-10-10, Days after vaccination: 0
Gender:Female  Submitted:2009-10-13, Days after onset: 3
Location:Massachusetts  Entered:2009-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IDLA
Administered by: Public     Purchased by: Public
Symptoms: Chest discomfort, Cough, Dysphonia, Lacrimation increased, Pruritus, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow)
Write-up: hoarseness, coughing,immediately followed by significant constriction in throat and chest, with watering eyes. Took 2 benadryl within 30 minutes of onset of symptoms and within another 30 minutes 2 puffs from inhaler ordered by PA friend. Severe symptoms subsided, and rest of evening and following 2 days (so far) still having watery eyes and some itching / small hives.

VAERS ID:360578 (history)  Vaccinated:2009-09-16
Age:50.0  Onset:2009-09-17, Days after vaccination: 1
Gender:Female  Submitted:2009-09-17, Days after onset: 0
Location:Unknown  Entered:2009-10-13, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No prior history on any.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED0574911A1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Vaccinated with AFLURIA 2009-2010 formula noon 09/16/09. By early evening hard 4 inch x 2 inch by 1 inch swollen area on deltoid an upper arm left. Next AM swollen lymph node left clavicle area 3. 5x2. 25 inch. tender to touch. No fever. Same afility 3 others have reported arm reactions with soreness, redness and warmth post injection.

VAERS ID:360689 (history)  Vaccinated:2009-09-22
Age:50.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-13, Days after onset: 21
Location:California  Entered:2009-10-13
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 known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED06649111A IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site mass, Injection site pain, Insomnia
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Burning and stinging at injection site which turned to soreness. Unable to sleep on her left arm. Note 1cm by 1cm palpable mass at injection site.

VAERS ID:360710 (history)  Vaccinated:2009-10-03
Age:50.0  Onset:2009-10-03, Days after vaccination: 0
Gender:Female  Submitted:2009-10-13, Days after onset: 10
Location:Nevada  Entered:2009-10-13
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: X-rays & CT scan
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3194AA10IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Computerised tomogram, Fatigue, Nausea, Syncope, Wound infection, X-ray
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)
Write-up: Nausea, chills, fatigue & syncopal episode requiring emergency care, sutures, X-rays, CT scan, secondary wound infection.

VAERS ID:361018 (history)  Vaccinated:2009-10-14
Age:50.0  Onset:2009-10-14, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 1
Location:California  Entered:2009-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Back pain
Preexisting Conditions: Hypothyroidism; Hyperlipidemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960363P0IMLA
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500759P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on neck, head, arms, and slightly on legs - began approx. 2 hours after vaccine was administered. No treatment given.

VAERS ID:361026 (history)  Vaccinated:2009-09-14
Age:50.0  Onset:2009-09-16, Days after vaccination: 2
Gender:Female  Submitted:2009-10-15, Days after onset: 29
Location:Michigan  Entered:2009-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
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TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2348BA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site discomfort, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Increasing discomfort at injection site, red, hot, swelling, tender to touch. Seen by Dr. on 9/22/09, three distinct areas of redness on right arm 7cm X 5cm, 3cm X 3cm, 1cm X 1cm. Diagnosed with cellulitis and treated with Bactrim and Prednisone.

VAERS ID:361073 (history)  Vaccinated:2009-06-29
Age:50.0  Onset:2009-06-30, Days after vaccination: 1
Gender:Female  Submitted:2009-09-30, Days after onset: 92
Location:California  Entered:2009-10-15, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mild flu like symptoms~Influenza (Seasonal) (no brand name)~UN~0.00~Patient
Other Medications: Thyroid meds; Fe; vitamins/min/supplements
Current Illness: Done at a well check up
Preexisting Conditions: Hypothyroid; Gluten intolerance; + ANA (Lupus?) Autoimmune
Diagnostic Lab Data: HS TSH changed from 1.67 pre-immun to 2064 post immuniz
CDC Split Type:
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TDAP: TDAP (ADACEL)SANOFI PASTEURUF971AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Blood thyroid stimulating hormone increased, Fatigue, Feeling hot, Joint swelling, Joint warmth, Muscle spasms, Myalgia, Neck pain, Nodule on extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Arthritis (broad)
Write-up: Multiple joint pain, heat, swelling;muscle pain and cramping throughout body, "hot" sensation all over body but no fever noted; sore ant. neck, paresthesias in legs and hands, painful nodule developed on finger, TSH increased from about 1.5 to 2.64 after injection, severe fatigue lasting more than 3 weeks still some resid. symptoms.

VAERS ID:361260 (history)  Vaccinated:2009-10-04
Age:50.0  Onset:2009-10-04, Days after vaccination: 0
Gender:Female  Submitted:2009-10-16, Days after onset: 12
Location:Connecticut  Entered:2009-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500709P1IN 
Administered by: Public     Purchased by: Private
Symptoms: Cough, Fatigue, Oropharyngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: SORE THROAT, RUNNY NOSE, NON-PRODUCTIVE COUGH, EXTREME FATIQUE, NO FEVER,LASTING 5 DAYS

VAERS ID:361319 (history)  Vaccinated:2009-09-28
Age:50.0  Onset:2009-09-29, Days after vaccination: 1
Gender:Female  Submitted:2009-10-17, Days after onset: 18
Location:Indiana  Entered:2009-10-17
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benicar, Hydrochlorothiazide, Pravastatin, Cymbalta, Trazodone, Advair HFA inhaler, Omeprazole, ProAir HFA inhaler
Current Illness: No
Preexisting Conditions: Allergy to Sulfa Asthma, GERD, Hypertension, Hyperlipidemia, Major Depression, Hiatal Hernia, Irritable Bowel Syndrome, Morphea.
Diagnostic Lab Data: Lab done not sure what tests they did Dx studies: Ct Sinus normal, PFT''s
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98445P1 IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Computerised tomogram normal, Cough, Eye swelling, Laboratory test, Lip swelling, Pharyngeal oedema, Pruritus, Pulmonary function test, Rash, Sinus operation, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Persistent and ongoing generalized hives from date of onset to present, rash, facial swelling, eye swelling, lip swelling. severe itching. Three ER visits received IM Epinephrine x2, IM SoluMedrol x2, IM DepoMedrol, oral Prednisone, IV Pepcid, oral Pepcid, IV SoluMedrol, IV Benadryl, oral Benadryl every 4 hours x 6 days, IV fluids, oral Tagamet x 7 days, Clarinex, Xyzal, Singulair, Medrol dose pack, Pulmocort nebulizer treaments. Had to see Allergist x 2 visits with follow-up scheduled.10/29/2009 records from Allergist MD for 10/9 and 10/13/2009. Patient presents with c/o''s hives, pruritis, "feels like throat swollen", chest tightness, cough, nasal drainage. Patient has stated that has had 3 ED visits for these c/o''s and was tx''d with steroids, antihistamines and Tagamet but sx persist. PE noted diffuse urticaria. Tx: Solu Medrol, Prednisone. CT sinus was negative. On 10/13/2009 visit hives had cleared 85%. F/up clinic 3 weeks.

VAERS ID:361486 (history)  Vaccinated:2009-10-17
Age:50.0  Onset:2009-10-18, Days after vaccination: 1
Gender:Female  Submitted:2009-10-19, Days after onset: 1
Location:Colorado  Entered:2009-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED07249111A0UNAR
Administered by: Other     Purchased by: Other
Symptoms: Eye swelling, Joint swelling, Oedema peripheral, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Body ache, swollen fingers and wrists, puffy eyes, sore throat, low grade fever.

VAERS ID:361610 (history)  Vaccinated:2009-10-15
Age:50.0  Onset:2009-10-16, Days after vaccination: 1
Gender:Female  Submitted:2009-10-19, Days after onset: 3
Location:Mississippi  Entered:2009-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FUROSEMIDE - 20 mg/1 a day; CELLECPT - 250 mg/ 1 a day; PREDNISONE - 10 mg/1 tablet every other day; CLONIDINE - 0.1 mg/1 a day
Current Illness: None
Preexisting Conditions: Lupus, High Blood Pressure.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IJLA
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Hypoaesthesia, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad)
Write-up: Arm started hurting after injection. Legs went numb and now unable to walk.

VAERS ID:361653 (history)  Vaccinated:2009-10-13
Age:50.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 2
Location:New Jersey  Entered:2009-10-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960302P0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Chills, Cough, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad)
Write-up: Per phone, reported chills with severe shaking, muscle aches, cough, fever (unconfirmed with thermometer). States "I was going to go to the ER".

VAERS ID:361679 (history)  Vaccinated:2009-10-04
Age:50.0  Onset:2009-10-06, Days after vaccination: 2
Gender:Male  Submitted:2009-10-20, Days after onset: 14
Location:Massachusetts  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED0824911A IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Localized red area at injection site

VAERS ID:361697 (history)  Vaccinated:2009-10-19
Age:50.0  Onset:2009-10-20, Days after vaccination: 1
Gender:Female  Submitted:2009-10-20, Days after onset: 0
Location:Louisiana  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Chills, Myalgia, Pyrexia, Rhinorrhoea, Sinus congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Fever, Chills, General Aches, joints, muscles.....head congestion, runny nose

VAERS ID:361712 (history)  Vaccinated:2009-10-06
Age:50.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-10-14, Days after onset: 8
Location:New Hampshire  Entered:2009-10-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: On 90 mg Iron daily not diagnosed w/anemia
Current Illness: No
Preexisting Conditions: Egg allergies, celiac disease, diabetes, low throid, asthma, , mold, eggs, wheat dairy, etc. dermatitis herpiformist.
Diagnostic Lab Data: Nurse day after tried nose swab-too painful to complete
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Cough, Hyperhidrosis, Increased upper airway secretion, Lymphadenopathy, Nausea, Oropharyngeal pain, Pain, Pain in extremity, Rash, Skin warm
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Rash on left side body within a couple of minutes felt achy all over hands hurt-painful-felt feverish-chills then sweats-nausea-throat hurts-head hurts stuffed up-coughed up phlem-lymp nodes swollen right arm & under-blood sugars high-weak. 7 1/2 days on Tylenol & Robitussin pacifying it still sick on 10/14.09 allergic to itching. Note: my mom had same flu shot & is fine-done together. Treatment saw Dr at same facility nex day on 10-7-09 at 10:30 am, because I had no fever to her, low thyroid, when my temp gets up 98.0 & higher I feel feverish - new regulations that no treatment can be given - so I''m suffering.

VAERS ID:361756 (history)  Vaccinated:2009-09-29
Age:50.0  Onset:2009-10-02, Days after vaccination: 3
Gender:Male  Submitted:2009-10-08, Days after onset: 6
Location:Illinois  Entered:2009-10-20, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: back surgery L5-S1 fusion. Spinal fusion. Difficulty sleeping. /ksk
Diagnostic Lab Data: Labs and daigs: EMG/Nerve conduction studies WNL. MRI spine showed multiple disc anomalies including bulging disc at C3/C4 with encroachment, spinal cord normal. CSF: protein 44 (WNL), RBC 7(H), WBC 1(WNL), MYELIN BASIC PROTEIN 1.22 (H). NEG OLIGOCLONAL BANDS. 10/28/09 Medical records received for dates 10/8/09 to 10/12/09. Diagnostics/Labs: MRI brain abnormal-cerebral atrophy, thoracic MRI(-), EEG(-), CSF RBC(+), serum IgG 659(L), myelin basic protein 122(H). Labs and daigs: EMG/Nerve conduction studies WNL. MRI spine showed multiple disc anomalies including bulging disc at C3/C4 with encroachment, spinal cord normal. CSF: protein 44 (WNL), RBC 7(H), WBC 1(WNL), MYELIN BASIC PROTEIN 1.22 (H). NEG OLIGOCLONAL BANDS. 12/10/09 Hospital r
CDC Split Type:
Vaccination
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P2A IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Balance disorder, Bladder disorder, CSF protein normal, CSF test abnormal, CSF white blood cell count negative, Cranial nerve disorder, Diplopia, Electroencephalogram normal, Electromyogram normal, Encephalomyelitis, Hypoaesthesia, Hypoaesthesia facial, Myelopathy, Neck pain, Nerve conduction studies normal, Nuclear magnetic resonance imaging abnormal, Pain in extremity, Paraesthesia, Parasite blood test, Red blood cells CSF positive, Sensation of pressure, Tremor, Visual impairment
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Arthritis (broad)
Write-up: Double vision pain at base of neck / brainstem. Numbness in toes and legs, Esp. left leg. 11/06/09 Medical records recieved for DOS 11/06/09: Neuro consult visit. Facial numbness. Resolved in 2 days. Vertical diplopia and binocular vision persists. Tilting head to L helps. Parasthesia persist bil feet and legs, spread to hands and forearms bil. Limb pain and weakness, unsteadiness, bladder fx disturbance. Action tremor bil UE w/finger to nose testing. All other neuro PE WNL. 10/28/09 Medical records received for dates 10/8/09 to 10/12/09. Pt seen by neurologist. DX: postvaccinal encephalomyelopathy, rt. 4th cranial nerve dysfunction, action tremor and myelopathy. Presenting sx: pt. states received flu vax 9/30, on 10/1 c/o vertical diplopia with binocular vision, 10/4 c/o tingling parethesia bilat legs and feet. Assessment: WNL, evidence of previous back surgery. Diagnostics ordered. ICD9 code 341.20 11/06/09 Medical records recieved for DOS 11/06/09: Neuro consult visit. Facial numbness. Resolved in 2 days. Vertical diplopia and binocular vision persists. Tilting head to L helps. Parasthesia persist bil feet and legs, spread to hands and forearms bil. Limb pain and weakness, unsteadiness, bladder fx disturbance. Action tremor bil UE w/finger to nose testing. All other neuro PE WNL. 12/10/09 Hospital records received. Service date 10/19/09. Patient presents with c/o pressure in head and base of skull, vision diminished, double vision. Paraparesis.

VAERS ID:361928 (history)  Vaccinated:2009-10-15
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-20
Location:Massachusetts  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960374P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Musculoskeletal stiffness, Oropharyngeal pain, Pharyngeal oedema
SMQs:, Angioedema (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Stiff neck, soar throat, swollen, throat

VAERS ID:362063 (history)  Vaccinated:2009-10-20
Age:50.0  Onset:2009-10-20, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 1
Location:Louisiana  Entered:2009-10-21
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: Hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP001AA1IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Angioedema, Hypoaesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Patient developed swelling and numbness of tongue. Angioedema of menal area. Evaluated in ED. Patient received diphenhydramine and dexamethasone IM, befroe being released home.

VAERS ID:362071 (history)  Vaccinated:2009-10-07
Age:50.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Female  Submitted:2009-10-19, Days after onset: 12
Location:Illinois  Entered:2009-10-21, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergy to THIMEROSAL
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3177CA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia oral, Oral pruritus, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Within 15 min. of receiving a single dose preservative free influenza vaccine pt experienced numb lips + tongue, itchy tongue + sl. tightness in throat, symp. lasted approx 15-20 min. Pt. din not seek treatment.

VAERS ID:362075 (history)  Vaccinated:2009-10-19
Age:50.0  Onset:2009-10-19, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 2
Location:Virginia  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Influenza
SMQs:
Write-up: All the h1n1 symptoms

VAERS ID:362163 (history)  Vaccinated:2009-10-20
Age:50.0  Onset:2009-10-20, Days after vaccination: 0
Gender:Female  Submitted:2009-10-22, Days after onset: 2
Location:Connecticut  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: H/O Bronchitis with oral steroids used (PREDNISONE 20 mg BID x3 days (QDx2d) last dose 10/19/09
Preexisting Conditions: Bronchitis onset 10/5/09
Diagnostic Lab Data: Metabolic lab test Brain MRI; baltery of lab tests pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Hypoaesthesia, Laboratory test, Metabolic function test, Nuclear magnetic resonance imaging brain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Felt numbness, and tingling Left toes Left fingers approximately 4-5 hours after injection went to ER for evaluation 10/21/2009 - early am - saw PCP next day, ongoing evaluation.

VAERS ID:362209 (history)  Vaccinated:2009-10-21
Age:50.0  Onset:2009-10-22, Days after vaccination: 1
Gender:Female  Submitted:2009-10-22, Days after onset: 0
Location:Michigan  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: No
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP007AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eye swelling, Hypersensitivity, Paraesthesia, Pruritus, Rash, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Awakened in am and noticed rash, swelling and itching right side of face. Urticaria rt eyelid, cheeks, neck and a few on center left side of face and neck. Skin tingely. Recommended antihistamine and cool compresses. No other adverse side effects. 10/26/09 ED records received from date 10/23/09. DX: Generalized allergic reaction. Presenting SX: pt. states received flu vax 10/21, face swelling, itching 10/22. ER 10/23 for continued swelling. Assessment: (+)facial swelling, right eye swelling. Pt. tx and d/c.

VAERS ID:362356 (history)  Vaccinated:2009-10-20
Age:50.0  Onset:2009-10-20, Days after vaccination: 0
Gender:Female  Submitted:2009-10-22, Days after onset: 2
Location:Alaska  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Celiac sprue; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURVP001AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Diarrhoea, Lip swelling, Migraine, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Received vaccine 10.20.09 at 12:00. At 20:30 on 10.20.09 had swollen lips and fingers, a migraine, severe abdominal cramps, and diarrhea. Took an antihistamine and symptoms went away. No medical treatment.

VAERS ID:362419 (history)  Vaccinated:2009-10-16
Age:50.0  Onset:2009-10-16, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 7
Location:Florida  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOTE: Adverse reaction to H1NI Less than 4 weeks seasonal flu taken in same arm.
Current Illness: None
Preexisting Conditions: PCN, sulfa, codiene
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP09AA IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Fatigue, Myalgia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Inital rash then onset of muscle aching & tired. Claritin taken

VAERS ID:362479 (history)  Vaccinated:2009-10-13
Age:50.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Male  Submitted:2009-10-19, Days after onset: 6
Location:Georgia  Entered:2009-10-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Disabled and in chronic pain from cancer treatments
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Got regular flu shot at noon on 10-13-09, Went to bed at 9pm and woke up at 1 am shaking with 103 fever - took 4 maximum strength Tylenol to bring fever down and I hurt all over for 2 days after 10 - 13.

VAERS ID:362523 (history)  Vaccinated:2009-10-23
Age:50.0  Onset:2009-10-23, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 0
Location:South Carolina  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Reaction to preservatives
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Erythema of Hands and Feet, given steroids in ED. Infectious Disease doctor saw patient and thought it was a reaction to the thimerosal.

VAERS ID:362631 (history)  Vaccinated:2009-10-23
Age:50.0  Onset:2009-10-23, Days after vaccination: 0
Gender:Female  Submitted:2009-10-24, Days after onset: 1
Location:Virginia  Entered:2009-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Work up 10/23/09 at 11:30pm sweats pressure in lower right arm(shot arm) keeps going to sleep, 10/24/09 9:00am diarrhea headache
Preexisting Conditions: none -
Diagnostic Lab Data:
CDC Split Type: UP004AA
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Diarrhoea, Headache, Hyperhidrosis, Hypoaesthesia, Limb discomfort, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: Sweats, pressure in lower right arm and hand keeps going to sleep. Lots of pressure. Heart palpitations, headache, diarrhea, back aching from 11:30pm 1/23/09 to now 10:55am 10/24/2009

VAERS ID:362707 (history)  Vaccinated:2009-10-16
Age:50.0  Onset:2009-10-19, Days after vaccination: 3
Gender:Female  Submitted:2009-10-25, Days after onset: 6
Location:Pennsylvania  Entered:2009-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Charcot-Marie-Tooth Dx Allergic to Flagyl
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR 0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: itchy rash on hands & arms continues to spread x 1 week

VAERS ID:362800 (history)  Vaccinated:2009-10-22
Age:50.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-26, Days after onset: 4
Location:Nevada  Entered:2009-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxycodon Tylenol
Current Illness: Client went to the ER on Oct. 6, 2009 and was treated for influenza-like illness and a bladder infection. States she had been fu
Preexisting Conditions: Fibromyalgia Alpha 1-antitrypsin
Diagnostic Lab Data: Misc. Blood work
CDC Split Type:
Vaccination
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Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA0IM 
Administered by: Public     Purchased by: Public
Symptoms: Blood test, Chest discomfort, Chest pain, Cough, Headache, Hypersensitivity, Oropharyngeal pain, Postnasal drip, Productive cough
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Client received H1N1 inactive influenza vaccine and within 3 minutes developed a headache that last about an hour. 20-30 minutes later she started having tightness, burning in her chest, sore throat, post nasal drainage and coughting. She took some Benadryl and went to bed. During the night she had a productive cough of yellow colored mucus. She denies fever, rash, swelling or tingling of lips. On Oct. 23, 2009 she went to her HCP and was told that she was having an allergic reaction. She was prescribed Augmentin, Singulair, Flovent, Albuterol and Ventolin.

VAERS ID:362810 (history)  Vaccinated:2009-10-07
Age:50.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Female  Submitted:2009-10-20, Days after onset: 13
Location:South Carolina  Entered:2009-10-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion; CLARITAN; SAVELLA
Current Illness: None
Preexisting Conditions: Peanut allergy; fibromyalgia; morphine allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED05549111A IMUN
Administered by: Other     Purchased by: Other
Symptoms: Headache, Hyperhidrosis, Immediate post-injection reaction, Injection site pain, Injection site warmth, Pain, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Immediate-tingling sensation, sweating. 1 hr-injection site hot, painful-headache. 2 hr-all over body ache-hives all over. From that time until 10/15/09-injection site hot, pain, headache, all over body ache-massive hives.

VAERS ID:362875 (history)  Vaccinated:2009-10-06
Age:50.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-10-14, Days after onset: 8
Location:Vermont  Entered:2009-10-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPAKOTE; levothyroxine
Current Illness: None
Preexisting Conditions: Seizure disorder; hypothyroid
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA456AA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Headache, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: Chills, h.a., vomiting, fever 101.9, muscle aches. H.A. lasted 3 days-other sx.-lasted 3 days.

VAERS ID:362953 (history)  Vaccinated:2009-10-22
Age:50.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 1
Location:California  Entered:2009-10-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0823Y0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Flushing, Muscle tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: Flushing of face, neck area a few minutes after the shot. Flushing did go away after 10 minutes. Patient also experienced muscle tightness around back (spinal cord) 15 minutes after shot. Pt felt well enough to return home with her husband. Pt later informed us she did go to emergency room b/c of stomach pain. Returned home after few hours. No treatment was given by ER.

VAERS ID:363117 (history)  Vaccinated:2009-09-29
Age:50.0  Onset:2009-09-30, Days after vaccination: 1
Gender:Female  Submitted:2009-10-02, Days after onset: 2
Location:Indiana  Entered:2009-10-27, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Bruise and swelling~Influenza (Seasonal) (no brand name)~~48.00~Patient
Other Medications: Lisinopril
Current Illness: None
Preexisting Conditions: Darvocet
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA454BA  LA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Injection site rash, Injection site swelling, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Achy feeling in limbs, rash around site and fingers hurt when made fist. Next day arm swollen around site (raised 1" in about 4-5" area). Headache, no rash and no achiness today.

VAERS ID:363170 (history)  Vaccinated:2009-10-19
Age:50.0  Onset:2009-10-21, Days after vaccination: 2
Gender:Female  Submitted:2009-10-22, Days after onset: 1
Location:West Virginia  Entered:2009-10-27, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMOXICILLIN 500 mg TID; GABAPENTIN 600 mg BID
Current Illness: Recovering from bronchitis
Preexisting Conditions: Trigeminal neuralgia
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP001AA IMUN
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA470BA IMUN
Administered by: Public     Purchased by: Public
Symptoms: Lip swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 10-21-09-4:00 AM awoke with welts on inside of both forearms-subsided throughout the day. 10-22-09 4:00 AM awoke with welts on outside of both forearms, itchy, swollen lower lip-subsided throughout the day.

VAERS ID:363185 (history)  Vaccinated:2009-09-23
Age:50.0  Onset:2009-09-23, Days after vaccination: 0
Gender:Female  Submitted:2009-09-29, Days after onset: 6
Location:Arizona  Entered:2009-10-27, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97846P IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0632Y1IMRA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Oral herpes, Pyrexia, Rash, Swelling, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: Pt reported fever (99.9-101.7 deg F), swelling, blurred vision, fever blisters and violent chills lasting 4 days post vaccination. Rash appeared on (R) arm four days post vaccination. Treated with Ibuprofen alternating with APAP.

VAERS ID:363221 (history)  Vaccinated:2009-10-20
Age:50.0  Onset:2009-10-20, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 1
Location:Virginia  Entered:2009-10-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXIPRO; PROTONICS
Current Illness:
Preexisting Conditions: Allergy to coconut
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Feeling hot, Muscle twitching, Skin tightness
SMQs:, Dyskinesia (broad), Dystonia (broad)
Write-up: Approximately 1 hour after receiving H1N1 vaccine, her R hand felt very hot and tight but with no obvious tx measure change or swelling; this sensation progressed over the hours to her wrists, elbow and then had "electrical jolts" which made her arm twitch.

VAERS ID:363302 (history)  Vaccinated:2009-10-15
Age:50.0  Onset:2009-10-16, Days after vaccination: 1
Gender:Female  Submitted:2009-10-26, Days after onset: 10
Location:Pennsylvania  Entered:2009-10-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO qd
Current Illness: None
Preexisting Conditions: Allergy: KEFLEX and Codeine; Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA470BA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Mobility decreased, Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: 10/15/09 appox 1430 - given flu vax in right deltoid - IM. Felt initial "soreness" entire deltoid/shoulder in AM of 10/16/09. This soreness/stiffness remained for 3 days. 10/23/09 - again had significant soreness/stiffness at (R) deltoid and shoulder joint with difficulty raising (R) arm.

VAERS ID:363478 (history)  Vaccinated:2009-09-28
Age:50.0  Onset:2009-09-28, Days after vaccination: 0
Gender:Female  Submitted:2009-10-28, Days after onset: 30
Location:Washington  Entered:2009-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA476AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Bursitis, Wrong technique in drug usage process
SMQs:
Write-up: Improperly adm. seasonal influenza vaccine (too high). Resulted in chemically induced bursitis + physical therapy is in progress.

VAERS ID:363717 (history)  Vaccinated:2009-10-28
Age:50.0  Onset:2009-10-29, Days after vaccination: 1
Gender:Female  Submitted:2009-10-29, Days after onset: 0
Location:Indiana  Entered:2009-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Low grade fever (99.9), mild headache

VAERS ID:363829 (history)  Vaccinated:2009-10-16
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-26
Location:California  Entered:2009-10-30, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500725P  UN
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: Vaccine not indicated for pt age group.

VAERS ID:364199 (history)  Vaccinated:2009-10-24
Age:50.0  Onset:2009-10-24, Days after vaccination: 0
Gender:Female  Submitted:2009-11-01, Days after onset: 8
Location:California  Entered:2009-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: asthma. 11/2/09: Hospital Records and Discharge Summary received for dates of service 10/25/09 to 10/26/09. PMH: Asthma.
Diagnostic Lab Data: Medically reduced heart rate (IV with medicines added, cardio conversion (under anesthesia) needed to convert back to normal rhythm. Spent 36 hours in ED and CCU units of hospital. Many tests, labs, xrays, electrocardiograms completed to assess heart normalcy. 11/2/09: Hospital Records and Discharge Summary received for dates of service 10/25/09 to 10/26/09. Labs and Diagnostics: Glucose 107 (H), BNP 198 (H), Cholesterol 213 (H), LDL Cholesterol 123 (H). CBC WNL. Portable CXR-Normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Atrial fibrillation, Blood cholesterol increased, Blood glucose increased, Blood lactate dehydrogenase increased, Brain natriuretic peptide increased, Cardioversion, Chest X-ray normal, Electrocardiogram, Full blood count normal, Heart rate increased, Heart rate irregular, Intensive care, Laboratory test, Palpitations, X-ray
SMQs:, Cardiac failure (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Lipodystrophy (broad)
Write-up: Rapid, irregular heartbeat - atrial fibrillation -continued after getting up in am - heart rate 155 bpm. Visit to urgent care center, referred to Hospital. Medically reduced heart rate, cardio conversion needed to convert back to normal rhythm. Spent 36 hours in ED and CCU units of hospital. Many tests, labs, xrays, electrocardiograms completed to assess heart normalcy. 11/2/09: Hospital Records and Discharge Summary received for dates of service 10/25/09 to 10/26/09. Dx: Atrial fibrillation with rapid ventricular rate. Assessment: Presented with 14 hour hx. of palpitations prior to admission. Found in A.fib with a rate of 150. Started on Lovenox and a Cardizem drip and her rate quickly improved while she maintained A. fib. No hx. of heart disease. Received H1N1 vaccine 4 hrs. prior to onset of sx. Successfully cardioverted on 10/26/09 and discharged home on Aspirin. ICD 9 Codes: 427.31, 493.90.

VAERS ID:364202 (history)  Vaccinated:2009-10-30
Age:50.0  Onset:2009-10-30, Days after vaccination: 0
Gender:Female  Submitted:2009-11-01, Days after onset: 2
Location:Alaska  Entered:2009-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Climara 0.1 patch zetia 10mg Vit D 50,000 units omega 3 fatty acid capsules b12 1000mg injection albuterol inhaler PRN zantac 150mg zyrtec 10mg
Current Illness: NO
Preexisting Conditions: environmental allergies, sulfa,AVC suppositories, Kefzol,Asthma,Mitral valve prolapse,aortic stenosis,menapausal
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthma, Headache, Nausea, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Asthma attack went to clinic needed nebulizer as inhaler not helping (have not had and attack like this in two years. by 10/31/2009 9am developed severe headache and Nausea and vomiting that lasted til 5pm that night. feel somewhat better on 11/1/2009 just achy all over

VAERS ID:364229 (history)  Vaccinated:2009-10-28
Age:50.0  Onset:2009-10-30, Days after vaccination: 2
Gender:Male  Submitted:2009-11-02, Days after onset: 3
Location:New York  Entered:2009-11-02
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: Allergy to penicilin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR36 JA ??  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Paleness, Dizziness, weakness, sweats. No treatment went home to bed.

VAERS ID:364234 (history)  Vaccinated:2009-10-28
Age:50.0  Onset:2009-10-29, Days after vaccination: 1
Gender:Female  Submitted:2009-10-30, Days after onset: 1
Location:North Carolina  Entered:2009-11-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD
Preexisting Conditions: COPD
Diagnostic Lab Data: Chest x-ray
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP008AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest X-ray, Dysphonia, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad)
Write-up: Voice hoarse, body aches, headache, low grade fever. Put pt on a course of LEVAQUIN 500 mg one everyday for seven days.

VAERS ID:364573 (history)  Vaccinated:2009-10-07
Age:50.0  Onset:2009-10-08, Days after vaccination: 1
Gender:Female  Submitted:2009-11-03, Days after onset: 26
Location:Colorado  Entered:2009-11-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98432P10IJLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Rash, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Red hot rash over the bicep muscle. Rash did not include injection site appeared 24 hours after immunization bicep muscle was the left arm.

VAERS ID:364609 (history)  Vaccinated:2009-10-03
Age:50.0  Onset:0000-00-00
Gender:Male  Submitted:2009-10-23
Location:Louisiana  Entered:2009-11-02, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0715Y2IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:364584 (history)  Vaccinated:2009-10-29
Age:50.0  Onset:2009-10-29, Days after vaccination: 0
Gender:Male  Submitted:2009-11-03, Days after onset: 5
Location:Arizona  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Contracted HSV2 in April 2009. Not symptomatic and otherwise healthy at time of vaccination.
Preexisting Conditions: Seasonal allergies with chronic high eosinophile count. Hyperlipidema.
Diagnostic Lab Data: Still watchful waiting. No objective testing as of report date.
CDC Split Type:
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500765P0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abnormal dreams, Anxiety, Atrial fibrillation, Bladder irritation, Chills, Fatigue, Feeling abnormal, Gastrointestinal pain, Hyperhidrosis, Hypoaesthesia, Insomnia, Muscle spasms, Nausea, No reaction on previous exposure to drug, Oedema peripheral, Paraesthesia, Peripheral coldness, Photosensitivity reaction, Pollakiuria, Pruritus, Skin burning sensation, Vertigo
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (narrow), Hypersensitivity (broad)
Write-up: I had no trouble at all with the regular flu shot 3 weeks ago. With the H1N1 vaccination I noticed photosensitivity in 30 to 40 minutes. By the following morning had developed skin itching and burning, numbness, electrical shocking sensations, vertigo, unusual muscle cramping, mildly swollen hands and feat, mild chills, mild nausea, foggy consciousness, and severe fatigue. A very different experience than the seasonal vaccination 3 weeks prior.

VAERS ID:364740 (history)  Vaccinated:2009-11-02
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2009-11-03
Location:South Dakota  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500781P   
Administered by: Unknown     Purchased by: Unknown
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: none

VAERS ID:365968 (history)  Vaccinated:2009-09-14
Age:50.0  Onset:2009-09-14, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 23
Location:Montana  Entered:2009-11-03, Days after submission: 27
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: Concomitant medications
Diagnostic Lab Data:
CDC Split Type: A0807884A
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA261AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Formication, Immediate post-injection reaction, Injection site pruritus, Injection site reaction
SMQs:, Peripheral neuropathy (broad), Hypersensitivity (narrow)
Write-up: Pruritis, injection site pruritis. This case was reported by a healthcare professional and described the occurrence of itching in a subject of unspecified age and gender who was vaccinated with influenza vaccine trivalent (FLULAVAL, GSK). On September 15 2009 the subject received unspecified dose of DLULAVAL (unknown). On September 15 2009, almost immediately after vaccination with FLULAVAL, the subject experienced itching. The reporter stated a subject experienced itching from the inside out which began almost immediately after the shot was given. Specific information was not known. The reported stated that the batch of vaccine for lot number AFLLA261AA might be defective which caused the adverse event. The reported did not have specific information and is seeking advice on whether to continue giving injection with this lot. The reported did not have an expiration date. At the time of reporting the outcome of the events were unspecified. The reported stated three additional subjects experienced adverse events. Follow up was received from Sept 15 2009, via Quality assurance (QA). QA stated this is an Adverse Event and it will not be recorded as a complaint. Follow-up was received on Sept 18 2009, via sales representative, who reported the 50 year old female subject received FluLaval on 14 September 2009. the onset of itchiness (described as skin crawling) at injection site was immediate following injection and lasted the rest of the day. Subject feeling well prior to vaccine, no fever, no other medications, no prior history of adverse events following flu vaccine. Subject was evaluated for rash and was negative. The events resolved on 14 September 2009 and was considered possibly related to FluLaval vaccination.

VAERS ID:364899 (history)  Vaccinated:2009-08-19
Age:50.0  Onset:2009-08-19, Days after vaccination: 0
Gender:Male  Submitted:2009-08-24, Days after onset: 5
Location:Unknown  Entered:2009-11-04, Days after submission: 72
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: Patient had not eaten anything since the previous evening 5-30pm.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Decreased appetite, Dizziness, Feeling cold, Flushing, Pallor, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Narrative: Patient reported to nurse 5-10 minutes after getting pneumococcal injection (at 9-05am 8/19/09) stating felt flushed, then turned pale and cool to the touch. Stated felt tingly in his stomach. Also stated that he had not eaten anything since 5-30pm the previous day. After sitting with the nurse for 10 minutes, he state he felt fine and continued on to his next appointment. Symptoms: Symptoms: 1. Dizziness. 2. Flushing, then pale and cool to the touch.

VAERS ID:364996 (history)  Vaccinated:2009-10-21
Age:50.0  Onset:2009-10-21, Days after vaccination: 0
Gender:Female  Submitted:2009-10-29, Days after onset: 8
Location:New Hampshire  Entered:2009-11-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: R ear pain
Preexisting Conditions: Prednisone; Meclizine; Sulf; Keflex
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3247AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Chills, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vaccine given 11am 10/21/09 that afternoon developed shaking chills, did not check temp. Developed abd pain 2 am that resolved on its own by morning, no intervention needed.

VAERS ID:365017 (history)  Vaccinated:2009-10-26
Age:50.0  Onset:2009-10-27, Days after vaccination: 1
Gender:Male  Submitted:2009-10-28, Days after onset: 1
Location:New York  Entered:2009-11-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AVAPRO; ASA
Current Illness: None
Preexisting Conditions: HTN, NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97850P1 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Soft tissue swelling with erythema 40mm around site of injection - significant induration

VAERS ID:365070 (history)  Vaccinated:2009-10-07
Age:50.0  Onset:2009-10-15, Days after vaccination: 8
Gender:Male  Submitted:2009-10-28, Days after onset: 13
Location:Massachusetts  Entered:2009-11-04, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Medical - had 2 spinal surgeries in 1991 & 1992 PMH: morbid obesity, HTA, DM, hyperlipidemia, spinal fusion, spinal surgery, viral meninogoencephalitis, striked by lightning.
Diagnostic Lab Data: Many at hosp. 10/22/09 Lab and DX studies: WBC: 12.1 (H), INR 1.1, AST 85; mild increase of ALT 131 and CPK 367; GCS: 14; CSF: nonseptic meningitis. Labs: blood culture neg Dx studies: CT head and CXR wnl dx study: KUB done 10/20/2009 noted probable ileus
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3188AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Alanine aminotransferase increased, Amnesia, Aspartate aminotransferase increased, Blood creatine phosphokinase increased, Blood culture negative, CSF test abnormal, Chest X-ray normal, Chills, Computerised tomogram normal, Contusion, Convulsion, Cough, Diplopia, Dyspnoea, Eye movement disorder, Eye pain, Fatigue, Glasgow coma scale, Grand mal convulsion, Headache, Hepatosplenomegaly, Ileus, Injection site erythema, Injection site warmth, International normalised ratio, Laboratory test, Malaise, Meningitis, Mental status changes, Pyrexia, Retinal disorder, Urinary system X-ray, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Retinal disorders (narrow), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: On October 7, 2009 Patient received the flu shot (regular flu shot) Two days later noticed redness, hot sensation at shot site, the size of a grapefruit. On October 15th became ill vomited. Oct. 16th had a seizure and lost memory. Hospitalized for 7 days. He was tired and easily winded just days after shot. 12/03/09 & 12/04/09 MR and DC summary for DOS 10/17/09 - 10/22/09 DX: aseptic meningitis Pt c/o malaise, fever, HA, altered mental status, tonic clonic seizure. Tx: vancomycin, ceftriaxone, Dilantin. On examination: mild hepatosplenomegaly. 12/03/09 & 12/04/09 MR and DC summary for DOS 10/17/09 - 10/22/09 DX: Pt c/o malaise, fever, HA, altered mental status, tonic clonic seizure. Tx: vancomycin, ceftriaxone, Dilantin. On examination: mild hepatosplenomegaly. 12/28/2009 duplicate DC summary for 10/17-10/19/2009 received 12/28/2009 ED records for 10/17/2009 12/30/2009 ED records for 10/16/2009 c/o''s fever, chills, malaise 1/4/2010 VA records for f/up visits post hospitalization, 10/23-12/28/2009 noted on visit 11/16/2009 patient with c/o''s cough, SOB and frontal headaches, rx''d ABX and albuterol inhaler Also included is Opthalomology consult for c/o''s eye pain, diplopia, and eye fluttering, Rx''d eye gtts, noted per eye exam peripheral retinal holes 01/11/10 Vaccine records received.

VAERS ID:365129 (history)  Vaccinated:2009-10-22
Age:50.0  Onset:2009-10-23, Days after vaccination: 1
Gender:Female  Submitted:2009-11-04, Days after onset: 12
Location:Wisconsin  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP007AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Arm felt weak with extended reaches and handling objects using left are yet on 10/29/2009

VAERS ID:365170 (history)  Vaccinated:2009-11-04
Age:50.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-04, Days after onset: 0
Location:California  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lopid
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP012AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling hot, Headache, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Employee complained of feeling warm and uticaria to both arms. Benadryl 50mg PO was given. Vitals were stable. Later complained of headache. She took Tylenol.

VAERS ID:365387 (history)  Vaccinated:2009-11-02
Age:50.0  Onset:2009-11-03, Days after vaccination: 1
Gender:Female  Submitted:2009-11-05, Days after onset: 2
Location:New Jersey  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien PRN; Xanax PRN
Current Illness: None
Preexisting Conditions: Occasional difficulty sleeping.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3253DA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Lip oedema, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Edema of both lips;Tingling around mouth. Applied Neosporin to area and took 25mg.-50 mg. Benadryl on an irregular basis.Given ice pack for lips and 25m. Benadryl on 11/5/09-day it was reported.Advised to consult personal physician.

VAERS ID:365459 (history)  Vaccinated:2009-11-03
Age:50.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2009-11-05, Days after onset: 2
Location:Oregon  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOVASTATIN 40 MG QD. ERRIN 0.35 QD
Current Illness: NO
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPO12AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: SWELLING OF INJECTION SITE TO THE SIZE OF APPROXIMATELY A LARGE WALNUT, AND TENDERNESS. UNCLEAR ON HOW LONG LASTED. ICE PACK APPLIED.

VAERS ID:365599 (history)  Vaccinated:2009-10-16
Age:50.0  Onset:2009-10-16, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 5
Location:Virginia  Entered:2009-11-06, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Musculoskeletal pain, Neck pain, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Client with c/o (R) arm "tingling"-radiating down forearm to 4th & 5th digits. Radiating pain also reported on right side up to (R) shoulder & base of neck.

VAERS ID:365617 (history)  Vaccinated:2009-10-01
Age:50.0  Onset:2009-10-01, Days after vaccination: 0
Gender:Female  Submitted:2009-10-01, Days after onset: 0
Location:Virginia  Entered:2009-11-06, Days after submission: 36
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: BP at 10:45am 10/1/09 128/82,
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97839P2 SCUN
Administered by: Other     Purchased by: Public
Symptoms: Blood pressure, Eye irritation, Nausea, Pruritus, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Hypersensitivity (broad)
Write-up: 8:40am received vaccine. 8:50 stated tongue thick, "burning" around eyelids, itchy face that went to arms, upper thighs. At 10:25 am patient took 25mg Diphenhydramine. 10:35am eyelids better, tongue better. 11am felt nausea, gave crackers; 11:10am better; 11:15am itchy resolved, nausea gone.

VAERS ID:366019 (history)  Vaccinated:2009-11-06
Age:50.0  Onset:2009-11-07, Days after vaccination: 1
Gender:Female  Submitted:2009-11-09, Days after onset: 2
Location:Maryland  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data: Chest X -Ray
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURNH013AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Chest X-ray normal, Condition aggravated, Dysphonia, Dyspnoea, Full blood count normal, Heart rate increased, Oropharyngeal pain, Productive cough, Respiratory distress, Speech disorder, Sputum discoloured, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Experienced severe inspiratory and expiratory wheezing, difficulty breathing, sore throat and hoarseness. Went to the emergency dept., vitals were stable, no fever, received breathing treatment, prednisone and Zithromax PO and was discharged with scrips for both meds. to continue. Then the early hours of Monday 11/8/09 same events but worse than previous, arrived at the same ED at 03:00 am . HR in the 150''s, bp 169/92, no fever. Over the course of 4 hours received 3 breathing treatment and Solu-Medrol IV. Chest X-Ray was taken; no abnormalities noted. Discharged home, instructions to continue meds. and use Albuterol inhaler q4h. Folow up with primary care physician.

VAERS ID:366077 (history)  Vaccinated:2009-10-29
Age:50.0  Onset:2009-10-30, Days after vaccination: 1
Gender:Female  Submitted:2009-11-05, Days after onset: 6
Location:Virginia  Entered:2009-11-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma PMH: Asthma Allergies: NKDA
Diagnostic Lab Data: Chest x-ray. FLU nasal swab Labs: Influenza A and B neg Dx studies: CXR 11/2 RML infiltrates, repeat CXR noted improvement
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Back pain, Chest X-ray, Chest discomfort, Headache, Influenza serology, Musculoskeletal chest pain, Neck pain, Pain, Pain in jaw, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad)
Write-up: Pt started with soreness in jaw and neck, back and body aches, fever (102), headaches less than 24 hours after vaccine. C/o chest tightness and rib pain a couple of days later. visited physician. Dx pneumonia. 11/18 and 11/24/2009 PCP records for 11/2 and 11/9/2009. Dx pneumonia Patient with c/o''s fever and chills. CXR noted RML infiltrates. Tx: Tamiflu, Z-pak Repeat CXR noted RML infiltrate improved

VAERS ID:366232 (history)  Vaccinated:2009-11-07
Age:50.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Female  Submitted:2009-11-09, Days after onset: 2
Location:Kansas  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pneumonia in Sept
Diagnostic Lab Data: None
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP017AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Pallor, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fever, vomit x 1, dizzy, weakness, pale. Onset 10:15 AM-12 noon to bed-no symptoms following day.

VAERS ID:366279 (history)  Vaccinated:2009-09-22
Age:50.0  Onset:2009-09-23, Days after vaccination: 1
Gender:Male  Submitted:2009-11-04, Days after onset: 42
Location:Kansas  Entered:2009-11-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever, headache, sore throar, achy~Influenza (Seasonal) (no brand name)~UN~49.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3186AA0UNRA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Fever, achy, sore throat, headache

VAERS ID:366688 (history)  Vaccinated:0000-00-00
Age:50.0  Onset:0000-00-00
Gender:Male  Submitted:2009-11-10
Location:Kansas  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP005AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Pain
SMQs:, Anaphylactic reaction (broad)
Write-up: Pt complained of cough & aching.

VAERS ID:366759 (history)  Vaccinated:2009-10-06
Age:50.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-09, Days after onset: 34
Location:Nebraska  Entered:2009-11-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No known allergies and no concurrent illness. The patient had a past history of orthostatic syndrome.
Diagnostic Lab Data: The patient was tested for GBS (Guillain Barre Syndrome) - date not reported; results unknown.
CDC Split Type: 200904649
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3199AA IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Immediate post-injection reaction, Laboratory test, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Initial report received 30 October 2009 from a health care professional. A 50-year-old female patient with a history of orthostatic syndrome, had received an intramuscular injection (site not reported) of FLUZONE SV 2009-2010, lot number U3199AA on 06 October 2009 and immediately following vaccination, she experienced dizziness, faintness, nausea and trembling hands. The patient was taken to the hospital where she was admitted, and subsequently discharged (dates not reported). At unspecified amount of time later, the patient was re admitted and was tested for GBS (Guillain Barre Syndrome) (dates not reported). Test results were unknown at the time of the report. The patient had no concurrent illness and no known allergies. It was unknown if she had been taking any concomitant medications. The patient had received influenza vaccines in the past, however it was unknown if she had experienced any adverse events following prior vaccinations. No further information was known at the time of the report. Documents held by sender: None.

VAERS ID:366770 (history)  Vaccinated:2009-11-09
Age:50.0  Onset:2009-11-09, Days after vaccination: 0
Gender:Male  Submitted:2009-11-10, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
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Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102045P12UNLA
Administered by: Private     Purchased by: Public
Symptoms: Hypoaesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Mouth felt numb and tightness in his throat 3 mins after vaccine.

VAERS ID:366711 (history)  Vaccinated:2009-09-25
Age:50.0  Onset:2009-09-26, Days after vaccination: 1
Gender:Female  Submitted:2009-09-28, Days after onset: 2
Location:Alaska  Entered:2009-11-11, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960335P1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad)
Write-up: Had seasonal flu shot in 9/25/09 - woke up next morning feeling bad + very dizzy. This lasted until about 2pm then went away.

VAERS ID:366890 (history)  Vaccinated:2009-11-05
Age:50.0  Onset:2009-11-11, Days after vaccination: 6
Gender:Female  Submitted:2009-11-12, Days after onset: 1
Location:Texas  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Taking antihistamine; will follow-up with a doctor''s visit if not better
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERV04.810 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Eye swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Redness and swelling around eyes

VAERS ID:366905 (history)  Vaccinated:2009-10-30
Age:50.0  Onset:2009-10-31, Days after vaccination: 1
Gender:Female  Submitted:2009-11-12, Days after onset: 12
Location:South Dakota  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tingling in arm~Influenza (Seasonal) (no brand name)~1~51.00~Patient
Other Medications: DIOVAN; LIPITOR; ALEVE; ibuprofen; mega 3
Current Illness: None
Preexisting Conditions: High blood pressure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1007393P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Cough, Pyrexia, Respiratory tract congestion, Sinus disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Cough, chest congestion, sinus, fever. Children at home had been ill same week she received vaccine.

VAERS ID:367028 (history)  Vaccinated:2009-11-06
Age:50.0  Onset:2009-11-08, Days after vaccination: 2
Gender:Female  Submitted:2009-11-13, Days after onset: 5
Location:Virginia  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: The above info can be obtained by MC''s employee wellness nurse...you have my permission to discuss this with her.
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Reported to employee wellness nurse..I am an RN.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: DIZZY, LIKE MOTION SICKNESS DIZZINESS,I feel like I have motion sickness, but not all the time...it comes and goes.I work nites..had a hard time Monday night...Tuesday a little better.

VAERS ID:367151 (history)  Vaccinated:2009-11-09
Age:50.0  Onset:2009-11-09, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 4
Location:California  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergic to Cipro
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Eye swelling, Nausea, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Dizziness, nausea, swelling of the eyes and throat.

VAERS ID:367255 (history)  Vaccinated:2009-10-23
Age:50.0  Onset:2009-10-23, Days after vaccination: 0
Gender:Male  Submitted:2009-11-13, Days after onset: 21
Location:Minnesota  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500751P IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Wrong drug administered
SMQs:
Write-up: Patient 49 years of age and received the flu mist.

VAERS ID:367606 (history)  Vaccinated:2009-11-13
Age:50.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 3
Location:Florida  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allegra, singulair, albuterol, are what I am aware of.
Current Illness: No
Preexisting Conditions: Allergies; asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPO24AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Ear discomfort, Erythema, Eye pruritus, Ocular hyperaemia, Rash macular, Rhinorrhoea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: Employee complained of a runny nose and itchy eyes about 15 minutes after receiving vaccine. Then her ears and throat began itching. Skin around her eyes became red. 37.5 mg of Benadryl po given. She went home that afternoon and took her allegra and singulair. She states around 2 pm the itchy eys and ears returned and she took more Benadryl. She states she continued taking Benadryl through Sunday when symptoms would return; states her eyes remained red and blotchy until Sunday. Today, Monday 11/16/2009 she states she is back to normal with no residual effects.

VAERS ID:367725 (history)  Vaccinated:2009-11-02
Age:50.0  Onset:2009-11-02, Days after vaccination: 0
Gender:Female  Submitted:2009-11-09, Days after onset: 7
Location:Massachusetts  Entered:2009-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP003AA0IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3253AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Eye swelling, Ocular hyperaemia, Paraesthesia, Swelling face, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Per pt. 5 hours after vaccinations, developed the following symptoms: eyes were puffy and red, face was puffy and tingling, pt started wheezing,; pt states she called the ER who advised pt to take BENADRYL "which helped her"; pt states symptoms lasted 48 hours and denied further swelling as of 11/4/09; pt "had not had a flu shot since she had been 30".

VAERS ID:367748 (history)  Vaccinated:2009-11-12
Age:50.0  Onset:2009-11-12, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 0
Location:Pennsylvania  Entered:2009-11-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VESICARE; METHIMAZOLE; DIOVAN
Current Illness:
Preexisting Conditions: Thyroid and HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP007AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Pain, Pharyngeal oedema
SMQs:, Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Vaccination administered 11/12/2009. Employee noted a numbness of muscles on the right side. A swelling feeling L side of throat then terrible body ache from throat to bottom of foot. Still had when went to bed @ 10:30. Woke up fine.

VAERS ID:368199 (history)  Vaccinated:2009-10-27
Age:50.0  Onset:2009-11-03, Days after vaccination: 7
Gender:Female  Submitted:2009-11-17, Days after onset: 14
Location:Ohio  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BP medication (atavan)?
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP001AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Nodule, Oedema peripheral, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 1 week after H1N1 injection knot came up on pt''s wrist. Quarter-sized, fluid filled and hot. On 11/05/2009 lower arm had swelled and pt went to drs. Was given a shot (not sure of what) which helped. 1 week later the knot popped and disappeared into a pea-sized hard knot. Itchy. No problem at site of injection itself only lower arm.

VAERS ID:368215 (history)  Vaccinated:2009-10-15
Age:50.0  Onset:2009-10-15, Days after vaccination: 0
Gender:Female  Submitted:2009-11-17, Days after onset: 33
Location:Massachusetts  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: left arm pain~Influenza (Seasonal) (FluLaval)~1~9.83~Patient
Other Medications: NO MEDS
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLA275AA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pain in extremity
SMQs:
Write-up: pain in left arm at site has perisited unchanged until 11/17 despite treatment of heat and aleve

VAERS ID:368335 (history)  Vaccinated:2009-11-18
Age:50.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-18, Days after onset: 0
Location:Virginia  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies none
Preexisting Conditions: Hx asthma-no episode-7 years; Has had flu vaccine in past with no problems 12/22/09 PMH: Migraine headaches with aura (photophobia, blurred vision, nausea, teariness), asthma
Diagnostic Lab Data: O2 NC applied- Epi 0.5cc given, rescue squad came, client A&O talking & transport to facility 11/18/2009 12/22/09 LABS and DIAGNOSTICS: SpO2- 94%, Strep screen-Neg, Influenza A&B antigen-Neg, CBC/diff- Glucose 171 (H), MPV 11.1 (H), ASI 47 (H), neutrophil 26 (L), lymph 62 (H), mono 11(H), absolute lymph 6.0 (H), absolute mono 1.1 (H).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102040P10IMLA
Administered by: Public     Purchased by: Other
Symptoms: Asthma, Blood glucose increased, Dyspnoea, Full blood count abnormal, Headache, Hypersensitivity, Influenza serology negative, Nausea, Oxygen saturation decreased, Phonophobia, Streptococcus identification test negative, Vision blurred, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: Came to HD for H1N1 vaccine, IM given. Client went to her truck & came back into health dept. SOB with audible wheezing with whistling. 911 called. Taken she walked to clinic room with O2 applied- Epi given. 12/22/09 Hospital ER records received for DOS 11/18/09. Dx: Allergic reaction, Asthma with acute exacerbation precipitated by vac. Patient at local health dept and received H1N1 and after injection c/o SOB and wheezing. Received epie injection. Presented with shortness of breath, wheezing, headache with blurred vision, photophobia and nausea. Treated with dexamethasone, diphenhydramine, ketorolac, promethazine, budesonide nebulizer susp. and albuterol-ipratropium. Discharged.

VAERS ID:368427 (history)  Vaccinated:2009-10-29
Age:50.0  Onset:2009-11-06, Days after vaccination: 8
Gender:Female  Submitted:2009-11-18, Days after onset: 12
Location:Virginia  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA IMUN
Administered by: Public     Purchased by: Other
Symptoms: Fatigue, Myalgia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: 1 wk after vaccine-rash on chest 12 day after vaccine-general fatigue and muscle aches-rash.

VAERS ID:368582 (history)  Vaccinated:2009-09-22
Age:50.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-11-18, Days after onset: 57
Location:Maryland  Entered:2009-11-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNLA
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Injection site mass, Injection site pain, Local swelling, Pain, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Large local swelling 09/22/2009. Arm had an egg size knot where she received the vaccine, pain down to the elbow and when lifting arm up. The swelling lasted for a week. She also reported an asthma attack on 10/21/09, she did go to the emergency room and was treated with I.A, she was diagnosed with asthma in January. Her previous dose of flu vaccine was in 1989 and at that time her arm was swollen from shoulder to elbow, cold and red. She gets hives after she eats fresh tomatoes.

VAERS ID:368716 (history)  Vaccinated:2009-11-05
Age:50.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 14
Location:Oklahoma  Entered:2009-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  IJAR
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: When my arm was penetrated it hurt.

VAERS ID:368912 (history)  Vaccinated:2009-10-06
Age:50.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-20, Days after onset: 45
Location:New York  Entered:2009-11-20
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: latex allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960336P0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: asthma exacerbation

VAERS ID:368940 (history)  Vaccinated:2009-11-20
Age:50.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Male  Submitted:2009-11-20, Days after onset: 0
Location:North Carolina  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hyperlipidemia, Cervical DDD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eyelid oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: Symptoms noticed upon waking. Urticaria involving face (left side mainly), right AC fossa, glans penis. Mild left upper eyelid edema. Treated with Xyzal 5mg daily.

VAERS ID:369023 (history)  Vaccinated:2009-11-14
Age:50.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Georgia  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP018AA0UNLA
Administered by: Public     Purchased by: Other
Symptoms: Flushing, Muscle tightness, Paraesthesia, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Flush (cheeks, neck), tightness in neck and throat, upper lip and nose tip tingly and itched.

VAERS ID:369148 (history)  Vaccinated:2009-11-18
Age:50.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-20, Days after onset: 2
Location:Illinois  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Generalized anxiety disorder
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1008144P0IMAR
Administered by: Private     Purchased by: Public
Symptoms: Diarrhoea, Headache, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Tachycardia, diarrhea, headache.

VAERS ID:369206 (history)  Vaccinated:2009-11-16
Age:50.0  Onset:2009-11-16, Days after vaccination: 0
Gender:Female  Submitted:2009-11-20, Days after onset: 4
Location:Pennsylvania  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: past: two open heart surgeries, 1 kidney surgery.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Chills, Erythema, Mobility decreased, Oedema peripheral, Pain in extremity, Palpitations, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: My arm was very swollen, red, hot to the touch, painful, could not lift.Then I went into 36 hour of chills, heart racing, fever of 101.5 to 102, paleness, weakness. I still do not have my full stamina back. It was bad. I have never had a reaction like this to a flu shot, and may consider, not getting the swine flu shot this year, or the regular flu shot next year, contrary to recommendations. My arm is still swollen,and feels like I have a bad sunburn,and now it is spreading down my arm. My doctor said to ride it all out, as they were hearing of many reaction. If I had to do it over, I would have gone in for the office visit or ER. I probably should have been admitted. Tylenol was of only short mild comfort, and the fever spiked again.Being on coumidin, made this all very difficult, as I can not take asprin, and very limited Tylenol. The shot this year, was too scary for comfort. I wonder when I will feel completely better.

VAERS ID:369286 (history)  Vaccinated:2009-11-20
Age:50.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Female  Submitted:2009-11-22, Days after onset: 2
Location:Arkansas  Entered:2009-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Chills, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: SEVERE NAUSEA, FEVER, CHILLS, BODY ACHES

VAERS ID:369311 (history)  Vaccinated:2009-11-18
Age:50.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 5
Location:Puerto Rico  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO REPORT
Preexisting Conditions: NO REPORT
Diagnostic Lab Data: NONE
CDC Split Type: PR0925
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP001AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: REDNESS IN FACE, NECK AND SUPERIOR EXTREMITIES. HIGH FEVER (103F) AND PRURITUS. WAS RECOMENDED THAT SHE GO TO THE EMERGENCY ROOM BUT REFUSED. TOOK BENADRYL.

VAERS ID:369389 (history)  Vaccinated:2009-11-14
Age:50.0  Onset:2009-11-15, Days after vaccination: 1
Gender:Female  Submitted:2009-11-18, Days after onset: 3
Location:Kentucky  Entered:2009-11-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP021AA0IMRL
Administered by: Public     Purchased by: Public
Symptoms: Dysphonia, Influenza, Musculoskeletal stiffness, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Patient phoned 3 days post vaccine. Reported, received H1N1 vaccine on 11-14-09. Woke up next am with hoarseness, wheezing, fever, and stiff neck. Has inhaler used albuterol inhaler did not seek any medical care, rested, patient started feeling better she states on 11-17-09.

VAERS ID:369564 (history)  Vaccinated:2009-11-04
Age:50.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 8
Location:Massachusetts  Entered:2009-11-23, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (GSK)GLAXOSMITHKLINE BIOLOGICALSAFLLA257CA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Back pain, Dyspepsia, Fatigue, Headache, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Lower backache; stomach cramps; headache; aching shoulders; fatigue; heartburn x 4 days.

VAERS ID:369611 (history)  Vaccinated:2009-11-09
Age:50.0  Onset:2009-11-10, Days after vaccination: 1
Gender:Female  Submitted:2009-11-23, Days after onset: 13
Location:Washington  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Started to increase cholesterol meds.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB711AH2IMLA
Administered by: Public     Purchased by: Private
Symptoms: Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 11-10-09 AM. Blotchy rash on arms. Recovered, however, she is getting a rash on arms again. Thinks it might be something else.

VAERS ID:369689 (history)  Vaccinated:2009-10-22
Age:50.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-11-24, Days after onset: 33
Location:Ohio  Entered:2009-11-24
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: History of dermatitis.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysphagia, Erythema, Pruritus, Rash, Rash macular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow)
Write-up: Received H1N1 vaccine, within hours had itchy, blotchy red areas, fine rash, facial swelling, and slight discomfort with swallowing but no respiratory distress.

VAERS ID:369808 (history)  Vaccinated:2009-11-04
Age:50.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-11, Days after onset: 7
Location:Hawaii  Entered:2009-11-24, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Patient is taking SINGULAIR and Fexofenadine
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP002AA0IJLA
Administered by: Other     Purchased by: Private
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)
Write-up: Approximately 5.5 hours after administration of H1N1 vaccine, patient had three episodes of palpitations within a one hour period. No further palpitations after one hour.

VAERS ID:369912 (history)  Vaccinated:2009-11-12
Age:50.0  Onset:2009-11-13, Days after vaccination: 1
Gender:Male  Submitted:2009-11-22, Days after onset: 9
Location:North Carolina  Entered:2009-11-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102046P10IMUN
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Rash macular
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Sudden edema bilateral lower legs, red splotches both legs.

VAERS ID:370001 (history)  Vaccinated:2009-11-21
Age:50.0  Onset:2009-11-22, Days after vaccination: 1
Gender:Female  Submitted:2009-11-23, Days after onset: 1
Location:Florida  Entered:2009-11-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Florse 1 every 6 hours
Current Illness: No
Preexisting Conditions: Penicillin; Codine-Allergies; Asthma/Bronchitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102046P1 UNLA
Administered by: Public     Purchased by: Public
Symptoms: Food allergy, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash all over body. Admitted through Emergency Room to hospital. Received pills at hospital. 12/02/09 ED Records for DOS 11/23/09 Pt presented to ED with generalized rash, vaccinated 11/21 09 . Ate eggs on 11/22 DX:egg allergy

VAERS ID:370182 (history)  Vaccinated:2009-11-24
Age:50.0  Onset:2009-11-24, Days after vaccination: 0
Gender:Female  Submitted:2009-11-25, Days after onset: 1
Location:Illinois  Entered:2009-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: COPD, Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP022AA0IDLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, redness and soreness at injection sight.

VAERS ID:370245 (history)  Vaccinated:2009-10-07
Age:50.0  Onset:2009-10-17, Days after vaccination: 10
Gender:Female  Submitted:2009-11-25, Days after onset: 39
Location:Illinois  Entered:2009-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P2 IJLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: 10 days after shot, pt started to experience severe shoulder pain and numbness in hand and shoulder

VAERS ID:370331 (history)  Vaccinated:2009-11-16
Age:50.0  Onset:2009-11-17, Days after vaccination: 1
Gender:Female  Submitted:2009-11-27, Days after onset: 10
Location:Ohio  Entered:2009-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Codeine allergy, Asthma, Hypertension, and Hyperlipidemia. 12/1/09 Medical records received, service dates 11/24/09 to 12/1/09. Parethesias in feet, numbness in toes. Chronic low back pain, cervical disk problems. Hyperlipidemia, hypertension, recurrent MRSA infections toe and perirectal, Migraines with aura - left sided vision changes, numb on left side, confused. Bronchial asthma. Cesarean section, hysterotomy. Ganglion (L) hand. Normal prior EMG studies.
Diagnostic Lab Data: Inconclusive EMG on 11/25/2009 to rule out Guillian-Barre Syndrome. 12/1/09 Medical records received, service dates 11/24/09 to 12/1/09. LABS and DIAGNOSTICS: EMG - Normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00349611A0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Asthenia, Caffeine consumption, Choking, Clonus, Dysphagia, Electromyogram normal, Fatigue, Hyperreflexia, Hypoaesthesia, Musculoskeletal pain, Pain in extremity, Paraesthesia, Sensory loss
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Experienced paresthesis and achiness of feet, then legs, then hands, and arms progressing over 9 days. Today, on day 10 hips and shoulders also painful. Weakness and pain worse on exertion. Numbness and tingling most concentrated in hands and feet, lower arms and legs. 12/1/09 Medical records received, service dates 11/24/09 to 12/1/09. Assessment: Muscle weakness, fatigue, paresthesias, and aching. Patient complains of body aches, presents with tingling, numbness, and migratory paresthesias. Worried re Guillain Barre. Numbness and tingling soles of feet, aching in feet. Weakness of dorsiflexion of left big toe. Numbness progessed to thighs, tingling numbness in hands, forearms. Feels cold all over. Weakness, fatigue. Choked on food, liquid, dysphagia. Clonus (L) foot. Decreased pinprick perception (L) lower extremity. Hyperreflexia. Caffeinated beverages. Continues to have pain in feet and legs, also shoulders and hips.

VAERS ID:370419 (history)  Vaccinated:2006-10-26
Age:50.0  Onset:2006-10-27, Days after vaccination: 1
Gender:Male  Submitted:2009-11-29, Days after onset: 1129
Location:Washington  Entered:2009-11-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~0.00~Patient
Other Medications:
Current Illness: none
Preexisting Conditions: lung condition
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJGM
Administered by: Private     Purchased by: Private
Symptoms: Chills, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Aches, fever, chills, 6 inches diamater of sewlling at injection site. The symptoms lasted for two days. I called to report the reaction and the nurse said that it never happens.

VAERS ID:370609 (history)  Vaccinated:2009-11-09
Age:50.0  Onset:2009-11-09, Days after vaccination: 0
Gender:Male  Submitted:2009-11-25, Days after onset: 16
Location:Arkansas  Entered:2009-11-30, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient denied any concurrent illnesses. He has no known allergies or medical history other than seasonal allergies. The patient denied having any adverse events with prior vaccination, and had not received any other vaccinations within four weeks of receiving FLUZONE on 09 November 2009.
Diagnostic Lab Data: not reported
CDC Split Type: 200904985
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3260EA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure increased, Chills, Hyperhidrosis, Hypoaesthesia oral, Lacrimation increased, Ocular hyperaemia, Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow)
Write-up: Initial report received on 16 November 2009 from a consumer''s spouse. A 50-year-old male patient, who has seasonal allergies, had received an intramuscular right deltoid injection of FLUZONE 2009-2010 (lot number U3260EA) on 09 November 2009. Four hours post-vaccination the patient complained of a "weird feeling in throat" so he took BENADRYL 50mg. Both eyes became blood shot and were tearing. His lower lip became numb and his tongue was swollen. The patient went to the emergency room. At that time, his blood pressure was increased (reading not provided) and he was administered SOLUMEDROL, PEPCID and "saline." The patient then developed chills and sweats. By the next morning, all symptoms had resolved. Documents held by sender: None.

VAERS ID:370662 (history)  Vaccinated:2009-11-25
Age:50.0  Onset:2009-11-26, Days after vaccination: 1
Gender:Female  Submitted:2009-11-30, Days after onset: 4
Location:South Carolina  Entered:2009-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaquenil,Lipitor,lisinipril,Tylenol Arthritis, , Nexium
Current Illness: None
Preexisting Conditions: Systemic Lupus Erythematosis Hypertension
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURUF451DA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1339Y2IMRA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Chills
SMQs:, Neuroleptic malignant syndrome (broad)
Write-up: Received Pneumovax on 11/26/09. Chills started 11/26 pm, on 11/27, chills and temp to 102.6 F, highest reached was 103.6. Started Motrin and no fever by 11/28 pm on Motrin.

VAERS ID:370669 (history)  Vaccinated:2009-11-25
Age:50.0  Onset:2009-11-26, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Florida  Entered:2009-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Heart disease; NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP027AB0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis contact, Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: Rash around injection site. (R) deltoid under arm and chest, raised area (appears as contact dermatitis) 24 hours after shot Loradine and Benadryl.

VAERS ID:370732 (history)  Vaccinated:2009-11-22
Age:50.0  Onset:2009-11-28, Days after vaccination: 6
Gender:Male  Submitted:2009-11-30, Days after onset: 2
Location:Colorado  Entered:2009-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine; Lisinopril; LANTUS; Glyburide; WELLBUTRIN
Current Illness: Diabetes
Preexisting Conditions: None listed
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP015AA0IJRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site anaesthesia, Injection site pain, Injection site swelling, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient received vaccination on 11/22/09. He states his arm swelled on 11/28/09, with numbness, tingling and pain. He called the pharmacy on 11/30/09 out of concern. We have asked him to visit a physician or urgent care.

VAERS ID:370788 (history)  Vaccinated:2009-11-07
Age:50.0  Onset:2009-11-12, Days after vaccination: 5
Gender:Female  Submitted:2009-11-30, Days after onset: 18
Location:Texas  Entered:2009-12-01, Days after submission: 1
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: Hypertension; Diabetes 12/02.09 PMH: Type II Diabetes Mellitus; hypertension. Allergies: NKDA
Diagnostic Lab Data: CT; MRI - normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR4P016AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Angiotensin converting enzyme, Blood folate normal, Blood thyroid stimulating hormone normal, Borrelia burgdorferi serology negative, Computerised tomogram normal, Ear pain,