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Found 505988 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:115707 (history)  Vaccinated:0000-00-00
Age:49.4  Onset:1988-10-27
Gender:Female  Submitted:1998-10-23, Days after onset: 3648
Location:Vermont  Entered:1998-11-04, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Asthenia, Facial palsy, Guillain-Barre syndrome, Hyperhidrosis, Hypokinesia, Myasthenic syndrome, Pain, Paraesthesia, Speech disorder
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax & exp sweat, numbness in feet & hands;pt then put in hosp;GBS 3 days later in ICU;had bell''s palsy;had to learn to talk, eat, walk again;pt states was in perfect health a/shot;

VAERS ID:116053 (history)  Vaccinated:1998-10-15
Age:49.4  Onset:1998-10-15, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:1998-11-09
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: vitamins
Current Illness: NONE
Preexisting Conditions: case reports that 20yrs ago had allergy tsting that showed many environmental allergies on 21OCT;reported that testing 20yr ago showed allergy to eggs but did not report this;hx of asthma;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09757800 RA
Administered by: Public     Purchased by: Public
Symptoms: Anxiety, Asthma, Condition aggravated, Cough, Dyspnoea, Hypersensitivity, Laryngospasm, Myalgia, Respiratory disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: 2hr p/vax devel sore arm, 3hr p/vax devel resp problems which indicated some difficulty breathing & deep, raspy, non productive cough;by 5hr later felt throat swelling & inc resp distress;went to ER 7PM;felt like asthma;poss allerg react

VAERS ID:116057 (history)  Vaccinated:1995-11-03
Age:49.6  Onset:1995-11-07, Days after vaccination: 4
Gender:Male  Submitted:1998-10-09, Days after onset: 1066
Location:Georgia  Entered:1998-11-09, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: emphysema
Preexisting Conditions: emphysema
Diagnostic Lab Data:
CDC Split Type: GA98079
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4958107 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: pt recv vax 3NOV95 & reports devel GBS;pt hosp for numbness in fingers & toes;referred to MD;

VAERS ID:116108 (history)  Vaccinated:1998-10-28
Age:49.9  Onset:1998-10-29, Days after vaccination: 1
Gender:Female  Submitted:1998-10-29, Days after onset: 0
Location:Virginia  Entered:1998-11-09, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: VA98075
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4543870 RL
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site abscess, Injection site hypersensitivity, Injection site pain, Skin disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: school nurse noted small amount serous drainage in area of inj, broken skin1cm upper are 7 3cm lower area where vax given site was pink & some soreness noted on palpation;

VAERS ID:116165 (history)  Vaccinated:1998-09-08
Age:49.2  Onset:1998-09-10, Days after vaccination: 2
Gender:Female  Submitted:1998-09-15, Days after onset: 5
Location:Washington  Entered:1998-11-10, Days after submission: 56
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKDA
Diagnostic Lab Data: NONE
CDC Split Type: WA981492
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4478270IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt w/redness, painful @ site lt deltoid;tx med;

VAERS ID:116191 (history)  Vaccinated:1998-10-27
Age:49.4  Onset:1998-10-28, Days after vaccination: 1
Gender:Female  Submitted:1998-11-03, Days after onset: 6
Location:Oklahoma  Entered:1998-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: clariten/seasonal allergies,tetracycline
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Public
Symptoms: Headache, Myalgia, Pyrexia, Rhinitis, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: h/a, temp 99.5, stuffy nose, severe muscle aches & pains all over body, broke out in hives, face/lt thigh ;

VAERS ID:116362 (history)  Vaccinated:1998-11-02
Age:49.1  Onset:1998-11-02, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1998-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882070 RA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Laryngospasm
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: SOB, feeling of constricted throat;given med;

VAERS ID:116409 (history)  Vaccinated:1998-11-03
Age:49.0  Onset:1998-11-03, Days after vaccination: 0
Gender:Female  Submitted:1998-11-04, Days after onset: 1
Location:Iowa  Entered:1998-11-16, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: Claritin
Current Illness: UNK
Preexisting Conditions: Feather allergies, seasonal allergies
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER00508P IML
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Conjunctivitis, Eye disorder, Eye pain, Face oedema, Lacrimal disorder, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/3/98; 3 hr later pt exp swollen/red/watery eyes, low back pain, thigh pain, chills; tx=ice for eyes & Tylenol

VAERS ID:116494 (history)  Vaccinated:1998-10-20
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1998-11-11
Location:Colorado  Entered:1998-11-18, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02198P1 RA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Diarrhoea, Headache, Influenza, Lung disorder, Myalgia, Nausea, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: 2wk muscle aches, nausea, stomach cramping, loose stools, all flu-like sx, severe h/a, congestion in head & lungs;

VAERS ID:116599 (history)  Vaccinated:1998-10-27
Age:49.1  Onset:1998-10-27, Days after vaccination: 0
Gender:Female  Submitted:1998-11-03, Days after onset: 7
Location:Massachusetts  Entered:1998-11-20, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: Feeling under the weather for a while
Preexisting Conditions: Allergic to Penicillin & Codeine
Diagnostic Lab Data: NONE
CDC Split Type: MA9833
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09757800IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/27/98; on same day pt exp red, itchy arm x 3 day

VAERS ID:116682 (history)  Vaccinated:1998-10-06
Age:49.8  Onset:1998-10-09, Days after vaccination: 3
Gender:Female  Submitted:1998-11-12, Days after onset: 34
Location:Kentucky  Entered:1998-11-23, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to Sulfa(hives & stinging)
Diagnostic Lab Data: NONE
CDC Split Type: KY980039
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2702A40IMLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Headache, Nuchal rigidity, Pain
SMQs:, Arthritis (broad)
Write-up: Pt recv vax on 10/6/98; on 10/9/98 pt exp headache, stiff neck, right elbow discomfort x 2 wk;tx=Advil & Tylenol

VAERS ID:116714 (history)  Vaccinated:1998-10-26
Age:49.4  Onset:1998-10-27, Days after vaccination: 1
Gender:Female  Submitted:1998-11-09, Days after onset: 13
Location:Maryland  Entered:1998-11-23, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hayfever
Diagnostic Lab Data: NONE
CDC Split Type: MD98021
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882120 LA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Confusional state, Diarrhoea, Dizziness, Headache, Hyperhidrosis, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: awakened by h/a @ 2Am or 3AM;cold sweats, dizziness, chills, vomited off & on until 7Am;felt weak, tired & disoriented & a sore arm;also admits to diarrhea;returned to work next day;

VAERS ID:116953 (history)  Vaccinated:1998-07-26
Age:49.8  Onset:1998-11-17, Days after vaccination: 114
Gender:Male  Submitted:1998-11-18, Days after onset: 1
Location:Iowa  Entered:1998-11-30, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: Laceration injury
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES454678  LA
Administered by: Private     Purchased by: Other
Symptoms: Injection site atrophy, Injection site pain, Myasthenic syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt recv vax on 7/26/98; on 11/17/98 pt exp LA pain & atrophy at vax site; pt referred to neurologist

VAERS ID:117009 (history)  Vaccinated:1998-11-19
Age:49.8  Onset:1998-11-20, Days after vaccination: 1
Gender:Male  Submitted:1998-11-23, Days after onset: 3
Location:Oregon  Entered:1998-12-01, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: Imipramine, Glucotrol XL
Current Illness: UNK
Preexisting Conditions: NIDDM, Hypertension
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882001IMLA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/19/98; on 11/20/98 pt exp itching (hands, feet, neck), hot skin w/ goose bumps

VAERS ID:117050 (history)  Vaccinated:1998-11-05
Age:49.0  Onset:1998-11-05, Days after vaccination: 0
Gender:Female  Submitted:1998-11-30, Days after onset: 25
Location:Illinois  Entered:1998-12-03, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Dehydration, Hyperhidrosis, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 11/5/98; 4 hr post vax pt exp fever, chills, sweats & body aches, dehydration & drained

VAERS ID:117076 (history)  Vaccinated:1998-11-09
Age:49.9  Onset:1998-11-09, Days after vaccination: 0
Gender:Female  Submitted:1998-11-19, Days after onset: 10
Location:Ohio  Entered:1998-12-04, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: diabetic/asthmatic (nose)
Preexisting Conditions: sulfa, darvon, Pcn, percocet, codeine, inc food allergies
Diagnostic Lab Data: NONE
CDC Split Type: OH98100
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4549770 RA
Administered by: Public     Purchased by: Public
Symptoms: Ecchymosis, Hypothermia, Injection site hypersensitivity, Injection site mass, Injection site oedema, Pharyngitis, Pruritus, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal infections (narrow), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 9NOV98 10PM noted some itching;by 6PM 10NOV98 had a baseball size redness & swelling @ inj site;saw MD on 11NOV98 p/4:00;stated had a definite rxn;ear temp 92;told to never have vax again;devel cold or pneumonia;bruise;c/o cold sx & cough;

VAERS ID:117129 (history)  Vaccinated:1998-10-29
Age:49.1  Onset:1998-10-30, Days after vaccination: 1
Gender:Male  Submitted:1998-11-19, Days after onset: 20
Location:Ohio  Entered:1998-12-07, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Vtamins, insulin;
Current Illness: NONE
Preexisting Conditions: diabetic x 25yr
Diagnostic Lab Data: Cat Scan-lab work;
CDC Split Type: OH98103
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09786705IMRA
Administered by: Other     Purchased by: Public
Symptoms: Diplopia, Myalgia, Paraesthesia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Ocular motility disorders (broad)
Write-up: 30OCT98 c/o diplopia, rt facial numbness;pt is diabetic; tested blood sugar-was WNL; referred to MD;also seen other referred to clinic for consult;c/o muscle aches, n/v;

VAERS ID:117451 (history)  Vaccinated:1998-10-27
Age:49.8  Onset:0000-00-00
Gender:Female  Submitted:1998-12-11
Location:Florida  Entered:1998-12-16, 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) (FLUZONE)CONNAUGHT LABORATORIES0981820  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Pharyngitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow)
Write-up: cough, sore throat;

VAERS ID:117713 (history)  Vaccinated:1998-12-11
Age:49.2  Onset:1998-12-12, Days after vaccination: 1
Gender:Female  Submitted:1998-12-15, Days after onset: 3
Location:New Jersey  Entered:1998-12-28, 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: HCTZ
Current Illness: NONE
Preexisting Conditions: biaxin-CNS, GI upset
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1094H0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: arm became very swollen, & red in color;

VAERS ID:117917 (history)  Vaccinated:1998-10-20
Age:49.5  Onset:1998-10-20, Days after vaccination: 0
Gender:Female  Submitted:1998-12-31, Days after onset: 72
Location:New York  Entered:1999-01-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: blood work done by MD
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Face oedema, Insomnia, Laryngospasm
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recv vax 20OCT98 6PM by 9PM felt very tired & throat felt strange;430Am awoke & upper lip & face especially the lt side were swollen & joints were swollen & ached;p/ 2 days lip & face were down;joints gave pt problems for 6wk;

VAERS ID:118036 (history)  Vaccinated:1998-10-23
Age:49.1  Onset:1998-10-23, Days after vaccination: 0
Gender:Female  Submitted:1998-10-24, Days after onset: 1
Location:Minnesota  Entered:1999-01-12, Days after submission: 80
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt daughter exp severe reaction to walnuts & PCN & some antibiotics-hives;carries epi pen;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09805300IMLA
Administered by: Public     Purchased by: Other
Symptoms: Amblyopia, Asthenia, Conjunctivitis, Dyspnoea, Hypokinesia, Influenza, Laryngospasm, Migraine, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: eyes very reddened-blurred;lump in throat, sl difficulty breathing;recv flu vax 2:30 came back 810PM sx had progressed over 5hr;911 called;IV DPH & meds for nausea given;weakened & body ache;could hardly walk;migraine;felt like had flu;

VAERS ID:118240 (history)  Vaccinated:1998-12-16
Age:49.0  Onset:1998-12-16, Days after vaccination: 0
Gender:Female  Submitted:1999-01-19, Days after onset: 34
Location:Pennsylvania  Entered:1999-01-21, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Allergic to antibiotics
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2796A21IMRA
Administered by: Public     Purchased by: Private
Symptoms: Face oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 12/16/98; 20 min post vax pt exp hives on rt arm, hands & face; swollen lips; itchy all over; tx= Benadryl

VAERS ID:118357 (history)  Vaccinated:1997-10-15
Age:49.8  Onset:1997-10-17, Days after vaccination: 2
Gender:Male  Submitted:1998-10-09, Days after onset: 357
Location:New Jersey  Entered:1999-01-26, Days after submission: 109
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: 7681
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.L05374IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: pt recv vax 15OCT97 & 3 days p/vax pt exp h/a, nausea & aches;h/a described as bad h/a that are progressively worse;

VAERS ID:118433 (history)  Vaccinated:1998-11-19
Age:49.8  Onset:0000-00-00
Gender:Female  Submitted:1999-01-08
Location:Michigan  Entered:1999-01-29, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: allerg PCN, dust, mold, mildew & cats
Diagnostic Lab Data: NONE
CDC Split Type: MI99004
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882041IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: approx 24-36hr post vax exp rash on lower arms & legs;pt stated they were red raised bumps caused itching;no other sx devel;rash lasted approx 2 days;

VAERS ID:118826 (history)  Vaccinated:1998-11-05
Age:49.3  Onset:1998-11-06, Days after vaccination: 1
Gender:Male  Submitted:1999-01-19, Days after onset: 74
Location:Kentucky  Entered:1999-02-09, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Norvasc, Hytrin
Current Illness: NONE
Preexisting Conditions: Hypertension, Hx of radical prostatectomy
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS021198P0 LA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/5/98; on 11/6/98 pt exp raised, red, itchy welts over body x 1 mon

VAERS ID:118882 (history)  Vaccinated:1998-11-03
Age:49.5  Onset:1998-11-04, Days after vaccination: 1
Gender:Female  Submitted:1999-02-05, Days after onset: 93
Location:Illinois  Entered:1999-02-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations: pt exp large scab center as child w/?smallpox vax;
Other Medications: NONE
Current Illness: not to my knowledge
Preexisting Conditions: allergy to PCN
Diagnostic Lab Data: pt had same type of scan to head which was negative;drew blood (can''t recall results);might have had another test;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09757900 LA
Administered by: Public     Purchased by: Private
Symptoms: Abdominal pain, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: severe h/a then nausea & severe vomiting;extreme nausea cont;pain in abd & chest;went to ER via husband transported;still had severe h/a;med given; hosp over noc on monitor;

VAERS ID:119110 (history)  Vaccinated:1998-11-04
Age:49.0  Onset:1998-11-04, Days after vaccination: 0
Gender:Male  Submitted:1998-11-13, Days after onset: 9
Location:Wisconsin  Entered:1999-02-11, Days after submission: 90
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: FLU90141198
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS00508P0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Lung disorder, Malaise, Myalgia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 11/4/98; on same day pt exp not feeling good, achy, possible congestion

VAERS ID:119181 (history)  Vaccinated:1999-02-15
Age:49.0  Onset:1999-02-15, Days after vaccination: 0
Gender:Male  Submitted:1999-02-15, Days after onset: 0
Location:New York  Entered:1999-02-19, 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: Vuscipt, Cobion, Acuplovi
Current Illness: NONE
Preexisting Conditions: HIV-normal T cell subsets on therapy
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120B90IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt recv vax on 2/15/99; in 1 hr post vax pt exp rigor & fever (102)

VAERS ID:119284 (history)  Vaccinated:1997-10-24
Age:49.6  Onset:1997-10-28, Days after vaccination: 4
Gender:Female  Submitted:1997-12-19, Days after onset: 52
Location:Michigan  Entered:1999-02-23, Days after submission: 431
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lariam given 24OCT97
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: VIV9810
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.  SC 
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD  PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & devel mouth rash-white like along teeth in cheek one side (DOSE #1); pt recv vax & devel 1 spot (rash) lower lip w/#2 dose;

VAERS ID:119300 (history)  Vaccinated:1998-08-21
Age:49.5  Onset:0000-00-00
Gender:Female  Submitted:1998-09-02
Location:Tennessee  Entered:1999-02-23, Days after submission: 174
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec for allergy), hormones,fungecide (toe now)
Current Illness:
Preexisting Conditions: PCN, sulfa, codeine, ceclor
Diagnostic Lab Data: NONE
CDC Split Type: VIV9833
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2719A21IMLA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD0150511A0PO 
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES09464900SCRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Headache, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt called clinic on 27AUG98 & reported that had nausea, stomach/abd, cramps, h/a, feeling bad 1 1/2 days p/vax 1st dose;

VAERS ID:119540 (history)  Vaccinated:1997-10-09
Age:49.2  Onset:1997-10-09, Days after vaccination: 0
Gender:Female  Submitted:1997-10-20, Days after onset: 11
Location:Pennsylvania  Entered:1999-02-26, Days after submission: 494
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: BP 60/40
CDC Split Type: 7621
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81883   
Administered by: Other     Purchased by: Other
Symptoms: Chills, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt recv vax on 10/9/97; 6 min post vax pt exp hypotension, coldness, clammy sweat, almost passing out

VAERS ID:119547 (history)  Vaccinated:1997-10-10
Age:49.8  Onset:1997-10-10, Days after vaccination: 0
Gender:Female  Submitted:1997-11-13, Days after onset: 34
Location:Michigan  Entered:1999-02-26, Days after submission: 470
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozar, Prempro
Current Illness: NONE
Preexisting Conditions: Allergic to Keflex, Penicillin & metal
Diagnostic Lab Data:
CDC Split Type: 7629
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81816   
Administered by: Private     Purchased by: Other
Symptoms: Chills, Cough, Diarrhoea, Injection site hypersensitivity, Injection site mass, Injection site pain, Pyrexia, Rhinitis, Vasodilatation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt recv vax on 10/10/97; 3 hr post vax pt exp local rxn of red, warmth, tender & induration; {12 hr post vax pt exp fever, chills, cough, runny nose, diarrhea &vomiting} x 24 hr

VAERS ID:119581 (history)  Vaccinated:1997-10-30
Age:49.0  Onset:1997-10-30, Days after vaccination: 0
Gender:Female  Submitted:1998-11-17, Days after onset: 383
Location:New Jersey  Entered:1999-02-26, Days after submission: 101
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: 7693
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81916   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Nausea, Pharyngitis, Rhinitis
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 30OCT97 & 5min p/vax pt exp h/a;10min p/vax pt exp nausea;40min p/pt exp sniffling & congestion;tx consisted of APAP & fluids;

VAERS ID:119585 (history)  Vaccinated:1997-10-15
Age:49.7  Onset:1997-10-16, Days after vaccination: 1
Gender:Male  Submitted:1998-11-17, Days after onset: 397
Location:Minnesota  Entered:1999-02-26, Days after submission: 101
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen 15OCT
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, sed rate
CDC Split Type: 7697
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817400 LA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 15OCT97 & the next day pt exp a generalized rash;pt had one episode of nausea & dizziness while had the rash;the episode lasted 15min;

VAERS ID:119671 (history)  Vaccinated:1997-10-24
Age:49.5  Onset:0000-00-00
Gender:Female  Submitted:1998-06-04
Location:Maryland  Entered:1999-02-26, Days after submission: 267
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Novacaine, nitrous oxide
Diagnostic Lab Data: NONE
CDC Split Type: U199800271
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817910IMLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Hypertonia, Hypokinesia, Injection site hypersensitivity, Injection site pain, Myalgia, Myasthenic syndrome, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt recv vax on 10/24/97; on 10/25/97 pt exp red/ aching upper LA, stiff LA to left upper back & left side neck, unable to lift LA

VAERS ID:119820 (history)  Vaccinated:1997-12-28
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1999-03-01
Location:Illinois  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant dat;
Other Medications: Estrogenic preparations;Thyroid;Vitamins;
Current Illness:
Preexisting Conditions: PCN allergy
Diagnostic Lab Data: NONE
CDC Split Type: WAES98012658
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Adverse drug reaction, Pharyngitis, Rhinitis, Similar reaction on previous exposure to drug
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow)
Write-up: pt recv vax 28DEC97 & pt devel cold sx for 10 days;24JAN98 pt recv 2nd dose of vax & devel upper resp sx for 10 days;

VAERS ID:119864 (history)  Vaccinated:1998-03-11
Age:49.2  Onset:1998-03-12, Days after vaccination: 1
Gender:Female  Submitted:1999-03-01, Days after onset: 354
Location:Tennessee  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: 3/16/98: Chest X-ray
CDC Split Type: WAES98031465
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Chills, Cough, Diarrhoea, Infection, Malaise, Pneumonia, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: Pt recv vax on 3/11/98 (vax expired 1/98); on 3/12/98 pt exp tiredness, malaise, non-productive cough, chills, fever (99-100F), diarrhea, vomiting; dx=pneumonia

VAERS ID:119992 (history)  Vaccinated:1998-09-08
Age:49.1  Onset:1998-09-09, Days after vaccination: 1
Gender:Male  Submitted:1999-03-01, Days after onset: 173
Location:Florida  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: PCN allergy
Diagnostic Lab Data:
CDC Split Type: WAES98090538
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1167E0IM 
Administered by: Public     Purchased by: Private
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: pt recv vax 8SEP98 & 9SEP98 pt exp extensive rash w/red bumps primarily on arms, legs, chest & back;the rash was treated w/steroids;

VAERS ID:120214 (history)  Vaccinated:1998-10-10
Age:49.0  Onset:1998-10-10, Days after vaccination: 0
Gender:Male  Submitted:1998-10-20, Days after onset: 10
Location:New Jersey  Entered:1999-03-03, Days after submission: 134
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: wound
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898299015A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4978074 IMA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 10OCT98 & later that day pt devel an inj site rxn characterized by redness, pain, mild swelling & warmth;

VAERS ID:120374 (history)  Vaccinated:1998-05-29
Age:49.1  Onset:1998-08-01, Days after vaccination: 64
Gender:Female  Submitted:1999-03-13, Days after onset: 224
Location:New York  Entered:1999-03-16, 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:
Preexisting Conditions: Existing granuloma & fatigue
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM58160086105   
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Condition aggravated, Granuloma skin
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Pt recv vax on 5/29/98; in 8/98 pt exp inc fatigue w/ inc granuloma of entire body

VAERS ID:120506 (history)  Vaccinated:1997-11-08
Age:49.4  Onset:1997-11-12, Days after vaccination: 4
Gender:Female  Submitted:1998-04-24, Days after onset: 162
Location:California  Entered:1999-03-22, Days after submission: 332
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: lt hand needlestick
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898118003L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)PFIZER/WYETH49781250IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax & 4 days post vax pt devel an inj site rxn characterized by swelling & pain;pt recovered;

VAERS ID:120785 (history)  Vaccinated:1999-02-02
Age:49.6  Onset:1999-02-02, Days after vaccination: 0
Gender:Female  Submitted:1999-03-23, Days after onset: 49
Location:North Carolina  Entered:1999-03-30, 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: multiple sclerosis remission
Preexisting Conditions: multiple sclerosis remission
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Hypertonia, Multiple sclerosis, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow)
Write-up: burning sensation & numbness in legs, exacerbation of MS sx, spasms in legs for several days;took anti spasticity med for several weeks;

VAERS ID:121227 (history)  Vaccinated:1999-04-07
Age:49.0  Onset:1999-04-07, Days after vaccination: 0
Gender:Female  Submitted:1999-04-12, Days after onset: 5
Location:New York  Entered:1999-04-14, 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: Lyme Disease, Orthostatic hypotension, similar rxn to medrol inj
Diagnostic Lab Data:
CDC Split Type: 19990081631
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Other     Purchased by: Other
Symptoms: Hypertension, Laryngospasm, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 7APR99 & same day pt exp inc BP, shakiness & throat closed;tx w/DPH;

VAERS ID:121469 (history)  Vaccinated:1998-12-14
Age:49.0  Onset:1998-12-15, Days after vaccination: 1
Gender:Female  Submitted:1999-03-25, Days after onset: 100
Location:California  Entered:1999-04-26, Days after submission: 31
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: ASP; Sulfur
Diagnostic Lab Data: Normal CT brain & sinuses CT Scan; MRI $g Head 1999; Blood tests
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0994610 IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Amnesia, Arthropathy, Facial palsy, Myalgia, Neuralgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Pt recv vax on 12/14/98; on 12/15/98 pt exp lt facial neuralgia. Medical record on 05/05/04 states: diagnoses of cervical and lumbar degenerative disc disease, Bell''s Palsy, and fibromyalgia. - UPDATE 08/04/2005 Received a fax from the patient requesting help with a ''vaccine petition'' because of her memory problems. UPDATE 10/17/05 Received letter from the patient asking for a note to be placed in her VAERS record about the fact that the vaccine contained mercury. Headaches and now nerve damage to the left side of my face. Pu on TEGNETOL in March of 00. Now on one TEGNETOL.

VAERS ID:121741 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:1998-09-17
Location:New York  Entered:1999-04-26, Days after submission: 221
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lariam 1996
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19980232671
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Asthma, Rash
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 1996 & exp fluid discharge from the rt nipple;nipple became raised & devel a rash;pt exp two days of wheezing;

VAERS ID:121758 (history)  Vaccinated:1999-02-01
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:1999-02-24
Location:New York  Entered:1999-04-26, Days after submission: 60
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pt had lyme disease 5 yr ago
Diagnostic Lab Data:
CDC Split Type: 19990032511
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Headache, Hypersensitivity, Pain
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt recv vax on 2/1/99; post vax pt exp headache, achy joints &burning knees; dx=allergic rxn to vax

VAERS ID:121764 (history)  Vaccinated:1999-02-22
Age:49.0  Onset:1999-02-22, Days after vaccination: 0
Gender:Female  Submitted:1999-02-26, Days after onset: 4
Location:Massachusetts  Entered:1999-04-26, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 19990048781
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Chills, Dizziness, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: Pt recv vax on 2/22/99; 3 hr post vax pt exp fever, nausea, aches, dizzy & chills

VAERS ID:121616 (history)  Vaccinated:1999-03-24
Age:49.0  Onset:1999-03-24, Days after vaccination: 0
Gender:Female  Submitted:1999-04-14, Days after onset: 20
Location:Minnesota  Entered:1999-04-27, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120D90 A
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain, Asthenia, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: sore arm 1st day lasted about 3-4 days;h/a 2nd day lasted 1 day;sore arm muscles calves to legs (both legs) 3rd day left knee & hip hurt 3rd day lasted 2 days;tired 3rd day & lasted many days;stomach cramp 3rd day lasted 2 days;no appetite

VAERS ID:121640 (history)  Vaccinated:1998-10-21
Age:49.6  Onset:1999-02-16, Days after vaccination: 118
Gender:Unknown  Submitted:0000-00-00
Location:Texas  Entered:1999-04-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: viral cult positive flu A
CDC Split Type: TX99073
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09739306IMRL
Administered by: Other     Purchased by: Public
Symptoms: Influenza
SMQs:
Write-up: flu-like illness;

VAERS ID:121891 (history)  Vaccinated:1999-04-21
Age:49.6  Onset:1999-04-21, Days after vaccination: 0
Gender:Female  Submitted:1999-04-27, Days after onset: 6
Location:New Mexico  Entered:1999-05-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Estrace;Chlortrimeton PRN;Vitamins
Current Illness: routine physical exam
Preexisting Conditions: hx allergies/asthma/hysterectomy 1982
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09895800IMRA
Administered by: Private     Purchased by: Private
Symptoms: Asthma, Condition aggravated, Hypersensitivity, Injection site pain, Lymphadenopathy, Rhinitis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 21APR99 9AM & later in the day exp allergy/asthma sx, +nasal congestion, swollen lymph glands bilat axilla, no fever, no general malaise, no h/a, no aches;states sx lasted 3-4 days +tenderness @ site;

VAERS ID:122092 (history)  Vaccinated:1999-05-04
Age:49.0  Onset:1999-05-05, Days after vaccination: 1
Gender:Female  Submitted:1999-05-07, Days after onset: 2
Location:Connecticut  Entered:1999-05-12, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Prior hx of lyme meningitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120B91IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 5/4/99; on 5/5/99 pt exp local erythema & swelling at and below vax site x 72 hr

VAERS ID:122099 (history)  Vaccinated:1999-04-28
Age:49.5  Onset:1999-04-29, Days after vaccination: 1
Gender:Male  Submitted:1999-05-12, Days after onset: 13
Location:Colorado  Entered:1999-05-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt devel sarcoidosis granulomas @ age 49 w/hep b dose 1;
Other Medications: Prilosec;Zyrtec;Zantac
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19990104091
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2803A41IMLA
Administered by: Public     Purchased by: Public
Symptoms: Adverse drug reaction, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 28APR99 & 29APR99 exp outbreak of red hard bumps of different sizes on both arms;they spread to the sides of the trunk & buttocks, back of legs, thighs & calves;none on abd;being tx w/ prednisone

VAERS ID:124340 (history)  Vaccinated:1998-11-17
Age:49.8  Onset:1998-12-09, Days after vaccination: 22
Gender:Female  Submitted:1999-05-14, Days after onset: 155
Location:Massachusetts  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No Relevant Data
Other Medications:
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98121092
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1259H0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dermatitis bullous, Infection, Lymphadenopathy, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: p/vax pt devel swollen glands, a few itchy vesicles & a low grade fever;pt sought medical attention & was dx w/chickenpox;

VAERS ID:122416 (history)  Vaccinated:1999-05-05
Age:49.3  Onset:1999-05-08, Days after vaccination: 3
Gender:Female  Submitted:1999-05-18, Days after onset: 10
Location:Oklahoma  Entered:1999-05-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: motrin
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Hypertonia, Hypokinesia, Injection site pain, Lymphadenopathy, Oedema, Osteoarthritis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow)
Write-up: pt very sore at inj site, edema, pain in all joints, very stiff, can not bend, pain in shoulder, can''t lift arm above head, swelling under arm & into breast& down arm, unable to move arm at times.

VAERS ID:124851 (history)  Vaccinated:1998-09-29
Age:49.2  Onset:0000-00-00
Gender:Unknown  Submitted:1999-05-27
Location:Indiana  Entered:1999-06-07, 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: carboplatintaxol/paclitaxel
Current Illness:
Preexisting Conditions: allergic: keflex
Diagnostic Lab Data: none rpt
CDC Split Type: MPI981880
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20178HE IM 
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES454976 IM 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: p/pt recv vax pt exp high fever, 104.3f

VAERS ID:124899 (history)  Vaccinated:1998-11-03
Age:49.0  Onset:1998-11-16, Days after vaccination: 13
Gender:Female  Submitted:1999-05-27, Days after onset: 191
Location:California  Entered:1999-06-07, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MPI982007B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.20128GC   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Myalgia, Pain, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: p/vax pt exp fever, sore throat & aches & pains 13 days p/vax;pt is still achy today;pt suffered from fever, sore throat & gen aches 13 days p/vax;

VAERS ID:124716 (history)  Vaccinated:1999-04-29
Age:49.5  Onset:1999-04-29, Days after vaccination: 0
Gender:Female  Submitted:1999-05-04, Days after onset: 5
Location:Texas  Entered:1999-06-14, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: NONE
Preexisting Conditions: allergic to codeine
Diagnostic Lab Data: NA
CDC Split Type: TX99114
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09394400IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: lt arm w/redness, warmth, swelling & severe pain distal to inj site w/onset several hours p/vax;pt consulted pvt MD who recommended cold packs & elevation of extremity;

VAERS ID:124736 (history)  Vaccinated:1999-04-08
Age:49.6  Onset:1999-04-21, Days after vaccination: 13
Gender:Female  Submitted:1999-04-28, Days after onset: 7
Location:Georgia  Entered:1999-06-14, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Cortisone, Capozide;Ogen;Cele;Tomptic
Current Illness: HTN
Preexisting Conditions: HTN, glacoma
Diagnostic Lab Data: NA
CDC Split Type: GA99047
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09447802IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Injection site pain, Oedema peripheral, Skin nodule
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt devel knot rt arm p/vax sl sore x 1wk;no tx states entire lt arm area was big & hard & gradually going down;palpable 1cm firm nodule inc lt arm deltoid area;

VAERS ID:124995 (history)  Vaccinated:1999-06-14
Age:49.5  Onset:1999-06-14, Days after vaccination: 0
Gender:Female  Submitted:1999-06-14, Days after onset: 0
Location:New York  Entered:1999-06-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM116A20IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt states 1hr p/vax chills/fever disorientation, nausea, felt like someone hit pt on head w/baseball bat;h/a;

VAERS ID:125351 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:1999-05-09
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:1999-06-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypokinesia, Myasthenic syndrome, Paraesthesia, Vasodilatation
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: arm went totally numb, weak & couldn''t move arm;red at first then cleared;

VAERS ID:125276 (history)  Vaccinated:1999-06-17
Age:49.9  Onset:1999-06-20, Days after vaccination: 3
Gender:Male  Submitted:1999-06-23, Days after onset: 3
Location:Colorado  Entered:1999-06-30, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX ID)PASTEUR MERIEUX INST.P040221IDLA
Administered by: Public     Purchased by: Private
Symptoms: Malaise, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: p/vax devel itchy hives all over body;pt made MD appt was given cortisone shot & cortisone cream;pt reports still have some itchy hives & feel sl off but expects to return to work on 6/24/99;afeb throughout;

VAERS ID:125312 (history)  Vaccinated:1999-06-07
Age:49.7  Onset:1999-06-08, Days after vaccination: 1
Gender:Female  Submitted:1999-06-10, Days after onset: 2
Location:Illinois  Entered:1999-07-02, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zestril-discontinued
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7302AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cellulitis, Injection site hypersensitivity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: p/vax pt devel low fever & local redness & swelling 6/8/99; adm to hosp for cellulitis of lt upper arm 6/10/99 Am;

VAERS ID:125403 (history)  Vaccinated:1998-06-10
Age:49.8  Onset:1999-05-05, Days after vaccination: 329
Gender:Female  Submitted:0000-00-00
Location:Virginia  Entered:1999-07-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp aching w/#1 vax; & one sided sore throat, swollen, inc mucous w/#2
Other Medications: Hormone replacemnt
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data: NONE
CDC Split Type: VA99029
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX ID)PASTEUR MERIEUX INST.N001822ID 
Administered by: Public     Purchased by: Public
Symptoms: Adverse drug reaction, Diarrhoea, Gastrointestinal disorder, Laryngospasm, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: p/vax pt devel sore throat, tight w/inc URi, low grade fever & GI sx, diarrhea;

VAERS ID:125627 (history)  Vaccinated:1999-05-24
Age:49.8  Onset:1999-05-24, Days after vaccination: 0
Gender:Male  Submitted:1999-07-06, Days after onset: 43
Location:Delaware  Entered:1999-07-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, Sed rate, LDH, CPK, RF, ANA (pending)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0430 LA
Administered by: Military     Purchased by: Military
Symptoms: Injection site mass, Paraesthesia, Somnolence, Tinnitus
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hearing impairment (narrow)
Write-up: p/vax pt c/o numbness lt arm & lt side of face; ringing in both ears, primarily lt ear; feeling of lethargy & recently devel bump @ inj site;

VAERS ID:126084 (history)  Vaccinated:1999-07-09
Age:49.3  Onset:1999-07-10, Days after vaccination: 1
Gender:Male  Submitted:1999-07-12, Days after onset: 2
Location:Washington  Entered:1999-07-19, 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: ippd connaught #250111 rt arm; Augmentin
Current Illness: resolving sinusitis
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0414 RA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Diarrhoea, Eye disorder, Eye pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: day p/vax pt felt feverish, eyes sting & burn, diffuse myalgias/arthralgias, nausea, diarrhea.

VAERS ID:126514 (history)  Vaccinated:1999-03-08
Age:49.5  Onset:1999-03-09, Days after vaccination: 1
Gender:Unknown  Submitted:1999-07-20, Days after onset: 132
Location:Minnesota  Entered:1999-07-30, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999007804
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120A90  
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Injection site hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: p/vax pt c/o severe arthralgias; local redness; rash that extended from inj site to shoulder; condition of pt unknown

VAERS ID:126542 (history)  Vaccinated:1999-03-17
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1999-04-19
Location:New York  Entered:1999-07-30, Days after submission: 102
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: evista
Current Illness:
Preexisting Conditions: allergic to penicillin, vicodin
Diagnostic Lab Data:
CDC Split Type: 1999008833
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: p/vax pt exp severe joint pain

VAERS ID:126676 (history)  Vaccinated:1999-04-24
Age:49.0  Onset:1999-04-25, Days after vaccination: 1
Gender:Female  Submitted:1999-06-02, Days after onset: 38
Location:New Jersey  Entered:1999-07-30, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure meds; prempro
Current Illness:
Preexisting Conditions: hypertension; mitral valve prolapse
Diagnostic Lab Data:
CDC Split Type: 1999012608
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Other     Purchased by: Private
Symptoms: Chest pain, Diarrhoea, Pain, Vasodilatation
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: p/vax pt exp D; hot feel; chest tightness; & sore arm; no treatment given

VAERS ID:126618 (history)  Vaccinated:1999-03-25
Age:49.0  Onset:1999-03-25, Days after vaccination: 0
Gender:Male  Submitted:1999-05-17, Days after onset: 52
Location:Connecticut  Entered:1999-07-31, Days after submission: 75
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: 1999011010
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Headache, Injection site hypersensitivity, Injection site pain, Myalgia, Neck pain, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: p/vax pt exp raised deep pink rash from elbow to shoulder on inj arm; inj arm achiness; shooting pain in neck & back; severe h/a; & achy joints;tx--ibuprofen;

VAERS ID:126783 (history)  Vaccinated:1999-07-06
Age:49.6  Onset:1999-07-06, Days after vaccination: 0
Gender:Female  Submitted:1999-07-06, Days after onset: 0
Location:Texas  Entered:1999-08-02, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no
Other Medications: none
Current Illness: none
Preexisting Conditions: allergy to amoxicillin
Diagnostic Lab Data: none
CDC Split Type: TX99150
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2888A40IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1751H SCLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Hypertension, Injection site hypersensitivity, Lymphadenopathy, Pruritus, Urticaria, Visual disturbance
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: p/recv vax pt exp generalized itching sensation, 15min later itching @ waist, under breast, under arms, 15min later tight chest, hives at waist, @ mmr infect site & arm, hives bilaterally in axillae & behind knees, spots before eyes

VAERS ID:126845 (history)  Vaccinated:1999-07-01
Age:49.0  Onset:1999-07-16, Days after vaccination: 15
Gender:Male  Submitted:1999-07-16, Days after onset: 0
Location:Georgia  Entered:1999-08-02, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: colon cancer, recv chemotherapy
Diagnostic Lab Data: unknown
CDC Split Type: 899198139A
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV: ROTAVIRUS (ROTASHIELD)PFIZER/WYETH 0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Intestinal obstruction, Secondary transmission
SMQs:, Gastrointestinal obstruction (narrow)
Write-up: 7/1/99, child recv rota shield; 7/16 father devel bowel obstruction & hosp; mom attributed the father''s bowel obstruction to rota shield from exposure to pt

VAERS ID:126997 (history)  Vaccinated:1999-07-22
Age:49.0  Onset:1999-07-27, Days after vaccination: 5
Gender:Male  Submitted:1999-07-29, Days after onset: 2
Location:Oregon  Entered:1999-08-09, 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: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0410SCLA
Administered by: Military     Purchased by: Military
Symptoms: Chills, Eye disorder, Hyperhidrosis, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad)
Write-up: minor aches & pains & not feel completely well; lt shoulder/arm very sore; woke w/cold chills & sweats, muscles very sore; painful when walking; woke w/crust over eyes, had to open w/ fingers;

VAERS ID:127204 (history)  Vaccinated:1998-03-31
Age:49.2  Onset:0000-00-00
Gender:Male  Submitted:1999-08-09
Location:Virginia  Entered:1999-08-13, 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: Accupril
Current Illness: NONE
Preexisting Conditions: HTN/allergy to sulfa, PCN, Ceclor
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Hyperhidrosis, Injection site hypersensitivity, Injection site oedema, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt presented on 8/9/99 told MD when had vax arm became red 7 swollen had fever, chills, sweating, aching;

VAERS ID:127530 (history)  Vaccinated:1999-08-07
Age:49.1  Onset:1999-08-08, Days after vaccination: 1
Gender:Male  Submitted:1999-08-08, Days after onset: 0
Location:Oregon  Entered:1999-08-24, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IPPD, congt, #248211, rt arm
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0412 RA
Administered by: Military     Purchased by: Military
Symptoms: Ear pain, Hyperhidrosis, Injection site pain, Palpitations, Pharyngitis, Tachycardia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)
Write-up: p/vax pt exp rapid heart beat (palpitation);extreme sweating; sore inner rt ear; very sore throat started; sore arm (inj site)

VAERS ID:127945 (history)  Vaccinated:1998-09-24
Age:49.2  Onset:1998-09-25, Days after vaccination: 1
Gender:Female  Submitted:1998-10-01, Days after onset: 6
Location:Indiana  Entered:1999-09-03, Days after submission: 337
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: taxol; carboplatin
Current Illness: unk
Preexisting Conditions: large cell lung cancer; chemo ended 2 days prior to immun
Diagnostic Lab Data: none
CDC Split Type: 898275050A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20178HB0 RA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4549760 RA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Pyrexia, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad)
Write-up: p/vax pt devel T104 which resolved p/24hr; oct 1,1998 had cough productive for white sputum & had chest congestion

VAERS ID:127965 (history)  Vaccinated:1998-10-15
Age:49.0  Onset:1998-10-15, Days after vaccination: 0
Gender:Male  Submitted:1998-10-16, Days after onset: 1
Location:Oklahoma  Entered:1999-09-03, Days after submission: 322
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pepcid; zrytec;
Current Illness: none
Preexisting Conditions: allergic penicillin; poison ivy; esophageal reflux & hay fever
Diagnostic Lab Data:
CDC Split Type: 898293014A
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4517960 RA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Lymphadenopathy, Myalgia, Pruritus, Pyrexia, Skin striae
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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)
Write-up: p/vax pt exp extreme muscle pain & unable to move rt arm; then devel T99.5; inj site rxn of red; itchy; streaky rash & edema from shoulder to elbow; tx APAP; DPH; & ice; then devel spider-like rash on rt arm

VAERS ID:128033 (history)  Vaccinated:1999-02-23
Age:49.0  Onset:1999-02-23, Days after vaccination: 0
Gender:Male  Submitted:1999-02-24, Days after onset: 1
Location:Wisconsin  Entered:1999-09-03, Days after submission: 190
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: Glucophage;Lipitor;Pemoline;Prozac;Trazodone;
Current Illness: unk
Preexisting Conditions: non-insulin dependent diabetes mellitus;
Diagnostic Lab Data: unk
CDC Split Type: 899057042A
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES  IMRA
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)PFIZER/WYETH  IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site mass, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: p/vax pt devel severe pain & induration @ the site of pnu-imune 23;the next morning pain radiated throughout entire rt arm;pt recovered;

VAERS ID:128129 (history)  Vaccinated:1999-08-29
Age:49.9  Onset:1999-08-31, Days after vaccination: 2
Gender:Female  Submitted:1999-09-07, Days after onset: 7
Location:Texas  Entered:1999-09-08, 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: hayfever
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax arm began to swell & itch & became red;tx w/advil, DPH & compress;

VAERS ID:128199 (history)  Vaccinated:1999-06-29
Age:49.1  Onset:1999-06-29, Days after vaccination: 0
Gender:Female  Submitted:1999-09-06, Days after onset: 69
Location:Minnesota  Entered:1999-09-13, 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: hormone replacement therapy
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: dip stick UA-neg; UA microscopy-nl;blood culture/ tests: hgb-11.8;erythrocyes-3.65;leukocytes:1.9;neutrophils-1.38;monocytes-0.13;lymphocytes-0.34;eosinophils-0.00;platelet count-101;alk phosphatase-340/ast (got)-192-elevated;protein/osmola
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 1 A
Administered by: Unknown     Purchased by: Private
Symptoms: Abdominal pain, Anaemia, Aspartate aminotransferase increased, Blood acid phosphatase increased, Dehydration, Hepatic function abnormal, Laboratory test abnormal, Pyrexia, Thrombocythaemia, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: exp nausea;vomiting;dehydration;fever;clinic 7/2-7/3-admit to ER w/high fever;dehydration;blood tests-elevated liver enzymes; monitored blood tests;rt flank pain;tiny calcified density projected over rt side of bladder;renal stone protocol

VAERS ID:128271 (history)  Vaccinated:1999-08-17
Age:49.1  Onset:1999-08-17, Days after vaccination: 0
Gender:Female  Submitted:1999-08-20, Days after onset: 3
Location:Georgia  Entered:1999-09-14, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: GA99096
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7258BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt devel swelling & redness along c/malaise; came in to have site inspected; was noted a hard; red; warm induration to lt arm 3''''x2.5''''; sore to touch;

VAERS ID:128318 (history)  Vaccinated:1999-08-12
Age:49.8  Onset:1999-08-21, Days after vaccination: 9
Gender:Female  Submitted:1999-08-30, Days after onset: 9
Location:New York  Entered:1999-09-16, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: blood work
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1497H0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Headache, Lymphadenopathy, Oedema peripheral, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt devel rash on chest/mid section;swollen glands of neck;inc T102;rash dec except for small area rt arm;rt hand swollen from wrist to 1st knuckle;tylenol;saw MD;h/a;fatigue;exhaustion; swollen feet;saw MD again;methylprednisone dose pack

VAERS ID:128485 (history)  Vaccinated:1999-04-09
Age:49.2  Onset:1999-05-01, Days after vaccination: 22
Gender:Female  Submitted:1999-09-20, Days after onset: 142
Location:Connecticut  Entered:1999-09-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: thyroid pills
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120B91 LA
Administered by: Private     Purchased by: Private
Symptoms: Arthropathy, Injection site pain, Osteonecrosis, Osteoporosis, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Osteoporosis/osteopenia (narrow), Osteonecrosis (narrow), Arthritis (broad)
Write-up: pt lt shoulder started aching;told MD office;then pain in lt hand/thumb; orthopaedic MD Dx rotator cuff problems in shoulder & Preiser''s disease in hand(Preiser''s is the avascular necrosis of scaphoid bone;very rare about 30 cases a year)

VAERS ID:128637 (history)  Vaccinated:1999-08-19
Age:49.0  Onset:1999-09-04, Days after vaccination: 16
Gender:Female  Submitted:1999-09-07, Days after onset: 3
Location:North Carolina  Entered:1999-09-27, Days after submission: 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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0377J0SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7358AB0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt exp swelling and redness at inj site

VAERS ID:128722 (history)  Vaccinated:1999-09-15
Age:49.3  Onset:1999-09-16, Days after vaccination: 1
Gender:Female  Submitted:1999-09-23, Days after onset: 7
Location:Wisconsin  Entered:1999-09-28, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Prempro, Celexa;Codimal, Ranitidine
Current Illness: NONE
Preexisting Conditions: NKA;Vasomotor rhinitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES456692 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Neck pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: lt arm swelling, tenderness over the lt upper arm radiating up into the neck, afeb, breathing w/o diff, erythema & induration extending from the inj site up lateral arm to deltoid w/some irritation @ the bra line-erythema 14x10cm

VAERS ID:128787 (history)  Vaccinated:1999-07-06
Age:49.3  Onset:0000-00-00
Gender:Female  Submitted:1999-09-21
Location:Virginia  Entered:1999-09-30, Days after submission: 9
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: NONE
CDC Split Type: VA99046
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM116A21IMLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Back pain, Hypertonia, Myalgia, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: 1 wk p/vax mild sx knees, hips, low back (lumbar) aching & stiffness;p/2nd dose sx significantly worse & on going 7/6/99;

VAERS ID:129557 (history)  Vaccinated:1999-10-10
Age:49.6  Onset:1999-10-10, Days after vaccination: 0
Gender:Female  Submitted:1999-10-12, Days after onset: 2
Location:Michigan  Entered:1999-10-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02979P IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1692H0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Myalgia, Skin nodule, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad)
Write-up: p/vax pt devel sl soreness @ 12:30;10/10/99 redness in evening & warm;hard lump size of plum;sx peaked @ 4AM 10/11/99;

VAERS ID:129592 (history)  Vaccinated:1999-10-11
Age:49.4  Onset:1999-10-11, Days after vaccination: 0
Gender:Female  Submitted:1999-10-13, Days after onset: 2
Location:Washington  Entered:1999-10-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: takes evista
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS01889P  LA
Administered by: Other     Purchased by: Unknown
Symptoms: Ear pain, Eye pain, Laryngospasm, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: p/vax pt eyes started burning then nose, ears, mouth;went to hosp ER 4PM IV w/DPH, pred & rx for hydroxyzine HCl, difficulty swallowing;

VAERS ID:129692 (history)  Vaccinated:1999-10-16
Age:49.0  Onset:1999-10-16, Days after vaccination: 0
Gender:Female  Submitted:1999-10-20, Days after onset: 4
Location:Tennessee  Entered:1999-10-22, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~~ ~~In patient
Other Medications: Vioxx
Current Illness:
Preexisting Conditions: hypertension,diabetes mellitus
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Back pain, Diabetes mellitus, Diarrhoea, Hypertension, Hypertonia, Hypokinesia, Nausea, Osteoarthritis
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow)
Write-up: joint pain, nausea, stiffness in TMJ area-neck, wrist, hip, spine pain;diarrhea med for nausea, hard time moving.Dxed w/ arthralgia secondary to Anthrax reactions.

VAERS ID:129789 (history)  Vaccinated:1999-10-05
Age:49.7  Onset:1999-10-05, Days after vaccination: 0
Gender:Female  Submitted:1999-10-06, Days after onset: 1
Location:New York  Entered:1999-10-25, Days after submission: 19
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 PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998240  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: itching, swelling, heat & pain @ site of inj;relieved by DPH by mouth as ordered by MD;

VAERS ID:129867 (history)  Vaccinated:1999-10-09
Age:49.6  Onset:1999-10-10, Days after vaccination: 1
Gender:Female  Submitted:1999-10-14, Days after onset: 4
Location:Virgin Islands  Entered:1999-10-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: vitamins
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09081801IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypokinesia, Injection site hypersensitivity, Injection site oedema, Neck pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: c/o fever, pain, inability to raised lt arm, arm warm to touch, swollen in deltoid area;s/s started on 10/10/99;took APAP w/o relief;c/o neck pain;

VAERS ID:129958 (history)  Vaccinated:1999-10-04
Age:49.1  Onset:1999-10-04, Days after vaccination: 0
Gender:Female  Submitted:1999-10-12, Days after onset: 8
Location:California  Entered:1999-10-26, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Beconase & allegra PRN allergies
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0067AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: c/o aches x 36hr;

VAERS ID:130066 (history)  Vaccinated:1999-10-19
Age:49.7  Onset:1999-10-20, Days after vaccination: 1
Gender:Female  Submitted:1999-10-25, Days after onset: 5
Location:Ohio  Entered:1999-10-29, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt reports allergy to PCN & sulfa, not to eggs;
Diagnostic Lab Data:
CDC Split Type: OH99080
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETHU0136AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax upper arm red, swollen, hot & tender;T101 saw MD;AM & started on Zithromax;sx improved & fever gone;dx cellulitis of inj site;

VAERS ID:130092 (history)  Vaccinated:1999-10-19
Age:49.0  Onset:1999-10-19, Days after vaccination: 0
Gender:Male  Submitted:1999-10-20, Days after onset: 1
Location:Pennsylvania  Entered:1999-11-01, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA~ ()~~0~Patient
Other Medications: Synthroid;DPH; BENADRYL
Current Illness: NONE
Preexisting Conditions: thyroid, diverticulitis, NKDA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998279 IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1573A0UNRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: erythema, edema to rt inner arm (upper), down to elbow;tx DPH;ice to arm;

VAERS ID:130100 (history)  Vaccinated:1999-10-15
Age:49.0  Onset:1999-10-16, Days after vaccination: 1
Gender:Male  Submitted:1999-10-18, Days after onset: 2
Location:Nevada  Entered:1999-11-01, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NV99014
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02779P0 LA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4543840 RA
Administered by: Public     Purchased by: Private
Symptoms: Abdominal pain, Lymphadenopathy, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: woke up w/pain on rt side trunk under rt arm, rt bad tenderness, rt groin pain, lumbar pain;2 ASA in PM helped;rt sided pain less severe today;

VAERS ID:130142 (history)  Vaccinated:1999-10-18
Age:49.0  Onset:1999-10-18, Days after vaccination: 0
Gender:Female  Submitted:1999-10-20, Days after onset: 2
Location:California  Entered:1999-11-02, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypertonia
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: involuntary muscle spasms from head to toe-approx every 5min initially then diminished frequency & severity over 18hr;

VAERS ID:130215 (history)  Vaccinated:1999-10-22
Age:49.0  Onset:1999-10-22, Days after vaccination: 0
Gender:Female  Submitted:1999-10-22, Days after onset: 0
Location:Oregon  Entered:1999-11-02, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: cough once a day
Preexisting Conditions: prmature born w/o epiglottis, coma, spinal meningitis, migraine;
Diagnostic Lab Data: BP 140/70;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH499823810IMLA
Administered by: Other     Purchased by: Private
Symptoms: Amnesia, Asthma, Chest pain, Condition aggravated, Dizziness, Migraine, Oedema peripheral, Paraesthesia oral, Vasodilatation, Visual disturbance
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: tingling lips, swelling hands, sl flushed, dizzy, lightheaded, migraine area, memory loss, chest tight, wheezing, felt hot;DPH;EPI;

VAERS ID:130261 (history)  Vaccinated:1999-10-19
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1999-10-22
Location:Missouri  Entered:1999-11-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MO99043
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02679P IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chills, Dizziness, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: pt reports racing heart, weakness, dizziness & chills lasting 4hr;pt reports recv shot @ ER which relieved sx;

VAERS ID:130284 (history)  Vaccinated:1999-10-11
Age:49.7  Onset:1999-10-30, Days after vaccination: 19
Gender:Male  Submitted:1999-11-03, Days after onset: 4
Location:California  Entered:1999-11-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergy: tetanus??; potential esophagitis
Diagnostic Lab Data: LP, MRI, EKG, CT scan of brain w/o contrast, CXR, CT of pelvis, abd, lumbar spine;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0109CA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Hypercholesterolaemia, Leukocytosis, Myelitis, Paralysis
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Lipodystrophy (broad)
Write-up: working in backyard when exp sudden onset of low back pain, to ER walking w/o problems but devel lower extremity paralysis acutely; Annual follow-up received on 12/13/2000 provided no additional data.

VAERS ID:130302 (history)  Vaccinated:1999-10-27
Age:49.8  Onset:1999-10-27, Days after vaccination: 0
Gender:Male  Submitted:1999-10-27, Days after onset: 0
Location:West Virginia  Entered:1999-11-04, 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: allergic to biaxin;
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS03079P1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt devel hives approx 1hr p/vax;when examined 2hr p/vax had 2 1/2cm papules on neck;exp dyspnea or dysphagia;

VAERS ID:130616 (history)  Vaccinated:1999-10-19
Age:49.6  Onset:0000-00-00
Gender:Female  Submitted:1999-10-21
Location:Illinois  Entered:1999-11-09, 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: unk
Current Illness: NONE
Preexisting Conditions: denied any allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998231 IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1693H IMLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Cough, Headache, Myalgia, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: pt devel h/a, body ache, T104, joint pain, cough, congestion;

VAERS ID:130759 (history)  Vaccinated:1999-11-05
Age:49.9  Onset:1999-11-06, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Florida  Entered:1999-11-15
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
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998218  RA
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Cough, Diplopia, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Ocular motility disorders (broad)
Write-up: cold, chills, high fever;migraines, lower back pain;heavy cough;double vision;saw PCP;rx amoxicillin;saw MD 11/10 rx DPH;saw MD 11/11 rx guaifenesin & augmentin;

VAERS ID:130893 (history)  Vaccinated:1999-11-02
Age:49.2  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:1999-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0106EA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 1 day p/vax pt had h/a & face turned red;went to ER;rx cortisone & lidocaine;still has rash;

VAERS ID:130914 (history)  Vaccinated:1999-11-01
Age:49.8  Onset:1999-11-01, Days after vaccination: 0
Gender:Female  Submitted:1999-11-02, Days after onset: 1
Location:North Carolina  Entered:1999-11-18, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER4998231   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: became immed lightheaded & dizzy p/vax;observed x 30min in occupational hlth services office w/no other adverse affects;

VAERS ID:130956 (history)  Vaccinated:1999-11-11
Age:49.9  Onset:1999-11-12, Days after vaccination: 1
Gender:Male  Submitted:1999-11-16, Days after onset: 4
Location:Michigan  Entered:1999-11-19, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt mom exp exn 11/9/99 @ age 70 w/pneumonia vax dose 2;
Other Medications: synthroid
Current Illness: NONE
Preexisting Conditions: thyroid cancer history
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0163AA0IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4664450IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)
Write-up: lateral aspect lt upper arm w/large area of dermal erythema, distal to inj site;skin mildly warm;

VAERS ID:130967 (history)  Vaccinated:1999-10-06
Age:49.2  Onset:1999-10-06, Days after vaccination: 0
Gender:Female  Submitted:1999-11-04, Days after onset: 29
Location:Ohio  Entered:1999-11-22, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: unk
CDC Split Type: FLU1101199
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02779P0 LA
Administered by: Other     Purchased by: Other
Symptoms: Oedema, Pain, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: pt devel redness, edema, warmth & pain shooting up shoulder & down arm;erythema from 15-25mm;

VAERS ID:131389 (history)  Vaccinated:1999-10-21
Age:49.4  Onset:1999-10-21, Days after vaccination: 0
Gender:Female  Submitted:1999-11-03, Days after onset: 13
Location:Maryland  Entered:1999-11-26, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: estrae, detrol, bp meds
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: MD99027
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02979P0  
Administered by: Other     Purchased by: Other
Symptoms: Dysphonia, Face oedema, Rash maculo-papular, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Hypersensitivity (narrow)
Write-up: 40 mins post vax pt experienced swelling of the lips and felt her voice changed. Left side of neck became red and blotchy. Pt took benadryl and was examine by site MD. MD states throat was not swollen and vital signs stable.

VAERS ID:131456 (history)  Vaccinated:1998-10-29
Age:49.0  Onset:1998-11-12, Days after vaccination: 14
Gender:Male  Submitted:1999-09-29, Days after onset: 320
Location:Texas  Entered:1999-11-29, Days after submission: 61
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX9935
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0983320 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Bursitis, Tendon disorder
SMQs:, Arthritis (broad)
Write-up: p/vax pt rt upper arm & shoulder started hurting;became worse 2mo later;saw MD dx bursitis & given naprosyn & took for 2mo;rt arm hurts to reach upward or behind;rt arm shoulder hurts very badly;dx tendonitis;given med;

VAERS ID:132643 (history)  Vaccinated:1999-11-29
Age:49.4  Onset:1999-11-30, Days after vaccination: 1
Gender:Female  Submitted:1999-12-13, Days after onset: 13
Location:Michigan  Entered:1999-12-20, 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: methotrexate,naprosyn,azulfione,folic acid
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02289P IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Itchy rash developed 24 hrs after vaccinated at site and down arm to wrist-lasted 2 wks.

VAERS ID:132085 (history)  Vaccinated:1999-10-28
Age:49.0  Onset:1999-10-29, Days after vaccination: 1
Gender:Female  Submitted:1999-11-03, Days after onset: 5
Location:Texas  Entered:1999-12-28, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Antibiotics
Current Illness: NONE
Preexisting Conditions: Predisposed to pollen allergies
Diagnostic Lab Data: NONE
CDC Split Type: 99TX235
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998243 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Mouth ulceration, Pruritus, Rash, Rhinitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Pt developed cold sores on mouth and lips and rash on face and neck on 11/3/99. Pt had itching on face and neck with sneezing. Pt saw a physician on 11/5/99, was given a prescription for antibiotics.

VAERS ID:132135 (history)  Vaccinated:1999-10-26
Age:49.8  Onset:1999-10-26, Days after vaccination: 0
Gender:Female  Submitted:1999-11-09, Days after onset: 14
Location:Wisconsin  Entered:1999-12-28, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02779P0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Hypothermia, Vomiting
SMQs:, Acute pancreatitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Unable to keep any liquid or food down (vomiting), temp. dropped to 96.6F//2000ml IV & shot for vomiting.

VAERS ID:132758 (history)  Vaccinated:1999-10-22
Age:49.3  Onset:1999-10-28, Days after vaccination: 6
Gender:Female  Submitted:1999-12-08, Days after onset: 41
Location:Florida  Entered:1999-12-28, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid,oxazepam,Tegretol
Current Illness: NONE
Preexisting Conditions: hypothyroidism,bi-polar disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS 0IM 
Administered by: Military     Purchased by: Military
Symptoms: Headache, Hyperhidrosis, Lymphadenopathy, Myalgia, Pyrexia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Swollen glands on both sides under my chin & down the front & back of my neck.Fever 101-102,night sweats,headache,body aches,& redness on legs up to my knees.Took ibuprofen w/o relief.Went to ER & tx w/ antibiotics.

VAERS ID:132797 (history)  Vaccinated:1998-11-06
Age:49.3  Onset:1998-11-06, Days after vaccination: 0
Gender:Female  Submitted:1999-11-06, Days after onset: 365
Location:Idaho  Entered:1999-12-28, Days after submission: 52
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: chemotherapy
Current Illness:
Preexisting Conditions: abdominal cancer
Diagnostic Lab Data:
CDC Split Type: ID99051
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4988200 IM 
Administered by: Other     Purchased by: Other
Symptoms: Neoplasm malignant, Visual field defect
SMQs:, Noninfectious encephalitis (broad), Optic nerve disorders (broad), Retinal disorders (broad), Malignant tumours (narrow)
Write-up: Peripheral blurred vision; pt called MD-was better before leaving his office.

VAERS ID:131821 (history)  Vaccinated:1999-10-25
Age:49.6  Onset:1999-10-25, Days after vaccination: 0
Gender:Female  Submitted:1999-11-03, Days after onset: 9
Location:Pennsylvania  Entered:1999-12-29, Days after submission: 56
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra-D, Premarin, Zoloft
Current Illness: NONE
Preexisting Conditions: DJD, Enviromental allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0132AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Vasodilatation
SMQs:
Write-up: Developed severe warmth & flushing of her face & neck, 20-30 mins after Flu vaccine. Resolved without treatment in about 15-20 mins.

VAERS ID:131929 (history)  Vaccinated:1999-10-29
Age:49.8  Onset:1999-10-30, Days after vaccination: 1
Gender:Male  Submitted:1999-11-15, Days after onset: 16
Location:Wisconsin  Entered:1999-12-29, 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: Prinivil, 10mg
Current Illness: NONE
Preexisting Conditions: High blood pressure
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982290IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4587450IMRA
Administered by: Private     Purchased by: Private
Symptoms: Face oedema, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: On 10/30/99, pt broke out in hives & rash all over body. Took Benadryl and improved by next day. On 11/2/99, pt at ball game, & eyes started to swell. Started Benadryl again & improved. No further episodes.

VAERS ID:131937 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:1999-10-16
Gender:Female  Submitted:1999-10-19, Days after onset: 3
Location:Nebraska  Entered:1999-12-29, Days after submission: 71
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0129AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)
Write-up: Couldn''t get out of bed 10/16/99, severe dizziness, room spinning, felt like motion sickness; better if I was horizontal. No fever, achiness or headache. Dizziness w/quick movement on 10/17/99, but less severe than on 10/16/99.

VAERS ID:132030 (history)  Vaccinated:1999-10-26
Age:49.9  Onset:1999-10-27, Days after vaccination: 1
Gender:Male  Submitted:1999-11-15, Days after onset: 19
Location:Minnesota  Entered:1999-12-29, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Centrum vitamin, iron supplement
Current Illness: NONE
Preexisting Conditions: Asthma, celiac sprue
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Headache, Injection site inflammation, Injection site oedema, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: Fever, chills, headache, bodyache, exhaustion, injection site inflamed and swollen. Last approx 48 hours.

VAERS ID:132895 (history)  Vaccinated:1999-12-07
Age:49.0  Onset:1999-12-08, Days after vaccination: 1
Gender:Female  Submitted:1999-12-15, Days after onset: 7
Location:Unknown  Entered:1999-12-29, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES09926800SCLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES456053 SCRA
Administered by: Other     Purchased by: Military
Symptoms: Cellulitis
SMQs:
Write-up: Right arm cellulitis; tx w/ antibiotics and anti-inflammatory medication.

VAERS ID:132939 (history)  Vaccinated:1997-03-28
Age:49.0  Onset:1997-04-14, Days after vaccination: 17
Gender:Female  Submitted:1999-12-22, Days after onset: 982
Location:Connecticut  Entered:1999-12-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Effexor, Synthroid
Current Illness: Hypothyroidism, Depression
Preexisting Conditions: Downs Syndrome
Diagnostic Lab Data: CT/MRI Subspecialty Eval.
CDC Split Type:
Vaccination
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.VHA516A4 IMLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES  IMRA
Administered by: 0     Purchased by: 0
Symptoms: Encephalitis, Mental retardation severity unspecified, Optic neuritis
SMQs:, Noninfectious encephalitis (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (broad)
Write-up: Acute disseminated encephalomyelitis. On 4/15/97, pt exp permanent loss of sight in rt eye.Dxed as optic neuritis.Dxed w/ ADEM on 6/5/97.Left eye began to lose sight on 5/13/98.

VAERS ID:133017 (history)  Vaccinated:1999-12-01
Age:49.6  Onset:1999-12-02, Days after vaccination: 1
Gender:Male  Submitted:1999-12-28, Days after onset: 26
Location:California  Entered:2000-01-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0163AA0IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0072AA0IMRA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA137AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Generalized urticaria 1 day after vaccine administration. 2nd day, to ER. Tx''d w/Dexamethasone injection and oral Prednisone f/u.

VAERS ID:133026 (history)  Vaccinated:1999-09-21
Age:49.7  Onset:1999-09-21, Days after vaccination: 0
Gender:Female  Submitted:1999-09-25, Days after onset: 4
Location:California  Entered:2000-01-05, Days after submission: 102
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefezil/Tyliprn
Current Illness: NONE
Preexisting Conditions: Allergic to Tetracyline
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982300IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Area red, hot, raised x 4 days post injection. 9/27/99, pt states arm fine now w/no problems.

VAERS ID:133037 (history)  Vaccinated:1999-10-21
Age:49.8  Onset:1999-11-15, Days after vaccination: 25
Gender:Female  Submitted:0000-00-00
Location:Oklahoma  Entered:2000-01-05
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: UNK
CDC Split Type: OK9962
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02089P6IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 10/21/99 hives 11/15/99. Seen MD 11/18/99 & seen Dermatologist 12/2/99. Has stopped all lotions & creams. Denies change in detergents, soaps, new meds. No changes. Continues to have hives.

VAERS ID:133273 (history)  Vaccinated:1999-11-19
Age:49.0  Onset:1999-11-21, Days after vaccination: 2
Gender:Female  Submitted:2000-01-10, Days after onset: 50
Location:New Mexico  Entered:2000-01-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 10/13/1999 Hep B (ENG3001A4) resulted in rash on back.
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3213C61IMRA
Administered by: Other     Purchased by: Public
Symptoms: Dermatitis bullous, Pruritus, Similar reaction on previous exposure to drug
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Blisters on back 3 days post Hep 1 (10/13) & 2 (11/19). Blisters scabbed on day 5. Itched.

VAERS ID:133589 (history)  Vaccinated:1999-11-28
Age:49.0  Onset:1999-11-29, Days after vaccination: 1
Gender:Female  Submitted:1999-12-15, Days after onset: 16
Location:Unknown  Entered:2000-02-01, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER467040 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Local T-Cell rxn to DT. Swollen, red, indurated left upper arm with heat & tenderness.

VAERS ID:133644 (history)  Vaccinated:2000-01-10
Age:49.0  Onset:2000-01-10, Days after vaccination: 0
Gender:Female  Submitted:2000-01-19, Days after onset: 9
Location:Utah  Entered:2000-02-02, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dioxx, Wellbutrin, Zoloft, Estrace, Prevacid
Current Illness: NONE
Preexisting Conditions: Depression, migrane, ulcer cothritis, sensitive to erythromycin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02289P IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chest pain, Cough, Dyspnoea, Headache, Infection, Pruritus, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Instant onset pneumonia like cough, breathing labored, heavy chest, rapid heart rate, itching. Developed severe strep throat by 1/12/2000 and continual headaches.

VAERS ID:133851 (history)  Vaccinated:1996-11-21
Age:49.7  Onset:1996-12-01, Days after vaccination: 10
Gender:Male  Submitted:2000-01-26, Days after onset: 1151
Location:Unknown  Entered:2000-02-10, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advil, Norvasc
Current Illness:
Preexisting Conditions: hypertension, fracture of ankle after discharge from hospital for vax reaction.
Diagnostic Lab Data: UNK
CDC Split Type: 0010150M0000001
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00376P1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Coordination abnormal, Cough, Guillain-Barre syndrome, Nausea, Rhinitis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow)
Write-up: On 11/21/96, pt recv''d Fluogen vax. In Dec ''96, he dvlped cough, nasal congestion, & nausea. Dxed on 12/17/96 w/ Guillain-Barre syndrome.Pt was hospitalized & tx w/ plasmapheresis.He was discharged w/ weakness & balance problems.

VAERS ID:133875 (history)  Vaccinated:1999-12-16
Age:49.0  Onset:1999-12-25, Days after vaccination: 9
Gender:Male  Submitted:2000-02-09, Days after onset: 46
Location:California  Entered:2000-02-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Sed rate - normal, rheumatoid factor - neg
CDC Split Type:
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  SC 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER  PO 
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: MMR given 12/16/99, 9 day later, pt developed joint pain and swelling r/ankle, pain and swelling increased over time and spread to l/ankle, knees and bilat. hands and joints. Follow up information on 2/9/00 states these vaccines were not give at our clinic and we didn''t have that information-patient does not have that information either-was required to get vaccine for entrance to citrus college.

VAERS ID:133894 (history)  Vaccinated:1999-11-12
Age:49.0  Onset:1999-11-13, Days after vaccination: 1
Gender:Female  Submitted:1999-11-16, Days after onset: 3
Location:New York  Entered:2000-02-11, Days after submission: 87
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zestril, climara
Current Illness: Scratchy throat
Preexisting Conditions: NKDA decreased platelet count
Diagnostic Lab Data:
CDC Split Type: NY99003
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS00199P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Chills, Diarrhoea, Injection site pain, Malaise, Myalgia, Nausea, Nuchal rigidity, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt experienced diarrhea, neck stiffness, ringing in ears, nausea, chills, body aches, injection site pain, malaise, abd pain.

VAERS ID:133942 (history)  Vaccinated:1999-04-23
Age:49.0  Onset:1999-05-06, Days after vaccination: 13
Gender:Male  Submitted:2000-02-02, Days after onset: 272
Location:Texas  Entered:2000-02-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Vision problem
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chest pain, Muscle spasms, Pain in extremity
SMQs:, Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Muscle spasm and pain left & right arm and side of chest area.

VAERS ID:134117 (history)  Vaccinated:1996-11-21
Age:49.0  Onset:1996-12-01, Days after vaccination: 10
Gender:Male  Submitted:2000-01-26, Days after onset: 1151
Location:Unknown  Entered:2000-02-16, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Diagnostic Lab Data:
CDC Split Type: M0000001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS00376P IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Coordination abnormal, Cough, Guillain-Barre syndrome, Injury, Nausea, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Demyelination (narrow)
Write-up: Pt rcvd vaccine 11/21/99, in Dec, 99, pt developed a cough, nasal congestion, nausea, without fever. The pt saw his MD and was immediately hospitalized. Dx of GBS. He was discharged with weakness and balance problems & fell and fx ankle.

VAERS ID:134258 (history)  Vaccinated:1999-10-21
Age:49.0  Onset:1999-11-04, Days after vaccination: 14
Gender:Female  Submitted:2000-02-16, Days after onset: 104
Location:Ohio  Entered:2000-02-29, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: MRI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0158AA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Myelitis
SMQs:
Write-up: Transverse myelitis per neurologist.

VAERS ID:134271 (history)  Vaccinated:2000-02-04
Age:49.0  Onset:2000-02-04, Days after vaccination: 0
Gender:Male  Submitted:2000-02-17, Days after onset: 13
Location:Oregon  Entered:2000-02-29, 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
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0472 LA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Injection site reaction
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Day of 3rd shot, had overwhelming fatigue, all the time. Extra sleep did not help. No illness for last 11 mos. Minimal reaction at shot site. Felt fatigue for 10days, then normal at day 12. No other symptoms.

VAERS ID:134605 (history)  Vaccinated:1999-11-29
Age:49.0  Onset:1999-12-25, Days after vaccination: 26
Gender:Female  Submitted:2000-03-01, Days after onset: 67
Location:Kentucky  Entered:2000-03-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Brochitis - resolving
Preexisting Conditions: NONE
Diagnostic Lab Data: EMG - NCV results pending.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0136AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Muscle atrophy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Local muscle atrophy.

VAERS ID:134687 (history)  Vaccinated:1999-12-14
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2000-02-29
Location:North Carolina  Entered:2000-03-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Est
Current Illness:
Preexisting Conditions: Allergic to Actifed & codeine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0314SCRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Pt experienced tingling sensation and arm felt like it was asleep in R/arm where the injection was given.

VAERS ID:150563 (history)  Vaccinated:1999-07-30
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2000-01-19
Location:New Hampshire  Entered:2000-03-29, Days after submission: 70
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: 19990261861
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Erythema marginatum, Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: One week post vax, the pt developed erythema chronicum migrans rash at the injection site. The rash was brownish in color, 3 cm, and centrally clear. The rash faded after one week.

VAERS ID:150579 (history)  Vaccinated:1999-10-21
Age:49.0  Onset:1999-10-21, Days after vaccination: 0
Gender:Male  Submitted:2000-01-19, Days after onset: 90
Location:New Jersey  Entered:2000-03-29, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravachol
Current Illness:
Preexisting Conditions: History of glaucoma, hyperlipidemia, Lyme disease in 1988
Diagnostic Lab Data:
CDC Split Type: 19990293371
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY123B90IM 
Administered by: Private     Purchased by: Private
Symptoms: Influenza like illness, Injection site erythema, Injection site mass, Pain, Pyrexia, Sluggishness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Post vax, on 10/21/99, the pt experienced a raised, red and tender area at the injection site, flu-like symptoms, achiness, fever and sluggishness. No treatment was given. The most recent information, received on 11/3/99, reports the symptoms resolved.

VAERS ID:150806 (history)  Vaccinated:2000-03-21
Age:49.0  Onset:2000-03-22, Days after vaccination: 1
Gender:Female  Submitted:2000-03-24, Days after onset: 2
Location:California  Entered:2000-04-06, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4988147 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site mass, Injection site pain, Vasodilation procedure
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Red, hot, painful and hard at right deltoid, injection site. More painful in the morning and got better during the day with movement.

VAERS ID:151003 (history)  Vaccinated:1999-03-04
Age:49.0  Onset:1999-03-15, Days after vaccination: 11
Gender:Male  Submitted:2000-03-31, Days after onset: 382
Location:New York  Entered:2000-04-19, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tetracycline, Lipitor, Zoloft, Benadryl
Current Illness: NA
Preexisting Conditions: High cholesterol, acne, allergies, depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120B91IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: Pt experienced joint pain in both knees, left hip and right shoulder.

VAERS ID:151654 (history)  Vaccinated:2000-04-25
Age:49.0  Onset:2000-04-25, Days after vaccination: 0
Gender:Female  Submitted:2000-04-25, Days after onset: 0
Location:Oregon  Entered:2000-05-08, Days after submission: 13
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of asthma and allergy to sulfa.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0750J1IM 
Administered by: Military     Purchased by: Other
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: Called by home heath nurse to say, pt developed a rash. Pt was seen in occupational medicine. Treatment given and ambulance called to transfer to hospital. Put on oxygen and getting IV prednisone.

VAERS ID:151860 (history)  Vaccinated:2000-04-13
Age:49.0  Onset:2000-04-14, Days after vaccination: 1
Gender:Male  Submitted:2000-05-02, Days after onset: 18
Location:Iowa  Entered:2000-05-12, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Celexa; Aciphex; Tylenol; Vioxx; Hydrocodone w/acetaminophen
Current Illness: Left thumb crushing injury
Preexisting Conditions: depression, GERD, injury to left thumb, hyperlipidemia, nausea
Diagnostic Lab Data: CBC-low WBC, ultrasound of arm 5/1/00-extensive induration of left upper arm-no abscess-(bone infection) inflammation extends to periosteum. F/U: blood urea nitrogen-31mg/dl (H); ESR-28mm/hr (H);
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)PFIZER/WYETH4988112 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood urea increased, Cellulitis, Depression, Diarrhoea, Erythema, Fatigue, Influenza like illness, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injury, Insomnia, Oral intake reduced, Palpitations, Pollakiuria, Red blood cell sedimentation rate increased, Tremor, Type III immune complex mediated reaction, Urinary hesitation, Weight decreased, White blood cell count decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad)
Write-up: Swelling, pain, redness, induration involving the entire left upper arm; associated with flu-like symptoms. Prolonged course-poorly responsive to antihistimines or antibiotics. Admitted to hospital 4/30/00. Follow-up reports that the pt still has a hard knot on the arm in the area of vax and also complained of fatigue. Per F/U; the pt was seen by the physician on 4/13/00 because of a left thumb crushing injury. He was administered Tetanus Toxoid. He was dx''d on 4/19/00 with cellulitis and administered IM ceftriaxone sodium for 2 days, then prescribed oral amoxicillin/clavulanate for 7 days. He later received IM ceftriaxone sodium for the next 3 days. The next day, the physician performed a needle aspiration to decompress the area because it was firm approx. the size of a 50 cent piece. His physician prescribed cefazolin for 3 days to be given at an infusion facility. The pt was depressed. At the infusion facility, the pt indicated that he had lost 7 pounds, had no appetite and experienced diarrhea for the past 2 weeks. On 4/30/00, his arm infection worsened; he developed streaking. He was admitted to the hospital for IV antibiotics with a dx of "Type III hypersensitivity", "arthur" reaction, "serum sickness", left arm pain and possible abscess, cellulitis and lymphangitis. He was treated also with rocecoxib. Then Citalopram was prescribed. Methylprednisolone sodium succinate was prescribed and the pt was discharged from the hospital with an additional prescrition for rabeprasole. He was prescribed propoxyphene napaylate for pain on 5/5/00. On 5/10/00, the MD noted that the pt experienced a red face, palpitations, hand shaking and urinary hesitancy with dribbling. Nitrofurantoin was prescribed and his dosage of prednisone was decreased. This did not help. Tamsulosin hydrochloride was prescribed on 5/17/00. The pt continued to have urinary frequency, hesitancy, difficulty urinating, tremors and sleeplessness. On exam, the fibrous thickened area at the injection site on his left arm had improved. Flomax was disconti

VAERS ID:151888 (history)  Vaccinated:1999-11-03
Age:49.0  Onset:1999-11-03, Days after vaccination: 0
Gender:Female  Submitted:2000-04-21, Days after onset: 169
Location:Connecticut  Entered:2000-05-12, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The pt had no history of Lyme disease or arthritis.
Diagnostic Lab Data:
CDC Split Type: 20000055211
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 2IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: In April, 1999 and May, 1999, the pt received her 1st and 2nd injection of Lymerix. In June, 1999, she experienced pain in her finger joints, which then spread to he ankles and toes. Treatment included prednisone and Vioxx to which she had some reactions (nos). The pt was given her 3rd injection of Lymerix on 11/3/1999 and her symptoms got immediately worse. Additional information has been requested.

VAERS ID:151906 (history)  Vaccinated:1999-06-28
Age:49.0  Onset:1999-08-09, Days after vaccination: 42
Gender:Female  Submitted:2000-04-21, Days after onset: 256
Location:Pennsylvania  Entered:2000-05-12, Days after submission: 21
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: Western Blot - neg, X-rays - some degenerative changes
CDC Split Type: 20000070801
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY123891IMRL
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Bone disorder
SMQs:, Arthritis (broad)
Write-up: In 5/99 and on 6/28/99, the pt self-administered the first and second left thigh doses of Lymerix using pre-filled syringes. Six weeks after receiving dose 2, on 8/9/99, the pt experienced a new onset of shooting pains through multiple joints. An MD''s visit was required, and she was treated with an unspecified medication. The treating medication masks the pain but does not take it away. She has been to several MD''s and no one can come up with any cause other than Lymerix. She went to an infectious disease physician and the Western blot was negative. X-rays taken "recently" showed nothing but "some degenerative changes" but physicians feel that the joint pain is not from this. "They have narrowed it down to Lymerix." The most recent information received on 3/10/00 reports the condition of the pt as ongoing.

VAERS ID:151912 (history)  Vaccinated:1999-07-01
Age:49.0  Onset:1999-07-09, Days after vaccination: 8
Gender:Female  Submitted:2003-02-14, Days after onset: 1316
Location:New Jersey  Entered:2000-05-12, Days after submission: 1008
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin-D, Levoxyl, Fosamax, Lodine XL, Premarin, and melatonin.
Current Illness:
Preexisting Conditions: allergies to morphine and intravenous pyelogram dye, allergic rhinitis, poor sleep and fatigue (May 1999), arthritis, osteopenia, chronic neck pain after fallng down stairs (1995), "Raynaud''s" (1998), hypercholesterolemia, hypothyroidism, bladder polyps (1997), recurrent urinary tract infections, chronic cystitis, constipation, hemorrhoids, irritable bowel syndrome, mitral valve pr
Diagnostic Lab Data: Antinuclear antibody negative; antistreptolysin antibodies 85.5IU/mL; C-reactive protein, serum negative; erythrocyte sedimentation rage 5mm/hr; rheumatoid factor negative; serum uric acid 2.5mg/dL. Lyme total antibodies 9/9/99 4.23 (positi
CDC Split Type: 2000007818
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS120D92IMLA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Medication error, Raynaud's phenomenon
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)
Write-up: In April, 99, the pt received her first injection of Lymerix, with no adverse effects. In June, 99, she received the second dose and experienced no ill effects. In July, 1999, the pt received the third injection of Lymerix and approximately 4 months post vax the pt experienced severe joint pain in her hands and feet. The pt took a pain medication and plans to see her MD on 3/21/00. The information received on 3/20/00 reports the symptoms are ongoing. The subject''s medical history included allergies to morphine and intravenous pyelogram dye, allergic rhinitis, poor sleep and fatigue (May 1999), arthritis, osteopenia, chronic neck pain after fallng down stairs (1995), "Raynaud''s" (1998), hypercholesterolemia, hypothyroidism, bladder polyps (1997), recurrent urinary tract infections, chronic cystitis, constipation, hemorrhoids, irritable bowel syndrome, mitral valve prolapse, palpitations, uterine fibroid, fibrocystic breast disease, and tick bite (1998). In December 1998, the subject complained of joint pian in her shoulders, hands, and hips. She also reported cramps in her feet. The physician noted swelling of the knuckles, "Raynauds''s," and hip tenderness at full extension. The subject reported that she had x-rays performed, but did not recall the results. She was "unsure" if she was told that she had arthritis. Dual-energy x-ray absorptiometry (DEKA) scan revealed osteopenia. The diagnosis of arthritis was later confirmed. Family history was significant for unspecified arthritis. Surgical history inclued tonsillectomy, breast lumpectomies, and partial hysterectomy. Concurrent medications included Claritin-D, Levoxyl, Fosamax, Lodine XL, Premarin, and melatonin. The subject recceived injections of LYMErix on 4/7/99 (120E9), 5/5/99 (120D9), and 6/30/99 (1209D). The third injection was administered two months after the first injection, rather than the recommended interval of 12 months. Initially, the subject reported that she received LYMErix in April 1999, June 1999, and 7/30/99. She reported that approximately

VAERS ID:151917 (history)  Vaccinated:1999-06-25
Age:49.0  Onset:1999-07-18, Days after vaccination: 23
Gender:Male  Submitted:2000-04-21, Days after onset: 278
Location:Maryland  Entered:2000-05-12, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: localized soreness;LYMERIX;1;49.00;In Patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: hx of tick bite
Diagnostic Lab Data: blood test - positive for Lyme disease
CDC Split Type: 2000078361
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY123891IMLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Headache, Infection, Pyrexia, Rash, Similar reaction on previous exposure to drug, Testicular disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Fertility disorders (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: On 5/25/99, the pt received his first injection of Lymerix, with localized soreness which resolve. On 6/26/95, he received the second dose, and 23 days post vax he experienced a bull''s eye rash between two toes on his left foot. Also, the pt experienced testicular pain, headache, fever, and heavy joint pain; and went to his MD. Blood work was performed on 7/8/99 which tested positive for Lyme disease. The pt received a prescription for antibiotics which were to be taken for 10-14 days. On 10/16/99, the pt received the third injection and has not gone back to the MD. The information received on 3/16/00 provides no further information.

VAERS ID:151970 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2000-03-07
Location:Pennsylvania  Entered:2000-05-16, Days after submission: 69
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00020794
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Post vax, the pt experienced an unspecified reaction.

VAERS ID:152155 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2000-03-07
Location:Massachusetts  Entered:2000-05-19, Days after submission: 72
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99061331
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Information has been received from a 49 year old female registered nurse with multiple sclerosis who received one dose of hepatitis b vax. The nurse inquired about any information on hepatitis b vax and multiple sclerosis. No adverse experience was noted.

VAERS ID:152260 (history)  Vaccinated:1997-03-03
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2000-03-07
Location:Louisiana  Entered:2000-05-23, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99090968
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IM 
Administered by: Public     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a health care professional concerning a pt who was vaccinated with Hep B vaccine. Subsequently, after the pt''s third dose of the vaccine, the pt tested false positive for Hep C. It was noted that another pt (WAES00021645) experienced a similar reaction after therapy with Hep B. The pt sought unspecified medical treatment. Follow up information from a health care professional regarding a 49 year old female nurse indicated that the pt was vaccinated with three doses of Hep B. In June 1997, the pt donated blood and then received information that her blood had "tested false positive for antibodies to the Hep C virus." In March, 1999 repeat blood work indicated "the repeat testing for HCV antibody was neg. The pt is now permitted to donate blood again. No further information is available.

VAERS ID:152423 (history)  Vaccinated:1999-05-24
Age:49.0  Onset:1999-05-26, Days after vaccination: 2
Gender:Female  Submitted:2000-05-22, Days after onset: 362
Location:Connecticut  Entered:2000-05-26, 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: Prelone
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: Lyme serology
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY130A91 LA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Headache, Injection site rash, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Post vax, 24 hours later, pt developed fatigue, dull headache, diarrhea and nausea. At site of injection, she has a rash, 9cm X 4cm.

VAERS ID:152780 (history)  Vaccinated:1998-10-09
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:1998-11-03
Location:South Carolina  Entered:2000-06-07, Days after submission: 581
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: U1998006320
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0980580   
Administered by: Other     Purchased by: Other
Symptoms: Cough, Dysphonia, Headache, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad)
Write-up: It was reported that a 49 year old male received Fluzone 98-99. Reportedly sometime after the vax, the pt experienced systemic reactions of headache, general malaise, fever, and myalgia. From additional information received on 11/3/98 it was reported that the pt also experienced hoarseness and cough lasting 48 hours. Reportedly the pt recovered from this experience.

VAERS ID:152934 (history)  Vaccinated:2000-04-18
Age:49.0  Onset:2000-04-19, Days after vaccination: 1
Gender:Female  Submitted:2000-04-29, Days after onset: 10
Location:Arizona  Entered:2000-06-08, Days after submission: 40
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
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0613J0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The pt experineced a fine red rash on both arms and cheeks. It itches slightly.

VAERS ID:153075 (history)  Vaccinated:2000-03-14
Age:49.0  Onset:2000-03-28, Days after vaccination: 14
Gender:Female  Submitted:2000-04-10, Days after onset: 12
Location:Texas  Entered:2000-06-08, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Low-grade fever and sore throat
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1510J SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 3/28/00, woke up in AM to find chest, neck, face and back, broken out in red, raised rash. Reports she had a low-grade fever and mild sore throat for past 3 days.

VAERS ID:153294 (history)  Vaccinated:2000-03-08
Age:49.0  Onset:2000-03-08, Days after vaccination: 0
Gender:Female  Submitted:2000-03-09, Days after onset: 1
Location:Georgia  Entered:2000-06-09, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA00029
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3200A60IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dry throat, Face oedema, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 2 hours post vax, the pt complained of dizziness, after lying down for several hours, the pt woke up with a complaint of swollen face, tongue, cotton throat, was taken to ER by sister. Treated with Benadryl, Prednisone. The pt was advised to see PMD the following day. Unable to contact pt for follow up.

VAERS ID:153637 (history)  Vaccinated:2000-04-12
Age:49.0  Onset:2000-04-15, Days after vaccination: 3
Gender:Male  Submitted:2000-05-15, Days after onset: 30
Location:Michigan  Entered:2000-06-09, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.158440IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR00640IMRA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA15AA0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Headache, Hyperhidrosis, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: April 15, 2000 pt had increase temp. 103F, chills and sweats. Also had headache and back pain noticed 3-4 inch swelling where yellow fever was given. Resolved itself in 3 days without treatment.

VAERS ID:153638 (history)  Vaccinated:2000-03-21
Age:49.0  Onset:2000-03-21, Days after vaccination: 0
Gender:Female  Submitted:2000-05-17, Days after onset: 56
Location:Texas  Entered:2000-06-09, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sular
Current Illness: NONE
Preexisting Conditions: Hypertension, seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3212A41IMRA
Administered by: Private     Purchased by: Public
Symptoms: Pain
SMQs:
Write-up: Pt received vax in right deltoid and complaint of stinging at time of administration. On 5/17/2000 stated that injection site will sting periodically. Has full strength and full range of motion of right arm.

VAERS ID:153723 (history)  Vaccinated:2000-03-30
Age:49.0  Onset:2000-03-30, Days after vaccination: 0
Gender:Female  Submitted:2000-04-20, Days after onset: 20
Location:Pennsylvania  Entered:2000-06-09, Days after submission: 50
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Parkdale/00669P/ID/RFA
Current Illness: NONE
Preexisting Conditions: Bee stings
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0230J0IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES00115D IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Feeling hot, Hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt received Hep-B vax to right deltoid. Noticed itching, swelling, redness that evening. Over next few days swelling and redness increased. Patient seen in office and dx with cellulitis vs allergic reaction. Did have warmth of skin in affected area.

VAERS ID:154030 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1999-12-21
Location:Indiana  Entered:2000-06-13, Days after submission: 174
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ8682615DEC1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982721IM 
Administered by: Other     Purchased by: Other
Symptoms: Contusion, Injection site pain, Injection site urticaria, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Two days post vax, the pt developed an injection site reaction characterized by a severe hive, itching, and pain which lasted 3 days. The pt then developed a bruise which lasted several days. The pt recovered. This is one of eight pts from this facility who had an adverse experience following receipt of vax.

VAERS ID:154107 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1999-11-15
Location:New Hampshire  Entered:2000-06-13, Days after submission: 210
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: UNK
CDC Split Type: HQ5134410NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site oedema, Rash, Skin discolouration, Vasodilation procedure
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: The pt stated that the night before the vaccine was administered she experienced 2 asthma attacks and used asthma inhalers. Within 20 minutes of vaccine administration, she developed an injection site reaction characterized by swelling, warmth, and skin discoloration described as purple/pink. She then developed a generalized rash that looked like "German measles and chicken pox". She was prescribed cortisone ointment and Claritin. Later, she was prescribed 3 stronger antihistamines because the rash did not resolve.

VAERS ID:154239 (history)  Vaccinated:2000-04-17
Age:49.0  Onset:2000-04-18, Days after vaccination: 1
Gender:Female  Submitted:2000-04-19, Days after onset: 1
Location:Pennsylvania  Entered:2000-06-15, Days after submission: 57
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil inhaler
Current Illness: UNK
Preexisting Conditions: asthma, hyperlipidemia
Diagnostic Lab Data: EKG-nml; CBC-nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Diarrhoea, Flushing, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: One day post vax pt experienced weakness, rapid heart beat, facial flushing, and diarrhea.

VAERS ID:154276 (history)  Vaccinated:1999-12-01
Age:49.0  Onset:1999-12-27, Days after vaccination: 26
Gender:Female  Submitted:2000-02-11, Days after onset: 46
Location:Washington  Entered:2000-06-15, Days after submission: 124
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: FLU2400100
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02979P0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Pt complained of severe pain in right arm that radiated from deltoid up to shoulder and lateral thorax.

VAERS ID:154344 (history)  Vaccinated:1999-06-23
Age:49.0  Onset:1999-06-24, Days after vaccination: 1
Gender:Male  Submitted:1999-09-29, Days after onset: 97
Location:Wisconsin  Entered:2000-06-15, Days after submission: 260
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19990156851
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Pain, Personality disorder
SMQs:, Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad)
Write-up: Within 5 hours post vax, the pt experienced an achy shoulder and one day later he had a headache and a foggy feeling.

VAERS ID:154369 (history)  Vaccinated:1999-05-28
Age:49.0  Onset:1999-06-01, Days after vaccination: 4
Gender:Female  Submitted:1999-09-29, Days after onset: 120
Location:Connecticut  Entered:2000-06-15, Days after submission: 260
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allergy shots, Zyrtec
Current Illness:
Preexisting Conditions: allergy to cats, dust, dust mite, grass, trees, hx of Lyme disease
Diagnostic Lab Data:
CDC Split Type: 19990166941
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt has a history of Lyme disease on two occasions. On 4/23/99, the pt received her first treatment with Lymerix, with no adverse effects. On 5/26/99, she received the second dose and two weeks later, experienced tenderness and a prickly feeling (migratory) at the injection site which resolved in 3 days. On 6/28/99, she received the third dose, and two hours later the prickly feeling returned. The most recent information received on 1/30/99 reports the symptoms are ongoing.

VAERS ID:154411 (history)  Vaccinated:1999-06-11
Age:49.0  Onset:1999-06-11, Days after vaccination: 0
Gender:Female  Submitted:1999-09-29, Days after onset: 110
Location:New Jersey  Entered:2000-06-15, Days after submission: 260
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: NONE
Diagnostic Lab Data:
CDC Split Type: 19990180951
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Influenza like illness
SMQs:
Write-up: This is a spontaneous report from a nurse referring to a 49 year old female pt who on 4/9/99, received her 1st treatment with Lymerix, with no untoward affects. On 6/11/99, she received the 2nd dose and 6 to 12 hours later, she experienced flu-like symptoms and chills. No treatment was given. The most recent information received on 8/9/99, reports the symptoms resolved after 2 weeks.

VAERS ID:154604 (history)  Vaccinated:1999-02-01
Age:49.0  Onset:1999-02-14, Days after vaccination: 13
Gender:Female  Submitted:1999-11-22, Days after onset: 281
Location:New Jersey  Entered:2000-06-19, Days after submission: 209
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99021071
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 2 weeks post vax, pt developed a flat rash on face and neck and a large node behind ear. There was no fever. A couple of days later the rash was all over body.

VAERS ID:154621 (history)  Vaccinated:1998-06-22
Age:49.0  Onset:1998-06-24, Days after vaccination: 2
Gender:Female  Submitted:1998-08-19, Days after onset: 56
Location:Maryland  Entered:2000-06-19, Days after submission: 670
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone; Premarin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: U199800417
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.M10531SCRA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Bone pain, Facial palsy, Influenza like illness, Pyrexia, Rash, Sinusitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt experienced flu like symptoms with temperature and joint and bone aches. Then spotty rash 3 inch red spots Bells Palsy then sinusitis. Pt was treated with Prednisone, eye ointment with antibiotics and Flonase for sinusitis.

VAERS ID:154627 (history)  Vaccinated:1998-07-29
Age:49.0  Onset:1998-07-29, Days after vaccination: 0
Gender:Female  Submitted:1998-09-30, Days after onset: 63
Location:Massachusetts  Entered:2000-06-19, Days after submission: 628
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexale, Oxycodone, Dapasone, Naprosyn, folic acid
Current Illness: Headaches, chills, body aches, temperature of 93.8 F
Preexisting Conditions: History of immunosuppressive disorder.
Diagnostic Lab Data:
CDC Split Type: U1998004500
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST. 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt experienced fever, headache and general malaise after receiving 2nd dose of Imovax. Followup 09/30/98 reported pt recovered.

VAERS ID:154644 (history)  Vaccinated:1999-02-11
Age:49.0  Onset:1999-03-11, Days after vaccination: 28
Gender:Female  Submitted:1999-03-25, Days after onset: 14
Location:Maryland  Entered:2000-06-19, Days after submission: 451
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: U1999001820
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.P0790 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Headache, Myalgia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Pt experienced muscle aches, headache, GI upset and itching with no observed rash.

VAERS ID:154828 (history)  Vaccinated:1998-10-12
Age:49.0  Onset:1998-10-14, Days after vaccination: 2
Gender:Male  Submitted:1999-02-24, Days after onset: 133
Location:South Carolina  Entered:2000-06-20, Days after submission: 481
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergic bronchitis and sinusitis
Diagnostic Lab Data: NONE
CDC Split Type: U1998006360
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0980580 IM 
Administered by: Public     Purchased by: Public
Symptoms: Cough, Dysphonia, Headache, Malaise, Musculoskeletal stiffness, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Two days post vax pt experienced systemic reactions of headache, general malaise, fever, nausea, vomiting and myalgia. Pt also experienced a low grade fever, stiffness, coughing with mucous, hoarseness and headache.

VAERS ID:155096 (history)  Vaccinated:1998-10-19
Age:49.0  Onset:1998-10-20, Days after vaccination: 1
Gender:Female  Submitted:1998-12-23, Days after onset: 64
Location:Ohio  Entered:2000-06-21, Days after submission: 545
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: abdominal pain
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U1998007370
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0980580 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: One day post vax, 11/20/98, the pt experienced redness, warmth and swelling at the site of injection. Reportedly the pt recovered from this experience. From additional information received on 11/16/98, it was reported "Reviewed, no additional information at this time".

VAERS ID:155153 (history)  Vaccinated:1998-11-03
Age:49.0  Onset:1998-11-07, Days after vaccination: 4
Gender:Male  Submitted:1998-12-08, Days after onset: 31
Location:New Jersey  Entered:2000-06-21, Days after submission: 560
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: EKG, lab tests, CXR, stress test-all neg
CDC Split Type: U1998008250
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0965770 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad)
Write-up: Several days post vax, the pt complained of myalgias, bilateral chest wall as well as lower extremity muscle weakness.

VAERS ID:155451 (history)  Vaccinated:2000-06-06
Age:49.0  Onset:2000-06-06, Days after vaccination: 0
Gender:Female  Submitted:2000-06-14, Days after onset: 8
Location:Unknown  Entered:2000-06-27, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec, synthroid and Prozac
Current Illness:
Preexisting Conditions: hx of GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0193AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: The pt experienced a local reaction to the DT vaccine. This is one of three pt''s to report a local reaction after receiving a similar vaccine in the past two weeks.

VAERS ID:156107 (history)  Vaccinated:2000-06-26
Age:49.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-27, Days after onset: 0
Location:Michigan  Entered:2000-07-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Demerol, asthma, allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
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HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM654A40IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P09980IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0147AA IMLA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA279AA0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Blood pressure increased, Dyspnoea, Face oedema, Feeling hot, Heart rate increased, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Approximately 2 hours post vax pt developed hives, face began to swell, and pt had difficulty breathing. BP increased and heart rate increased, skin felt like it was on fire. Pt was treated in ER with Benadryl and epinephrine.

VAERS ID:156129 (history)  Vaccinated:2000-06-21
Age:49.0  Onset:2000-06-26, Days after vaccination: 5
Gender:Male  Submitted:2000-07-07, Days after onset: 11
Location:Pennsylvania  Entered:2000-07-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 05/24;LYMERIX;1;.00;In Patient
Other Medications: Vioxx, Prilosec, Carbitrol, Zyrtec, Celexa, allergy shots
Current Illness: Upper respiratory infection
Preexisting Conditions: allergy to dust, mold, pollen, arthritis, carpal tunnel syndrome, facial tic, smoker, trigger thumb
Diagnostic Lab Data:
CDC Split Type: 20000202281
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Back pain, Condition aggravated, Cough, Influenza like illness, Malaise, Myalgia, Nasal congestion, Pharyngolaryngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad)
Write-up: 06/24, 3 days post vax, this pt experienced sore throat. The following day he was ''ill'' (NOS). 06/26, he had fever, muscle aches (back), cough, flu-like symptoms and sputum ranging in color from clear to yellow-brown. He also experienced sinus congestion, and runny nose. Symptoms of flu continue. He complains of muscle aches only. He still is unable to work. His sore throat seems to be resolving, but sinus congestion and runny nose and cough are not improving, according to the vaccinee. This case is considered serious because the vaccinee is incapacitated due to his inability to work. The most recent information received 06/29, reports the outcome of the event is ongoing.

VAERS ID:156135 (history)  Vaccinated:2000-07-08
Age:49.0  Onset:2000-07-08, Days after vaccination: 0
Gender:Female  Submitted:2000-07-09, Days after onset: 1
Location:Texas  Entered:2000-07-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1715J0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt experienced a severe rash on face and a headache 12 - 13 hours post vax.

VAERS ID:156796 (history)  Vaccinated:1999-03-11
Age:49.0  Onset:1999-03-30, Days after vaccination: 19
Gender:Female  Submitted:2000-05-16, Days after onset: 412
Location:New York  Entered:2000-07-14, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99040663
Vaccination
Manufacturer
Lot
Dose
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Public     Purchased by: Public
Symptoms: Infection
SMQs:
Write-up: Approximately 2 weeks post vax the pt developed a rash and was diagnosed with chickenpox.

VAERS ID:157428 (history)  Vaccinated:1999-07-16
Age:49.0  Onset:1999-07-16, Days after vaccination: 0
Gender:Female  Submitted:2000-05-16, Days after onset: 305
Location:Florida  Entered:2000-07-19, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Soma 350 mg
Current Illness:
Preexisting Conditions: meperidine, pentazocine, pollen allergies and history of back surgery.
Diagnostic Lab Data:
CDC Split Type: WAES99080751
Vaccination
Manufacturer
Lot
Dose
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0879J0SCLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Injection site hypersensitivity, Injection site pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: On the same day post one dose of varicella virus vaccine live the pt developed 2 spots below injection site. The spots were described as tender, sensitive and pruritic lasting approximately 3-4 days. They were treated with antibiotic ointment to ensure proper healing. The pt developed a tenderness and sensitivity around the waist that was often painful. The pt also developed a fever. She subsequently recovered.

VAERS ID:157471 (history)  Vaccinated:1999-07-16
Age:49.0  Onset:1999-07-18, Days after vaccination: 2
Gender:Female  Submitted:2000-05-16, Days after onset: 303
Location:Florida  Entered:2000-07-19, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99080863
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Approximately two days subsequent to receiving varicella virus vaccine live, the pt experienced pain in the waist bilaterally, fever and a rash in the armpits which was non-vesicular and described as transient and self-limiting.

VAERS ID:157594 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:1998-09-25
Gender:Female  Submitted:2000-05-05, Days after onset: 588
Location:Indiana  Entered:2000-07-20, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carboplatin; Taxol
Current Illness:
Preexisting Conditions: non small cell lung adenocarcinoma
Diagnostic Lab Data:
CDC Split Type: MPU19990037
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20176HB IM 
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES454976 IM 
Administered by: Private     Purchased by: Private
Symptoms: Cough, Nasal congestion, Productive cough, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt received Pnu-Imune 23 and Fluvirin on the same day into the right deltoid. Within 24 hours post vax the pt developed a fever of 104F which persisted for several days then decreased to 102F. She was afebrile as of 10/01/1998, but had a cough productive for white sputum and had chest congestion. It is recommended that these two vaccines be injected into separate sites when they are administered concomitantly. Follow up information information indicated that the vaccinee had a history of small cell lung adenocarcinoma which was treated with Taxol and carboplatin. Pt was treated with Tylenol which relieved her symptoms of fever, chest congestion and productive cough. The fever resolved after 48 hours and all symptoms are stated as having resolved 4 days post onset. Reporting physician strongly believes that the pts reaction may be related to injection of influenza and pneumo vax simultaneously.

VAERS ID:157703 (history)  Vaccinated:1999-06-30
Age:49.0  Onset:1999-10-01, Days after vaccination: 93
Gender:Female  Submitted:2002-09-05, Days after onset: 1070
Location:New Jersey  Entered:2000-07-21, Days after submission: 776
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: X-rays show severe arthritis; blood work also taken.
CDC Split Type:
Vaccination
Manufacturer
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LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS120D92IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Arthritis, Pain, Raynaud's phenomenon
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)
Write-up: Pain in hands and feet. X-rays show severe arthritis in joints. Dr treating pain with Vioxx 25mg. A follow up report received 2/3/2003 adds: (From FDA Researcher): On this date at 11:30 AM I spoke to subject patient. She provided an update regarding her condition and the adverse event she experienced following the Lyme vaccine. She stated that she is now doing worse since the time of her VAERS report and follow-up survey interview. She stated that she was still experiencing aches and pains. She is still taking medication to keep her symptoms under control. She was on a trial drug from Merck which helped, however she experienced side effects and has since stopped taking that drug. She now has severe pain in her hips as well as other previously reported joints (hands, feet, elbows). She developed Reynaud''s syndrome following her Lyme vaccination, approximately 2 years ago, and asked about that being a possible side effect of the vaccine. I responded that there was no evidence at this time to indicate that. A follow up report received 9/9/2002 adds: Report A0323036A (formerly 2000007818-1) describes osteoarthritis in a 49-year-old female who was vaccinated with Lyme disease vaccine recombinant OspA (Lymerix) for prophylaxis. The initial report was received from the subject; follow-up info was received from her physician and frm her attorney with forwarding of medical records. Allergies included morphine and intravenous pyelogram (IVP) dye. Medical history included arthritis, cystitis, pain in her feet and hands (occasionally drops things), hayfever, hemorrhoids, hypothyroidism, lumpectomies (1981 and 1985) mitral valve prolapse, thyroid biopsy, palpitations, partial hysterectomy (1986), tonsillectomy (1956), irritable bowel syndrome, poor sleep and fatigue (May 1999) and gravida two, para two. At the time of the events, she was taking loratadine (Claritin), levothyroxine (Levoxyl), alendronate (Fosamax), etodalac (Lodine XL) (only when the pain gets bad) and melatonin. The pt received Lymerix in April 1999 (lo

VAERS ID:157766 (history)  Vaccinated:1999-09-01
Age:49.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Male  Submitted:2000-03-15, Days after onset: 196
Location:Georgia  Entered:2000-07-21, Days after submission: 127
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ1524106OCT1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES  IMLA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Within 30 minutes of vax, pt developed a headache with the sensation of increased pressure in his head, burning sensation on his tongue, joint pain and muscle pain. Pt was seen in the ER and treated with antihistamines. His symptoms persisted as of 10/01/1999.

VAERS ID:157782 (history)  Vaccinated:1999-11-20
Age:49.0  Onset:0000-00-00
Gender:Unknown  Submitted:2000-03-23
Location:New York  Entered:2000-07-21, Days after submission: 119
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: left thumb injury
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ0206104JAN2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES463321 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction
SMQs:
Write-up: Subsequent to receiving Tetanus and Diphtheria Toxoids Adsorbed Purogenated pt developed an injection site reaction.

VAERS ID:157837 (history)  Vaccinated:1999-04-01
Age:49.0  Onset:2000-01-13, Days after vaccination: 287
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:2000-07-24
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: All relevant test/lab data should be available upon request from physicians. All medical releases are enclosed.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120D90IM 
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: All relevant test/lab data should be available upon request from physicians. All medical releases are enclosed.

VAERS ID:157883 (history)  Vaccinated:2000-02-18
Age:49.0  Onset:2000-02-20, Days after vaccination: 2
Gender:Female  Submitted:2000-06-02, Days after onset: 102
Location:New Jersey  Entered:2000-07-24, Days after submission: 52
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: Dx with Lyme in 1992, but was in remission
Diagnostic Lab Data: Western blot-positive for Lyme disease
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 2IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Fatigue, Feeling cold, Headache, Hypoaesthesia, Infection, Influenza like illness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Pt developed fatigue, numbness in arms and hands, pain in joints, and flu-like symptoms. The annual follow-up states arthritis pain, flu like symptoms, headache, fatigue and cold-no circulation. 07/25/2000 09:25 1st attempt to reach pt-message left on answering machine requesting a call back. 07/26/2000 09:40 2nd attempt to reach pt-message left on answering machine requesting a call back. 07/26/2000 call from pt-her symptoms are presistant and is being seen by rheumatologist and Tx''d with Celebrex. She had other vaccines with 4 weeks prior to Lymerix #3. Consent form sent for rheumatogy records.

VAERS ID:157886 (history)  Vaccinated:2000-05-06
Age:49.0  Onset:2000-05-07, Days after vaccination: 1
Gender:Male  Submitted:2000-07-08, Days after onset: 62
Location:New York  Entered:2000-07-24, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PCN allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0310SCLA
Administered by: Military     Purchased by: Unknown
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Same day post vax, the pt experienced light-headedness and dizziness.

VAERS ID:158140 (history)  Vaccinated:2000-05-19
Age:49.0  Onset:2000-05-20, Days after vaccination: 1
Gender:Male  Submitted:2000-07-19, Days after onset: 60
Location:Pennsylvania  Entered:2000-07-28, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Malaria
Diagnostic Lab Data:
CDC Split Type: 20000182841
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IM 
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Injection site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: On 4/16/00, the pt received his 1st dose of Lymerix and within the 1st hour, post vax, the pt experienced right arm numbness for 15 hours, arm soreness for 24 hours and tingling in the arm for 6 hours. The events resolved after 24 hours. On 5/19/00, the pt received his 2nd dose of Lymerix and within 18 hours, he experienced nausea, vomiting, diarrhea, dizziness and some arm soreness. It was noted that the pt was sick for 3 days. The most recent information received on 5/26/00, reports the outcome of the events as resolved.

VAERS ID:158142 (history)  Vaccinated:2000-05-27
Age:49.0  Onset:2000-05-27, Days after vaccination: 0
Gender:Female  Submitted:2000-07-19, Days after onset: 53
Location:New Jersey  Entered:2000-07-28, 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: Singulair
Current Illness:
Preexisting Conditions: Mild asthma, small fallopian cyst
Diagnostic Lab Data: Ultrasound and unspecified lab work-all wnl
CDC Split Type: 20000183061
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Headache, Influenza like illness, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad), Arthritis (broad)
Write-up: On 5/27/00, the pt received her 1st dose of Lymerix and within 1 1/2 hours, post vax, the pt experienced flu symptoms, headache, joint pain, and severe abdominal pain (in the ovary area). She also reported her menstrual period lasted 12 days. The most recent information received on 6/12/00 reports the outcome of the events as not yet recovered but resolving slowly.

VAERS ID:158163 (history)  Vaccinated:1999-05-09
Age:49.0  Onset:2000-01-10, Days after vaccination: 246
Gender:Male  Submitted:2000-07-28, Days after onset: 199
Location:Wisconsin  Entered:2000-07-31, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120092IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Difficulty in walking, Joint swelling
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Knees, swollen and sharp pain and hard to walk. Jaw pain. Started in January 2000 and progressively has worsened. It is hard to work and hard to walk.

VAERS ID:158314 (history)  Vaccinated:2000-06-26
Age:49.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-06-28, Days after onset: 2
Location:Washington  Entered:2000-08-02, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;;.00;In Patient
Other Medications: PPD / Connaught
Current Illness:
Preexisting Conditions: allergy to multiple medications
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0162AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Chest discomfort, Hypoaesthesia, Pain, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Within 2 minutes, the pt had blotting and itching of upper body. 1/2 hour post vax, the pt had a slight tightness in the chest. The pt received Benadryl and was observed for 2 hours. Returned 2 days later with soreness and numbness in left arm.

VAERS ID:158820 (history)  Vaccinated:2000-08-05
Age:49.0  Onset:2000-08-06, Days after vaccination: 1
Gender:Male  Submitted:2000-08-07, Days after onset: 1
Location:Missouri  Entered:2000-08-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0084SCRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt received his 5th Anthrax on 8/5/00 and noted redness and swelling to below the elbow in the right arm with minimal pain.

VAERS ID:158935 (history)  Vaccinated:2000-05-26
Age:49.0  Onset:2000-05-27, Days after vaccination: 1
Gender:Female  Submitted:2000-08-08, Days after onset: 73
Location:Massachusetts  Entered:2000-08-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: EM20000223
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Post vax, the pt developed tingling in her left arm and leg after receiving vax.

VAERS ID:159116 (history)  Vaccinated:2000-07-13
Age:49.0  Onset:2000-07-13, Days after vaccination: 0
Gender:Male  Submitted:2000-08-16, Days after onset: 34
Location:Wisconsin  Entered:2000-08-23, 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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0061AA1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Pain in the right forearm, upper shoulder and the pain in the joints. The arm feels numb.

VAERS ID:159406 (history)  Vaccinated:2000-07-20
Age:49.0  Onset:2000-07-22, Days after vaccination: 2
Gender:Female  Submitted:2000-08-24, Days after onset: 33
Location:Minnesota  Entered:2000-09-06, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Monopril, Hrt, ASA, B6
Current Illness: sutured a laceration
Preexisting Conditions: hayfever; seasonal allergies; hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0194AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site urticaria, Vasodilation procedure
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt developed large welt around injection site on left deltoid. Raised, red, warm and painful. Continued to increase in size to 6 inches in diameter. Pt treated with ice, Benadryl and Tylenol/Aleve without relief. Gradually decreased in size, redness, and warmth over the next week or more.

VAERS ID:159689 (history)  Vaccinated:1999-07-27
Age:49.0  Onset:1999-07-28, Days after vaccination: 1
Gender:Female  Submitted:1999-08-06, Days after onset: 9
Location:California  Entered:2000-09-08, Days after submission: 399
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: U1999005220
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.PMP056732IMLA
RUB: RUBELLA (NO BRAND NAME)BURROUGHS WELLCOME    
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: It was reported that an adult female received Imovax ID vaccine on July 27, 1999. Reportedly sometime after the vaccination the pt experienced a local reaction which consisted of redness, itching and vesicles around the ID site. From additional information received on August 5, 1999, it was reported that on July 28, 1999, 2 x 4mm of vesicles covered the injection site on pt left arm, was red and hot. Pt saw MD on July 29th, 1999. and was told will be okay. The pt reportedly recovered from this experience.

VAERS ID:159712 (history)  Vaccinated:1999-05-14
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:1999-12-15
Location:Pennsylvania  Entered:2000-09-08, Days after submission: 267
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: U1999009560
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM568B6 IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7258BA IMRA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES0971920 SCRA
Administered by: Private     Purchased by: Other
Symptoms: Hypoaesthesia, Myalgia, Night sweats, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Eight - ten hours after the vax, pt developed night sweats and fever for two nights. Aches and numbness of the right shoulder muscle only continuous over several weeks lessened to only evenings and now only it arm is used quite often. Pt denies weakness in right arm or hand and denies numbness anywhere else.

VAERS ID:159574 (history)  Vaccinated:1999-06-07
Age:49.0  Onset:1999-06-08, Days after vaccination: 1
Gender:Female  Submitted:1999-06-11, Days after onset: 3
Location:Texas  Entered:2000-09-10, Days after submission: 457
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: U1999003880
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Arthralgia, Headache, Hostility, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Arthritis (broad)
Write-up: It was reported that a 49 year old female received Rabies Imovax vaccine on 6/7/99. Reportedly, on 6/8/99, the pt complained of nausea, fever, agitation, angry, joint pain and headache. These symptoms reportedly lasted for 2 days.

VAERS ID:160032 (history)  Vaccinated:2000-08-31
Age:49.0  Onset:2000-09-01, Days after vaccination: 1
Gender:Female  Submitted:2000-09-05, Days after onset: 4
Location:Michigan  Entered:2000-09-25, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lozol, Deconamine SR
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0267AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Fever and sore arm, 24-96 hours, post vax. Still has small firm swelling at injection site.

VAERS ID:160101 (history)  Vaccinated:2000-08-11
Age:49.0  Onset:2000-08-11, Days after vaccination: 0
Gender:Female  Submitted:2000-09-08, Days after onset: 28
Location:Arizona  Entered:2000-09-26, Days after submission: 18
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: AZ0019
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0147AA2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Cough, Dizziness, Lethargy, Lymphadenopathy, Musculoskeletal stiffness, Nasal congestion, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Within one hour post vax, this pt reports feeling dizzy, lethargic, developed fever 5 hours later, chills swollen glands in neck, stiffness of neck, aches, body pains, cough, mucous lasting 2 weeks. Reports continues to have stiffness in neck almost one month post vax. No treatment per client.

VAERS ID:162331 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2002-06-24
Location:Washington  Entered:2000-10-13, Days after submission: 619
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: Patient has not been exposed to the influenza vaccination. She is presently recovering from bronchitis (amoxicillin was discontinued last week. She has a positive history of migraines and is allergic to bee stings (carries an epi-pen).
Diagnostic Lab Data:
CDC Split Type: U199900975
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0130AA SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Injection site reaction, Medication error, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: It was reported that a traveling health nurse who was providing TB screening to employees at a daycare center stated that after several complaints of severe burning upon administration, she discovered that she was in fact, injecting influenza (Fluzone SV ''99-''00). A 49 year old female states that she experienced "redness and swelling" which developed into painful itching and burning at site of injection (approx. 1 1/2" in diameter). At the time of report, she states that her "whole arm hurts". She has not been exposed to the influenza vaccination. She is presently recovering from bronchitis (amoxicillin was discontinued last week). She has a positive history of migraine and is allergic to bee stings (carries an epi-pen). Follow up #1 06/19/02: During internal auditing oif all files, it was deemed necessary to amend the report by updating the Adverse Event coding ( Added Medication Error and re-ranked Adverse Events).

VAERS ID:160576 (history)  Vaccinated:2000-09-20
Age:49.0  Onset:2000-09-20, Days after vaccination: 0
Gender:Male  Submitted:2000-09-26, Days after onset: 6
Location:Alaska  Entered:2000-10-16, Days after submission: 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: Type 1 diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)PFIZER/WYETH  IM 
Administered by: Military     Purchased by: Military
Symptoms: Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Approximately 9 hours post vax, the to experienced swelling of the right index finger that became painful. The pt was instructed to take Ibuprofen as directed and follow up if not better in 1 week.

VAERS ID:160809 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-04, Days after onset: 1
Location:Florida  Entered:2000-10-23, Days after submission: 19
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: BP 160/95
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5816085901 IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Blood pressure increased, Dizziness, Dysgeusia, Hypersensitivity, Hypoaesthesia, Tachycardia, Vision blurred
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Pt was dxed with allergic reaction just minutes post vax. Pt started to suffer numbness peripheral, blurred vision, tachycardia, fainting sensation, metallic taste. He was not hospitalized. He had no previous reaction from IZs. He was treated with Prednisone and was noted as having partial recovery.

VAERS ID:160976 (history)  Vaccinated:2000-10-10
Age:49.0  Onset:2000-10-11, Days after vaccination: 1
Gender:Male  Submitted:2000-10-16, Days after onset: 5
Location:Virginia  Entered:2000-10-25, Days after submission: 9
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: Reaction with tetanus shot once.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0888H1IM 
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA302AA SC 
Administered by: Military     Purchased by: Military
Symptoms: Unevaluable event
SMQs:
Write-up: No data provided.

VAERS ID:161033 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2000-10-27
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0335AD0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Post vax, the pt developed pain and redness at injection site.

VAERS ID:161278 (history)  Vaccinated:2000-10-02
Age:49.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-24, Days after onset: 21
Location:Pennsylvania  Entered:2000-11-02, 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: Lozol, Claritin
Current Illness: NONE
Preexisting Conditions: Hypertension, seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0267AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left upper extremity swelling and severe pain and itching. Treated with diphenhydramine, local measures.

VAERS ID:161279 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-20, Days after vaccination: 17
Gender:Female  Submitted:2000-10-26, Days after onset: 6
Location:Florida  Entered:2000-11-02, 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: Diovan, labetalol, Premarin, prednisone, methotrexate, Klonopin
Current Illness: NONE
Preexisting Conditions: SLE, glomerulonephritis, hypertension
Diagnostic Lab Data: CBC-nml; UA-hematuria; cultures-unknown results
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1784H0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Cough, Flushing, Haematuria, Headache, Lymphadenopathy, Malaise, Myalgia, Pharyngolaryngeal pain, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (narrow), Tubulointerstitial diseases (broad)
Write-up: Onset 10/20/00, in the afternoon with sore throat, dry cough, increasingly severe headache, flush. Awoke approx. 06:30 on 10/21/00, with elevated temperature, facial rash along with red facial flush, lymphadenopathy (especially suboccipital, cervical and post auricular), severe arthralgia/myalgia. By the time I arrived at ER, rash had spread over chest, back, abdomen and extremities and accompanied by chills and malaise. Rash persisted X 5 1/2 days. Persistent lymphadenopathy and arthritis.

VAERS ID:163230 (history)  Vaccinated:0000-00-00
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:2000-05-09
Location:Florida  Entered:2000-11-06, Days after submission: 181
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ2572110APR2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH499823610IMLA
Administered by: Military     Purchased by: Military
Symptoms: Pain
SMQs:
Write-up: Subsequent to receiving vax the pt developed aches and pains described as mainly joint pain.

VAERS ID:161540 (history)  Vaccinated:2000-09-28
Age:49.0  Onset:2000-09-28, Days after vaccination: 0
Gender:Female  Submitted:2000-10-30, Days after onset: 32
Location:Massachusetts  Entered:2000-11-07, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3231A60IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt complained of dyspnea and facial urticaria. Pt treated with po diphenhydramine.

VAERS ID:161829 (history)  Vaccinated:2000-10-27
Age:49.0  Onset:2000-10-27, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:2000-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MPI2000048810
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.H66340HA IM 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Same day post vax, the pt experienced fever, chills, and a rash that was all over his body. The pt was bedridden for five days. It was also reported that the pt was seen by a dermatologist and was treated with Prednisone. No other information was available. .

VAERS ID:161936 (history)  Vaccinated:2000-11-04
Age:49.0  Onset:2000-11-04, Days after vaccination: 0
Gender:Female  Submitted:2000-11-07, Days after onset: 3
Location:Florida  Entered:2000-11-14, 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: NONE
Preexisting Conditions: Allergy to Tigan, documented in 1976.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0409AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure increased, Chest discomfort, Dyspnoea, Feeling abnormal, Heart rate increased, Injection site pain, Neuralgia, Rash macular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Immediately felt pain and burning at site and felt like nerve endings were on edge. Approx. 1 hour later, did not feel well and noticed her cheeks and upper neck were bright red and blotchy. Chest felt tight and had to use accessory muscles to breathe. BP 150/88, HR 109. Treated in ER with Solu-Medrol IV and Pepcid IV and given a prescription for Pepcid po and Medrol dose pack to take when discharged from the ER.

VAERS ID:161944 (history)  Vaccinated:2000-11-03
Age:49.0  Onset:2000-11-06, Days after vaccination: 3
Gender:Female  Submitted:2000-11-09, Days after onset: 3
Location:California  Entered:2000-11-14, 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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0406AA0IM 
Administered by: Public     Purchased by: Private
Symptoms: Nasal congestion, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 11/6/00, states had nasal/sinus symptoms in the morning. On 11/9/00, noticed a rash on chest.

VAERS ID:163317 (history)  Vaccinated:1999-11-17
Age:49.0  Onset:0000-00-00
Gender:Female  Submitted:1999-12-22
Location:New Jersey  Entered:2000-11-14, Days after submission: 328
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: allergic to codeine, PCN; eczema; possibly allergic to yeast
Diagnostic Lab Data:
CDC Split Type: 19990332831
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E24249GA0IMLA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3074A20IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Subsequent to receiving vax, the pt experienced rash and itching at the injection site. Engerix B was discontinued. The most recent information received reports the condition of the pt is unknown.

VAERS ID:163352 (history)  Vaccinated:2000-02-23
Age:49.0  Onset:2000-02-25, Days after vaccination: 2
Gender:Male  Submitted:2000-03-01, Days after onset: 5
Location:Illinois  Entered:2000-11-14, Days after submission: 258
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin, Vitamin C, Vitamin E
Current Illness:
Preexisting Conditions: Allergies are unspecified. The patient has back problems (nos) and started "high dose" Motrin, Vitamin C and E on 02/23/00.
Diagnostic Lab Data:
CDC Split Type: 20000058171
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3351C60  
Administered by: Other     Purchased by: Other
Symptoms: Bone disorder, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This case reference number 2000005817-1, is a spontaneous report from a registered nurse referring to a 49 year old male. Allergies are unspecified. The patient has back problems (nos) and started taking "high dose" Motrin, vitamin C and E on 02/23/00. On 02/23/00, the patient received his first dose of Engerix-B. Two days later, on 02/25/00, the patient experienced a rash. Reporting nurse is not sure if the rash is due to Engerix-B or his concomitant medications. The most recent information, received on 02/29/00, reports the condition of the patient as unknown.

VAERS ID:162110 (history)  Vaccinated:2000-08-22
Age:49.0  Onset:2000-09-01, Days after vaccination: 10
Gender:Female  Submitted:2000-11-18, Days after onset: 78
Location:New York  Entered:2000-11-17, 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: N/A
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: All Rheum Testing neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.R078923IMLA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Polymyalgia after 5th dose.

VAERS ID:162509 (history)  Vaccinated:2000-08-29
Age:49.0  Onset:2000-08-30, Days after vaccination: 1
Gender:Female  Submitted:2000-11-17, Days after onset: 79
Location:Maryland  Entered:2000-11-22, 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: Abdominal pain related to gallstones
Preexisting Conditions: Allergy to aspirin and PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site swelling, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt stated she "passed out" after using the bathroom, the night after she received her pneumovax and tetanus shot. She also stated, she had redness and swelling down to above the elbow.

VAERS ID:162581 (history)  Vaccinated:2000-11-14
Age:49.0  Onset:2000-11-15, Days after vaccination: 1
Gender:Female  Submitted:2000-11-21, Days after onset: 6
Location:Texas  Entered:2000-11-24, Days after submission: 3
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: migraine headaches
Diagnostic Lab Data: WBC - elevated
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER470593 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.U0423AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: The pt was given Pneumovax and developed right arm (?) with a fever of 99.3. WBC elevated. The MD states "I suspect this is related to administrated techniques not to serum."

VAERS ID:162665 (history)  Vaccinated:2000-11-01
Age:49.0  Onset:2000-11-01, Days after vaccination: 0
Gender:Female  Submitted:2000-11-06, Days after onset: 5
Location:California  Entered:2000-11-28, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes, chronic pulmonary disease, sleep apnea
Diagnostic Lab Data: NONE
CDC Split Type: CA000117
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E67380KA0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt felt a sharp pain to the left shoulder and arm at the time of injection. Moderate edema and redness at the injection site for 1 hour. No improvement after 3 days. The pt was seen by MD. Treated with Motrin and warm packs.

VAERS ID:162813 (history)  Vaccinated:2000-11-22
Age:49.0  Onset:2000-11-22, Days after vaccination: 0
Gender:Female  Submitted:2000-11-22, Days after onset: 0
Location:Connecticut  Entered:2000-11-29, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0428AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Joint swelling, Pain, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: I vaccinated client at 05:00 and at 06:15, client returned to me complaining of pain in wrists, ankles and hips. Upon inspection, I noted that her wrist and ankles appeared swollen. She also, complained of feeling achy all over her body. She further complained of feeling very thirsty. I called the manufacturer at 06:30 and was advised to have client be seen by MD.

VAERS ID:162864 (history)  Vaccinated:1999-10-01
Age:49.0  Onset:1999-10-01, Days after vaccination: 0
Gender:Female  Submitted:2000-11-08, Days after onset: 404
Location:Alaska  Entered:2000-11-30, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Deseril
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  IMLA
Administered by: Other     Purchased by: Private
Symptoms: Hypersensitivity, Injection site pain, Pain
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Soreness and aching at the site of injection for the past year. No Rx. Pt received the vaccine at a local store in lobby site.

VAERS ID:163547 (history)  Vaccinated:2000-11-27
Age:49.0  Onset:2000-11-29, Days after vaccination: 2
Gender:Female  Submitted:2000-11-30, Days after onset: 1
Location:North Carolina  Entered:2000-12-11, 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: NONE
Current Illness:
Preexisting Conditions: allergic to PCN and Compazine
Diagnostic Lab Data: NONE
CDC Split Type: NC00095
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0154AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt noticed a hand sized band of erythema, warmth, and tenderness at injection site two days post vax. Pt advised to take Alleve or Advil as directed, use cool compresses and apply hydrocortisone topically to affected site.

VAERS ID:163563 (history)  Vaccinated:2000-10-09
Age:49.0  Onset:2000-10-09, Days after vaccination: 0
Gender:Female  Submitted:2000-12-01, Days after onset: 53
Location:Pennsylvania  Entered:2000-12-11, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Constipation; (mild inclusion cyst, chest wall)
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0346AA2IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4705900IMLA
Administered by: Private     Purchased by: Other
Symptoms: Eye pain, Hyperhidrosis, Hypertension, Hypothermia, Injection site swelling, Injection site warmth, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Hypertension (narrow), Eosinophilic pneumonia (broad)
Write-up: Area hot, swollen and spreading down to elbow; cold sweats; temperature 97F; dizzy; BP 145/92; nausea; burning eyes and myalgias.

VAERS ID:163658 (history)  Vaccinated:2000-11-14
Age:49.0  Onset:2000-11-18, Days after vaccination: 4
Gender:Female  Submitted:2000-11-21, Days after onset: 3
Location:California  Entered:2000-12-12, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA000131
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3214A42IM 
Administered by: Other     Purchased by: Public
Symptoms: Infection, Injection site induration, Injection site pain, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient developed sore arm muscle. Her arm became hard and hot to the touch from shot to shoulder. She awoke Saturday night with shooting pains in her arm and had a fever of 102 degrees. She saw a physician on 11/19/00 and was told she had an infection. She was treated with ibuprofen and cephalexin.

VAERS ID:164146 (history)  Vaccinated:2000-12-13
Age:49.0  Onset:2000-12-14, Days after vaccination: 1
Gender:Female  Submitted:2000-12-14, Days after onset: 0
Location:Massachusetts  Entered:2000-12-27, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin and depression medications
Current Illness: NONE
Preexisting Conditions: Allergic to dust mites, mold and pollen.
Diagnostic Lab Data: NONE
CDC Split Type: MA0016
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0403AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Client received injection at 08:35 on 12/13/00; called nurse at 08:50 complaining of rash all over, pink on face, pinpoint spots on arms, stomach and chest red. Also complaining of itchiness. Improving. Referred to MD for ? Rx and to check rash. Denies temperature.

VAERS ID:164229 (history)  Vaccinated:2006-05-03
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:2000-12-08
Location:Michigan  Entered:2000-12-28, Days after submission: 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: NONE
Diagnostic Lab Data: Blood drawn-No anti HB found on 3/23/98
CDC Split Type: 00AEFAV178
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV014 SCRA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Joint effusion, Joint swelling, Laboratory test abnormal, Oedema peripheral, Rheumatoid arthritis
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow)
Write-up: Employee began receiving IZ''s on 3/11/98 as requirement of employment. In April, 1999, he noted symptoms of swelling and pain in his hands. In September of 1999, he was dx''d with rheumatoid arthritis. Through the fall and winter of 1999-2000 he had occasional episodes of joint pain and swelling, though less frequent and less severe than over the summer of 1999. These episodes of joint pain and swelling affected mainly joint; hands, wrists, elbows, shoulders, knees and hips. In the spring and summer of 2000, the frequency and severity of joint pain and swelling increased. By August, 2000, he was having longer lasting and severe pain and swelling. He had fluid aspirated from his left knee. His RA factor was elevated. He began oral and IV steroid therapy. In August, 2000, he started Embrel injections with good response. Symptoms have been decreasing in frequency and severity. He is currently taking Embrel, Azulfidine, Plaquenil and Celebrex.

VAERS ID:164698 (history)  Vaccinated:2000-12-01
Age:49.0  Onset:2000-12-02, Days after vaccination: 1
Gender:Female  Submitted:2001-01-04, Days after onset: 33
Location:Oklahoma  Entered:2001-01-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl, Prempro
Current Illness: NONE
Preexisting Conditions: Hypothyroidism; replaced
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0447AA IM 
Administered by: Private     Purchased by: Private
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Petechia appeared from knees down (bilateral) and persist to date, starting the day after vaccination.

VAERS ID:164700 (history)  Vaccinated:2000-12-29
Age:49.0  Onset:2000-12-29, Days after vaccination: 0
Gender:Female  Submitted:2001-01-04, Days after onset: 6
Location:New York  Entered:2001-01-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Atrovent inhaler
Current Illness: NONE
Preexisting Conditions: Airborne allergies, household cleaners and perfumes.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40082213IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Injection site erythema, Injection site swelling, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Went to clinic at 17:00 on 12/30/00 with arm swollen and red, 4" below shot site, in left arm. Developed shortness of breath and swollen throat. Treated with 1 shot of Prednisone and po X 6 days and Benadryl X 2 days.

VAERS ID:164878 (history)  Vaccinated:2001-01-09
Age:49.0  Onset:2001-01-10, Days after vaccination: 1
Gender:Male  Submitted:2001-01-10, Days after onset: 0
Location:Montana  Entered:2001-01-18, 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: Occasionally uses an inhaler prior to exercise
Current Illness: A RESOLVING COLD
Preexisting Conditions: Mild asthma, allergic to penicillin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO333AA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Erythema, Rash macular
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Patient noted 20-30 flat, non-raised, red blotches on his chest, back, and legs approximately 24 hours after receiving vaccine. The spots were about 1/2 the size of a dime. Patient also reported periods of slight lightheadedness.

VAERS ID:164884 (history)  Vaccinated:2000-10-26
Age:49.0  Onset:2000-10-26, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New Mexico  Entered:2001-01-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3066A40IMLA
Administered by: Private     Purchased by: Private
Symptoms: Disturbance in attention, Fatigue, Headache, Immune system disorder
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad)
Write-up: This patient had headaches, extreme fatigue, inability to concentrate, immune impairment (continuing ten weeks later).

VAERS ID:165106 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2001-01-16, Days after onset: 104
Location:Minnesota  Entered:2001-01-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: MRI and EMG pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0298AA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Pt experienced severe arm pain, numbness and muscle soreness.

VAERS ID:165185 (history)  Vaccinated:2001-01-09
Age:49.0  Onset:2001-01-09, Days after vaccination: 0
Gender:Female  Submitted:2001-01-10, Days after onset: 1
Location:Wisconsin  Entered:2001-01-24, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: estrogen patch
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: BP - 110/72, P-66
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E64500HA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Hyperventilation, Injection site erythema, Injection site oedema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 30 minutes post vax, the pt complained of site redness, swelling and itching. The area was 3cm x 2 1/2cm that was warm and elevated. No systemic symptoms. Lung are clear. Treated with Benadryl.

VAERS ID:165404 (history)  Vaccinated:2000-11-27
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:2000-12-27
Location:Kentucky  Entered:2001-01-30, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ4632308DEC2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4008185 IM 
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: A healthcare professional reported that a 49 year old male received an injection of Flu Shield ''00-''01 on 11/27/00 and subsequently experienced tingling in his legs and nausea. This is 1 of 2 pts from this facility who experienced this event, post vax, lot #4008185. .

VAERS ID:165697 (history)  Vaccinated:2000-06-15
Age:49.0  Onset:0000-00-00
Gender:Male  Submitted:2001-07-19
Location:Pennsylvania  Entered:2001-02-02, Days after submission: 166
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetysalicyclic acid allergy injections
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000323161
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY123A91IMRA
Administered by: Private     Purchased by: Private
Symptoms: Tendonitis
SMQs:
Write-up: Subsequent to receiving second dose of Lymerix, the pt experienced tendinitis in the right arm. As of 11/01/2000, the outcome of the event was not completely resolved; the right arm flared with use. Subsequent to receiving the third dose of Lymerix, the pt experienced tendinitis in his elbows. No treatment was given. The reporting physician stated that the tendinitis was moderate in intensity and possibly related to Lymerix. He stated that the tendinitis could be associated with the pts occupation of landscaper. As of. 2/13/2000, the outcome of the event is unknown.

VAERS ID:165580 (history)  Vaccinated:1999-05-19
Age:49.0  Onset:1999-05-19, Days after vaccination: 0
Gender:Male  Submitted:2001-01-31, Days after onset: 623
Location:Unknown  Entered:2001-02-05, 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: Prilosec, Synthroid
Current Illness:
Preexisting Conditions: acid reflux, allergy to PCN, colitis, hyperthyroidism
Diagnostic Lab Data:
CDC Split Type: 20010025311
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Fatigue, Headache, Injection site pain, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: The same day as vax, on 5/19/99, the pt became dizzy and developed a fever, nausea, and headache. He recovered within 24 hours without treatment, The pt received his second injection of Lymerix on 6/17/99 he had no adverse experience following this injection. The pt received his third injection on 5/11/00. The next day on 5/12/00 the pt became tired and experienced pain at the injection site. The injection site pain resolved. The pt was still tired as of 1/30/01.

VAERS ID:165607 (history)  Vaccinated:2001-01-19
Age:49.0  Onset:2001-01-19, Days after vaccination: 0
Gender:Female  Submitted:2001-01-25, Days after onset: 6
Location:Maryland  Entered:2001-02-06, 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:
Current Illness: COPD
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MD01003
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES474932 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm pain and swelling apporx. 8 hours after injection.

VAERS ID:165950 (history)  Vaccinated:2000-12-05
Age:49.0  Onset:2000-12-06, Days after vaccination: 1
Gender:Female  Submitted:2001-01-04, Days after onset: 29
Location:Idaho  Entered:2001-02-16, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ID01002
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40081814IMLA
Administered by: Public     Purchased by: Private
Symptoms: Hemiparesis,