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Found 475569 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:92688 (history)  Vaccinated:1996-10-10
Age:56.7  Onset:1996-10-10, Days after vaccination: 0
Gender:Female  Submitted:1996-11-22, Days after onset: 43
Location:Arkansas  Entered:1996-12-09, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ogen, Atroicort
Current Illness: NONE
Preexisting Conditions: emphysema;lower back/pretruding disk;pt father allergic to TD;
Diagnostic Lab Data: NA
CDC 'Split Type': AR9683
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)CONNAUGHT LABORATORIES6F81204 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Condition aggravated, Hypertonia, Hypokinesia, Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (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), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 10OCT96 & arm was red & swollen for approx 7 days;p/that it was sore & soreness inside has inc w/time;22NOV96 painful to lift or use lt arm;rt arm sore but usuable;muscle spasms in upper back muscles;

VAERS ID:93677 (history)  Vaccinated:1996-06-01
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:1996-11-18
Location:New York  Entered:1996-12-24, Days after submission: 36
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: colon carcinoma;NKA;
Diagnostic Lab Data:
CDC 'Split Type': 960167101
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IMA
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax JUN96 & was found to have an inadequate response p/1st dose;2nd dose will be administered;

VAERS ID:93604 (history)  Vaccinated:1996-10-18
Age:56.5  Onset:1996-11-01, Days after vaccination: 14
Gender:Female  Submitted:1996-11-21, Days after onset: 20
Location:California  Entered:1997-01-07, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Phenyfen, Zantac
Current Illness: NONE
Preexisting Conditions: sulfa
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49682650 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: localized pain;

VAERS ID:94047 (history)  Vaccinated:1996-12-30
Age:56.2  Onset:1997-01-10, Days after vaccination: 11
Gender:Male  Submitted:1997-01-20, Days after onset: 10
Location:New York  Entered:1997-01-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': CO7066
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71277   
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, CSF test abnormal, Depression, Guillain-Barre syndrome, Myasthenic syndrome, Neuropathy, Paralysis
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (narrow)
Write-up: pt recv vax 5JAN97 & on 10JAN97 pt c/o heavy feeling in legs;11NOV97 c/o bilat weakness in the lower extremities & ascending paralysis;13JAN97 was hosp for GBS;

VAERS ID:94567 (history)  Vaccinated:1996-10-24
Age:56.1  Onset:1996-10-26, Days after vaccination: 2
Gender:Female  Submitted:1996-10-31, Days after onset: 5
Location:Texas  Entered:1997-01-30, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': TX96171
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES3910 LA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Injection site reaction
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: 4-5 water filled blisters @ inj site;largest was 1cm in diameter;pt exp no discomfort;

VAERS ID:95660 (history)  Vaccinated:1996-10-16
Age:56.8  Onset:1996-10-17, Days after vaccination: 1
Gender:Female  Submitted:1996-10-22, Days after onset: 5
Location:Ohio  Entered:1997-03-06, Days after submission: 135
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:
Diagnostic Lab Data:
CDC 'Split Type': 896303040L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681810IMLA
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 in AM & the next day pt devel redness & swelling @ the inj site;this is 1 of 12 pt from this site to have an adverse rxn;

VAERS ID:95762 (history)  Vaccinated:1996-10-22
Age:56.0  Onset:1996-10-23, Days after vaccination: 1
Gender:Female  Submitted:1996-11-07, Days after onset: 15
Location:Nebraska  Entered:1997-03-06, 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: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type': 896346009L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968172 IM 
Administered by: Public     Purchased by: Private
Symptoms: Anorexia, Back pain, Headache, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: this is 1 of 5 employees @ this site to have an unspecified adverse exp following vax;

VAERS ID:95444 (history)  Vaccinated:1996-10-11
Age:56.6  Onset:1996-11-10, Days after vaccination: 30
Gender:Male  Submitted:1997-02-24, Days after onset: 106
Location:Alabama  Entered:1997-03-07, 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: Morphine PUMP
Current Illness: NONE
Preexisting Conditions: hx of disc fusion (3 surgeries)
Diagnostic Lab Data: NONE
CDC 'Split Type': 001015097008800
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00966P0IMA
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Condition aggravated, Myelitis, Paralysis
SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: pt recv vax 11OCT96 & 10NOV96 pt devel severe pain in back & was hosp on the same day for 8 days;dx w/transverse myelitis;pt is paralyzed from waist down;

VAERS ID:96032 (history)  Vaccinated:1996-04-10
Age:56.0  Onset:1996-04-10, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:California  Entered:1997-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin
Current Illness:
Preexisting Conditions: allergy, acetone;allergy, medication;
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96061275
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Insomnia, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 10APR96 & about 1 1/2 min p/vax pt exp tenderness in arm like got hit by an elephant;could not sleep or rt arm;felt very tired & exp malaise;no migraine was noted;no dx work-up was conducted;

VAERS ID:96045 (history)  Vaccinated:1996-02-26
Age:56.6  Onset:1996-07-10, Days after vaccination: 135
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:1997-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obese
Diagnostic Lab Data: 21DEC95 Anti-HBS negative;15FEB96 ANTI-HBS negative;3APR96 ANTI-HBS negative;10JUL96 ANTI-HBS negative;
CDC 'Split Type': WAES96062515
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 4  
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Ecchymosis, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Lack of efficacy/effect (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax 26FEB96 & lab eval on 3APR96 & 10JUL96 revealed negative anti-HB s titers;pt exp rt arm pain& a big black like monkey on arm which was reported to occur following vax in FEB96;rt arm was larger than lt arm;

VAERS ID:96454 (history)  Vaccinated:1997-03-14
Age:56.0  Onset:1997-03-15, Days after vaccination: 1
Gender:Female  Submitted:1997-03-18, Days after onset: 3
Location:New York  Entered:1997-03-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: local rxn
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6A810070IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site mass, Injection site pain, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: pt exp pain @ inj site devel local rxn w/induration rt hand;

VAERS ID:97284 (history)  Vaccinated:1996-10-07
Age:56.3  Onset:1996-10-07, Days after vaccination: 0
Gender:Female  Submitted:1997-04-24, Days after onset: 199
Location:California  Entered:1997-04-29, 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: Prozac, hormone therapy, prilisec, vitamins
Current Illness: NONE
Preexisting Conditions: sulfa, keflex, erath
Diagnostic Lab Data: med exam x-rays, orthopedic exam, neuro & physical therpay;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Hypokinesia, Injection site pain, Neck pain, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: pain immed upon recv vax in lt arm;pain got sl worse w/each day;eventually consulted personal MD;provided pain med which helped some;painful to raise;lt hand got numb;pain in neck & back lt side;

VAERS ID:98138 (history)  Vaccinated:1997-04-18
Age:56.5  Onset:1997-05-04, Days after vaccination: 16
Gender:Male  Submitted:1997-05-08, Days after onset: 4
Location:South Dakota  Entered:1997-05-21, 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: ASA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: No lab test up to this date following this event;
CDC 'Split Type': SD97022
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7B915181IM 
Administered by: Public     Purchased by: Public
Symptoms: Hypothermia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (broad)
Write-up: 4MAY tingling both arms intensified by holding arm away from body tingling in legs also;to MD 7MAY97, t97.6;

VAERS ID:98931 (history)  Vaccinated:1995-06-15
Age:56.0  Onset:1995-06-15, Days after vaccination: 0
Gender:Male  Submitted:1996-02-21, Days after onset: 251
Location:New York  Entered:1997-05-22, Days after submission: 455
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:
Diagnostic Lab Data:
CDC 'Split Type': 896138013L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49580981IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt devel an inj site rxn characterized by redness & induration following vax;

VAERS ID:98951 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:1996-07-10
Location:Connecticut  Entered:1997-05-22, Days after submission: 316
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 896193025L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49582390IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & exp an inj site rxn characterized by swelling, redness, induration & pain;

VAERS ID:99388 (history)  Vaccinated:1996-09-09
Age:56.2  Onset:1996-09-11, Days after vaccination: 2
Gender:Female  Submitted:1996-09-27, Days after onset: 16
Location:Texas  Entered:1997-05-29, Days after submission: 244
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glucophage, Vitamin E, Vitamin B comples, calan Sr, Hytrin, hydrochlorothiazide, multivitamins, Zoloft, Elavil, ASA;
Current Illness: unk
Preexisting Conditions: hx of HTN, diabetes;
Diagnostic Lab Data: NONE
CDC 'Split Type': 010150960020000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS01066P0IMA
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Lymphadenopathy, Myalgia, Oedema, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 9SEP96 & 11SEP96 pt devel an inj site rxn;lt arm was sorer than usual & a knot devel under the lt armpit w/swelling which extended to the outside of the lt breast which was very tender;

VAERS ID:99647 (history)  Vaccinated:1996-10-01
Age:56.9  Onset:1996-10-15, Days after vaccination: 14
Gender:Male  Submitted:1996-12-17, Days after onset: 63
Location:Minnesota  Entered:1997-05-29, Days after submission: 162
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: stool psecimen positive for food poisoning;
CDC 'Split Type': 010150970051000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS    
Administered by: Other     Purchased by: Other
Symptoms: Dehydration, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 1OCT96 & 15OCT96 pt devel severe vomiting & diarrhea;p/2 days pt was eval in Er & was hydrated IV;MD felt that pt had food poisoning & should be adm but the pt chose to leave several hr later;stool specimen was positive for food

VAERS ID:99650 (history)  Vaccinated:1996-10-16
Age:56.0  Onset:1996-12-03, Days after vaccination: 48
Gender:Female  Submitted:1996-12-30, Days after onset: 27
Location:Pennsylvania  Entered:1997-05-29, Days after submission: 149
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: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': 010150970055000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS 0  
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Cough, Myalgia, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 16OCT96 & 3DEC96 pt exp fever, sore throat, cough, muscles aches & fatigue for 2 1/2wk;pt has not yet recovered;pt indicated had been vaccinated w/one of the recalled lot, but unable to ID specific lot#;

VAERS ID:99676 (history)  Vaccinated:1996-10-17
Age:56.4  Onset:1996-10-17, Days after vaccination: 0
Gender:Female  Submitted:1997-01-30, Days after onset: 105
Location:Michigan  Entered:1997-05-29, Days after submission: 118
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: 5DEC96 blood & urine tests-nl;12DEC96 stress test nl;6DEC96 EKG nl;
CDC 'Split Type': 010150970086000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS 0IMA
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Asthenia, Depression, Hyperhidrosis, Palpitations, Syncope, Tinnitus, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 17OCT96 & same day pt passed out p/blood rushed to head, ear were ringing & had heart palpitation;19OCT96 devel laryngitis extreme weakness, shakes for 2 days;NOV96 exp panic attacks;dx mild depression;17OCT96 sweating;

VAERS ID:99180 (history)  Vaccinated:1997-06-06
Age:56.1  Onset:1997-06-06, Days after vaccination: 0
Gender:Female  Submitted:1997-06-09, Days after onset: 3
Location:North Carolina  Entered:1997-06-19, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4359611  
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: size of baseball @ inj site, hard, hot;

VAERS ID:99714 (history)  Vaccinated:1997-02-01
Age:56.0  Onset:1997-02-01, Days after vaccination: 0
Gender:Male  Submitted:1997-04-02, Days after onset: 60
Location:New Jersey  Entered:1997-06-24, Days after submission: 82
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol;Vitamins;;Alprazolam;Paxil
Current Illness: gout
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 970076701
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IM 
Administered by: Private     Purchased by: Other
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax FEB97 & 1wk p/1st dose pt devel a rash w/itching on both arms & spread to other areas;pt went to dermatologist & was treated w/DPH & hydrocortisone cream;rash cleared up in some spots & moved to others;

VAERS ID:100148 (history)  Vaccinated:1997-03-19
Age:56.0  Onset:1997-04-10, Days after vaccination: 22
Gender:Female  Submitted:1997-05-28, Days after onset: 48
Location:South Dakota  Entered:1997-07-10, Days after submission: 43
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: Penicillin, PPD
Diagnostic Lab Data: Myalgia, arthralgia, hypokinesia, myasthenia
CDC 'Split Type': SD97019
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6F812023IMLA
Administered by: Private     Purchased by: Public
Symptoms: Arthralgia, Hypokinesia, Injection site pain, Muscular weakness, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: lt arm & shoulder pain w/movements started a few wk p/inj;ASA & APAP but pain cont & movement became limited;took Relafen w/no results;saw MD 28MAY97 noted muscle weakness & limited movement d/t pain r/t vax; 1/2" size diff

VAERS ID:101519 (history)  Vaccinated:1996-09-13
Age:56.5  Onset:1996-09-13, Days after vaccination: 0
Gender:Female  Submitted:1996-09-20, Days after onset: 7
Location:Louisiana  Entered:1997-07-22, Days after submission: 305
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:
Diagnostic Lab Data:
CDC 'Split Type': 896278018L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES  IM 
Administered by: Private     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: this is one of two pt from this site to devel a 4 to 6inch area of swelling @ inj site immed p/vax;addtl info was recv 13NOV96;pt also devel a 6inch area of redness, hardness, & warmth @ inj site;pt recovered;

VAERS ID:101538 (history)  Vaccinated:1997-01-16
Age:56.4  Onset:1997-01-23, Days after vaccination: 7
Gender:Female  Submitted:1997-02-11, Days after onset: 19
Location:Michigan  Entered:1997-07-22, Days after submission: 160
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin;Prinivil;Provera;
Current Illness: NOEN
Preexisting Conditions: HTN & hyperlipidemia;
Diagnostic Lab Data:
CDC 'Split Type': 897073007L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES438594 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 7 days p/vax pt devel an inj site rxn characterized by redness & swelling which extended to the elbow;pt rx w/Keflex & recovered;

VAERS ID:101712 (history)  Vaccinated:1995-06-19
Age:56.2  Onset:1995-06-20, Days after vaccination: 1
Gender:Female  Submitted:1997-03-31, Days after onset: 650
Location:Florida  Entered:1997-07-22, Days after submission: 112
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: NKA
Diagnostic Lab Data:
CDC 'Split Type': CO5974
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.J05242IMA
Administered by: Public     Purchased by: Other
Symptoms: Hyperhidrosis, Pain
SMQs:, Neuroleptic malignant syndrome (broad)
Write-up: diaphoresis & rt flank pain;11SEP95 f/u completed series w/o further events;

VAERS ID:102014 (history)  Vaccinated:1996-10-07
Age:56.0  Onset:1996-10-12, Days after vaccination: 5
Gender:Female  Submitted:0000-00-00
Location:Illinois  Entered:1997-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergy, floxin;allergy, bactrim;
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96110927
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Injection site oedema, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: pt recv vax 7OCT96 & on 12OCT96 pt devel severe swelling radiating from the inj site & exp pain that moved from fingers to the mid chest;

VAERS ID:101737 (history)  Vaccinated:1997-06-24
Age:56.9  Onset:1997-06-24, Days after vaccination: 0
Gender:Female  Submitted:1997-06-26, Days after onset: 2
Location:California  Entered:1997-08-19, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Motrin;Premarin
Current Illness: NONE
Preexisting Conditions: skin problem-psoriasis (neosporin, lotion allergies);
Diagnostic Lab Data: post series (3 vaccines) surface antibody negative
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2214A43IMLA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Ecchymosis, Headache, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: h/a & neck, general body ache for 17 hr (bruise 1" x 1");

VAERS ID:101772 (history)  Vaccinated:1997-07-18
Age:56.6  Onset:1997-07-18, Days after vaccination: 0
Gender:Female  Submitted:1997-08-15, Days after onset: 28
Location:California  Entered:1997-08-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid;female hormones
Current Illness: NONE
Preexisting Conditions: NONE/sulfa allergies;
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1710D IMRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES  PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91556 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Myalgia, Oedema peripheral, Osteoarthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: swollen & sore arm on lt side beginning on noc of vax 3 days later reported that joints started to hurt-stiffness & swelling in hands;arthralgia disseminated;poly arthralgia of body;

VAERS ID:102553 (history)  Vaccinated:1997-08-29
Age:56.3  Onset:1997-08-29, Days after vaccination: 0
Gender:Female  Submitted:1997-09-16, Days after onset: 18
Location:Indiana  Entered:1997-09-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid;ASA
Current Illness: NONE
Preexisting Conditions: codeine, sulfa, PCN-mycins;
Diagnostic Lab Data: NONE
CDC 'Split Type': IN97022
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2128B62IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diarrhoea, Dysgeusia, Nausea, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: onset urticaria, pinpoint rash on torso spreading to lower extremities approx 7hr p/vax;some nausea w/bile like taste in mouth;self-rx DPH began 10PM, through following day;rash & other distress resolved p/48hr;diarrhea also reported;

VAERS ID:102794 (history)  Vaccinated:1997-09-03
Age:56.4  Onset:1997-09-14, Days after vaccination: 11
Gender:Female  Submitted:1997-09-16, Days after onset: 2
Location:Missouri  Entered:1997-09-29, 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:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MO97036
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7D91611 IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Myalgia, Skin nodule, Urticaria, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: red raised welt on arm approx 2cm in diameter;knot under welt-tender to touch;

VAERS ID:102795 (history)  Vaccinated:1997-06-25
Age:56.1  Onset:1997-07-06, Days after vaccination: 11
Gender:Female  Submitted:1997-07-17, Days after onset: 11
Location:Mississippi  Entered:1997-09-29, Days after submission: 74
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: skin problems;
Diagnostic Lab Data: NONE
CDC 'Split Type': MS97034
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER1004D SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6H81269 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Laryngospasm, Lymphadenopathy, Oedema peripheral, Pruritus, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: 6JUL97 noticed glands in neck are swollen maybe harder to swallow rt side worse than lt c/o joints in knees very sore-better now;whelps on hands itch, hands swollen & red;no fever;

VAERS ID:102801 (history)  Vaccinated:1997-09-17
Age:56.3  Onset:1997-09-17, Days after vaccination: 0
Gender:Female  Submitted:1997-09-19, Days after onset: 2
Location:Iowa  Entered:1997-09-29, 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: HCTZ;Quinamm;Ibuporfen;vit C;Estrace:provera;Vit b-6;Nacin;Diflucan;K20;Calcium w/vit;Iron Dexrran;
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817408  
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: sl redness @ inj site about 48hr-itchy;

VAERS ID:103346 (history)  Vaccinated:1997-10-07
Age:56.9  Onset:1997-10-07, Days after vaccination: 0
Gender:Female  Submitted:1997-10-12, Days after onset: 5
Location:Massachusetts  Entered:1997-10-21, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81802 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Ecchymosis, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (broad)
Write-up: pt recv vax & p/15min pt c/o mild itch;but 2hr later noticed warmth & redness;bruise formation also noted;no tx was given;pt did not report this until next day;

VAERS ID:103400 (history)  Vaccinated:1997-10-02
Age:56.5  Onset:1997-10-02, Days after vaccination: 0
Gender:Female  Submitted:1997-10-15, Days after onset: 13
Location:Tennessee  Entered:1997-10-22, 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: sinusitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81840 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Chills, Headache, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: temp 102;uncontrollable tremors;body weakness;h/a, chills;lasted approx 12-14hr;

VAERS ID:103991 (history)  Vaccinated:1997-10-17
Age:56.0  Onset:1997-10-17, Days after vaccination: 0
Gender:Female  Submitted:1997-10-21, Days after onset: 4
Location:Maryland  Entered:1997-10-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp local site rxn w/flu & pneumoccal;
Other Medications: Toprol XL;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Chills, Nausea, Oedema peripheral, Pyrexia, Skin nodule, Somnolence, Vasodilatation
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: arm swelled down to elbow-baseball size w/redness-lethargic-nausea, diarrhea, fever, chills;

VAERS ID:104011 (history)  Vaccinated:1997-10-20
Age:56.4  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1997-10-22, Days after onset: 1
Location:Ohio  Entered:1997-10-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium, plaquenil;valium, vanceril, ventolin;naifen
Current Illness: NONE
Preexisting Conditions: NKA;asthma, depression,rheumataciarthritis, HTN, osteoarthritis
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER4431821IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Myalgia, Rash, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: soreness, redness, blotching to lt deltoid treated w/APAP or advil;

VAERS ID:104038 (history)  Vaccinated:1997-10-17
Age:56.6  Onset:1997-10-17, Days after vaccination: 0
Gender:Male  Submitted:1997-10-17, Days after onset: 0
Location:Texas  Entered:1997-10-29, 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: ASA
Current Illness: sinus
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139  LA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: itching to back-neck lt hive noted to neck area-head itching took ASA around 430AM 16OCT97;

VAERS ID:106045 (history)  Vaccinated:1997-04-01
Age:56.0  Onset:1997-04-01, Days after vaccination: 0
Gender:Female  Submitted:1997-04-18, Days after onset: 16
Location:Colorado  Entered:1997-10-30, Days after submission: 195
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 970093991
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Visual disturbance
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: pt recv vax 1APR97 & 15min later devel visual distortion;sx lasted 5min & then resolved;

VAERS ID:106078 (history)  Vaccinated:1997-04-28
Age:56.0  Onset:1997-05-12, Days after vaccination: 14
Gender:Female  Submitted:1997-06-23, Days after onset: 42
Location:Kansas  Entered:1997-10-30, Days after submission: 129
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': 970151481
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2145B60IMRA
Administered by: Other     Purchased by: Other
Symptoms: Alopecia
SMQs:
Write-up: pt recv vax 28APR97 & 2wk post vax exp loss of clumps of hair;pt had used hair straightener @ the time of the hair loss;some hair was growing back @ the time of this report 9JUN, but some is still being lost;no tx of the event is reported;

VAERS ID:104097 (history)  Vaccinated:1997-09-18
Age:56.3  Onset:1997-09-18, Days after vaccination: 0
Gender:Male  Submitted:1997-09-22, Days after onset: 4
Location:Illinois  Entered:1997-11-03, Days after submission: 42
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: contact dermatis
Diagnostic Lab Data: NONE
CDC 'Split Type': IL97093
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978296   
Administered by: Private     Purchased by: Public
Symptoms: Dyspnoea, Hypertension, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad)
Write-up: pt reports was at home & had a sudden onset of SOB;pt then went to local ER;BP grossly elevated 230/150;treated for pulmonary edema & released 19SEP97;

VAERS ID:104314 (history)  Vaccinated:1997-10-27
Age:56.8  Onset:1997-10-27, Days after vaccination: 0
Gender:Male  Submitted:1997-10-28, Days after onset: 1
Location:Arkansas  Entered:1997-11-03, 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: NONE
Current Illness: NONE
Preexisting Conditions: allergic rxn in past to undetermined food product
Diagnostic Lab Data: NONE
CDC 'Split Type': AR9786
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818031IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 12hr p/vax pt devel hives begin on trunk spreading to upper & lower extremities;self rx''d DPH;resolved 3hr later;pt denies allergy to egg/products;however has had allergic rxn in past to undetermined food product;

VAERS ID:104557 (history)  Vaccinated:1997-10-24
Age:56.8  Onset:1997-10-25, Days after vaccination: 1
Gender:Female  Submitted:1997-10-31, Days after onset: 6
Location:New York  Entered:1997-11-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin;Thyroid;
Current Illness: NONE
Preexisting Conditions: thyroid def
Diagnostic Lab Data:
CDC 'Split Type': NYS97058
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978169 IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4456360SCLA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Malaise, Myalgia, Oedema peripheral, Pain, Rash, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & 25OCT early AM lt arm throbbing-took advil;malaise & body aches which improved by SUnday;26OCT97 fine rash upper body noted in evening;lt arm had become tender, red, swollen including axilla & hot;

VAERS ID:104587 (history)  Vaccinated:1997-10-03
Age:56.8  Onset:1997-10-03, Days after vaccination: 0
Gender:Female  Submitted:1997-10-30, Days after onset: 27
Location:Michigan  Entered:1997-11-10, 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: Fosamax;Ibuprophine
Current Illness: NONE
Preexisting Conditions: post polio synd
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Headache, Injection site pain, Lymphadenopathy, Pain, Pyrexia, Skin nodule
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: severe chills, fever, h/a, swelling, size of golf ball armpit of inj arm, local soreness shoulder to elbow rt arm, duration 3-4 days;

VAERS ID:104619 (history)  Vaccinated:1997-10-24
Age:56.6  Onset:1997-10-24, Days after vaccination: 0
Gender:Female  Submitted:1997-11-02, Days after onset: 9
Location:Massachusetts  Entered:1997-11-12, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Betapace-Prilosic;Propulsid, Zocor;
Current Illness: NONE
Preexisting Conditions: arthritis-AO fibliration-undercontrol;
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81793   
Administered by: Other     Purchased by: Other
Symptoms: Tachycardia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)
Write-up: 3hr p/vax pt heart started to race & go into AV fibrillation;hosp for tx in ICU;

VAERS ID:104706 (history)  Vaccinated:1997-10-30
Age:56.2  Onset:1997-10-30, Days after vaccination: 0
Gender:Female  Submitted:1997-10-31, Days after onset: 1
Location:Mississippi  Entered:1997-11-12, 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: Synthroid, Librax, Enderal, Premarin
Current Illness: NONE
Preexisting Conditions: fibromyalgia & mitral valve prolapse
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3287GB1IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0585D IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Hypotension, Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 30OCT97 & approx 4:30PM gen edema @ site, warm to touch & tender to site;BP 106/70

VAERS ID:104825 (history)  Vaccinated:1994-12-01
Age:56.0  Onset:1995-08-01, Days after vaccination: 243
Gender:Female  Submitted:1997-11-14, Days after onset: 836
Location:Unknown  Entered:1997-11-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: 1997 ESR elevated;
CDC 'Split Type': WAES97081534
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 3 A
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Myalgia, Red blood cell sedimentation rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: pt recv vax & in 1995 pt began to exp the sx of resistant polymyalgia rheumatica for which pt has been treated w/pred since AUG96;pt had to stop running & was not able to perform many activities;AUG97 pt exp inc severity of arthralgia;

VAERS ID:104886 (history)  Vaccinated:1997-10-10
Age:56.1  Onset:1997-10-11, Days after vaccination: 1
Gender:Female  Submitted:1997-11-12, Days after onset: 32
Location:Montana  Entered:1997-11-19, 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: estrogen/progestin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': MT98016
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978167 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Hypertonia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: woke up w/several knotted & sore sites in muscles of rt shoulder-blade area (shot in rt arm);some shooting pain in scalp stopped p/2 days but knotted muscles painful;acupuncture/massage/heat helped;felt fatigue, dizziness w/tilt of head;

VAERS ID:105175 (history)  Vaccinated:1997-10-20
Age:56.2  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1997-11-13, Days after onset: 23
Location:Michigan  Entered:1997-11-25, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818345IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: severe redness & swelling involving outer lt arm from shoulder to elbow;

VAERS ID:105238 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:California  Entered:1997-11-28
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: benign prostatic hypertrophy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F819300IMLA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Neck pain, Pain
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad)
Write-up: exp intense neck, back & bilat shoulder pain lasting about 5 days;

VAERS ID:105479 (history)  Vaccinated:1997-11-25
Age:56.5  Onset:1997-11-25, Days after vaccination: 0
Gender:Female  Submitted:1997-12-03, Days after onset: 8
Location:Nebraska  Entered:1997-12-08, 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: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818294 LA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4481880 RA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: localized pain, redness, swelling in rt deltoid area;body aches & pain;tx ice, pain med;

VAERS ID:106170 (history)  Vaccinated:1997-10-01
Age:56.4  Onset:1997-10-27, Days after vaccination: 26
Gender:Female  Submitted:1997-12-15, Days after onset: 49
Location:Texas  Entered:1998-01-07, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F81754 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Myositis, Oedema, Oedema peripheral, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: pt presented to clinic w/pain & tenderness in arms & legs along w/edema that cont to spread to back & neck over next several wk;pt sent to MD neuro end of NOV;dx inflammation myositis secondary to adverse vax rxn;

VAERS ID:107573 (history)  Vaccinated:1996-10-15
Age:56.4  Onset:0000-00-00
Gender:Female  Submitted:1997-11-28
Location:Virginia  Entered:1998-01-15, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrace
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': CO7059
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712124 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypokinesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 15OCT96 & p/vax devel soreness for 3-4 days, then on 25OCT pt had pain in that area;arm hasn''t stopped aching since then;doesn''t feel that it is the joint but has limited ROM, pt has not yet seen MD;

VAERS ID:107611 (history)  Vaccinated:1996-10-16
Age:56.7  Onset:1996-10-17, Days after vaccination: 1
Gender:Female  Submitted:1997-12-03, Days after onset: 412
Location:Virginia  Entered:1998-01-15, Days after submission: 43
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': CO6884
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71224   
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Lymphadenopathy, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & w/in 24hr of vax the arm @ site was red, swollen & had pain above the site & in arm pit;w/in 24hr was red & itchy;no allergy to thimersol;

VAERS ID:107032 (history)  Vaccinated:1998-01-13
Age:56.4  Onset:1998-01-14, Days after vaccination: 1
Gender:Female  Submitted:1998-01-19, Days after onset: 5
Location:Wisconsin  Entered:1998-01-27, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp rxn to TD booster @ 10yr old;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: severe swelling in arm, hives in area of shot, fever onset in 48hr;visit to personal MD-pred & clariton prescribed for 12 days;tx on going;

VAERS ID:107091 (history)  Vaccinated:1995-10-26
Age:56.3  Onset:1995-10-26, Days after vaccination: 0
Gender:Female  Submitted:1998-01-22, Days after onset: 819
Location:Illinois  Entered:1998-01-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosomide;Spironolactone:Atenolol;Cardizem CD;Synthroid;Premarin;Zocor;HumulinN;Humulin R;Multivitamin; Vitamin E;Calcium;
Current Illness:
Preexisting Conditions: diabetes;
Diagnostic Lab Data: CAT Scan, MRI, Spinal Tap, Brain Function Testing, Daily Blood Testing for 7 days in hosp, Muscle Testing w/needles, etc;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH5F61126   
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Confusional state, Gait disturbance, Nausea, Neuropathy, Pain, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt disoriented, nauseous & felt ill;pt exp no feeling on rt side of body;body totally affected w/paralysis;lt leg numb;walks w/sl limp-rt leg very painful diff & painful to walk;legs stiff;no energy;dx diabetic neuropathy;

VAERS ID:107431 (history)  Vaccinated:1997-10-16
Age:56.7  Onset:1997-12-05, Days after vaccination: 50
Gender:Male  Submitted:1998-01-20, Days after onset: 46
Location:Ohio  Entered:1998-02-10, 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: denies
Current Illness: denies
Preexisting Conditions: denies
Diagnostic Lab Data:
CDC 'Split Type': OH98005
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81917 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pain, Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax 16OCT97 & exp painful & sore lt arm;flu vax given lt deltoid;-knot seen in inner aspect lt arm;had knot in arm several inches from site of vax;

VAERS ID:107729 (history)  Vaccinated:1998-02-03
Age:56.0  Onset:1998-02-05, Days after vaccination: 2
Gender:Female  Submitted:1998-02-05, Days after onset: 0
Location:Utah  Entered:1998-02-13, 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': UT981005
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM503B60IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4440690IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Myalgia, Pain, Rash maculo-papular
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: beginning in the afternoon of 3FEB98 lt arm was very sore upon rising 5FEB98, red blotchy area noted below inj site, mid way between shoulder & elbow & anterior to inj site;tender;

VAERS ID:107831 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:1997-10-03
Gender:Male  Submitted:1998-01-28, Days after onset: 117
Location:Unknown  Entered:1998-02-25, Days after submission: 28
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 MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis
SMQs:
Write-up: cellulitis;

VAERS ID:108002 (history)  Vaccinated:1998-02-13
Age:56.7  Onset:1998-02-14, Days after vaccination: 1
Gender:Male  Submitted:1998-02-23, Days after onset: 9
Location:Kentucky  Entered:1998-03-04, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: avulsion laceration 4th digit lt hand;
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC 'Split Type': KY980010
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C915744IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Injection site hypersensitivity, Injection site oedema, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt reported having elevated temp, diff breathing, aching all over-unable to lie down to sleep d/t DIB;localized swelling, redness to lt deltoid where vax given;

VAERS ID:108593 (history)  Vaccinated:1997-09-02
Age:56.0  Onset:1997-09-02, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC 'Split Type': WAES97110356
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1554D0IM 
Administered by: Public     Purchased by: Other
Symptoms: Arrhythmia, Gastrointestinal disorder, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)
Write-up: pt recv vax 2SEP97 & & that evening pt exp palpitations, irregular heartbeat for approx 4 to 5 hr & GI upset that lasted for 1 to 2 days;

VAERS ID:109077 (history)  Vaccinated:1996-10-15
Age:56.2  Onset:1996-10-15, Days after vaccination: 0
Gender:Female  Submitted:1997-10-10, Days after onset: 360
Location:Minnesota  Entered:1998-03-16, Days after submission: 157
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 897293025L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0IMA
Administered by: Public     Purchased by: Other
Symptoms: Chills, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: 12hr p/vax pt devel fever, sweating & chills;pt recovered w/in 12hr;

VAERS ID:109163 (history)  Vaccinated:1997-10-16
Age:56.1  Onset:1997-10-16, Days after vaccination: 0
Gender:Male  Submitted:1997-10-17, Days after onset: 1
Location:North Carolina  Entered:1998-03-26, Days after submission: 160
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline;Colace, Relafen, Phenergan, Bentyl, Valium;
Current Illness: prostate cancer
Preexisting Conditions: prostate cancer
Diagnostic Lab Data:
CDC 'Split Type': 897303024L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0IMA
Administered by: Public     Purchased by: Public
Symptoms: Delirium
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad)
Write-up: pt stated became delirious approx 6hr p/vax (MFR unk);

VAERS ID:111056 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:1998-04-05
Location:Florida  Entered:1998-05-19, Days after submission: 43
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': CO 7358
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91574   
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Day of vax pt exp local rxn of swelling & redness up entire arm & down to hand area. Redness noted on shoulder & neck area.

VAERS ID:111074 (history)  Vaccinated:1997-06-16
Age:56.0  Onset:1997-06-24, Days after vaccination: 8
Gender:Female  Submitted:1998-04-05, Days after onset: 285
Location:North Carolina  Entered:1998-05-19, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': CO7434
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6L81412   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: pt recv vax 16JUN97 & 24JUN97 pt exp a large rxn that extended to the pt elbow;A cellulitis was suspected & pt was treated w/unspecified ATB;

VAERS ID:111264 (history)  Vaccinated:1997-10-08
Age:56.2  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYnthroid;Estrogen,Claritin D;
Current Illness: NONE
Preexisting Conditions: hypothyroidism, airbone allergies
Diagnostic Lab Data:
CDC 'Split Type': 898117014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781391IMA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 3hr p/vax pt devel an inj site rxn characterized by 80mm by 90mm area of erythema, induration & pruritus;applied ice to the area & recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax w/lot# 4978139;

VAERS ID:111381 (history)  Vaccinated:1998-04-20
Age:56.0  Onset:1998-04-20, Days after vaccination: 0
Gender:Male  Submitted:1998-04-21, Days after onset: 1
Location:Texas  Entered:1998-06-01, Days after submission: 41
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: ragweed-environmental
Diagnostic Lab Data: NA
CDC 'Split Type': TX98067
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2398A60IM 
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM542A60IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Rash maculo-papular, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 20APR98 & devel rash to arms, abd, back, neck & face beginning 20APR evening raised/red itchy rash;applying DPH cream;

VAERS ID:111358 (history)  Vaccinated:1998-01-13
Age:56.2  Onset:0000-00-00
Gender:Female  Submitted:1998-01-16
Location:Hawaii  Entered:1998-06-02, Days after submission: 136
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: NA
CDC 'Split Type': HI9801
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1171E   
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: swelling of arms, chills, feverish feeling;

VAERS ID:111943 (history)  Vaccinated:1998-05-26
Age:56.6  Onset:1998-05-28, Days after vaccination: 2
Gender:Female  Submitted:1998-06-01, Days after onset: 4
Location:North Carolina  Entered:1998-06-16, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Propulsed;Zantac;Prempro
Current Illness: NONE
Preexisting Conditions: PCN, sulfa allergies;hx prolapsed mitral valve, reflux
Diagnostic Lab Data: NONE
CDC 'Split Type': NC98023
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F91694 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site pain, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 28MAY98 soreness @ inj site;29MAY98 redness & heat 6cm diameter;31MAY98 inc redness;1JUN98 inc redness & itching 18cm diameter;

VAERS ID:112031 (history)  Vaccinated:1998-06-10
Age:56.0  Onset:1998-06-10, Days after vaccination: 0
Gender:Male  Submitted:1998-06-17, Days after onset: 7
Location:Ohio  Entered:1998-06-22, 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: Ketoprofen ER
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM579A40IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: GI dx-vomiting, diarrhea, low grade temp, fatigue w/in 24hr et lasting approx 1 noc;no treatment;

VAERS ID:112435 (history)  Vaccinated:1998-06-30
Age:56.7  Onset:1998-07-01, Days after vaccination: 1
Gender:Female  Submitted:1998-07-05, Days after onset: 4
Location:California  Entered:1998-07-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin
Current Illness: NONE
Preexisting Conditions: allergy PCN
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES451310 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: inc redness/swelling lt deltoid minimally tender started 24hr p/vax;seen 4JUL w/lt tricep entire area bright red;

VAERS ID:112461 (history)  Vaccinated:1997-10-17
Age:56.9  Onset:1997-10-21, Days after vaccination: 4
Gender:Female  Submitted:1998-06-11, Days after onset: 233
Location:Missouri  Entered:1998-07-13, Days after submission: 32
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: 25NOV97 mastectomy status hx of bilat mastectomy a few yr ago;adult resp distress dynd (ARDS);hypogammaglobulinemia;
Diagnostic Lab Data: blood & sputum cult negative;
CDC 'Split Type': MPI97972
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3287GG IM 
Administered by: Other     Purchased by: Other
Symptoms: Bronchitis, Hypoxia, Infection, Lung disorder, Pneumonia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad)
Write-up: w/in a wk of vax pt slowly deteriorated & got bronchitis;lungs filled w/fluid & was adm to hosp p/collapsing;pt put in ICU on ventilator & then a respirator;dx pneumonia;pulmonary specialist felt problem not r/t vax;

VAERS ID:112640 (history)  Vaccinated:1998-03-11
Age:56.4  Onset:1998-03-11, Days after vaccination: 0
Gender:Male  Submitted:1998-03-11, Days after onset: 0
Location:Ohio  Entered:1998-07-14, Days after submission: 124
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': 898093005L
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS 0 A
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
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 hosp recv vax the HIBTITER was inadvertently administered intradermally;w/in several hr the pt devel redness & swelling @ the HIBTITER inj site;tx w/warm compresses;

VAERS ID:113135 (history)  Vaccinated:1998-03-10
Age:56.4  Onset:1998-03-10, Days after vaccination: 0
Gender:Male  Submitted:1998-07-30, Days after onset: 141
Location:Unknown  Entered:1998-08-03, 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: Lipitor, Cardizem CD, Glynase Prestab, Synthroid, Zinc preparation (composition)
Current Illness: abdominal pain, pancreatic malignat neoplasm, venous occlusio
Preexisting Conditions: drug allergy, erythromycin allergy
Diagnostic Lab Data: None
CDC 'Split Type': WAES98030878
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC. 0  
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia
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: Pt recv vax 10MAR98 devel redness, swelling and pain at the injection site. On 12MAR98 pt exp a fever of 101 degrees F. The pt was afebrile by 14MAR98. Pt recovered on 16MAR98.

VAERS ID:113145 (history)  Vaccinated:0000-00-00
Age:56.4  Onset:1997-10-15
Gender:Female  Submitted:1998-07-30, Days after onset: 288
Location:Unknown  Entered:1998-08-03, 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: Insulin
Current Illness:
Preexisting Conditions: diabetes mellitus
Diagnostic Lab Data:
CDC 'Split Type': WAES98040319
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site mass, 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 & 15OCT97 pt devel a knot @ the site of inj;@ time of report, it was noted that knot is still there, if presses on it;the area that cont to be tender was the size of a half dollar;knot felt like muscle just stayed swollen;

VAERS ID:113163 (history)  Vaccinated:1998-05-11
Age:56.5  Onset:1998-05-11, Days after vaccination: 0
Gender:Male  Submitted:1998-07-30, Days after onset: 80
Location:Unknown  Entered:1998-08-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: UKN
Diagnostic Lab Data:
CDC 'Split Type': WAES98050706
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0994E IM 
Administered by: Public     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Pt recv vax 11MAY98 and exp a sore right arm. It was reported that the nurse pulled the wrong vaccine from the refrigerator and gave the patient a double dose (1cc) in the left deltoid.

VAERS ID:113812 (history)  Vaccinated:1998-06-27
Age:56.1  Onset:1998-06-27, Days after vaccination: 0
Gender:Female  Submitted:1998-07-15, Days after onset: 18
Location:Missouri  Entered:1998-09-01, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 48year old w/tetanus toxoid
Other Medications:
Current Illness: NONE
Preexisting Conditions: environmental allergies
Diagnostic Lab Data:
CDC 'Split Type': MO98042
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH    
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site hypersensitivity, Injection site oedema, Injection site pain, Myalgia, Nausea, Pruritus, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: low grade fever, h/a, overall bodyache, chills, nausea;recv inj in hip, had 4x8'' redness, raised, sore & itching are of hip;called ER 28JUN98 was told to ingest DPH;29JUN98, no change in condition;called MD prescription for 5 days on pred;

VAERS ID:113911 (history)  Vaccinated:1997-07-01
Age:56.5  Onset:1997-08-01, Days after vaccination: 31
Gender:Male  Submitted:0000-00-00
Location:New Jersey  Entered:1998-09-08
Life Threatening? No
Died? Yes
   Date died: 1997-10-11
   Days after onset: 71
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocar
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Private
Symptoms: Gastrointestinal carcinoma
SMQs:, Malignant tumours (narrow)
Write-up: pt recv vax DEC96 & JUL97 blood work in MAR showed no sign of disease;cancer of colon w/advanced metastases to liver detected in AUG because of rapid onset, want this on record;

VAERS ID:113917 (history)  Vaccinated:1998-01-30
Age:56.2  Onset:1998-01-31, Days after vaccination: 1
Gender:Unknown  Submitted:1998-02-04, Days after onset: 4
Location:Alaska  Entered:1998-09-08, Days after submission: 215
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: stable angina, HTN
Diagnostic Lab Data:
CDC 'Split Type': AK9199813
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3257FA1IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0906E0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Angioneurotic oedema, Condition aggravated, Face oedema, Oedema, Rash, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: rash, swelling of face, urticaria, angina & hypertension;1st noticed sl rash Friday PM;much worse Sat AM w/swelling, angina & hypertension;angioedema;had angina & Hypertension before;

VAERS ID:114046 (history)  Vaccinated:1998-08-28
Age:56.7  Onset:1998-08-30, Days after vaccination: 2
Gender:Female  Submitted:1998-09-02, Days after onset: 3
Location:South Carolina  Entered:1998-09-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: HCTZ
Current Illness: fall-knee contusion
Preexisting Conditions: inc BP, no allergies;
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH447939 IMLA
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: pt exp shoulder pain @ the side of inj had approx 50 cent piece size, small superficial area of erythema;

VAERS ID:114551 (history)  Vaccinated:1997-11-10
Age:56.7  Onset:1997-11-10, Days after vaccination: 0
Gender:Female  Submitted:1997-11-13, Days after onset: 3
Location:California  Entered:1998-09-30, Days after submission: 320
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:
Diagnostic Lab Data:
CDC 'Split Type': 897337044L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4425220IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Injection site hypersensitivity, Injection site oedema, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & devel swelling @ the inj site;the swelling was described as a wheal which extended down the arm;pt exp chills & nausea;

VAERS ID:114588 (history)  Vaccinated:1997-12-04
Age:56.3  Onset:1997-12-04, Days after vaccination: 0
Gender:Female  Submitted:1997-12-08, Days after onset: 4
Location:Washington  Entered:1998-09-30, Days after submission: 295
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pepcid;Premarin;Provera;
Current Illness: unk
Preexisting Conditions: allergic to codeine;
Diagnostic Lab Data:
CDC 'Split Type': 898015041L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4412160IMLA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Headache, Injection site hypersensitivity, Injection site oedema, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & later that day devel swelling, redness & pain @ the inj site;also exp nausea & h/a;pt was seen by MD next day, dx cellulitis & prescribed an oral ATB;

VAERS ID:114738 (history)  Vaccinated:1998-09-11
Age:56.6  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Montana  Entered:1998-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin;Vitamins;
Current Illness: cat bite
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4978242 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Arthralgia, Injection site oedema, Myalgia, Skin striae
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: lt arm swelling, red streaking inc elbow, shoulder & joint pain;

VAERS ID:114766 (history)  Vaccinated:1998-09-09
Age:56.1  Onset:1998-09-19, Days after vaccination: 10
Gender:Female  Submitted:1998-09-30, Days after onset: 11
Location:Florida  Entered:1998-10-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: sinusitis
Preexisting Conditions: diverticulitis, depression
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES456053  RA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Headache, Neck pain, Osteoarthritis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Arthritis (broad)
Write-up: temp to 103, h/a, neck pain & back pain, knee & ankle swelling 22SEP98;

VAERS ID:114807 (history)  Vaccinated:1998-09-21
Age:56.6  Onset:1998-09-22, Days after vaccination: 1
Gender:Female  Submitted:1998-09-24, Days after onset: 2
Location:Alabama  Entered:1998-10-08, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Premarin
Current Illness: NONE
Preexisting Conditions: amoxicillin, sulfatrim, cotrim, neosporin allergies
Diagnostic Lab Data:
CDC 'Split Type': AL989
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09346001IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pain, Pruritus, Skin striae
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 24SEP98 pt reports rt upper arm very swollen, w/red streaks & pimple forming @ site of Td inj;states area itches severely;denies fever, SOB; does c/o some pain;has taken DPH & used anti-itch cream;encouraged to notify MD;

VAERS ID:115095 (history)  Vaccinated:1998-10-09
Age:56.4  Onset:1998-10-09, Days after vaccination: 0
Gender:Female  Submitted:1998-10-12, Days after onset: 3
Location:Virginia  Entered:1998-10-18, 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: NONE
Current Illness: NONE
Preexisting Conditions: sjogren''s synd
Diagnostic Lab Data: NOen
CDC 'Split Type': VA98064
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4988212 IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4549571IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Malaise, Nausea, Pyrexia, Tachycardia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 9OCT98 approx 5PM 7hr p/vax had queasy feeling;12hr p/vax felt bad had chills, fever (temp not taken) inj site rt arm swollen & neck w/pain, heart rate rapid;sx duration approx 6hr;

VAERS ID:115152 (history)  Vaccinated:1998-10-12
Age:56.3  Onset:1998-10-12, Days after vaccination: 0
Gender:Female  Submitted:1998-10-12, Days after onset: 0
Location:California  Entered:1998-10-21, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Atenolol;Verapamil;Paxil B
Current Illness: mild URI sx
Preexisting Conditions: COPD, prior hx of bronchospasm;
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20228KA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Asthma, Dyspnoea, Hypertension, Hypoxia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt recv vax & immed went to restroom to void-came out 3-5min later wheezing, c/o diff breathing-02 sate 98-99, HR 98, Bp 150/100 given breathing tx & med;pt had some URI sx prior;

VAERS ID:115279 (history)  Vaccinated:1998-10-01
Age:56.4  Onset:1998-10-03, Days after vaccination: 2
Gender:Female  Submitted:1998-10-15, Days after onset: 12
Location:Tennessee  Entered:1998-10-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type': TN98046
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4528411IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Pain, Pyrexia
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: pt recv vax 1OCT98 & pt states arm began to hurt w/in a short time of adm then began to be red, swollen on large area of lt arm-had inc temp to 102 x 2 days;used ice packs & saw pt 5OCT98;advised not to take another Td d/t local rxn;

VAERS ID:115957 (history)  Vaccinated:1998-05-04
Age:56.0  Onset:1998-05-05, Days after vaccination: 1
Gender:Male  Submitted:1998-10-26, Days after onset: 174
Location:Kentucky  Entered:1998-11-02, 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:
Preexisting Conditions: bronchitis (1994), long-time smoke, lumbar pain (1995);
Diagnostic Lab Data: CXR mild pulmonray obstruction;May98 pulmonary function tests nl;MAY1998 pulmonary function tests low vital capacity;blood work 29Apr98-nl
CDC 'Split Type': 19980130531
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2299A40IMA
Administered by: Private     Purchased by: Private
Symptoms: Bronchitis, Cough, Dyspnoea, Ear disorder, Infection, Insomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt recvv ax 4MAY98 & 4MAY98 pt devel myalgia both arms, felt feverish (did not measure temp);over the peirod of the next day pt also devel cough, dyspnea (unable to lie down-had to sit in chair to breath);flud behind ear drum;exhausted;

VAERS ID:115633 (history)  Vaccinated:1998-10-20
Age:56.2  Onset:1998-10-20, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 6
Location:Minnesota  Entered:1998-11-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Blood pressure med
Current Illness: NONE
Preexisting Conditions: High blood pressure, Stroke 2 yr prior
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0983310 IMA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Cough, Face oedema, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/20/98; on same day pt exp cough, tight chest, eye itch & swelling, fever &chills X 1 day

VAERS ID:115739 (history)  Vaccinated:1998-10-12
Age:56.9  Onset:1998-10-13, Days after vaccination: 1
Gender:Female  Submitted:1998-10-27, Days after onset: 14
Location:Florida  Entered:1998-11-04, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications:
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: NONE
CDC 'Split Type': FL98054
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20158HC1 LA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dyspnoea, Oedema, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 13OCT & devel dizziness, itching, hives, red spots, some swelling & SOB lasted 4-5 days;didn''t call to see a MD -2wk later called to report rxn & advised to see MD;

VAERS ID:116091 (history)  Vaccinated:1998-10-07
Age:56.8  Onset:1998-10-08, Days after vaccination: 1
Gender:Female  Submitted:1998-10-08, Days after onset: 0
Location:Georga  Entered:1998-11-09, Days after submission: 32
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: h/o asplenia-got repeat provac @ pt request
Diagnostic Lab Data: NA
CDC 'Split Type': GA98089
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES097580 IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES444073M IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: c/o tenderness, redness & swelling @ inj site;

VAERS ID:116101 (history)  Vaccinated:1998-10-24
Age:56.8  Onset:1998-10-25, Days after vaccination: 1
Gender:Male  Submitted:1998-10-30, Days after onset: 5
Location:Minnesota  Entered:1998-11-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Dyspnoea, Headache, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: h/a, breathing difficulty, pounding heart;

VAERS ID:116306 (history)  Vaccinated:1998-10-13
Age:56.7  Onset:1998-10-13, Days after vaccination: 0
Gender:Female  Submitted:1998-10-15, Days after onset: 2
Location:Vermont  Entered:1998-11-09, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': FLU88121098
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02298P0IM 
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Conjunctivitis, Cough, Dyspnoea, Face oedema
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/13/98; post vax pt exp increased cough, tight chest, red/puffy eyes & difficulty breathing

VAERS ID:116234 (history)  Vaccinated:1998-10-26
Age:56.0  Onset:1998-10-28, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Kansas  Entered:1998-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1286H IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Malaise, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 2 days p/vax pt devel erythema, warmth, swelling & induration;general malaise rt deltoid where pneumonia was given;

VAERS ID:116407 (history)  Vaccinated:1998-11-02
Age:56.3  Onset:1998-11-02, Days after vaccination: 0
Gender:Female  Submitted:1998-11-03, Days after onset: 1
Location:Ohio  Entered:1998-11-16, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': OH98088
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0977170  RA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4549770 RA
Administered by: Public     Purchased by: Public
Symptoms: Dry mouth, Injection site hypersensitivity, Injection site oedema, Injection site pain, Pruritus, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/2/98; on same day pt exp pain/swollen/red/itchy vax site, increased heart rate & dry mouth; tx=Benadryl, Keflex, Tylenol, ice packs &heat to site

VAERS ID:116424 (history)  Vaccinated:1998-10-26
Age:56.0  Onset:1998-10-26, Days after vaccination: 0
Gender:Female  Submitted:1998-10-30, Days after onset: 4
Location:Louisiana  Entered:1998-11-16, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09845400IM 
Administered by: Military     Purchased by: Public
Symptoms: Influenza
SMQs:
Write-up: Pt recv vax on 10/26/98; on same day pt exp flu-like sxs x 1wk

VAERS ID:116498 (history)  Vaccinated:1998-11-04
Age:56.5  Onset:1998-11-04, Days after vaccination: 0
Gender:Male  Submitted:1998-11-13, Days after onset: 9
Location:Arkansas  Entered:1998-11-18, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Chills, Dizziness, Influenza, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: dizzy & weak, aches & pain like flu sx & chills;

VAERS ID:116564 (history)  Vaccinated:1998-10-29
Age:56.6  Onset:1998-10-30, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Georga  Entered:1998-11-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: IVp Dye & allergic to PCN;
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20118GA  RA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Hyperaesthesia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: T100.8, generalized aching of joints & skin sensitivity;

VAERS ID:116665 (history)  Vaccinated:1998-09-28
Age:56.3  Onset:1998-10-01, Days after vaccination: 3
Gender:Female  Submitted:1998-11-18, Days after onset: 48
Location:Michigan  Entered:1998-11-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
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 BEECHAM2296A40IMRA
Administered by: Public     Purchased by: Private
Symptoms: Condition aggravated, Face oedema, Oedema, Oedema genital, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 9/28/98; on 10/1/98 pt exp puffy eyes & labia, 2 hives on back, edema, pruritus; tx=Benadryl

VAERS ID:116709 (history)  Vaccinated:1998-10-28
Age:56.2  Onset:1998-10-29, Days after vaccination: 1
Gender:Female  Submitted:1998-11-05, Days after onset: 7
Location:Connecticut  Entered:1998-11-23, 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': CT9904
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0983320  LA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Headache, Injection site hypersensitivity, Injection site mass, Injection site pain, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: about 24hr p/vax pt devel h/a, chills, fever (T101, 102 oral), muscle & body aches, fatigue, gen malaise lasting 2 days;also devel 2 1/2inch area of induration, redness & tenderness @ vax site lasting 5 days;

VAERS ID:116909 (history)  Vaccinated:1998-11-10
Age:56.5  Onset:1998-11-13, Days after vaccination: 3
Gender:Female  Submitted:1998-11-20, Days after onset: 7
Location:Virginia  Entered:1998-11-27, 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: Premarin;Diazide
Current Illness: NONE
Preexisting Conditions: asthma 9allergy induced) dgenerative disc disease;
Diagnostic Lab Data:
CDC 'Split Type': VA98080
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4988224 IMLA
Administered by: Public     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: local & transient pain down lt arm;inj site warm & swollen 7 days p/vax given;tx warm compresses & naproxen;sx are beginning to subside;

VAERS ID:116942 (history)  Vaccinated:1998-10-29
Age:56.9  Onset:1998-10-30, Days after vaccination: 1
Gender:Female  Submitted:1998-11-24, Days after onset: 25
Location:Massachusetts  Entered:1998-11-30, Days after submission: 6
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: ASA, Chemical allergy, Asthma, Egg sensitivity & pesticides
Diagnostic Lab Data: UNK
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09757800IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthma, Condition aggravated, Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/29/98; on 10/30/98 pt exp shortness of breath, wheezing & hives; tx=Albuterol, Epinephrine, Solumedrol, Benadryl, Tagamet, Ventolin inhaler

VAERS ID:117151 (history)  Vaccinated:1998-11-16
Age:56.6  Onset:1998-11-16, Days after vaccination: 0
Gender:Female  Submitted:1998-11-16, Days after onset: 0
Location:Georga  Entered:1998-12-07, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: denies
Other Medications: denied
Current Illness: denies
Preexisting Conditions: denies
Diagnostic Lab Data: NONE
CDC 'Split Type': GA98117
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09758500IMRA
Administered by: Public     Purchased by: Public
Symptoms: Ecchymosis, Injection site oedema, Injection site reaction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt returned to clinic approx 10min p/vax;pt has approx 2 1/2 x 2 1/2 x 1 1/2 swollen area on rt arm @ inj site;approx 1/8" area of blue bruising noted @ inj site;

VAERS ID:117177 (history)  Vaccinated:1998-10-28
Age:56.3  Onset:1998-10-28, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Missouri  Entered:1998-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Oedema peripheral, Pruritus, Pyrexia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: low temp, felt very tired & 930PM woke up w/hives from bottom of feet up to waist, itching legs, swollen but could have been from scratching them;took 2 DPH & fell asleep;woke in morning feeling fine-no side effects;

VAERS ID:117341 (history)  Vaccinated:1998-10-23
Age:56.2  Onset:1998-10-26, Days after vaccination: 3
Gender:Female  Submitted:1998-12-10, Days after onset: 45
Location:New York  Entered:1998-12-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER5301410010   
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: hives;

VAERS ID:117386 (history)  Vaccinated:1998-10-09
Age:56.9  Onset:1998-10-09, Days after vaccination: 0
Gender:Female  Submitted:1998-11-10, Days after onset: 32
Location:Ohio  Entered:1998-12-15, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Allergy shot, Propulsid, Premarin, Welbutrin, Rhiocort, Allegra, Migrinal
Current Illness: NONE
Preexisting Conditions: Allergic to Compazine, Conhist, Penicillin, Elavil, Biaxin; Migraines
Diagnostic Lab Data: Lab tests
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09758400IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Pt recv vax on 10/9/98; 25 min post vax pt exp dizziness, lightheaded, tingling in mouth, face& right hand, swollen tongue; pt to E.R.; tx=Prednisone &Benadryl

VAERS ID:117486 (history)  Vaccinated:1998-10-23
Age:56.0  Onset:1998-10-23, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 3
Location:Ohio  Entered:1998-12-17, Days after submission: 52
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~~~0~In Patient
Other Medications: Premarin, Synthroid
Current Illness: NONE
Preexisting Conditions: Allergic to Penicillin
Diagnostic Lab Data: Watching for signs of infection
CDC 'Split Type': OH98109
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882040IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4543790SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, 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: Pt recv vax on 10/23/98; on same day pt exp red/ edema/ warmth/ raised area of LA, fever; tx=Camexin, Motrin

VAERS ID:117856 (history)  Vaccinated:1998-10-22
Age:56.7  Onset:1998-10-23, Days after vaccination: 1
Gender:Female  Submitted:1998-12-21, Days after onset: 59
Location:Florida  Entered:1998-12-31, 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: NONE
Current Illness: NONE
Preexisting Conditions: SOD, bisulfate (diarrhea) codeine
Diagnostic Lab Data: NONE
CDC 'Split Type': FL98063
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20158HF0IML
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: since vax on 22OCT98 lt arm remains sore & painful;

VAERS ID:117981 (history)  Vaccinated:1998-09-30
Age:56.4  Onset:1998-09-30, Days after vaccination: 0
Gender:Male  Submitted:1999-01-06, Days after onset: 98
Location:New Jersey  Entered:1999-01-11, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: Prednisone
Current Illness: UNK
Preexisting Conditions: Occular myasthenia
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09758200 LA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Pt recv vax on 9/30/98; post vax pt exp shoulder pain at vax site; pain when shoulder rotation; joint pain in legs

VAERS ID:118589 (history)  Vaccinated:1997-05-29
Age:56.7  Onset:1998-04-01, Days after vaccination: 307
Gender:Female  Submitted:1999-02-05, Days after onset: 310
Location:New York  Entered:1999-02-08, Days after submission: 3
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol 100 mg 1 x dy
Current Illness: UNK
Preexisting Conditions: High blood pressure
Diagnostic Lab Data: 4/98:ANA testing-lupus, Skin testing
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2220B61IMLA
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody, Arthralgia, Rash, Skin disorder, Systemic lupus erythematosus
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt recv vax on 5/29/97; in 3/98 pt exp joint pain, skin rx w/ sun & fluorescent lights; dx=lupus; tx=Hydroxychloroquine &Dripolene, Annual follow-up received on 10/17/00 that a diagnosis of Lupus has been made.

VAERS ID:118697 (history)  Vaccinated:1999-01-11
Age:56.0  Onset:1999-01-12, Days after vaccination: 1
Gender:Female  Submitted:1999-01-14, Days after onset: 2
Location:Pennsylvania  Entered:1999-02-09, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin;Promantine
Current Illness: NONE
Preexisting Conditions: allergy sulfa
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4978114 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: itchy, red, hard, induration @ inj site;tender, warm to touch;area 5x10cm;

VAERS ID:119218 (history)  Vaccinated:1998-10-14
Age:56.4  Onset:1998-10-14, Days after vaccination: 0
Gender:Male  Submitted:1999-01-21, Days after onset: 99
Location:Colorado  Entered:1999-02-22, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC 'Split Type': CO99001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20188H IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0870H IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pain, Tendon disorder
SMQs:
Write-up: Pt recv vax on 10/14/98; on same day pt exp pain of rt arm; dx=classic rotator cuff, tendinitis; tx=Motrin

VAERS ID:119335 (history)  Vaccinated:1998-10-22
Age:56.1  Onset:1998-10-23, Days after vaccination: 1
Gender:Male  Submitted:1999-02-19, Days after onset: 119
Location:D.C.  Entered:1999-02-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: arthritis
Current Illness:
Preexisting Conditions: arthritis;Reiter''s syndrome
Diagnostic Lab Data: MRI of spine;LP
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02888P9IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Myelitis, Neuropathy, Paraesthesia, Salivary gland enlargement, Skin disorder
SMQs:, Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: transverse myelitis of cervical & thoracic spinal cord;

VAERS ID:119377 (history)  Vaccinated:1999-02-03
Age:56.3  Onset:1999-02-04, Days after vaccination: 1
Gender:Female  Submitted:1999-02-08, Days after onset: 4
Location:Alabama  Entered:1999-02-25, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec;Lasix;
Current Illness: NONE
Preexisting Conditions: HTN-vasotec & lasex;NKDA
Diagnostic Lab Data:
CDC 'Split Type': AL9901
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0944780 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Injection site hypersensitivity, Injection site mass, 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: Reports lt arm swelling, knot came up, stinging & hot to touch;reports chills 5FEB99 PM;red by 6FEB99;went to urgent care 6FEB99 PM; was prescribed pred & cephalexin;

VAERS ID:120133 (history)  Vaccinated:1999-03-01
Age:56.2  Onset:1999-03-03, Days after vaccination: 2
Gender:Female  Submitted:1999-03-04, Days after onset: 1
Location:Mississippi  Entered:1999-03-09, 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: Hydrochlorothiozide
Current Illness: NONE
Preexisting Conditions: Hypertension
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4978247  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site oedema, Myalgia, Pyrexia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 3/1/99; on 3/3/99 pt exp chills, fever, aches; swollen/hot vax site

VAERS ID:120718 (history)  Vaccinated:1998-08-27
Age:56.5  Onset:0000-00-00
Gender:Female  Submitted:1998-11-10
Location:Pennsylvania  Entered:1999-03-29, Days after submission: 139
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic fatigue syndrome
Preexisting Conditions: CFS restless legs syndrome, Long-term disability hx
Diagnostic Lab Data:
CDC 'Split Type': U199800572
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0960580   
Administered by: Private     Purchased by: Other
Symptoms: Influenza, Myasthenic syndrome, Pain
SMQs:, Malignancy related conditions (narrow)
Write-up: Pt recv vax on 8/27/98; post vax pt exp LA weak, pain & flu-like sx

VAERS ID:121624 (history)  Vaccinated:1998-10-19
Age:56.2  Onset:1999-02-08, Days after vaccination: 112
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:
CDC 'Split Type': TX99056
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0973930 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Influenza, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: 8FEB99 inc temp APAP;Bactrim;flu dx;

VAERS ID:121838 (history)  Vaccinated:1999-03-11
Age:56.0  Onset:1999-03-24, Days after vaccination: 13
Gender:Female  Submitted:1999-04-30, Days after onset: 36
Location:Maryland  Entered:1999-05-03, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin
Current Illness:
Preexisting Conditions: allergy to tetanus, neuralgia on lt side of face;
Diagnostic Lab Data: 1999 CT scan of head & neck not specified;CXR not specified;Blood work some blood was tested for virus;hearing test not specified;
CDC 'Split Type': 1999009219
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120B91IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Coordination abnormal, Dizziness, Ear disorder, Headache, Infection, Lymphadenopathy, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad)
Write-up: pt recv vax 11MAR99 & on 24MAR99 pt devel swollen lymph nodes on the lt side of neck, bilat clogged ears w/o fluid, h/a, dizziness & equilibrium was way off;dx viral infect;

VAERS ID:121839 (history)  Vaccinated:1999-04-06
Age:56.1  Onset:1999-04-07, Days after vaccination: 1
Gender:Male  Submitted:1999-04-26, Days after onset: 19
Location:Connecticut  Entered:1999-05-03, 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: Coriguard, Gout medicine
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
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Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM    
Administered by: Private     Purchased by: Private
Symptoms: Amblyopia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Optic nerve disorders (broad), Vestibular disorders (broad)
Write-up: Pt recv vax on 4/6/99; on 4/7/99 pt exp light headedness, blurred long range vision

VAERS ID:122061 (history)  Vaccinated:1999-04-05
Age:56.8  Onset:1999-04-06, Days after vaccination: 1
Gender:Female  Submitted:1999-04-28, Days after onset: 22
Location:Ohio  Entered:1999-05-11, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': OH99030
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2803A41IMLA
Administered by: Public     Purchased by: Private
Symptoms: Hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 5APR99 & exp allergic rxn of itching & redness on back & stomach, duration of 1wk;family physician back a strong possibility it was caused by vax;

VAERS ID:124855 (history)  Vaccinated:1998-10-14
Age:56.0  Onset:1998-10-14, Days after vaccination: 0
Gender:Female  Submitted:1999-05-27, Days after onset: 225
Location:Idaho  Entered:1999-06-07, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none rpt
Diagnostic Lab Data: none rpt
CDC 'Split Type': MPI981909B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.20218HB   
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Nausea, Neck pain, Pain, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)
Write-up: 15min p/vax pt exp dizziness, tingling lips, left arm pain neck to shoulder & nausea.

VAERS ID:124883 (history)  Vaccinated:1998-10-27
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:1999-05-27
Location:Tennessee  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 rpt
Diagnostic Lab Data: none rpt
CDC 'Split Type': MPI981972
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.20248KC IM 
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Asthenia, Diarrhoea, Headache, Infection, Influenza, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: approx 2hrs p/vax pt exp headache, nausea, sore abdomen, tiredness, achy bones & diarrhea.

VAERS ID:124902 (history)  Vaccinated:1998-10-23
Age:56.0  Onset:1998-10-24, Days after vaccination: 1
Gender:Female  Submitted:1999-05-27, Days after onset: 215
Location:Georga  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': MPI982017B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.20248KD   
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Pain, Pyrexia, Vasodilatation
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: p/vax pt exp a warm & sore arm, nausea & fever;

VAERS ID:123867 (history)  Vaccinated:1999-05-20
Age:56.7  Onset:1999-05-20, Days after vaccination: 0
Gender:Female  Submitted:1999-05-24, Days after onset: 4
Location:New York  Entered:1999-06-09, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp high fever @ age 15 w/flu vax;
Other Medications: Premarin;Calcium, Vitamins, ASA
Current Illness: NONE
Preexisting Conditions: allergy to PCN, sulfa, Morphine, tx for mild osteoarthritis
Diagnostic Lab Data: NONe
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1  
Administered by: Private     Purchased by: Private
Symptoms: Cough, Injection site reaction, Malaise, Myalgia, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: 4hr p/vax pt generally not feeling well achy, chills, low grade fever on & off for 3 days;also devel hacking cough & rhinitis also mild local rxn;

VAERS ID:123919 (history)  Vaccinated:1999-05-27
Age:56.5  Onset:1999-05-27, Days after vaccination: 0
Gender:Female  Submitted:1999-06-04, Days after onset: 8
Location:Alabama  Entered:1999-06-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none commments: phone rpt
Other Medications: none
Current Illness: noen
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain, Headache, Injection site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: after recv vax pt exp 2 sore arms, fever, vomited all night, stomach cramps, headache, in bed 5 days

VAERS ID:124939 (history)  Vaccinated:1998-11-01
Age:56.1  Onset:1998-11-02, Days after vaccination: 1
Gender:Female  Submitted:1999-06-14, Days after onset: 223
Location:Georga  Entered:1999-06-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amaryl
Current Illness: Diabetes
Preexisting Conditions: pt has a 5 year hx of non-insulin dependent diabetes
Diagnostic Lab Data: bone scan positive for bone disease;later positive cult for staph
CDC 'Split Type': U199900397
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bone disorder, Condition aggravated, Gangrene, Hyperglycaemia, Infection, Influenza, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: 1 day p/vax pt exp severe flu like sx for next 6-7 days;pt notice rise in home monitored blood sugar level $g300 to 400;pt exp swelling in both great toes;saw MD & determined to have bone disease;toes damaged & gangrene;great toes amputated;

VAERS ID:125142 (history)  Vaccinated:1999-04-20
Age:56.1  Onset:1999-04-22, Days after vaccination: 2
Gender:Male  Submitted:1999-06-21, Days after onset: 60
Location:California  Entered:1999-06-24, 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: APAP;Albuterol;Pulmicort
Current Illness: asthma, bronchitis
Preexisting Conditions: anemia;asthma;encephalitis;hypersensitivity rxn;malaria;pneumonia;poliomyelitis;tetanus;pepic ulcer, spinal surgery, urinary rentention, nephrolithiasis, nasal septal perforation; allergic rhinitis; atrophic rhinitis; lithotripsy
Diagnostic Lab Data: BP 195/165;T102; 4/30/99 xray degen joint disease back, BP severe hypertension, MRI-no signs of aneurysm, spinal tap-neg organism;protein elevated @ 301, glucose, temp-102F, 5/6/99spinal tap-glucose 37, protein 282, sl xanthochromia; MRI-nl
CDC 'Split Type': WAES99061086
Vaccination
Manufacturer
Lot
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1247H0IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Back pain, Bone disorder, CSF test abnormal, Condition aggravated, Headache, Hypertension, Hypertonia, Infection, Meningism, Meningitis, Myalgia, Nephrolithiasis, Nuchal rigidity, Orchitis, Pain, Pneumonia, Pyrexia, Renal pain, Sinusitis, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt recv vax & immed p/vax pt devel a fever which led to stiffening of musculoskeletal system & aching body organs such as kidney, liver, etc;p/ 4 or 5 days devel into meningitis;pt hosp in critical condition;BP 195/165, T102; Annual follow-up received on 11/27/2000 provided no additional data.

VAERS ID:125812 (history)  Vaccinated:1997-10-01
Age:56.9  Onset:1997-10-01, Days after vaccination: 0
Gender:Female  Submitted:1999-07-12, Days after onset: 649
Location:Maryland  Entered:1999-07-14, 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: none
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC 'Split Type': WAES97101151
Vaccination
Manufacturer
Lot
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: it was rpt from HCP concerning pt who in aug97 was vax w/pneumococcal; there was no concomitant med; in oct97 pt recv 2nd dose of vax; addl info recv indicated pt exp ``no react other than little soreness at inj site''''

VAERS ID:125888 (history)  Vaccinated:1998-10-27
Age:56.6  Onset:1998-10-27, Days after vaccination: 0
Gender:Female  Submitted:1999-07-12, Days after onset: 257
Location:Texas  Entered:1999-07-14, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No Relevant Data
Other Medications: Darvocet-N;Miacalcin;OS-cal;Librium;Premarin;Prilosec;
Current Illness:
Preexisting Conditions: drug allergy;iodine allergy;PNC allergy;
Diagnostic Lab Data:
CDC 'Split Type': WAES98102117
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 2  
Administered by: Other     Purchased by: Other
Symptoms: Dysgeusia, Vasodilatation
SMQs:, Taste and smell disorders (narrow)
Write-up: p/vax pt exp hot flash post vax & reported could taste in mouth;

VAERS ID:126396 (history)  Vaccinated:1999-07-01
Age:56.1  Onset:1999-07-01, Days after vaccination: 0
Gender:Male  Submitted:1999-07-22, Days after onset: 21
Location:California  Entered:1999-07-27, 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: Lipitor
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
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Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM116A20IM 
Administered by: Private     Purchased by: Private
Symptoms: Headache, Influenza, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: on the evening of vax & had flu like sx w/ h/a, fever/chills & body aches, pt has cont to have low grade body aches;

VAERS ID:126428 (history)  Vaccinated:1999-06-01
Age:56.5  Onset:1999-07-22, Days after vaccination: 51
Gender:Female  Submitted:1999-07-27, Days after onset: 5
Location:New Jersey  Entered:1999-07-29, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 1999018196
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Private     Purchased by: Other
Symptoms: Face oedema, Facial palsy, Hypotonia, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: p/vax pt devel itching behind rt ear & swelling & drooping of the rt side of face;7/8/99 pt devel rt partial facial paralysis;tx w/pred, Valtrex;today has complete rt facial paralysis

VAERS ID:126556 (history)  Vaccinated:1999-04-08
Age:56.0  Onset:1999-04-08, Days after vaccination: 0
Gender:Female  Submitted:1999-05-10, Days after onset: 32
Location:Rhode Island  Entered:1999-07-30, Days after submission: 81
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: estratest; natural tears; lacribibe?; salagen
Current Illness:
Preexisting Conditions: osteoarthritis; probable sjogrens syndrome
Diagnostic Lab Data:
CDC 'Split Type': 1999009266
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Public     Purchased by: Other
Symptoms: Chills, Nausea, Tremor, Vasodilatation
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: p/vax pt exp shaking chills; nausea & felt hot & cold the next 2 days; no tx given

VAERS ID:126582 (history)  Vaccinated:1999-04-20
Age:56.0  Onset:1999-04-26, Days after vaccination: 6
Gender:Male  Submitted:1999-05-03, Days after onset: 7
Location:Pennsylvania  Entered:1999-07-30, Days after submission: 88
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 3/21/99-pt; inj site pain; age 56; lymerix; dose 1
Other Medications: claritin d; nasonex
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 1999009842
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: p/vax pt devel bull''s eye rash; seen by MD; no treatment given

VAERS ID:126602 (history)  Vaccinated:1999-04-15
Age:56.0  Onset:1999-04-22, Days after vaccination: 7
Gender:Female  Submitted:1999-05-07, Days after onset: 15
Location:New Jersey  Entered:1999-07-30, Days after submission: 84
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: allergic to demerol
Diagnostic Lab Data:
CDC 'Split Type': 1999010308
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Public     Purchased by: Public
Symptoms: Herpes zoster, Myalgia, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: p/vax pt exp pain over all muscles & aches for 1day; pt also later devel shingles on lower back & groin area & exp severe pain; pain & numbness in rt leg also associated w/shingles; shingles required pt to get epidural nerve block as out p

VAERS ID:126620 (history)  Vaccinated:1999-04-26
Age:56.0  Onset:1999-04-26, Days after vaccination: 0
Gender:Male  Submitted:1999-05-18, Days after onset: 22
Location:New York  Entered:1999-07-30, Days after submission: 73
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': 1999011012
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120F9 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Influenza, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: p/vax pt exp acute onset of chills; vomiting & flu-like symptoms; had chest pain; shortness or breath; tx benadryl & ibuprofen; lymerix was discontinued

VAERS ID:126642 (history)  Vaccinated:1999-04-12
Age:56.0  Onset:1999-04-12, Days after vaccination: 0
Gender:Male  Submitted:1999-05-21, Days after onset: 39
Location:Pennsylvania  Entered:1999-07-30, 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: Cozaar
Current Illness:
Preexisting Conditions: HTN, Mitral Valve repair, seasonal allergies;
Diagnostic Lab Data:
CDC 'Split Type': 1999011524
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Private     Purchased by: Private
Symptoms: Influenza
SMQs:
Write-up: p/vax pt devel flu like sx;pt recovered 3hr later;

VAERS ID:126680 (history)  Vaccinated:1999-03-26
Age:56.0  Onset:1999-05-01, Days after vaccination: 36
Gender:Female  Submitted:1999-06-03, Days after onset: 33
Location:New York  Entered:1999-07-30, Days after submission: 57
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': 1999012725
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: p/vax pt exp sensation of pins & needles in hands & legs; BP 120/80 at the time; further lymerix was discontinued

VAERS ID:126691 (history)  Vaccinated:1999-05-18
Age:56.0  Onset:1999-05-18, Days after vaccination: 0
Gender:Female  Submitted:1999-06-08, Days after onset: 21
Location:New Jersey  Entered:1999-07-30, 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: Vitamins
Current Illness:
Preexisting Conditions: NKA;
Diagnostic Lab Data:
CDC 'Split Type': 1999013164
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: p/vax pt exp nausea, feeling cold, internal tremors & had an elevated temp of 101.6;

VAERS ID:126835 (history)  Vaccinated:1999-07-10
Age:56.1  Onset:1999-07-13, Days after vaccination: 3
Gender:Male  Submitted:1999-07-21, Days after onset: 8
Location:Massachusetts  Entered:1999-08-03, Days after submission: 13
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: unk
Diagnostic Lab Data: liver function tests: elevated
CDC 'Split Type': 899203061A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Erythema multiforme, Hepatic function abnormal, Jaundice
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Severe cutaneous adverse reactions (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Hypersensitivity (narrow)
Write-up: 3days p/vax pt devel erythema multiforme, became jaundiced, & was hosp on 7/19; pt remained hosp due to elevated liver function tests

VAERS ID:127497 (history)  Vaccinated:1999-06-29
Age:56.9  Onset:1999-06-29, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:1999-08-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma medication
Current Illness: NONE
Preexisting Conditions: asthma;has been bitten by deer ticks in the past;
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM116A41IM 
Administered by: Other     Purchased by: Private
Symptoms: Adverse drug reaction, Arthralgia, Chills, Influenza, Malaise, Pain, Pyrexia, Similar reaction on previous exposure to drug, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad)
Write-up: p/vax pt wrists aching & burned, hands aching, flu sx, fever, felt terrible, cold, shaky & chills;

VAERS ID:127639 (history)  Vaccinated:1999-07-08
Age:56.1  Onset:1999-07-09, Days after vaccination: 1
Gender:Male  Submitted:1999-08-22, Days after onset: 44
Location:Massachusetts  Entered:1999-08-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Probenicid;Indocin;
Current Illness: NONE
Preexisting Conditions: gouty arthritis (controlled); NKDA
Diagnostic Lab Data: liver function test, ultrasound liver, CBC, UA, EBV, CMV titers;
CDC 'Split Type': U199900480
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7258BA  RA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthma, Erythema multiforme, Face oedema, Hepatitis, Jaundice
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: p/vax pt exp wheezing, erythema multiforme & swelling of the lips & face;pt reportedly was seen by MD 7/13/99; hepatitis, jaundice;hosp;

VAERS ID:128053 (history)  Vaccinated:1999-06-07
Age:56.5  Onset:0000-00-00
Gender:Male  Submitted:1999-06-28
Location:California  Entered:1999-09-03, Days after submission: 67
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: Sumatriptan succinate;Zantac;
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC 'Split Type': 899181181A
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES   RA
Administered by: Military     Purchased by: Military
Symptoms: Neuritis, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: p/vax pt devel neuritic distal pain & rt arm swelling;pain & swelling persisted;

VAERS ID:128506 (history)  Vaccinated:1999-09-15
Age:56.3  Onset:1999-09-15, Days after vaccination: 0
Gender:Male  Submitted:1999-09-16, Days after onset: 1
Location:Utah  Entered:1999-09-27, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0241 LA
Administered by: Military     Purchased by: Military
Symptoms: Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: p/vax pt has very sore arm; muscle pains in back; hip & shoulders; general aches & pins throughout body

VAERS ID:128573 (history)  Vaccinated:1999-09-07
Age:56.6  Onset:1999-09-07, Days after vaccination: 0
Gender:Female  Submitted:1999-09-14, Days after onset: 7
Location:California  Entered:1999-09-27, Days after submission: 13
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: size=130x75mm;seen by MD& prescribed motrin & cold compress
CDC 'Split Type': CA990102
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, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt started to have swollen inj site, redness & pain;pt took unk chinese herbs OTC by self & claimed that dec swelling;seen at clinic;lt upper arm swelling, red, pain & warm to touch;

VAERS ID:128791 (history)  Vaccinated:1999-09-03
Age:56.5  Onset:1999-09-03, Days after vaccination: 0
Gender:Female  Submitted:1999-09-09, Days after onset: 6
Location:Pennsylvania  Entered:1999-09-30, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp flu like sx 6/28/95 w/GCB dose 4/6;
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
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BCG: BCG (NO BRAND NAME)UNKNOWN MANUFACTURER822122  
Administered by: Private     Purchased by: Private
Symptoms: Chills, Gastrointestinal haemorrhage, Influenza, Myalgia, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad)
Write-up: 5hr p/vax pt c/o chills & flu-like feeling, achy, no fever;blood noted on toilet tissue post void;encouraged fluids & suggested APAP;instructed to contact MD for worsening of sx;lasted 4hr;

VAERS ID:129325 (history)  Vaccinated:1999-09-21
Age:56.3  Onset:1999-09-22, Days after vaccination: 1
Gender:Female  Submitted:1999-10-06, Days after onset: 14
Location:Virginia  Entered:1999-10-13, 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: NONE
Preexisting Conditions: hypothyroidism
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0003BA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: large area (12cm) of erythema, induration @ site of shot;

VAERS ID:129494 (history)  Vaccinated:1999-09-28
Age:56.8  Onset:1999-09-29, Days after vaccination: 1
Gender:Female  Submitted:1999-10-07, Days after onset: 8
Location:California  Entered:1999-10-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sick 20 years ago w/Td
Other Medications: PPD
Current Illness: maybe had flu or cold
Preexisting Conditions: milk
Diagnostic Lab Data: NOen
CDC 'Split Type': CA990109
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0989580 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Malaise, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 2 days p/vax pt stated arm (immun site) was warm, swollen & itchy for days;felt poisoned for 2 days;

VAERS ID:129519 (history)  Vaccinated:1999-07-06
Age:56.2  Onset:1999-07-09, Days after vaccination: 3
Gender:Male  Submitted:1999-10-13, Days after onset: 96
Location:South Carolina  Entered:1999-10-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv Anthrax by Bioport lot# FAV024 given 9/29/99;
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0430SCRA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Myalgia, Skin discolouration
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax & a small brown-colored lesion formed approx 1cm by 0.6cm;pt states had achy muscles & felt fatigued for about 5 days;

VAERS ID:129719 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:1999-10-14
Gender:Female  Submitted:1999-10-18, Days after onset: 4
Location:Florida  Entered:1999-10-22, 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: Naproxin;Synthroid;Bospara;Accolaid;Euexer
Current Illness:
Preexisting Conditions: asthma, hypothyroid, PCN;
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: Anorexia, Cough, Dry mouth, Laryngitis, Lung disorder, Myalgia, Pharyngitis, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad)
Write-up: sore scratchy throat-nasal area stuffy, laryngitis, chest congestion, coughs, body aches & pains, dry mouth, loss of appetite;call in to MD;

VAERS ID:129895 (history)  Vaccinated:1999-10-05
Age:56.9  Onset:1999-10-07, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:1999-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvasc;Prilosec;
Current Illness: NONE
Preexisting Conditions: PCN allergy
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998281 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)
Write-up: p/vax pt noticed raised bumps (not red at first) @ inj site & redness across chest & then to arm;

VAERS ID:130057 (history)  Vaccinated:1999-10-20
Age:56.6  Onset:0000-00-00
Gender:Female  Submitted:1999-10-25
Location:Maryland  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: pt devel hives @ age 21 w/tetanus;
Other Medications: ?BP meds;?antiole ped
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49983441 LA
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: soreness lt arm;no noted edema;T97.8;BP 122/60;APAP given;referred to PMD tomorrow;

VAERS ID:130227 (history)  Vaccinated:1999-10-18
Age:56.2  Onset:1999-10-20, Days after vaccination: 2
Gender:Male  Submitted:1999-10-27, Days after onset: 7
Location:Maryland  Entered:1999-11-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Dizziness, Hyperacusis, Influenza, Pharyngitis, Photosensitivity reaction, Pyrexia, Rhinitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: flu sx, sensitivity to light & sound;upper resp congestion, spikes in temp;chills, myalgias, fatigue, rt h/a;

VAERS ID:130655 (history)  Vaccinated:1999-02-02
Age:56.0  Onset:1999-02-02, Days after vaccination: 0
Gender:Male  Submitted:1999-06-18, Days after onset: 135
Location:Florida  Entered:1999-11-10, Days after submission: 145
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': FL99043
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2715B62IMLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Injection site reaction, Lymphadenopathy, Neuritis, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: p/vax local rxn site lt arm pain, swelling, inc warmth, induration or lump w/o abscess;adenopathy local inj site area;pain in joints;neuritis, neuralgia;paresthesias;tingling lt arm;

VAERS ID:130723 (history)  Vaccinated:1999-10-19
Age:56.7  Onset:1999-10-31, Days after vaccination: 12
Gender:Female  Submitted:1999-11-03, Days after onset: 3
Location:Wyoming  Entered:1999-11-12, 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:
Diagnostic Lab Data: NONE
CDC 'Split Type': WY9917
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998209 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Herpes zoster, Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: papular rash 20mm lt upper arm @ inj site;pt denies pain or itching;no redness or heat @ site;lesion very similar to herpes zoster w/no pain involved;

VAERS ID:130818 (history)  Vaccinated:1999-10-15
Age:56.9  Onset:1999-10-15, Days after vaccination: 0
Gender:Female  Submitted:1999-11-10, Days after onset: 26
Location:Illinois  Entered:1999-11-15, 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: Zyrtec;nasonex;Premarin;Provera;
Current Illness:
Preexisting Conditions: seasonal allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0150AA2 A
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4585850 A
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: erythematous indurated skin rxn covering entire deltoid area eval pt 2 day p/vax;skin rxn approx 6cm;it was not documented which arm each vax was given in;

VAERS ID:130846 (history)  Vaccinated:1999-10-27
Age:56.0  Onset:1999-10-28, Days after vaccination: 1
Gender:Female  Submitted:1999-10-30, Days after onset: 2
Location:Florida  Entered:1999-11-16, 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: Lotrimin solution;
Current Illness: elevated cholesterol, menopause
Preexisting Conditions: PCN, codeine, tetracycline;
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4988033 IMLA
Administered by: Public     Purchased by: Public
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: p/vax sx started 10/28/99 swollen, reddened, lt upper arm, itching, discomfort;

VAERS ID:130908 (history)  Vaccinated:1999-10-13
Age:56.9  Onset:1999-10-13, Days after vaccination: 0
Gender:Female  Submitted:1999-10-15, Days after onset: 2
Location:Massachusetts  Entered:1999-11-18, Days after submission: 34
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: allergic to PCN, bandaids
Diagnostic Lab Data: NONE
CDC 'Split Type': MA9916
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4628100IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: redness circular from shoulder to elbow, skin hot & tender;

VAERS ID:130933 (history)  Vaccinated:1999-10-13
Age:56.5  Onset:1999-10-13, Days after vaccination: 0
Gender:Female  Submitted:1999-10-15, Days after onset: 2
Location:Massachusetts  Entered:1999-11-18, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergic rxn to sulfa as a young adult
Diagnostic Lab Data: NONe
CDC 'Split Type': MA9917
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4628100IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: redness lt arm @ inj site & tender to touch;redness & swelling moved down to elbow;very painful;lt elbow still swollen & warm to touch;

VAERS ID:131449 (history)  Vaccinated:1999-10-11
Age:56.6  Onset:1999-10-24, Days after vaccination: 13
Gender:Male  Submitted:1999-11-03, Days after onset: 10
Location:Massachusetts  Entered:1999-11-29, Days after submission: 26
Life Threatening? No
Died? Yes
   Date died: 1999-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none
Other Medications: 2 types insulin, synthroid, antidepressants-buspar;anapheril, Ritalin, flexaril, melatonin
Current Illness: NONE; blood sugar nl 10/23, 10PM
Preexisting Conditions: diabetes (for 37 years), Graves disease (for 20yrs), diabetic depression
Diagnostic Lab Data:
CDC 'Split Type': MA9924
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU011AB10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: pt was found dead 12.5 days p/vax;

VAERS ID:131646 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:1999-11-24
Location:Illinois  Entered:1999-12-02, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ?
Preexisting Conditions:
Diagnostic Lab Data: although extensive, invasive & debilitating tests were performed, unable to get the data;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Immune system disorder, Pain
SMQs:, Guillain-Barre syndrome (broad)
Write-up: severe, chronic autoimmune problems throughout life;tx w/steroids, ATB & surgery;ASA now;60 day follow-up states the pt still has severe pain and weakness resemblin flu-like symptoms.

VAERS ID:131664 (history)  Vaccinated:1999-10-18
Age:56.8  Onset:1999-10-19, Days after vaccination: 1
Gender:Male  Submitted:1999-10-20, Days after onset: 1
Location:Florida  Entered:1999-12-02, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv flu vax by Wyeth lt# 4998234 given 10/30/99;pt recv IPPD-TB by connaught lot# 250411 given 10/2/99;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0241 RA
Administered by: Military     Purchased by: Military
Symptoms: Coordination abnormal, Dizziness, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: shot site very painful;extreme dizziness;equilibrium was effected, even setting in a chair;severe h/a comes & goes;pain goes to dull ach;had to take sick leave;home & in bed;

VAERS ID:131679 (history)  Vaccinated:1999-10-09
Age:56.2  Onset:1999-10-09, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Texas  Entered:1999-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt devel myalgia w/dose 1&2 of anthrax vax;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV024   
Administered by: Military     Purchased by: Military
Symptoms: Myalgia, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: w/in 2hr of vax complete shoulder & neck area have became extremely sore;the soreness is deep & not localized @ the shot area;the first two sx were over a week long;

VAERS ID:132664 (history)  Vaccinated:1999-10-20
Age:56.5  Onset:1999-10-21, Days after vaccination: 1
Gender:Female  Submitted:1999-10-25, Days after onset: 4
Location:New York  Entered:1999-12-20, Days after submission: 56
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardizem
Current Illness: NONE
Preexisting Conditions: Cardiac
Diagnostic Lab Data:
CDC 'Split Type': NY99039
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS01889P IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1584H0SC 
Administered by: Other     Purchased by: Other
Symptoms: Myalgia, Oedema peripheral, Pyrexia, Tremor, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: 10/20/99 at 3p pt recv flu and pneumo vax., 2 a 10/4/99:temp 101.1, chills, shakes, aches all over. Temp continues till 10/22/99 along w/ aches. L arm red, warm swollen 4 days after imm.

VAERS ID:132821 (history)  Vaccinated:1999-11-22
Age:56.0  Onset:1999-11-26, Days after vaccination: 4
Gender:Male  Submitted:1999-12-14, Days after onset: 18
Location:Illinois  Entered:1999-12-27, Days after submission: 13
Life Threatening? No
Died? Yes
   Date died: 1999-12-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: CT of head:central herniation,cerebral edema.EEG:low applitude.MRI of brain:thalamus,temporal lobes ischemic.Autopsy results pending.
CDC 'Split Type': U199901040
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD052281A PO 
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA071AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Brain oedema, Confusional state, Dyspnoea, Febrile convulsion, Hypoxia, Pyrexia, Stupor, Subarachnoid haemorrhage
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Haemorrhagic cerebrovascular conditions (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 11/22/99:pt. rcvd vacc.11/30/99:Pt. dvlped fever,chills,SOB, confusion,& less responsive.12/1/99:EMS called,pt.had fever of 105 and began seizing.In hospital, pt. dxed w/ central herniation and cerebral edema.12/2/99:pt pronounced dead.

VAERS ID:131826 (history)  Vaccinated:1999-11-09
Age:56.0  Onset:1999-11-10, Days after vaccination: 1
Gender:Female  Submitted:1999-11-18, Days after onset: 8
Location:Kentucky  Entered:1999-12-29, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocar, ASA
Current Illness: NONE
Preexisting Conditions: Allergy Macrodantin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0169HA0IM 
Administered by: Military     Purchased by: Military
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 24 hrs after shot administered, increased pruritic at site of injection. No fever, n/v/d, sob. 2 1/2" erythema.

VAERS ID:132460 (history)  Vaccinated:1999-10-12
Age:56.5  Onset:1999-10-14, Days after vaccination: 2
Gender:Female  Submitted:1999-10-20, Days after onset: 6
Location:Georga  Entered:2000-01-06, Days after submission: 78
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: N/A
Other Medications: N/A
Current Illness: NONE
Preexisting Conditions: KNA
Diagnostic Lab Data:
CDC 'Split Type': GA99151
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS03279P3IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1402H1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, 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: 10/14 2 days post vax, pt c/o redness, tenderness with swelling & fever at site R deltoid. 23x20 red hardened area just below inject site. Area inc warm to touch. 10/15 site lger but swelling/tenderness dec. 10/20 problem resolved.

VAERS ID:132477 (history)  Vaccinated:1999-10-30
Age:56.0  Onset:1999-10-30, Days after vaccination: 0
Gender:Female  Submitted:1999-11-26, Days after onset: 27
Location:Virginia  Entered:2000-01-06, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore armpit, shortly after Flu vax.
Other Medications: Triamterene/HCTZ75/50mg, Premarin, Promerium,Aspirin, Centrum Silver, Caltrate, Vitamins E & C, Garlic
Current Illness: NONE
Preexisting Conditions: High B/P-controlled
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998261 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: My underarm became sore. This time it lasted longer (8 days) & was more pronounced. At times it felt like a knife stabbing into the upper right (toward torso) quadrant of my left armpit. Moving my arm was not a factor.

VAERS ID:133080 (history)  Vaccinated:1999-10-05
Age:56.0  Onset:1999-10-05, Days after vaccination: 0
Gender:Male  Submitted:1999-10-08, Days after onset: 3
Location:Massachusetts  Entered:2000-01-06, Days after submission: 90
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Topral
Current Illness: NONE
Preexisting Conditions: High B/P
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0107AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1585H  RA
Administered by: Private     Purchased by: Public
Symptoms: Oedema, Pain, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Began experiencing redness, swelling of upper arm, chills & fever, at night. 10/8, Continued w/pain & swelling, advised to see MD. Saw MD 10/8 & given injection of antibiotic & Rx for same & told to keep arm in sling & elevated.

VAERS ID:133387 (history)  Vaccinated:1999-11-04
Age:56.0  Onset:1999-11-07, Days after vaccination: 3
Gender:Male  Submitted:2000-01-10, Days after onset: 64
Location:Maryland  Entered:2000-01-20, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0372  
Administered by: Military     Purchased by: Military
Symptoms: Hypertonia, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Pain on the back of left hand, also two fngers on left hand have become extremely stiff and hard to bend or use.

VAERS ID:133491 (history)  Vaccinated:2000-01-10
Age:56.0  Onset:2000-01-10, Days after vaccination: 0
Gender:Male  Submitted:2000-01-17, Days after onset: 7
Location:Texas  Entered:2000-02-01, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zestril, mevacor, HCTZ
Current Illness: NONE
Preexisting Conditions: HX of hypertension, hypercholesterolemia
Diagnostic Lab Data: EKG at Cardiologist office
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR00741 IMLA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA137AA SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Atrial fibrillation, Atrial septal defect, Diarrhoea, Malaise, Palpitations, Pyrexia, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Congenital, familial and genetic disorders (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)
Write-up: Pt received vaccine on 1/10/00, felt weak and fatigued. Pt received additional vaccines on 1/12/00, felt malaise, fatigue, fever. On 1/14/00, pt had palpitations, syncope, fast heart rate. 1/17/00 saw MD pos atrial fib.

VAERS ID:133760 (history)  Vaccinated:1999-12-14
Age:56.0  Onset:1999-12-17, Days after vaccination: 3
Gender:Female  Submitted:1999-12-22, Days after onset: 5
Location:Texas  Entered:2000-02-07, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium
Current Illness: cuts and bruises
Preexisting Conditions: allergy to PCN
Diagnostic Lab Data:
CDC 'Split Type': 99TX271
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0977220 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt given Td vax on 12/14/99. Dvlped rash on 12/17 and itching on 12/18. Clearing along spinal area; txed w/ Benadryl.

VAERS ID:133817 (history)  Vaccinated:2000-01-07
Age:56.0  Onset:2000-01-08, Days after vaccination: 1
Gender:Female  Submitted:2000-01-11, Days after onset: 3
Location:California  Entered:2000-02-08, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardizem, Dyazide
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data: NONE
CDC 'Split Type': CA000004
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982210IMLA
Administered by: Other     Purchased by: Other
Symptoms: Pain, Pruritus, Pyrexia, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 1/8/00, itchy palms bilaterally; $g over body during day. Taking Benadryl for severe itching; Gold Bond. Red, raised, pin-head areas over body & discomfort. Temp 102.

VAERS ID:133824 (history)  Vaccinated:1999-10-20
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-01-13
Location:West Virginia  Entered:2000-02-08, Days after submission: 26
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:
Diagnostic Lab Data: UNK
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS0267AP IMRA
Administered by: Public     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:133876 (history)  Vaccinated:1999-11-02
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:2000-02-08
Location:Connecticut  Entered:2000-02-10, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hx of allergy injections - asthmatic
Diagnostic Lab Data:
CDC 'Split Type': CT200002
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.24949GA IMA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Patient complained of burning rash, lump, prickly sensation at site of injection - has had this for approximately 2 months.

VAERS ID:133946 (history)  Vaccinated:1999-11-16
Age:56.0  Onset:1999-11-18, Days after vaccination: 2
Gender:Female  Submitted:2000-02-03, Days after onset: 77
Location:Pennsylvania  Entered:2000-02-15, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Serentil, trazadone
Current Illness: NONE
Preexisting Conditions: Cold 1 week before
Diagnostic Lab Data: UNK
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Private     Purchased by: Private
Symptoms: Asthma, Haemoptysis, Laryngospasm, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Had chest noises, wheezes & spit blood. Throat swelling a lot when lying down at night. Sit in recliner, legs & feet swelled still.

VAERS ID:133983 (history)  Vaccinated:2000-01-12
Age:56.0  Onset:2000-01-14, Days after vaccination: 2
Gender:Female  Submitted:2000-01-25, Days after onset: 11
Location:South Dakota  Entered:2000-02-15, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0012AA0IMA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Soreness, redness at inject site, area became quite red and swollen and require coritsone injection and IM antibiotic.

VAERS ID:134406 (history)  Vaccinated:1999-10-06
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-02-25
Location:Illinois  Entered:2000-02-29, 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: Cardizem
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': 1183123FEB
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982631IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diplopia, Guillain-Barre syndrome, Injection site oedema, Injection site pain, Neoplasm malignant, Vasodilatation, Weight decreased
SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Demyelination (narrow), Ocular motility disorders (broad), Malignant tumours (narrow)
Write-up: Post vax, pt immediately devel inject site react characterized by swelling, pain & heat. Lost 12 pounds and was ''developing GBS''. She devel cancer, is receiving chemotherapy. Hosp for unspecified tests. Per 60-Day FU: double vision 10/99; Guillain Barre Syndrome 1/2000, still have this. Have not worked since 1/2000.

VAERS ID:150093 (history)  Vaccinated:2000-03-04
Age:56.0  Onset:2000-03-05, Days after vaccination: 1
Gender:Female  Submitted:2000-03-06, Days after onset: 1
Location:South Carolina  Entered:2000-03-15, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy to pollen
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0315SCLA
Administered by: Military     Purchased by: Military
Symptoms: Chills, Feeling hot, Hyperhidrosis, Injection site erythema, Injection site mass, Neck pain, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Pt experienced chills and sweats, swelling, headache, sore neck, redness, itching, hot to the touch at injection site, redness from elbow to shoulder on left arm, a 12 x 8 cm area of erythema and 3 x 5 cm area of firmness.

VAERS ID:150582 (history)  Vaccinated:1999-07-01
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-01-19
Location:Maryland  Entered:2000-03-29, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Elavil, Ziac, Claritin, Provera,
Current Illness:
Preexisting Conditions: arthritis, hypertension
Diagnostic Lab Data: Lyme test-positive
CDC 'Split Type': 19990298141
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IMRA
Administered by: Private     Purchased by: Other
Symptoms: Infection, Laboratory test abnormal, Pain
SMQs:
Write-up: The pt received the first and second dose in June and July, 1999. After the 2nd dose the pt experienced achiness all over. A Lyme test on 11/9/99 was positive. The most recent information received on 11/12/1999 reported the condition of the pt is ongoing.

VAERS ID:150738 (history)  Vaccinated:2000-02-25
Age:56.0  Onset:2000-02-26, Days after vaccination: 1
Gender:Female  Submitted:2000-03-06, Days after onset: 9
Location:Maine  Entered:2000-04-04, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergies: PCN, Biaxin, Amoxicillin, Propulsid
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1595H3IM 
Administered by: Private     Purchased by: Private
Symptoms: Anaphylactic reaction, Rash, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: Anaphylactic reaction, 24 hours post vax. Given cortisone, antihistamines and symptoms resolved, shortly thereafter. Perioral swelling, rash.

VAERS ID:150953 (history)  Vaccinated:2000-03-04
Age:56.0  Onset:2000-03-04, Days after vaccination: 0
Gender:Male  Submitted:2000-03-13, Days after onset: 9
Location:New York  Entered:2000-04-13, Days after submission: 30
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
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0470SC 
Administered by: Military     Purchased by: Military
Symptoms: Cough, Nasal congestion
SMQs:, Anaphylactic reaction (broad)
Write-up: Persistent congestion and coughing after 1 week.

VAERS ID:151802 (history)  Vaccinated:2000-05-02
Age:56.0  Onset:2000-05-02, Days after vaccination: 0
Gender:Female  Submitted:2000-05-05, Days after onset: 3
Location:Pennsylvania  Entered:2000-05-10, 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: Vasotec, Prempro
Current Illness: NONE
Preexisting Conditions: hypertension
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY13892IMLA
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Pt experienced swelling and redness in shoulder with pain at times. Pt is able to move arm but difficulty making a fist. No strength.

VAERS ID:151816 (history)  Vaccinated:1999-12-30
Age:56.0  Onset:1999-12-30, Days after vaccination: 0
Gender:Male  Submitted:2000-04-21, Days after onset: 112
Location:Virginia  Entered:2000-05-10, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 20000001161
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: On 12/30/99, the pt received his first IM-left deltoid dose of Lymerix. A few hours later on 12/30/99, the pt experienced injection site soreness and a tingling prickly sensation on his whole body. An MD visit was required and anti-inflammatories were prescribed. The symptoms lasted a few days and then subsided. However they reoccurred and persist. The most information received on 1/5/00 report the condition of the pt is ongoing.

VAERS ID:151824 (history)  Vaccinated:2000-01-13
Age:56.0  Onset:2000-01-13, Days after vaccination: 0
Gender:Male  Submitted:2000-04-21, Days after onset: 98
Location:Minnesota  Entered:2000-05-10, 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: Contac, acetylasalicysic acid, Advil
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 20000011991
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY126A20IM 
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: On 1/13/00, the pt received his first right arm dose of Lymerix. Following the first dose on 1/13/00, the pt experienced severe arm pain which kept his awake all night. No treatment was given. The most recent information received on 1/14/00, reported the condition of the pt as unknown.

VAERS ID:151980 (history)  Vaccinated:1999-01-05
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-03-07
Location:Ohio  Entered:2000-05-16, Days after submission: 69
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: History of lymphoma
Diagnostic Lab Data: hepatitis B titer was below 6 IU/mL
CDC 'Split Type': WAES99011075
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 3IM 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Laboratory test abnormal, Lymphadenopathy
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Pt received 4th vax on 01/05/1999. It was reported that in 02/1995 the pt received full series of hepatitis B vax. Subsequently, the pt''s hepatitis B titer was below 6 IU/mL. Sometime after the booster dose, the pt developed enlarged cervical and axillary lymph nodes. The physician was ''not certain of the relationship to the vax due to the pt''s history of lymphoma. The physician will be taking biopsies of the lymph nodes.'' Additional information has been requested.

VAERS ID:152092 (history)  Vaccinated:1999-04-06
Age:56.0  Onset:1999-04-07, Days after vaccination: 1
Gender:Male  Submitted:2000-03-07, Days after onset: 335
Location:Illinois  Entered:2000-05-18, Days after submission: 71
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES99040559
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1168T0IM 
Administered by: Private     Purchased by: Other
Symptoms: Dysuria, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: One day post vax, this pt experienced a fever and nausea with painful respirations and urination. He presented to a physician on 04/08 with symptoms. It was reported that the pt is feeling much better. The physician expressed concern with the vax lot number. The pt''s physician reported in follow-up that he recovered from symptoms. No further information is available.

VAERS ID:152279 (history)  Vaccinated:1999-09-30
Age:56.0  Onset:1999-10-06, Days after vaccination: 6
Gender:Female  Submitted:2000-03-07, Days after onset: 153
Location:Arizona  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: facial edema; hypertension
Diagnostic Lab Data: (09/28/1999) blood pressure 144/9; blood pressure 144/1;(10/07/1999) chloride 110; glucose 188; pulse oximetry 110; serum alkaline 165;(10/05?1999)
CDC 'Split Type': WAES99100600
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 3IM 
Administered by: Public     Purchased by: Other
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: On 10/6/99, the pt experienced swelling of her forehead. In the evening of the following day, the pt''s cheeks and eyelids also swelled. The pt reported that she used hair dye on 10/3/99 and she had had a similar reaction 9 to 10 years ago following the use of hair dye. The pt reports no difficulty breathing or swallowing.

VAERS ID:152336 (history)  Vaccinated:1999-09-14
Age:56.0  Onset:1999-09-23, Days after vaccination: 9
Gender:Female  Submitted:2000-03-07, Days after onset: 166
Location:New York  Entered:2000-05-25, Days after submission: 78
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Propulsid, digoxin, Zyprexa, Prilosec, Aldactoke, Depakote, Effexor
Current Illness: UNK
Preexisting Conditions: Bipoplar disorder, Hypertension, Schizophrenia, Seasonal allergies, Bronchitis
Diagnostic Lab Data: CT scan of head-normal, CXR-revealed Emphysema changes, Pulse oxygen was 92%.
CDC 'Split Type': WAES99102343
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Dysarthria, Emphysema, Facial palsy, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: On 9/23/99 and again on 9/26/99, the pt went to an ER "with severe headaches, slurring speech, and drooping mouth." The pt was dx with Bell''s Palsy. On 9/27/99, the pt presented to an MD with left side facial drooping, muscle aches and weakness and headaches. On 10/4/99, the pt was seen by an MD and presented with fever, chills, and facial drooping. On 10/21/99, the pt presented to an MD with uncontrollable headaches and slightly improved Bell''s Palsy.

VAERS ID:152714 (history)  Vaccinated:1999-10-06
Age:56.0  Onset:1999-10-08, Days after vaccination: 2
Gender:Female  Submitted:1999-11-09, Days after onset: 32
Location:Ohio  Entered:2000-06-07, Days after submission: 210
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: allergy to sulfa
Diagnostic Lab Data: NONE
CDC 'Split Type': FLU211199
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02879P0 RA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: The pt experienced erythema, edema but no heat below the injection site.

VAERS ID:152760 (history)  Vaccinated:1998-10-09
Age:56.0  Onset:1998-10-09, Days after vaccination: 0
Gender:Female  Submitted:1998-11-06, Days after onset: 28
Location:California  Entered:2000-06-07, Days after submission: 578
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': U1998006000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0968420  LA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: It was reported that a 56 year old female received Fluzone 98-99 on 10/9/98. Reportedly the pt experienced large red area 4 inches in diameter at the injection site, also experienced pain and swelling since administration.

VAERS ID:153648 (history)  Vaccinated:2000-03-24
Age:56.0  Onset:2000-04-07, Days after vaccination: 14
Gender:Female  Submitted:2000-05-05, Days after onset: 28
Location:Texas  Entered:2000-06-09, Days after submission: 35
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: Congenital amputation below right elbow
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1258J SCLA
Administered by: Military     Purchased by: Private
Symptoms: Lymphadenopathy, Neck pain
SMQs:, Arthritis (broad)
Write-up: Enlarged lymph nodes on left side of neck. Pain in left side of face and neck, two weeks post vax.

VAERS ID:153950 (history)  Vaccinated:2000-04-03
Age:56.0  Onset:2000-04-03, Days after vaccination: 0
Gender:Female  Submitted:2000-04-04, Days after onset: 1
Location:Pennsylvania  Entered:2000-06-13, Days after submission: 70
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: CAD, recurrent CVA, COPD
Diagnostic Lab Data:
CDC 'Split Type': PA2024
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4661870IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cellulitis
SMQs:
Write-up: The pt developed Cellulitis, and was treated with E-mycin

VAERS ID:154072 (history)  Vaccinated:1999-10-11
Age:56.0  Onset:1999-10-15, Days after vaccination: 4
Gender:Female  Submitted:2000-01-27, Days after onset: 104
Location:California  Entered:2000-06-13, Days after submission: 137
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin, Prempro
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ2646318OCT1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998273 IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, 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: A physician reported that a 36 year old female received the vaccine on 10/11/99. On 10/15/99, she developed an injection site reaction characterized by redness and swelling which extended to the elbow. She also developed a low-grade fever of 99.8. The pt was treated with antibiotics and antihistamines. She recovered.

VAERS ID:154104 (history)  Vaccinated:1999-10-06
Age:56.0  Onset:1999-10-13, Days after vaccination: 7
Gender:Female  Submitted:1999-11-16, Days after onset: 34
Location:Utah  Entered:2000-06-13, Days after submission: 209
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: UNK
Diagnostic Lab Data: arm x-ray-neg
CDC 'Split Type': HQ4718305NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Other
Symptoms: Neuropathy peripheral
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)
Write-up: On 10/13/99, the pt developed brachial neuritis. She was seen by the physician. The pt was prescribed an unspecified pain medication and NSAID.

VAERS ID:154127 (history)  Vaccinated:0000-00-00
Age:56.0  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': HQ8682915DEC1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982721IM 
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Subsequently post vax, the pt developed arm pain which lasted several days. The pt recovered.

VAERS ID:154283 (history)  Vaccinated:0000-00-00
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2000-06-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': 899089029A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: A pharmacist reported that a pt had an unknown reaction to a previous dose of tetanus toxoid which contained thimerosal. No further information was available at the date of this report. On 5/10/99, the reporter stated that no adverse event had occurred and that he only called for drug information.

VAERS ID:154405 (history)  Vaccinated:1999-06-04
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:1999-08-31
Location:New York  Entered:2000-06-15, Days after submission: 289
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mevacor, Climara (estradiol), Maxair
Current Illness:
Preexisting Conditions: Allergic to corn, molds, rye, wheat; arthritis, asthma, carpal tunnel syndrome, psoriasis
Diagnostic Lab Data: ESR-67 (2nd week of July,1999)
CDC 'Split Type': 19990200141
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120F91IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lymphoedema, Red blood cell sedimentation rate increased
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This is a spontaneous report from a physician and a 56 year old female pt who received the 1st and 2nd dose of Lymerix on 4/30/99 and 6/4/99, respectively. In early July, 1999, one month after 2nd dose of Lymerix and 64 days after 1st dose, the pt developed a swollen lymph node in her left armpit. At approximately the same time, the pt had poison ivy exposure to her left hand. The pt indicated that a surgeon was possibly going to operate on the swollen lymph node. The most recent information, received on 8/31/99, reported the condition of the pt is unknown.

VAERS ID:154425 (history)  Vaccinated:1999-04-28
Age:56.0  Onset:1999-04-28, Days after vaccination: 0
Gender:Male  Submitted:1999-09-29, Days after onset: 154
Location:New York  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:
Current Illness:
Preexisting Conditions: Environmental allergies
Diagnostic Lab Data:
CDC 'Split Type': 19990207391
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Injection site pain, Pain, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: This is a spontaneous report from a 56 year old male who, received his 1st Lymerix on 3/28/1999 and subsequently, for 3-4 days he had discomfort at the injection site which resolved. On 4/28/99, the pt received his 2nd Lymerix and subsequently, he had pain at the injection site radiating to the chest for "several" months. The pt stated that his doctor recommended that the pt receive corticosteroid injection or physical therapy. The pt has used Advil for 1 month to treat discomfort. The most recent information, received on 8/18/1999, reports the condition of the pt as ongoing. On 3/10/00, the pt''s wife reported that the pt had experienced lack of mobility again in shoulder and has completed four months of physical therapy. His symptoms are much improved, but are below his baseline. Additionally, the pt experienced pain in knucles.

VAERS ID:154435 (history)  Vaccinated:1999-06-05
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:1999-08-27
Location:New Jersey  Entered:2000-06-15, Days after submission: 293
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvasc, Demadex, Accupril, allergy injections
Current Illness: Knee pain
Preexisting Conditions: Hypertension, knee pain, allergic to mold, allergic to pollen
Diagnostic Lab Data:
CDC 'Split Type': 19990220141
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Oedema peripheral, Rheumatoid arthritis
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow)
Write-up: This is a spontaneous report from a physician referring to a 56 year old female who received her 1st dose of Lymerix on 5/5/99 and shortly thereafter, she experienced joint pain and her knee pain increased. Outcome is ongoing. On 6/5/99, she had her 2nd dose of Lymerix and subsequently, she had swelling in her hands and wrists. The physician stated that the pt has been given a tentative dx of rheumatoid arthritis. The pt plans to see a rheumatologist. The most recent information, received on 8/25/99, reports the condition of the pt as ongoing.

VAERS ID:154525 (history)  Vaccinated:2000-05-30
Age:56.0  Onset:2000-05-30, Days after vaccination: 0
Gender:Male  Submitted:2000-06-12, Days after onset: 13
Location:Maryland  Entered:2000-06-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergy to drug
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY144B9 IM 
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4988173 IM 
Administered by: Private     Purchased by: Private
Symptoms: Anaphylactic reaction, Asthenia, Chills, Hypotension, Nausea, Somnolence
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Anaphylactic reaction after vax. Hypotension, chills, nausea, weakness, and prolonged sleepiness.

VAERS ID:154884 (history)  Vaccinated:1998-10-16
Age:56.0  Onset:1998-10-16, Days after vaccination: 0
Gender:Female  Submitted:1998-12-31, Days after onset: 76
Location:Florida  Entered:2000-06-21, Days after submission: 537
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': U1998006800
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09846100IMRA
Administered by: Public     Purchased by: Private
Symptoms: Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad)
Write-up: Pt experienced red eyes with drainage.

VAERS ID:154996 (history)  Vaccinated:1998-09-01
Age:56.0  Onset:1998-09-04, Days after vaccination: 3
Gender:Male  Submitted:2000-04-21, Days after onset: 595
Location:Unknown  Entered:2000-06-21, Days after submission: 61
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 19990072411
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM  IM 
Administered by: Other     Purchased by: Other
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)
Write-up: Three days post vax pt developed an unspecified arrhythmia. This unspecified arrhythmia had been diagnosed 3-4 years prior to vaccination. Physician prescribed medication which the pt has been taking ever since. The physician stated that the vaccine had nothing to do with the arrhythmia.

VAERS ID:155490 (history)  Vaccinated:2000-06-18
Age:56.0  Onset:2000-06-20, Days after vaccination: 2
Gender:Male  Submitted:2000-06-22, Days after onset: 2
Location:Unknown  Entered:2000-06-27, 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: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0043J  LA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Two days post vax, the pt complained of left arm swelling and redness from shoulder region to elbow.

VAERS ID:155533 (history)  Vaccinated:1999-04-09
Age:56.0  Onset:1999-04-11, Days after vaccination: 2
Gender:Female  Submitted:1999-05-17, Days after onset: 36
Location:California  Entered:2000-06-28, Days after submission: 408
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': U1999002590
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0997390 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: This pt reportedly experienced cellulitis around the injection site and was hospitalized. Onset occurred 2 days post vax. Follow up 10/28/2002: "It was reported that the patient''s recovery status is unknown. "I forwarded information to (physician''s) office they also filed a VAERS." From additional correspondence received on 12/03/2001, no further information is available regarding this patient or this case. This case is closed. 08/26/2002: During internal review of all files, it was deemed necessary to amend the report by updating the narrative from a 57-year-old female to the correct age of 55-year-old female. Also, this case was upgraded to a 15-Day Alert Report due to unlabeled events."

VAERS ID:156124 (history)  Vaccinated:2000-05-26
Age:56.0  Onset:2000-06-21, Days after vaccination: 26
Gender:Female  Submitted:2000-07-06, Days after onset: 15
Location:Massachusetts  Entered:2000-07-07, 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: Synthroid
Current Illness: NONE
Preexisting Conditions: Hashimotos thyroiditis
Diagnostic Lab Data: EMG scheduled
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LAB67 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Neuritis
SMQs:, Peripheral neuropathy (narrow)
Write-up: Pt experienced brachial neuritis approximately 3 weeks post vax.

VAERS ID:157765 (history)  Vaccinated:2000-03-03
Age:56.0  Onset:2000-03-04, Days after vaccination: 1
Gender:Female  Submitted:2000-03-31, Days after onset: 27
Location:California  Entered:2000-07-21, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ1460609MAR2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES468868 IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: One day post vax the pt developed an injection site reaction characterized by itching, rash and a wheel. Pt refused medication for treatment and was slowly recovering. Follow up states the patient recovered. .

VAERS ID:157971 (history)  Vaccinated:2000-05-08
Age:56.0  Onset:2000-05-08, Days after vaccination: 0
Gender:Female  Submitted:2000-05-19, Days after onset: 11
Location:Unknown  Entered:2000-07-26, Days after submission: 68
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: hypertension
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0475SCRA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Dizziness, Injection site hypersensitivity, Nausea, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Post vax, the pt developed dizziness, weakness, and nausea immediately after the vax and then the injection site became red and itchy in about 6 hours. Pt also complained of having a low-grade fever and felt like a lump is in her throat. Pt sought medical attention and was treated with Triamcinolone cream and Loratadine.

VAERS ID:158014 (history)  Vaccinated:1999-06-01
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-04-27
Location:New York  Entered:2000-07-27, 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:
Current Illness:
Preexisting Conditions: Lyme Disease
Diagnostic Lab Data:
CDC 'Split Type': 20000106691
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthritis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)
Write-up: The patient had Lyme Disease that went undetected 8-12 months ago. She stated she had excellent treatment and did fine. June 1999, she received her first vax. Sometime post vax she experienced arthritic symptoms that were bothersome. In July 1999 while the arthritic symptoms were ongoing, she received the second dose, she said she really had Lyme arthritic problems, the same as when she had Lyme Disease. Laboratory studies were not performed, and the third shot was not given.

VAERS ID:158029 (history)  Vaccinated:2000-04-01
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-05-04
Location:Pennsylvania  Entered:2000-07-27, Days after submission: 84
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: Blood work in mid April revealed decreased white blood cells 35,000 and decreased platelets 88,000 and peripheral blood smear with increased atypical lymphocytes. The hematologists thought the abnormal blood test may be due to a viral infec
CDC 'Split Type': 2000012672
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM 2  
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Myalgia, Platelet count decreased, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: On 04/01/1999 and 05/01/1999, the patient received her first two injections with no untoward effects. On 04/01/2000, she received the third dose and sometime afterward experienced arthralgias and myalgias.

VAERS ID:158243 (history)  Vaccinated:2000-05-30
Age:56.0  Onset:2000-05-30, Days after vaccination: 0
Gender:Male  Submitted:2000-08-01, Days after onset: 63
Location:Maryland  Entered:2000-08-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetylsalicylic acid
Current Illness: NONE
Preexisting Conditions: Allergy to ampicillin which causes hives.
Diagnostic Lab Data:
CDC 'Split Type': 20000223982
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY144B90IMLA
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH45881730IMRA
Administered by: Private     Purchased by: Private
Symptoms: Blindness, Dizziness, Headache, Hypotension, Influenza like illness, Loss of consciousness, Pyrexia, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: This report describes flu-like symptoms, lightheadedness and transient loss of vision in a 55 year-old male receiving Havrix [this should be LYMERix-Ed Gaunt 4/15/02) for prevention of Lyme disease. This report was received from a vaccinee and has been verified by a physician. Twenty minutes post vax, this pt experienced chills, fever, flu and headache. He felt light-headed and "passed out." He stated that the health clinic could not "get" his blood pressure. Vaccinee stated that he lost his sight and faded into and out of consciousness several times. After getting home, he reportedly slept for 2 days, getting up only to go to the bathroom. Information recieved 07/24 reports the outcome of events resolved. The event of ''lost eyesight (temporary)'' is considered medically serious. The events of ''headache, lightheaded,'' and ''loss of consciousness'' do not meet ICH serious criteria but are being admitted expeditiously for informational purposes.

VAERS ID:158442 (history)  Vaccinated:1999-04-07
Age:56.0  Onset:1999-04-08, Days after vaccination: 1
Gender:Female  Submitted:2000-07-27, Days after onset: 476
Location:New Jersey  Entered:2000-08-02, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES99072014
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: Next day post vax, the pt experienced loud ringing in her ear. It was noted that the pt has seen several physicians regarding her symptom.

VAERS ID:158522 (history)  Vaccinated:1999-10-11
Age:56.0  Onset:1999-10-11, Days after vaccination: 0
Gender:Male  Submitted:2000-07-27, Days after onset: 290
Location:Missouri  Entered:2000-08-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': WAES99101190
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1095H0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from an LPN concerning a 56 year old white male who on 10/11/99 was vaccinated with a 1st dose of neumococcal vaccine 23 polyvalent, IM in the right arm. The same day as vaccination, the pt experienced arm redness, soreness and swelling over the entire upper arm. The pt was also febrile. The pt was seen by a physician. The pt was treated with cold packs for 20 minutes. The pt was also treated with Rofecoxib, Diphanhydramine HC1, and cephalexin monohydrate. Subsequently, the pt recovered.

VAERS ID:158703 (history)  Vaccinated:2000-07-31
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-08-02
Location:New York  Entered:2000-08-09, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0194AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: The pt experienced swelling, redness and tenderness 24 hours post vax.

VAERS ID:158850 (history)  Vaccinated:2000-06-28
Age:56.0  Onset:2000-06-28, Days after vaccination: 0
Gender:Female  Submitted:2000-06-30, Days after onset: 2
Location:Tennessee  Entered:2000-08-15, Days after submission: 46
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': TN00024
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0194AA0IMLA
Administered by: Private     Purchased by: 0
Symptoms: Chills, Injection site hypersensitivity, Injection site pain, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Erythematous papule at site, less than 24 hours post vax, muscle aches, chills, myalgia, pain in entire arm at first then just upper arm. Pt recovering at time of report.

VAERS ID:158852 (history)  Vaccinated:2000-07-14
Age:56.0  Onset:2000-07-15, Days after vaccination: 1
Gender:Female  Submitted:2000-07-24, Days after onset: 9
Location:Tennessee  Entered:2000-08-15, 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: Premarin/ Provera
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TN00027
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0194AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Contusion, Erythema, Injection site infection, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Developed redness, swelling, and bruising the day of injection. On 07/15, developed pain from shoulder to wrist. Developed red streak of redness down arm. Seen at ER and given Cephalexin 500 mg for 3 days for infection at injection site. 07/21, improved with only bruising at injection site.

VAERS ID:159580 (history)  Vaccinated:1999-07-08
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:1999-09-13
Location:Alabama  Entered:2000-09-10, Days after submission: 363
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': U1999005540
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.P08324IM 
Administered by: Public     Purchased by: Other
Symptoms: Memory impairment
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad)
Write-up: It was reported that a male pt received Rabies Imovax IM vaccination on 7/8/99. Reportedly 24 to 48 hours, post vax, the pt developed forgetfulness, which resolved after 48 hours. From additional information received on 9/10/99, additional patient and vaccine information was provided. (Received 4 doses-developed forgetfulness after each dose.)

VAERS ID:159979 (history)  Vaccinated:2000-08-10
Age:56.0  Onset:2000-08-11, Days after vaccination: 1
Gender:Female  Submitted:2000-09-13, Days after onset: 33
Location:Illinois  Entered:2000-09-21, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prempro
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, TSH, CMV, EBU, Bilirubin, C-reactive Protein, MRI of brain
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3214AA1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Asthenia, Chest pain, Disturbance in attention, Dizziness, Dysarthria, Dyspnoea, Eye disorder, Feeling abnormal, Gait disturbance, Headache, Musculoskeletal stiffness, Pain, Pyrexia, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: The pt experienced dizziness, aches, low grade fever, stiff neck, burning sensation in feet, Shortness of Breath, chest pain, severe headache, pressure behind eyes, thoughts are fuzzy, lack of concentration, slurred speech, weakness, fatigue, staggering gait.

VAERS ID:161706 (history)  Vaccinated:1999-10-11
Age:56.0  Onset:1999-10-12, Days after vaccination: 1
Gender:Female  Submitted:2000-06-04, Days after onset: 236
Location:Georga  Entered:2000-10-06, Days after submission: 124
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, ibuprofen, Lansoprazole
Current Illness: NONE
Preexisting Conditions: Drug hypersensitivity
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ2612515OCT1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES458385 IMLA
Administered by: Private     Purchased by: Other
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: A nurse reported that a 56 year old female received an injection of Pnu-Imune 23 on 10/11/99. On 10/12/99, she developed an injection site reaction characterized by a 17cm X 18cm area of redness, swelling and warmth. She was seen by the physician and treated with ciprofloxacin.

VAERS ID:162053 (history)  Vaccinated:1999-10-13
Age:56.0  Onset:1999-10-13, Days after vaccination: 0
Gender:Male  Submitted:1999-12-14, Days after onset: 62
Location:Vermont  Entered:2000-10-06, Days after submission: 296
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': HQ8314513DEC1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998212 IM 
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES461144 IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site haemorrhage, Injection site oedema, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On the same day of vax, the pt developed an injection site reaction in the right arm characterized by swelling which extended over the upper arm and pain. The pt also developed ecchymotic areas in the upper arm and forearm. The pt recovered.

VAERS ID:160435 (history)  Vaccinated:2000-10-09
Age:56.0  Onset:2000-10-09, Days after vaccination: 0
Gender:Female  Submitted:2000-10-10, Days after onset: 1
Location:Texas  Entered:2000-10-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil, albuterol
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURERU0403AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 30-60 minutes post vax, the pt developed chest tightness with wheezing. Albuterol was administered with relief.

VAERS ID:162260 (history)  Vaccinated:1999-10-12
Age:56.0  Onset:1999-10-13, Days after vaccination: 1
Gender:Male  Submitted:1999-12-14, Days after onset: 62
Location:California  Entered:2000-10-13, Days after submission: 303
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': U1999007870
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0094AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: It was reported that a 56 year old male received Fluzone SV ''99-''00 on 10/12/99. "Twenty-four hours, post vax, he developed an 8cm reddened area at site" and he also experienced tenderness. No further information available at this time. From additional correspondence received on 11/22/99, additional pt and vaccine information was provided.

VAERS ID:162273 (history)  Vaccinated:1999-10-27
Age:56.0  Onset:1999-10-27, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 5
Location:Washington  Entered:2000-10-13, Days after submission: 346
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': U1999008090
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0110AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Dysgeusia, Headache, Heart rate increased, Hyperhidrosis, Hypertension, Hypoaesthesia oral, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (narrow)
Write-up: It was reported that a 56 year old female received Fluzone SV ''99-''00 on 10/27/99. "Within 5 minutes, post vax, she developed numbness and tingling of lips and gums. Also, sweaty palms, stated she could "taste it", elevated blood pressure and heart rate, vertigo, nausea and temple pressure. Forty minutes later, she walked out of office." No further information is available at this time.

VAERS ID:162348 (history)  Vaccinated:1999-10-14
Age:56.0  Onset:1999-10-31, Days after vaccination: 17
Gender:Male  Submitted:1999-12-29, Days after onset: 59
Location:Vermont  Entered:2000-10-13, Days after submission: 288
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: MRI scan of right brain-nml
CDC 'Split Type': U1999010150
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: It was reported that a 56 year old male pt received a Fluzone UNSP ''99-''00 vaccination on 10/14/99. Reportedly, on 10/31/99, the pt developed paresthesia from sole of left foot with gradual increase to left leg, left side of body and left arm to the forearm. The paresthesia has faded in the same pattern it progressed. No right side involvement, pt''s reflexes were normal. Pt also developed paresthesia below right ankle at this time and is fading. The doctor has not confirmed dx with spinal tap or nerve conduction studies due to symptoms resolving at this time. No additional information was provided from correspondence returned on 12/17/99.

VAERS ID:160547 (history)  Vaccinated:2000-10-04
Age:56.0  Onset:2000-10-05, Days after vaccination: 1
Gender:Female  Submitted:2000-10-05, Days after onset: 0
Location:Ohio  Entered:2000-10-16, 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: Allergy to iodine
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E65710MA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Contusion, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt stated her left upper arm got red, sore and swelled and felt hot. Pt said she felt hot. She reported this the day following the injection. Her doctor was called and she was instructed to take Tylenol. On 10/9/00, there was no redness or soreness at the injection site, only a small bruise at the injections site.

VAERS ID:160972 (history)  Vaccinated:2000-10-17
Age:56.0  Onset:2000-10-17, Days after vaccination: 0
Gender:Female  Submitted:2000-10-19, Days after onset: 2
Location:Wisconsin  Entered:2000-10-25, 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: Depakote, Imitrex, ranitidine, dicyclomine, Ultram, Lasix, Synthroid
Current Illness: NONE
Preexisting Conditions: Allergic to prednisone, Compazine, Dilaudid, morphine; migraines, GERD, duodenal ulcer
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3355A41IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0267AA3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Pt states she developed inflammation on left upper arm, including redness, swelling, throbbing and itching within about 4-5 hours, post vax. Area also was warmer than surrounding portion of upper arm. Pt states these symptoms became more pronounced in the next 36 hours. States also has some soreness in left neck. Saw MD on 10/19/00. He advised ice pack application.

VAERS ID:160983 (history)  Vaccinated:2000-10-10
Age:56.0  Onset:2000-10-10, Days after vaccination: 0
Gender:Female  Submitted:2000-11-13, Days after onset: 34
Location:Washington  Entered:2000-10-25, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Diabetes Type II
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES58600GA0  
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site pain, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Severe local pain, redness, swelling; WBC 9.3/ ESR 31.

VAERS ID:162884 (history)  Vaccinated:1999-12-01
Age:56.0  Onset:0000-00-00
Gender:Female  Submitted:2000-07-06
Location:Unknown  Entered:2000-10-26, Days after submission: 112
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': 20000202541
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: Following vaccinations, the pt experienced a "burning sensation" in "all of her joints". the pt believed that she had pre-existing Lyme disease which was exacerbated by the vaccine. Reportedly, prior to vaccination she was absolutely symptomatic and believed herself to be Lyme disease free. The most recent information received on 6/26/00 reports the outcome of the event as unknown.

VAERS ID:161381 (history)  Vaccinated:2000-10-11
Age:56.0  Onset:2000-10-12, Days after vaccination: 1
Gender:Female  Submitted:2000-10-13, Days after onset: 1
Location:North Carolina  Entered:2000-11-06, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Deseryl, Progesterone, Premsen
Current Illness:
Preexisting Conditions: allergy to PCN
Diagnostic Lab Data: NONE
CDC 'Split Type': NC00072
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1216J IMLA
Administered by: Private     Purchased by: Other
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: The pt experienced redness, warmth, edema to left upper arm. Treated with cool compresses, Tylenol, and Benadryl.

VAERS ID:161927 (history)  Vaccinated:2000-11-03
Age:56.0  Onset:2000-11-04, Days after vaccination: 1
Gender:Female  Submitted:2000-11-06, Days after onset: 2
Location:New York  Entered:2000-11-14, 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: Lo-Trol, Premarin, Darvocet, Flexeril
Current Illness: NONE
Preexisting Conditions: Sulfa drugs, ibuprofen, iodine, seafood allergies.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0416DA IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4637480IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site erythema
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Received flu vaccine and pneumonia vaccine on 11/3/00 in right deltoid. On 11/6/00, presented with localized redness encircling left arm and light generalized redness of upper body.

VAERS ID:163276 (history)  Vaccinated:1999-03-19
Age:56.0  Onset:1999-10-25, Days after vaccination: 220
Gender:Male  Submitted:1999-11-24, Days after onset: 30
Location:Texas  Entered:2000-11-14, Days after submission: 356
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 PCN; Hemodialysis pt; possible exposure to Hepatitis B
Diagnostic Lab Data: HBSAN (10/25/1999) - positive; Hepatitis B titer - Nonresponder
CDC 'Split Type': 19990283701
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