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Case Details (Sorted by Age)

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VAERS ID:341834 (history)  Vaccinated:2009-03-04
Age:43.0  Onset:2009-03-13, Days after vaccination: 9
Gender:Male  Submitted:2009-03-16, Days after onset: 3
Location:Wisconsin  Entered:2009-03-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURERVV04-003A IDLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site cellulitis
SMQs:
Write-up: Developed area cellulitis at innoculation site.

VAERS ID:341835 (history)  Vaccinated:2009-03-04
Age:43.0  Onset:2009-03-13, Days after vaccination: 9
Gender:Male  Submitted:2009-03-16, Days after onset: 3
Location:Wisconsin  Entered:2009-03-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURERVV04-003A IDRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site cellulitis
SMQs:
Write-up: Developed Cellulitis at innoculation site.

VAERS ID:341923 (history)  Vaccinated:2009-03-15
Age:43.0  Onset:2009-03-15, Days after vaccination: 0
Gender:Female  Submitted:2009-03-17, Days after onset: 2
Location:New Jersey  Entered:2009-03-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ALLERGIES: PCN, SULFA, SILVADENE
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1593IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB034722IMLA
Administered by: Military     Purchased by: Military
Symptoms: Inappropriate schedule of drug administration, Vaccination site reaction
SMQs:
Write-up: Vaccine was administered 15 Mar 2009, during Mobilization Orders activity. Vaccines were administered at the facility. Pt states, and the immunization record verifies that she received an Anthrax shot #4 (Lot # FAV 159), and a Typhoid Vaccine (Lot # B03472) both vaccines were given in the Left Deltoid Region. The Chief Medical Officer assessed the vaccine region as a Moderate Anthrax Vaccine Reaction, and recommended Motrin for the patient. Immunization records show that the Typhoid vaccine was administered 18 months too early. She received a Typhoid vaccine on 13 Sept 2008 and another dose on 15 Mar 2009. The vaccine booster schedule is every 2 years. A VAERS report will be prepared.

VAERS ID:343108 (history)  Vaccinated:2008-11-11
Age:43.0  Onset:2008-11-12, Days after vaccination: 1
Gender:Female  Submitted:2009-03-06, Days after onset: 114
Location:Michigan  Entered:2009-03-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins (unspecified)
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0811USA02179
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Pruritus generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a pharmacist, with no medical history of allergies, 43 year old female, who on 11-NOV-2008 was intramuscularly vaccinated with dose 1 of RECOMBIVAX HB. Concomitant therapy included multivitamin. On 12-NOV-2008 the patient experienced itchy all over her body. She also had redness and hives. She treated herself with BENADRYL at night but has not had improvement. At the time of reporting she did not recover. The pharmacist tried to contact her physician for medical attention but did not reach the physician. Follow-up information has been received from a 43 year old asian pharmacist with no known allergies or pertinent medical history who on 11-NOV-2008 was vaccinated IM with a first dose of RECOMBIVAX HB at 15:00. There was no illness at the time of vaccination. Subsequently, on 12-NOV-2008 in the afternoon the patient experienced redness, hives and itchy all over her body. Medical attention was sought, the patient had a doctor''s visit. There were no lab studies performed. At the time of the report, it was noted that the patient recovered ten days later (21-NOV-2008). Additional information is not expected.

VAERS ID:343177 (history)  Vaccinated:2003-06-20
Age:43.0  Onset:0000-00-00
Gender:Unknown  Submitted:2009-03-06
Location:Unknown  Entered:2009-03-18, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0810USA00177
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Fibromyalgia, Intervertebral disc degeneration, Myalgia, Pain in extremity, Paraesthesia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a lawyer from a case in litigation concerning a 43 year old patient who on 20-JUN-2003 was vaccinated with a first dose of RECOMBIVAX HB. Subsequently the patient developed myalgia and fibromyalgia, experienced itching on her arms and pain in her knees but did not report to her physician. On 28-JUL-2003 the patient had a second vaccination with RECOMBIVAX HB. The patient developed itching and "an odd tingling sensation" in her fingers. Then she developed more significant problems such as pain in her fingers which would travel up her left arm and shoulder to her posterior neck causing sharp pain. The treating physicians diagnosed the patient as having a degenerative disc disease from a review of an MRI. No further information available.

VAERS ID:343279 (history)  Vaccinated:0000-00-00
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:2009-03-06
Location:Unknown  Entered:2009-03-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Carpal tunnel syndrome; Numbness in hand
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0805USA00042
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Multiple sclerosis
SMQs:, Optic nerve disorders (broad), Demyelination (narrow)
Write-up: Information has been received regarding a case in litigation concerning a 43 year old female with carpal tunnel syndrome and numbness in hand (both at 15 years of age) who on 12-AUG-1992 was vaccinated with the first dose of RECOMBIVAX HB, a second dose was received but date was not specified. Concomitant medication was not reported. Subsequently on an unspecified date, after the second vaccination with RECOMBIVAX HB, the patient developed multiple sclerosis. The reporter concluded that a "biologically plausible theory connected the vaccine with her injury, a logical sequence of cause and effect, and there was a medically appropriate time frame between vaccination and onset." The outcome of the event was not reported. Upon internal review, multiple sclerosis was considered to be an other important medical event. No further information is available.

VAERS ID:342350 (history)  Vaccinated:2009-03-19
Age:43.0  Onset:2009-03-19, Days after vaccination: 0
Gender:Male  Submitted:2009-03-20, Days after onset: 1
Location:Florida  Entered:2009-03-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: pancreatic pseudocyst
Preexisting Conditions:
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1085X UNLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling @ site of injection. Post 12-12 hours later redness, hot to touch and swelling.

VAERS ID:342383 (history)  Vaccinated:0000-00-00
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-03-20
Location:Unknown  Entered:2009-03-23, 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: Unknown
Current Illness:
Preexisting Conditions: Immunisation; Fever; Swelling
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0903USA02300
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Autism
SMQs:
Write-up: Information has been received from a consumer concerning her son (a "43 year old" male) who "developed autism after receiving a dose of MMR II". Consumer also reported that "after the patient, who is her son received a dose of DTP he had a severe high fever and swelling." The consumer also reported that "after she received DTP she experienced swelling of the arm." Upon internal review, autism was determined to be an other important medical event. No further information is available.

VAERS ID:342734 (history)  Vaccinated:2009-02-27
Age:43.0  Onset:2009-02-27, Days after vaccination: 0
Gender:Female  Submitted:2009-03-18, Days after onset: 18
Location:California  Entered:2009-03-26, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3058AA IMUN
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness and swelling

VAERS ID:342771 (history)  Vaccinated:2009-03-23
Age:43.0  Onset:2009-03-24, Days after vaccination: 1
Gender:Male  Submitted:2009-03-26, Days after onset: 2
Location:Virginia  Entered:2009-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 1) Glucosamine chondroitin PO BID, 2) Cymbalta 60 mg PO QD.
Current Illness: None reported.
Preexisting Conditions: 1) Knee pain (client runs 45 - 50 miles/week). 2) Anxiety and obsessive thoughts.
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3058AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Arthralgia, Asthenia, Axillary pain, Back pain, Chills, Contusion, Feeling of body temperature change, Hyperhidrosis, Injection site erythema, Malaise, Musculoskeletal pain, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient received Tdap (Adacel) on 3-23-09 @ 3:20 pm. He awoke @ 8 am on 3-24-09 with joint aches, chills (hot, cold, sweats), malaise, weakness and unable to go to work. He returned to bed, slept until 2:30 pm and woke up hungry and ate a good meal of chicken soup, toasted cheese sandwich and fruit. Took Tylenol 1000 mg PO @ 6 pm. At 8 pm oral T was 100.2-100.4. (Throughout this entire time period, this has been the measured temperature.) He drank about a half gallon of water on 3-24-09. At 12 MN Tylenol dose was repeated. He then slept throughout the night except for waking twice for the bathroom, each time the pillow was wet and cold. He then woke up @ 8 am, repeated Tylenol dose, ate, returned to sleep until 2:15 pm. Then repeated Tylenol @ 2:30 pm and began to feel like he was getting better. He ate a salad. He then decided to drive to CVS @ 5:15 pm, then visited his girlfriend and new baby @ 6 pm--who live 5 miles away from his house. By 6:30 pm he just wanted to sleep, and slept until 7:30 pm, then returned (with difficulty) to home. Then took another dose of Tylenol, and had a large cup of hot tea @ 8 pm. He also drank a few glasses of water and Gatorade on 3-25-09. He then went to sleep @ 8:30 pm and woke up only twice for bathroom trips. On only one of those trips was the pillow wet. On 3-26-09, awoke @ 8 am with a feeling of low back pain like "someone put concrete on it", tender and sore left shoulder and axilla--bruise reported, also. He also reports that the injection is red.

VAERS ID:342773 (history)  Vaccinated:2009-03-25
Age:43.0  Onset:2009-03-25, Days after vaccination: 0
Gender:Male  Submitted:2009-03-26, Days after onset: 1
Location:Pennsylvania  Entered:2009-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: Hypertension, Hypercholesterolemia, allergic to adhesive tape
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF434AA0SCLA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Hyperhidrosis, Malaise, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient received vaccine and reports not feeling well a few hours later. Symptoms began as a headache and bodyaches, and later progressed to sweating and vomiting. He claims to have had a fever of 103 to 104 that evening. Symptoms resolved on their own within 24 hrs.

VAERS ID:342791 (history)  Vaccinated:1999-06-04
Age:43.0  Onset:1999-06-04, Days after vaccination: 0
Gender:Female  Submitted:2009-03-26, Days after onset: 3583
Location:Pennsylvania  Entered:2009-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: HEART MURMUR, MIGRAINE, PALPITATION, TENSION HEADACHE, URINARY INCONTINENCE, VAGINAL VAULT PROLAPSE REPAIR
Preexisting Conditions: AUTOMOBILE ACCIDENT, CARPAL TUNNEL RELEASE, CARPAL TUNNEL SYNDROME, ENDOMETRIOSIS, HYSTERECTOMY, NERVE COMPRESSION, OVARIAN CYST; Following her automobile accident on 19 February 2001, the subject experienced almost immediate back pain, which occasionally radiated down the right leg. Family history of cerebral palsy (son).
Diagnostic Lab Data: 26 March 2001: MRI of cervical spine showed moderate cervical spondylosis more prominent to the left of midline where there was potential compression of the left C6 nerve root; bilateral foraminal stenosis. MRI lumbar spine showed moderate
CDC Split Type: A0756654A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Amnesia, Anxiety, Arthralgia, Back pain, Body temperature decreased, Borrelia burgdorferi serology positive, Chills, Computerised tomogram abnormal, Coordination abnormal, Dysgeusia, Dyskinesia, Dysphagia, Electromyogram abnormal, Facial palsy, Fatigue, Feeling abnormal, Food allergy, Foramen magnum stenosis, Headache, Hot flush, Hyperhidrosis, Hypoaesthesia, Immediate post-injection reaction, Immunology test, Influenza like illness, Injection site pruritus, Injection site rash, Injection site warmth, Insomnia, Intervertebral disc degeneration, Lyme disease, Memory impairment, Migraine, Muscle strain, Muscular weakness, Musculoskeletal pain, Myalgia, Mycoplasma serology positive, Myodesopsia, Nasopharyngitis, Nausea, Neck pain, Nightmare, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Oropharyngeal pain, Osteoarthritis, Paraesthesia, Phonophobia, Photophobia, Pollakiuria, Pyrexia, Rash, Road traffic accident, Rotator cuff syndrome, Sleep disorder, Spinal X-ray abnormal, Spinal osteoarthritis, Temperature intolerance, Tension headache, Thirst, Tinnitus, Tremor, Vomiting, Weight increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Dyskinesia (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (narrow)
Write-up: This case was reported via medical records forwarded by a lawyer and described the occurrence of Lyme disease in an adult female subject who was vaccinated with LYMERIX vaccine. The patient received unspecified dose of LYMERIX vaccine on 06 July 1999. The patient had a history of headaches that were described as "disabling" as early as 1994. On an unspecified date she was diagnosed with degenerative arthritis. In February 1998 and June 1998 the subject complained of medial right knee and lateral right elbow pain, with diagnostic findings including a gangilion cyst on the knee. She was also diagnosed with a possible meniscal tear and early degenerative arthritis of the knee and lateral epicondylitis in the right elbow. In November 1998, the subject was noted to have bilateral upper extremity overuse tendonitis, cervical and lumbosacral syndrome with strain and sprain pattern, and cervical degenerative disc disease. In May 1999, the subject was receiving SKELAXIN, ASPIRIN, and IMITREX due to back and neck pain and headaches. On 14 February 2000, the subject received CORTISONE injection due to bilateral shoulder pain, and review of x-rays of the cervical and lumbar spine showed degenerative disc disease. The subject was noted to have been in an automobile accident on 19 February 2001, and on 26 February 2001 experienced back pain sometimes radiating down the right leg, and headaches which were reportedly improved. Neurologic exam was unrevealing, and it was noted that she continued to suffer form a mixed headache disorder with features of both migraine and tension headaches. On 26 March 2001, magnetic resonance imaging of the cervical and lumbar spine showed moderate cervical spondylosis, bilateral foraminal stenosis, moderate degenerative disc disease and osteoarthritis at L4/5 with mild stenosis of the central spinal canal. Physician''s impression on 30 March 2001 included degenerative disc disease in cervical and lumbar spine in regions suspicious for upper extremity radiculopathy, and right shoulder strain and im

VAERS ID:342963 (history)  Vaccinated:2000-07-13
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-03-30
Location:New Jersey  Entered:2009-03-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Lyme Disease. The subject''s medical history, concurrent conditions and concurrent medications were not reported.
Diagnostic Lab Data: Diagnostic Results: 09 August 1999: Lyme AB IgM Interp., EIA was positive; Lyme IgG and IgM Western Blot were positive. 18 September 2000: Two AP views of the pelvis were performed as well as coned AP and frog lateral views of the right hip
CDC Split Type: A0605475A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Activities of daily living impaired, Arthralgia, Autoimmune disorder, Borrelia burgdorferi serology positive, Chest X-ray normal, Cognitive disorder, Exercise electrocardiogram normal, Exostosis, Gait disturbance, Groin pain, Hip arthroplasty, Immunology test, Joint swelling, Musculoskeletal pain, Nervous system disorder, Osteoarthritis, X-ray abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Osteoporosis/osteopenia (broad), Osteonecrosis (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported by a lawyer and described the occurrence of arthralgias in a male subject of unspecified age who was vaccinated with LYMERIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of LYMERIX (unknown). On an unspecified date after vaccination with LYMERIX, the subject experienced arthralgias, difficulty walking, hip pain, swollen joints, and rheumatologic, neurologic, and/or cognitive impairment of an autoimmune, immune-mediated or other mechanism, all reported to be caused by vaccination with LYMERIX. He also has decreased activities of daily life and decreased ability to participate in recreational activities. At the time of reporting the outcome of the events was unspecified. This information was received via a Statement of Injuries. Follow-up information was received on 13 February 2009 in the form of a claimant interview. It was reported that the subject received three doses of LYMERIX with the 1st on 14 July 1999, the 2nd on 02 September 1999 and the 3rd on 13 July 2000. The subject had a past medical history of Lyme disease diagnosed in mid 1999. The subject believed these symptoms resolved following a course of antibiotics. Events experienced by the subject that he attributes to LYMERIX include hip pain and swelling with onset of September 2000 and groin pain and difficulty walking with onset in late 2001. These events were said to have resolved. Events experienced by the subject that he did not attribute to LYMERIX included stomach pain and shoulder pain. No medications were reported. Follow-up information was received on 25 March 2009 in the form of medical records. The subject was evaluated on 07 March 2002 for the purpose of an orthopaedic consultation regarding right hip symptoms. Impression was osteoarthritis of the bilateral hips, right greater than the left. X-rays obtained during the visit included AP pelvis, AP and lateral views of both the right and left hip. The right hip

VAERS ID:343823 (history)  Vaccinated:2009-04-08
Age:43.0  Onset:2009-04-09, Days after vaccination: 1
Gender:Female  Submitted:2009-04-09, Days after onset: 0
Location:Kansas  Entered:2009-04-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Spleen removed in 1998
Diagnostic Lab Data: N?A atthis time
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1729X SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0053Y0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Silver dollar sized redness and warm to touch at administration site.

VAERS ID:344199 (history)  Vaccinated:2009-04-08
Age:43.0  Onset:2009-04-08, Days after vaccination: 0
Gender:Male  Submitted:2009-04-10, Days after onset: 2
Location:New York  Entered:2009-04-15, 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:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF451AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Pain in extremity, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe left arm pain, fever, chills and palpitations lasting 24 hours.

VAERS ID:344301 (history)  Vaccinated:2009-04-01
Age:43.0  Onset:2009-04-01, Days after vaccination: 0
Gender:Male  Submitted:2009-04-01, Days after onset: 0
Location:Puerto Rico  Entered:2009-04-16, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURD25122IMLA
Administered by: Military     Purchased by: Military
Symptoms: Abdominal discomfort, Body temperature increased, Chills, Headache, Musculoskeletal pain, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 1 hr after vaccine: Headache, neck and shoulder pain at noon - chills at temp 101.7 at 1:00 o''clock associated to stomach discomfort. No chest pain or tightness, SOB, nausea or vomiting. No dizziness no headache.

VAERS ID:344801 (history)  Vaccinated:2009-03-27
Age:43.0  Onset:2009-03-27, Days after vaccination: 0
Gender:Female  Submitted:2009-04-24, Days after onset: 28
Location:Missouri  Entered:2009-04-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: stated "no"
Preexisting Conditions: stated "no"
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEUR02348CA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Joint range of motion decreased, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: client called this facility and stated that since she was administered her Td vaccination in the right deltoid on 3/27/09 she has had "pain off and on in the right arm and decreased range of motion to the point of 50% motion in arm". Client responded that there were no areas of swelling, redness, or itching in that arm. There was no palpable masses in right deltoid. Client advised to call primary care physician by this nurse and have her arm examined.

VAERS ID:345421 (history)  Vaccinated:2009-04-24
Age:43.0  Onset:2009-04-30, Days after vaccination: 6
Gender:Female  Submitted:2009-05-01, Days after onset: 1
Location:North Carolina  Entered:2009-05-01
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: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1255X SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF452CA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Six days after administration of MMR client noticed reddness the size of 50 cent coin. The following day (5/1/09) swelling had increased to 50mm in size, warm to touch with erythema. Client states it itched 4/30 and she scratched it. Ice placed today with improvement per client. T 98.4, P 60, R 18, BP 118/70. Given Cephalexin 500 mg po tid x 7 days.

VAERS ID:345730 (history)  Vaccinated:2009-03-06
Age:43.0  Onset:2009-03-18, Days after vaccination: 12
Gender:Male  Submitted:2009-05-05, Days after onset: 48
Location:New York  Entered:2009-05-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD, Phlebitis 5/18/09 Hospital records received DOS 3/18/09 to 3/20/09. DVT
Diagnostic Lab Data: 5/18/09 Hospital records received DOS 3/18/09 to 3/20/09. LABS and DIAGNOSTICS: EKG - nonspecific T-wave changes. Coagulation studies - INR 1 (range 0.9-1.1) PTT 0.7 D-dimer 0.87 UG/ML FEU (critical). CBC - RDW 14.4% (H) Neut 41.7% (H) other values WNL. CT - pulmonary emboli.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0074Y1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activated partial thromboplastin time, Back pain, Chest pain, Coagulation test abnormal, Computerised tomogram thorax abnormal, Dyspnoea, Electrocardiogram abnormal, International normalised ratio, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Patient states that he developed diffculty breathing and chest pain on 3/18/09 and went to the Emergency room where he was admitted for a pulmonary embolism. He spent approximately 10 days at the hospital and was given heparin inthe hospital and was released on coumadin. He will probably remain on coumadin for at least 6 months maybe longer depending on his hematologist. Patient states that he had a DVT in 2008 that occurred while on a plane. 5/18/09 Hospital records received DOS 3/18/09 to 3/20/09. FINAL DIAGNOSIS: Pulmonary emboli Post vaccination: chest pain, back pain, shortness of breath.

VAERS ID:346276 (history)  Vaccinated:2009-05-11
Age:43.0  Onset:2009-05-11, Days after vaccination: 0
Gender:Female  Submitted:2009-05-13, Days after onset: 2
Location:Georgia  Entered:2009-05-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0906X UN 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: "...began to hve severe joint pain

VAERS ID:346640 (history)  Vaccinated:2009-05-13
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-05-18
Location:California  Entered:2009-05-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3158 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm swollen and red at injection site.

VAERS ID:347434 (history)  Vaccinated:2008-12-01
Age:43.0  Onset:2008-12-03, Days after vaccination: 2
Gender:Female  Submitted:2009-05-15, Days after onset: 162
Location:Louisiana  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0812USA01586
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1135X0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a registered nurse concerning a 43 year old female employee who on 01-DEC-2008 was vaccinated with the first dose of VARIVAX (Lot# 661658/1135X). On 03-DEC-2008 the patient developed swelling and erythema at the injection site. The patient sought medical attention at the employee health. At the time of reporting (04-DEC-2008) the outcome of the patient was unknown. The nurse requested a lot a search of VARIVAX. A standard lot check investigation was performed. All in-process quality checks for the lot number investigation was performed. The testing performed. The testing performed on the batch prior to release met all release specifications. The lot met the requirements of the Center for Biologics Evaluation and Research and was released. This is one of several cases from the same source. Additional information has been requested.

VAERS ID:347541 (history)  Vaccinated:2009-01-23
Age:43.0  Onset:2009-01-25, Days after vaccination: 2
Gender:Male  Submitted:2009-05-15, Days after onset: 109
Location:Ohio  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Serum varicella zoster, showed no immunity
CDC Split Type: WAES0901USA04419
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1276X0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 43 year old male with no pertinent medical history and no drug reactions/allergies on 23-JAN-2009 was vaccinated with the first dose of VARIVAX 0.5ml SQ on the left arm (LOT# 661979/1276X). There was no concomitant medication. On 25-JAN-2009 the patient developed a couple of red raised spots on the left chest. One was about 1 cm and the other was 2 cm. The patient was not recovered from the adverse event. It was reported that the patient sought medical attention: was seen by primary office. Follow up information was received from the registered nurse who reported that the patient on 23-JAN-2009 10:00 AM was vaccinated with the first dose of VARIVAX 0.5 ml SQ on the left arm (LOT# 661979/1276X). On 25-JAN-2009 unspecified time, the patient developed a rash on his abdomen on his left side which was macupapular in nature (2 areas, 1 about 1cm''s, 1 about 2cm in diameter) was seen in occupational health. On 30-JAN-2009, the patient came to health service and stated that he received the Chickenpox vaccine Friday 23-JAN and he noticed a rash on his abdomen Sunday 25-JAN-2009. The patient had a varicella titer drawn last week that showed to immunity. So he received the VARIVAX. The patient denied any other symptoms (no fever, pruritis, etc.) other than a rash on his mid anterior and lateral torso. The patient denied using any new products such as clothing, detergents or lotions and can recall no other possible offending agent. No OTC MEDS requested. The patient was advised to use OTC Benadryl or Cortisone oint PRN and the patient stated did not need anything at this time as he only had rash. It was noted by the health professional at this time that the patient had a 2-3 inch area of dry, red raised 1cm spots on mid anterior abdomen and 1 inch area of same on upper left lateral abdomen. No blisters noted. ALT in skin integrity abdomen R/T rash possibly due to recent VARIVAX. Keep areas clean dry. May use OTC Benadryl or Cortisone oint as instructed. The pa

VAERS ID:347020 (history)  Vaccinated:2009-05-22
Age:43.0  Onset:2009-05-23, Days after vaccination: 1
Gender:Male  Submitted:2009-05-24, Days after onset: 1
Location:Maryland  Entered:2009-05-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Contusion, Headache, Lethargy, Myalgia, Pain in extremity, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: 103 fever, tachycardia, myalgias, severe arm pain,arm bruising, headaches, lethargy. all symptoms lasted about 2.5 days. worst being 24-36 hours after pneumococcal vaccination

VAERS ID:348242 (history)  Vaccinated:2009-05-11
Age:43.0  Onset:2009-05-12, Days after vaccination: 1
Gender:Female  Submitted:2009-05-13, Days after onset: 1
Location:Louisiana  Entered:2009-06-01, 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: None
Current Illness: None
Preexisting Conditions: Allergic to sulfur; Based antibiotics and Neomycin
Diagnostic Lab Data:
CDC Split Type: LA090505
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF584AA0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient returned to clinic on 5-13-09. Lft arm injection site with 4-5 cm area of swelling. Area red and non tender to touch. Patient reports itching to area. Denies any other discomfort. Patient to take Benadryl for itching and see personal MD if condition worsens.

VAERS ID:348366 (history)  Vaccinated:2009-05-22
Age:43.0  Onset:2009-05-22, Days after vaccination: 0
Gender:Female  Submitted:2009-05-26, Days after onset: 4
Location:Massachusetts  Entered:2009-06-02, 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: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3246BA0UNLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Erythema, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Received Tdap to right deltoid 5/22; developed chills and fever and headache that evening. Seen in UC 5/24; right UE was not red, warm or tender. On 5/26, right UE was slightly red; treated with KEFLEX.

VAERS ID:348395 (history)  Vaccinated:2009-05-13
Age:43.0  Onset:2009-05-15, Days after vaccination: 2
Gender:Female  Submitted:2009-05-29, Days after onset: 14
Location:California  Entered:2009-06-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Been seen for needle stick
Preexisting Conditions: None Known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)SANOFI PASTEUR  IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Joint range of motion decreased, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Left upper arm became very red, warm to touch, tender. Limited ROM with inflammation. TX= P.O. Antibiotics, pain meds, subsequent IV antibiotics.

VAERS ID:348551 (history)  Vaccinated:2009-05-24
Age:43.0  Onset:2009-05-25, Days after vaccination: 1
Gender:Male  Submitted:2009-06-01, Days after onset: 7
Location:New Jersey  Entered:2009-06-05, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1198X IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3246BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Injection site rash, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: 100 - 102 degree F fever, body aches, joint pain: Rash at injection site. Symptoms began to subside after 36-48 hours.

VAERS ID:348713 (history)  Vaccinated:2009-05-29
Age:43.0  Onset:2009-05-30, Days after vaccination: 1
Gender:Female  Submitted:2009-06-08, Days after onset: 9
Location:New York  Entered:2009-06-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none that i know of~ ()~NULL~~In Patient|none that i know of~ ()~NULL~~In Sibling1|none that i know of~ ()~NULL~~In Sibling2
Other Medications: After vaccination and bronchitis symptoms started: 25 mg azithromychin (greenstone), 4 mg doses of Methylprednisolone(qualitest), proventil, advair, motrin and mucinex dm to treat bronchitis.
Current Illness: no illness prior to vaccination.
Preexisting Conditions: avoids antihystamines - experienced dizziness in the past
Diagnostic Lab Data: Doctor requested lab tests. Will get data back in a few days.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 2UNLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Blood pressure fluctuation, Bronchitis, Chest discomfort, Chills, Diarrhoea, Dizziness, Eye pain, Feeling abnormal, Headache, Impaired driving ability, Injection site erythema, Injection site swelling, Laboratory test, Muscle contractions involuntary, Muscle twitching, Musculoskeletal stiffness, Myalgia, Oral pruritus, Productive cough, Pruritus, Pyrexia, Syncope, Vision blurred, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (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), Glaucoma (broad), Hypertension (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Within 12 hours: Significant swelling at injection site and redness, 101 - 102 Fever, Chills, Muscle pain. After 30 hours: Wet Cough (diagmosed as bronchitis), tight chest. After 2 days: Headache, eye pain. After 4 days: Dizziness and itching of tongue, hands mouth prompts ER visit. Went to ER and released. Thought to have adverse reaction to medication, but unsure of which. Told to drink water to expel from system. Followed by severe Vomiting, Diarrhea, Muscle twitching especially in feet, muscle contractions in legs, blood pressure swings. Out of body feeling and brief syncope. After 6 days: No more fever, but stomach pain and muscle pain continue. Dizzy and hazy. Unable to drive. Went back to doctor. Sent for bloodwork. After 8 days: No fever or cough. Dizziness and muscle aches continue. Difficulty focusing eyes. Noticeable stiffness in hips, at base of neck, and shoulders.

VAERS ID:349029 (history)  Vaccinated:2009-06-04
Age:43.0  Onset:2009-06-05, Days after vaccination: 1
Gender:Female  Submitted:2009-06-12, Days after onset: 7
Location:Georgia  Entered:2009-06-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: None
Preexisting Conditions: No known Drug Allergies;
Diagnostic Lab Data: Sedimentation Rate, Creatine kinase labs drawn on 6/12/2009. Already had normal sugar, liver, anemia, thyroid tests, urine tests done on day of immunization.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2875AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3098AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood creatine phosphokinase, Discomfort, Muscle spasms, Neck pain, Red blood cell sedimentation rate, Sensory disturbance, Tenderness
SMQs:, Peripheral neuropathy (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad)
Write-up: Day after immunizations began having neck pain with radiation down back; right arm discomfort and then later in week right knee lateral discomfort and right lateral small toe discomfort, Symptoms not worsening, but not resolved 8 day later. Also 8 days later had slightly reduced subjective sensation left arm and left leg, not worsening. Patient given Ibuprofen for inflammation and Flexeril for muscle spasm. Exam revealed no neurologic deficit or swelling or erythema. Mild muscle spasm, neck and mild tenderness neck, right arm, right lateral knee and right lateral 5th toe.

VAERS ID:349167 (history)  Vaccinated:0000-00-00
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:2009-06-15
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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC5028AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:349244 (history)  Vaccinated:2009-06-10
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-06-10
Location:Louisiana  Entered:2009-06-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.05584 IMUN
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB25AA IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:349750 (history)  Vaccinated:2009-06-11
Age:43.0  Onset:2009-06-12, Days after vaccination: 1
Gender:Male  Submitted:2009-06-18, Days after onset: 6
Location:Illinois  Entered:2009-06-22, 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 6-18-09
Current Illness: None 6-18-09
Preexisting Conditions: Seasonal Allergies
Diagnostic Lab Data: None 6-18-09
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS438011C5IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Donor reported a rash that developed on back, neck and arms. Rash cleared up the same day.

VAERS ID:350372 (history)  Vaccinated:2009-05-14
Age:43.0  Onset:2009-05-30, Days after vaccination: 16
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:2009-06-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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Lot
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Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1363X0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Arthralgia, Body temperature increased, Cough, Gait disturbance, Hypoaesthesia, Joint range of motion decreased, Joint swelling, Oedema peripheral, Oropharyngeal pain, Paraesthesia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 2 days after vaccination temp. - sore throat, cough. This lasted 2 1/2 weeks. Then on the 30th of May I awoke to a painful left knee. This got worse over the course of the day. By days end knee swollen- painful to walk on. Next morning both knees ached, they felt as if they were going to explode. Couldn''t knell down, or go down stairs, moved up to hips.. This lasted about a week, then moved to hands, elbows, and feet, (knees and hips felt better). Hand and fingers swelled, I could barely bend them, constant aching. They would also feel as tough they were going to sleep. No position made any difference. Swelling has gone and tingling, numbness and pain in finger persist. Over the last week it comes and goes. 6-24 it has moved back to left knee. Only joints its missed is shoulders. As of this time it is still ongoing.

VAERS ID:350430 (history)  Vaccinated:2009-06-24
Age:43.0  Onset:2009-06-24, Days after vaccination: 0
Gender:Female  Submitted:2009-06-29, Days after onset: 5
Location:California  Entered:2009-06-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gyn Exam
Preexisting Conditions:
Diagnostic Lab Data: 0
CDC Split Type:
Vaccination
Manufacturer
Lot
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TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURAVPU2590CA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, 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: 06/29/09 Pt came in today c/o redness on left deltoid had fever X 2d. Used alcohol on area. Redness & swelling warmed to touch 6" X 4 1/2"

VAERS ID:350511 (history)  Vaccinated:2009-06-03
Age:43.0  Onset:2009-06-09, Days after vaccination: 6
Gender:Female  Submitted:2009-06-25, Days after onset: 16
Location:Wisconsin  Entered:2009-06-30, 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: Simvastatin; Metoprolol/HCTZ; Fish Oil; CO QID
Current Illness: None
Preexisting Conditions: HTN; enlarged thyroid; NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3068AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Mass, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 2 inch lump, itching, hot to the touch. - Warm compress, gentle massage, BENADRYL if needed for itching.

VAERS ID:350647 (history)  Vaccinated:2009-06-23
Age:43.0  Onset:2009-06-26, Days after vaccination: 3
Gender:Male  Submitted:2009-07-01, Days after onset: 5
Location:Illinois  Entered:2009-07-01
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: examined by the nurse
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEURUF471CA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Local reaction, Skin reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Localized skin reaction. Red raised irregular border 10cm x 8cm. Fading center/clearing.

VAERS ID:351000 (history)  Vaccinated:2009-07-06
Age:43.0  Onset:2009-07-06, Days after vaccination: 0
Gender:Male  Submitted:2009-07-07, Days after onset: 1
Location:South Dakota  Entered:2009-07-08, 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: Metformin ER - 500mg - BID; MVT- daily
Current Illness: Pt here for 1 month follow-up
Preexisting Conditions: DM2
Diagnostic Lab Data: CBC, CMP
CDC Split Type:
Vaccination
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1287X0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Full blood count, Injection site pain, Metabolic function test
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Severe pain at injection site.

VAERS ID:351850 (history)  Vaccinated:2008-11-25
Age:43.0  Onset:2008-11-27, Days after vaccination: 2
Gender:Female  Submitted:2008-12-26, Days after onset: 29
Location:Pennsylvania  Entered:2009-07-14, Days after submission: 199
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NORVASC; MOTRIN; FLEXERIL
Current Illness: Illnesses at the time of vaccination were cough and staple in the patient''s finger.
Preexisting Conditions: There were no known allergies. Concomitant medications were unknown. The patient denied receiving any other vaccines within four weeks of 25 November 2008 and denied experiencing adverse events following prior vaccinations.
Diagnostic Lab Data: Not reported.
CDC Split Type: 200803801
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEURC30041IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Overdose
SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial report received from a health care professional on 01 December 2008. A 43-year-old female patient who had stepped on a nail and who had a pre-existing cough, was inadvertently given a second dose of ADACEL, administered intramuscularly to the left deltoid on 25 November 2008 (lot number UF455BA; other lot number C3004). The patient had previously received a dose of ADACEL on 10 January 2007. On 27 November 2008, the patient experienced an orange-sized area of redness, swelling, warmth and itching that became worse in 28 November 2008. As of 01 December 2008, the symptoms had resolved. It was also reported that the patient''s cough had worsened after the ADACEL vaccination. No fever or additional events were reported. Outcome of cough was not reported. Follow up information was received on 22 December 2008 from a health care professional. The reporter clarified the patient had a staple in her finger at the time of vaccination, previously reported as stepping on a nail. The reporter confirmed that the orange sized redness, swelling, warmth and itching were all symptoms at the injection site, the left deltoid. Treatment included ice and MOTRIN. Concomitant therapy included NORVASC, FLEXERIL and MOTRIN. The cough worsened on 26 November 2008 and then resolved by 28 November 2008. The patient did not seek medical attention. No other information was provided. Documents held by sender: None.

VAERS ID:352019 (history)  Vaccinated:2009-07-20
Age:43.0  Onset:2009-07-20, Days after vaccination: 0
Gender:Female  Submitted:2009-07-21, Days after onset: 1
Location:Maine  Entered:2009-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 20mg 3 tabs daily, benadryl 25mg qhs prn, vitamin D 1000mg daily
Current Illness: abdominal pain
Preexisting Conditions: klonopin, malaria pills
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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TDAP: TDAP (ADACEL)SANOFI PASTEURC2994AA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Injection site warmth, 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: Patient reports fever last evening. Marked swelling of left upper arm with redness and several bumps on the skin. Area is warm to touch. Area outlined with ballpoint and patient instructed to use ibuprofen 800mg TID as well as ice to area and benadryl 50mg every 6 hours as needed. She will report back with any increase in size

VAERS ID:352158 (history)  Vaccinated:2009-06-10
Age:43.0  Onset:2009-06-10, Days after vaccination: 0
Gender:Male  Submitted:2009-07-22, Days after onset: 42
Location:Colorado  Entered:2009-07-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History of musculoskelatal pain (elbow, lumbar), no PMH allergy. PMH: Tooth infection. Skin graft right ''pinky''.
Diagnostic Lab Data: MRI demonstrated a solitary, 1 cm ring enhancing lesion in the right cerebellar region and 2 small enhancing lesions in the pons; CSF demonstrated increased WBC (12/hpf and 95% lymphocytes), protein of 55, gram stain negative; CBC/Chem panels are normal. Additional CSF studies are pending. 7/31/09 Hospital records received DOS 7/10/09 to 7/11/09. LABS and DIAGNOSTICS: CSF - WBC 12 10^6/L (H) RBC 23 10^6/L (H) Lymph 95% (H) MO/MAC 5% (L). CSF Leukemia/Lymphoma FLOWCYTO - abnormal. CSF Oligoclonal Banding Serum - Abnormal. CSF Glucose 56 (H) CSF Protein 55 mg/dL (H). CHEM - Creatinine 1.34 mg/dL (H). CBC - MCH 27.4 pg (L) MONOs 1.1% (H). CSF Culture - results pending. Protime 15 sec (H). INR 1.2 (H). MRI Brain - Abnormal, cerebellar lesion.
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1775IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB10262IMLA
Administered by: Military     Purchased by: Military
Symptoms: Acute disseminated encephalomyelitis, Blood creatinine increased, CSF cell count abnormal, CSF culture, CSF glucose increased, CSF lymphocyte count increased, CSF oligoclonal band present, CSF protein increased, CSF test abnormal, CSF white blood cell count increased, Dysgeusia, Flow cytometry, Gram stain negative, International normalised ratio increased, Mean cell haemoglobin decreased, Monocyte percentage increased, Nervous system disorder, Nuclear magnetic resonance imaging brain abnormal, Prothrombin level increased, Red blood cells CSF positive, Sensory disturbance, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Peripheral neuropathy (narrow), Haemorrhage laboratory terms (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Glaucoma (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Malignant lymphomas (broad), Tumour lysis syndrome (broad)
Write-up: Patient experienced change in sense of taste and change in facial sensation within 12 hours of his 6th Anthrax and 3rd Typhoid vaccination. The symptoms progressed, leading to brain MRI, hospitalization and ultimately the diagnosis of suspected acute disseminated encephalomyelitis. 7/31/09 Hospital records received DOS 7/10/09 to 7/11/09. Assessment: Suspected acute disseminated encephalomyelitis. Patient experienced some decrease in taste on his tongue as well as some loss of sensation over the lower portion of his jaw and face. Decreased sensation in the right upper extremity and the right lower extremity. Imaging revealed a cerebellar lesion. On admission patient presents with decreased sensation in bilateral lower face. Decreased to cold, pinprick, light touch throughout thr right side. Blurry vision. 8/18/09 ICD-9 Codes: 323.9 Encephalitis myelitis and encephalomyelitis unspecified cause.

VAERS ID:352643 (history)  Vaccinated:2009-07-23
Age:43.0  Onset:2009-07-25, Days after vaccination: 2
Gender:Female  Submitted:2009-07-28, Days after onset: 3
Location:Pennsylvania  Entered:2009-07-28
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:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1672X SCRA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Fatigue, Nasal congestion, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Began 7-25-09 with "mild achy". Worsened on 7/27/09 -$g fever (subjective), body aches, nasal congestion cough & chest congestion, arms & legs aches, fatigue. No GI symptoms.

VAERS ID:353831 (history)  Vaccinated:2008-10-13
Age:43.0  Onset:2008-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 290
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic reaction to antibiotics
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0810USA03401
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0989U IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site warmth, Lymph node pain, Malaise, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a 43 year old female with allergic reaction to tetracycline who in the fall of 2003 was vaccinated with the first dose of PNEUMOVAX 23 vaccine, IM. On 13-OCT-2008, the patient was revaccinated with PNEUMOVAX 23 vaccine (Lot# 658449/0989U) in her right arm. Concomitant therapy included influenza virus vaccine, in the left arm (name and manufacturer unspecified). On 13-OCT-2008 the patient experienced high fever, pain in lymph nodes, her left side hurt, high injection site heat, extreme pain and heaviness in her arm, malaise, not feeling good and achiness after getting revaccinated in right arm. The patient had symptoms by the afternoon. At the time of the report, the patient was recovering. The patient did not seek medical attention. This is one of several reports received from the same source. No further information is available.

VAERS ID:353844 (history)  Vaccinated:2008-09-26
Age:43.0  Onset:2008-09-26, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 307
Location:New York  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0810USA04111
Vaccination
Manufacturer
Lot
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1960U UNUN
Administered by: Public     Purchased by: Public
Symptoms: Incorrect route of drug administration, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a registered nurse concerning a 43 year old female who at 11:00 AM on 26-SEP-2008 was vaccinated with PNEUMOVAX 0.5ml intradermally mistakenly (lot # 659487/1960U) instead of PPD (manufacturer unspecified). At 12:30 on 26-SEP-2008 the patient experienced severe pain in arm, and continued to complain of pain in arm though not as severe throughout the week. The patient sought medical treatment at ER. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:354206 (history)  Vaccinated:2008-12-17
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:2009-07-30
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0812USA04278
Vaccination
Manufacturer
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0867X1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: Information has been received from a registered nurse concerning a 43 year old female who on 17-December was vaccinated IM with the second dose of PNEUMOVAX 23 (lot#661528/0867X). Subsequently the patient developed injection site reaction after vaccination with PNEUMOVAX 23 vaccine. The patient developed cellulitis and was treated with unspecified antibiotics. The patient''s injection site reaction and cellulitis persisted. It was reported that the patient sought medical attention; seen in office. This is one of several reports received from the same source.

VAERS ID:354566 (history)  Vaccinated:2008-12-22
Age:43.0  Onset:2008-12-23, Days after vaccination: 1
Gender:Female  Submitted:2009-07-30, Days after onset: 218
Location:California  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VICODIN; vitamins (unspecified)
Current Illness: Sulfonamide allergy
Preexisting Conditions: Arthralgia; Alcoholism; Hepatic failure; Adverse drug reaction
Diagnostic Lab Data: None
CDC Split Type: WAES0902USA00040
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1163X0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Induration, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a medical technologist concerning a 43 year old female with a sulfonamide allergy and a history of arthralgias, alcoholism, liver failure and drug reaction to ARTHROTEC who on 22-DEC-2008 was vaccinated with her first dose of PNEUMOVAX (lot number 663012/1163X) Im into her left arm. Concomitant therapy included VICODIN and vitamin supplements. On 23-DEC-2008 the patient was seen by the physician because she had swelling, induration, warmth and erythema at the injection site. The are was 15 x 10 cm. the patient also had satellite areas of induration and erythema. The patient had no fever. The patient was prescribed clindamycin and told to ice the are. On 24-DEC-2008 the patient was doing better. A standard lot check was performed. All in-process quality checks for the lot number in question were satisfactory. In addition, an expanded lot check investigation was performed. The testing performed on the batch prior to release met all release specifications. The lot met the requirements if the Center and was released. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:354606 (history)  Vaccinated:2009-02-09
Age:43.0  Onset:2009-02-10, Days after vaccination: 1
Gender:Female  Submitted:2009-07-30, Days after onset: 169
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Arthritis; Scoliosis; Hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0902USA02406
Vaccination
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Influenza like illness, Injection site pain, Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a retired registered nurse concerning her 43 year old daughter with "MELOXOCAM" allergy and arthritis and scoliosis who on 09-FEB-2009 was vaccinated with her first dose of PNEUMOVAX. On 10-FEB-2009 the patient experienced widespread muscle aching and "flu-like symptoms". The patient also developed soreness and swelling at the injection site of the right upper arm. The nurse reported that her daughter had not sought medical attention for the adverse reaction. At the time of reporting the patient''s adverse reaction persisted. No further information is available.

VAERS ID:355298 (history)  Vaccinated:2008-10-11
Age:43.0  Onset:2008-10-11, Days after vaccination: 0
Gender:Female  Submitted:2008-10-14, Days after onset: 3
Location:Ohio  Entered:2009-08-13, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0007255
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Back pain, Joint stiffness, Musculoskeletal stiffness, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: A non-serious, spontaneous report of sore and stiffness in back, neck and shoulders was received from a consumer, concerning a 43 year-old female patient subsequent to FLUMIST. The patient reported no relevant medical history. Concomitant medications include lisdexamfetamine dimesylate. The patient received FLUMIST on 11-Oct-2008 for flu vaccination. That evening the patient reported soreness and stiffness in the back, neck and shoulders. The patient was seen by her primary care physician and suggested the events may be related to physical exertion earlier in the day. The events were ongoing as of 17-Oct-2008 and described as soreness occurring in the triangular area at the base of the back of the neck.

VAERS ID:355452 (history)  Vaccinated:2008-11-05
Age:43.0  Onset:2008-11-05, Days after vaccination: 0
Gender:Female  Submitted:2008-11-07, Days after onset: 2
Location:Pennsylvania  Entered:2009-08-13, Days after submission: 278
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: MEDI0007468
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: A non-serious spontaneous report of sore throat, body aches and low grade temperature has been received from a consumer concerning a 43 year-old female, subsequent to FLUMIST. No medical history or concomitant medication information was provided. The patient received FLUMIST on 5-Nov-2008. Less than 24 hours after receiving FLUMIST, the patient reported developing symptoms of sore throat, body aches and low grade temperature. The outcome of these events was not reported. The causality was not reported.

VAERS ID:355628 (history)  Vaccinated:2009-01-06
Age:43.0  Onset:2009-01-06, Days after vaccination: 0
Gender:Female  Submitted:2009-04-09, Days after onset: 92
Location:Iowa  Entered:2009-08-13, Days after submission: 126
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0007717
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500563P0IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious report of administration of expired FLUMIST to two patients was received from a pharmacist concerning a 43-year-old female. The patient''s medical history and concomitant medications were not available. On 06-Jan-2009, the patient received expired FLUMIST (expiration date 30-Dec-2008) at a Pharmacy. The pharmacist states that she did not check the expiration date prior to administration. The patient was doing well. There was no adverse event associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause for the medication errors were caused by 1) customers not discarding product from the previous season and 2) product expiring during the peak of the flu season resulting in some medication errors that occurred shortly after the product expired. Additional information was received on 09-Apr-2009: product complaint investigation results.

VAERS ID:355977 (history)  Vaccinated:2009-03-02
Age:43.0  Onset:2009-03-02, Days after vaccination: 0
Gender:Male  Submitted:2009-05-12, Days after onset: 70
Location:New Jersey  Entered:2009-08-13, Days after submission: 93
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: MEDI0008186
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P IN 
Administered by: Military     Purchased by: Military
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious spontaneous report of administration of expired FLUMIST was received from a nurse concerning a 43-year-old male. Neither medical history nor concomitant medications were reported. On 02-Mar-2009, the patient received expired FLUMIST vaccine. The vaccine had an expiration date of 11-Jan-2009. As of 18-Mar-2009, there was no adverse events associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause of the medication errors were caused by 1) customers not discarding product from previous season and 2) product expiring during the peak of flu season resulting in some medication errors that occurred shortly after the product expired. Additional information was received on 12-May-2009: product complaint investigation results.

VAERS ID:355988 (history)  Vaccinated:2009-03-02
Age:43.0  Onset:2009-03-02, Days after vaccination: 0
Gender:Female  Submitted:2009-05-12, Days after onset: 70
Location:New Jersey  Entered:2009-08-13, Days after submission: 93
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: MEDI0008201
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P IN 
Administered by: Military     Purchased by: Military
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious spontaneous report of administration of expired FLUMIST was received from a nurse concerning a 43-year-old female. Neither medical history nor concomitant medications were reported. On 02-Mar-2009, the patient received expired FLUMIST vaccine. The vaccine had an expiration date of 11-Jan-2009. As of 18-Mar-2009, there was no adverse events associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause of the medication errors were caused by 1) customers not discarding product from previous season and 2) product expiring during the peak of flu season resulting in some medication errors that occurred shortly after the product expired. Additional information was received on 12-May-2009: product complaint investigation results.

VAERS ID:356327 (history)  Vaccinated:2009-08-10
Age:43.0  Onset:2009-08-11, Days after vaccination: 1
Gender:Female  Submitted:2009-08-28, Days after onset: 17
Location:North Carolina  Entered:2009-09-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT; podacly; clonazepam; OTC MUCINEX
Current Illness: none
Preexisting Conditions: Hx of high cholesterol; panic attacks; Depression
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
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TDAP: TDAP (ADACEL)SANOFI PASTEURC3158AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient went to ER 8/13/09 with complaint of swelling in arm, redness and fever. ER visit 8/13/09 temperature = 100.1, BP 106/74, patient was placed on Doxycycline 100 mg PO BID, VICODIN 5mg, 1 or 2 tabs every 6hrs prn. Dx: cellulitis

VAERS ID:356361 (history)  Vaccinated:2009-09-01
Age:43.0  Onset:2009-09-01, Days after vaccination: 0
Gender:Female  Submitted:2009-09-02, Days after onset: 1
Location:Indiana  Entered:2009-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac - daily vitamin
Current Illness: None that I was aware of
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERNOT AVAILABLE0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Chills, Eye discharge, Eye irritation, Influenza, Nausea, No reaction on previous exposure to drug, Pain, Pyrexia, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Hypersensitivity (narrow)
Write-up: Received shot in clinic around 2:00 p.m. Around 4:00 p.m. my eyes started burning and felt like I had sand in them - by the time I got home at 5:30 p.m. they were very runny - producing a lot of "sleep" that required me to wipe them off about every 20minutes or so. Also about 5:30 - the soft pallet under my tongue began to swell up. From 5:30 - 7:30 I ran the entire course of flu symptoms with fever (99/100) chills, aches, nasaue in addition to the eyes and swollen tongue. Took a benedryl which relieved the symptoms of the swelling and the eyes running as much. Today - I ended up taking another benedryl because my tongue felt as if it was swelling up again. Other than that and some minor eye irritation still today I feel better. I am not allergic to eggs at all and have never had any previous issues with flu shots.

VAERS ID:356598 (history)  Vaccinated:2009-08-11
Age:43.0  Onset:2009-08-12, Days after vaccination: 1
Gender:Female  Submitted:2009-09-07, Days after onset: 26
Location:Ohio  Entered:2009-09-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Injection site erythema, Injection site induration, Injection site nodule, Injection site pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Administered 8/11/09 for pre-employment. Last Td vaccine received 2005. First time receiving Tdap. Approximately 6 cm x 4 cm red area at injection site. Swollen glands in left axillary and left sub-mandibular/tonsillar lymph nodes (injection site left upper arm). Persistent headache x 3-4 days. Persistent generalized muscle aches x 4-5 days. Also, muscle ache/hard knot at site (not unusual per past history with Td vaccine).

VAERS ID:356970 (history)  Vaccinated:2009-09-09
Age:43.0  Onset:2009-09-09, Days after vaccination: 0
Gender:Male  Submitted:2009-09-10, Days after onset: 1
Location:Oregon  Entered:2009-09-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED05749111A0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash erythematous, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Raised red area silver dollar size hot to touch.

VAERS ID:356988 (history)  Vaccinated:1966-09-10
Age:43.0  Onset:1966-09-10, Days after vaccination: 0
Gender:Female  Submitted:2009-09-11, Days after onset: 15707
Location:Maryland  Entered:2009-09-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies to strawberry, eggs, outside and inside, sinusitis, border line diabetes.
Diagnostic Lab Data: N/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR113176AA0UNRA
Administered by: Military     Purchased by: Unknown
Symptoms: Abdominal pain upper, Cough, Dysphonia, Eye pruritus, Eye swelling, Ocular hyperaemia, Oropharyngeal pain, Pain, Pruritus, Rhinorrhoea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: Body itching, eyes swollen shut, red itching eyes, stomach aches, body aches, cough hoarness, sore throat, runnning nose.

VAERS ID:357251 (history)  Vaccinated:2009-09-01
Age:43.0  Onset:2009-09-02, Days after vaccination: 1
Gender:Female  Submitted:2009-09-10, Days after onset: 8
Location:Iowa  Entered:2009-09-14, 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: LAMICTAL; Hormone replacement
Current Illness: None
Preexisting Conditions: Seizures - 9 yrs
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED018449211A0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pruritus, Rash macular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Over the course of 2 days developed redness and swelling on left arm that itched and was blotchy. On 9/3/09 went to Clinic to see physician. She stated it was starting to spread dawn bicep. Plan-Prednisone X 11 days and loratadine. Follow up in 2 wks.

VAERS ID:357316 (history)  Vaccinated:2009-09-10
Age:43.0  Onset:2009-09-10, Days after vaccination: 0
Gender:Female  Submitted:2009-09-10, Days after onset: 0
Location:Maryland  Entered:2009-09-15, 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:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA256AA IDRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1441X0IDLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 7.0 x 5.0 cm wheal. 25mg BENADRYL given & ice applied.

VAERS ID:357447 (history)  Vaccinated:2009-09-15
Age:43.0  Onset:2009-09-15, Days after vaccination: 0
Gender:Male  Submitted:2009-09-16, Days after onset: 1
Location:Illinois  Entered:2009-09-16
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: ADVERSE REACTION TO FLU SHOT.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3203AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Back pain, Eye pruritus, Ocular hyperaemia, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad)
Write-up: Red and itchy eyes, upper back pain, sore throat, fever.

VAERS ID:357563 (history)  Vaccinated:2009-09-08
Age:43.0  Onset:2009-09-11, Days after vaccination: 3
Gender:Female  Submitted:2009-09-17, Days after onset: 6
Location:Maine  Entered:2009-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CYMBALTA 60 MG CPEP (DULOXETINE HCL) one tablet daily PROTONIX 40 MG TBEC (PANTOPRAZOLE SODIUM) daily COLACE CAPS (DOCUSATE SODIUM CAPS) as directed REGLAN 5 MG TABS (METOCLOPRAMIDE HCL) one tablet before meals and before bed (fo
Current Illness: none
Preexisting Conditions: Current Allergies: ! STEROIDS * FLU VACCINATION PENICILLIN COMPAZINE TYLENOL PHENERGAN
Diagnostic Lab Data: SHOT REACTION (ICD-786.05) discussed topical treatmetn, ice nsaid (motrin. alleve) monitor for fever return if reaction expanding or fever
CDC Split Type:
Vaccination
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HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVB27AA1IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0528Y1IMRA
TD: TETANUS DIPHTHERIA (TENIVAC)SANOFI PASTEURC3355AA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: She had injection on tuesday here in her R arm. she noted some reaction that started a little that night and then more on wednesday wiht redness and spreading. it does not itchin, no exudate or pus from shot/injection side. she did put some ice on it and took tylenol. she has not had a fever, no chills. no nausea or vomit. no diarrhea. she has less appetite.

VAERS ID:357706 (history)  Vaccinated:2009-09-15
Age:43.0  Onset:2009-09-15, Days after vaccination: 0
Gender:Female  Submitted:2009-09-18, Days after onset: 3
Location:Oregon  Entered:2009-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levsin 0.125 mg
Current Illness: States no
Preexisting Conditions: Patient states has hx of allergies-has strange reactions to certain elements.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU2937BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Injection site erythema, Injection site pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Patient states she had pain, redness at site of injection, hives, fever, joint pain-occurred same day of injection.

VAERS ID:357742 (history)  Vaccinated:2009-09-14
Age:43.0  Onset:2009-09-14, Days after vaccination: 0
Gender:Female  Submitted:2009-09-17, Days after onset: 3
Location:Kansas  Entered:2009-09-18, 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:
Current Illness: None
Preexisting Conditions: Anal CA-3 months since last chemo
Diagnostic Lab Data: CMP, UA, CBC, underlying UTI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3202AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0981X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Full blood count, Metabolic function test, Pain, Pain in extremity, Pyrexia, Skin warm, Urinary tract infection, Urine analysis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: 9/14/09 after shot arm pain. 24 hours fever, body aches. 72 hours still fever, arm red, welts, warm to touch. This arm received PNEUMOVAX.

VAERS ID:357992 (history)  Vaccinated:2009-09-22
Age:43.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-09-22, Days after onset: 0
Location:North Carolina  Entered:2009-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NO~ ()~NULL~~In Patient|NO~ ()~NULL~~In Sibling1
Other Medications: NONE EXCEPT ASPIRIN
Current Illness: NO ILLNESS DAY OF ADMINISTRATION NOR RECENTLY
Preexisting Conditions: HIGH CHOLESTEROL
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB734AA2IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B037AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Feeling hot, Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: STARTED FEELING WEAK ABOUT 10 MINUTES AFTER SHOT; FELT WARM; HAD A DULL ACHE IN HER HEAD; WAS SHAKY WHEN SHE WALKED AND SHE WAS TAKEN TO THE EMERGENCY ROOM. B/P WAS 140/82 SITTING AND 173/92 WHEN STANDING

VAERS ID:358136 (history)  Vaccinated:2009-09-22
Age:43.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-09-23, Days after onset: 1
Location:Alaska  Entered:2009-09-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Avvapro 300, Vytorn 10/40, Nexium 40
Current Illness: none
Preexisting Conditions: allergies to: penicillen, lisinapril, and constrast dye.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA259AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Dysphonia, Dyspnoea, Heart rate increased, Hypertension, Pruritus, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Rapid heart rate, high blood pressure, itching of tongue and back of throat, hoarseness, slight wheezing, and difficulty breathing.

VAERS ID:358165 (history)  Vaccinated:2009-09-11
Age:43.0  Onset:2009-09-18, Days after vaccination: 7
Gender:Female  Submitted:2009-09-21, Days after onset: 3
Location:Washington  Entered:2009-09-23, Days after submission: 2
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
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA257AB0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: First episode of herpes zoster one week after administration of the vaccine.

VAERS ID:358281 (history)  Vaccinated:2009-09-19
Age:43.0  Onset:2009-09-21, Days after vaccination: 2
Gender:Female  Submitted:2009-09-24, Days after onset: 3
Location:Wisconsin  Entered:2009-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam, Erythromycin Topical, Zolpidem, Oxybutynin, Naproxen
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97838P1 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Allergy to vaccine, Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Arm showed redness and swelling approximately 4 inches below the injection site. Patient was seen by physician and diagnosed with an allergy to a component of the flu vaccine

VAERS ID:358341 (history)  Vaccinated:2009-09-22
Age:43.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-09-22, Days after onset: 0
Location:Unknown  Entered:2009-09-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic to PCN, sulfa
Diagnostic Lab Data: Time-24 hours later reports no symptoms
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED07849111A IMLA
Administered by: Private     Purchased by: Other
Symptoms: Hypoaesthesia, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: Lt deltoid injection-10 min. later pain shot to hand and lt thumb numb. Injection site noted in std location, belly of deltoid.

VAERS ID:358454 (history)  Vaccinated:2009-09-01
Age:43.0  Onset:2009-09-01, Days after vaccination: 0
Gender:Female  Submitted:2009-09-02, Days after onset: 1
Location:Illinois  Entered:2009-09-25, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97839P2 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Injection site pain, Musculoskeletal pain, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Injection site sore, pain in left shoulder radiating into neck. Headache after injection, gone after 12 hours.

VAERS ID:358460 (history)  Vaccinated:2009-09-22
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:2009-09-25
Location:Minnesota  Entered:2009-09-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3202AA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Dizziness, Myalgia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Muscle ache, Joint pain, dizziness vision was blurry 2 hrs after receiving injection the symptoms started.

VAERS ID:358455 (history)  Vaccinated:2009-09-26
Age:43.0  Onset:2009-09-26, Days after vaccination: 0
Gender:Female  Submitted:2009-09-26, Days after onset: 0
Location:Tennessee  Entered:2009-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate; RELAFEN; PREDNISONE
Current Illness: None
Preexisting Conditions: Arthritis
Diagnostic Lab Data: Reviewed VAR with patient and no allergies reported
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P2A0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient developed hematoma at injection site of deltoid of left arm with reddening of upper left arm. Patient was watched for 30 minutes while using ice pack and received diphenhydramine.

VAERS ID:358988 (history)  Vaccinated:0000-00-00
Age:43.0  Onset:0000-00-00
Gender:Unknown  Submitted:2009-09-30
Location:Wisconsin  Entered:2009-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3187AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling abnormal, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Hypersensitivity (narrow)
Write-up: Patient called clinic today stating she has hives to face and feels this is from flu vaccine received 9/29/09 at clinic. Patient states she "felt funny" last night after vaccine received.Patient advised to use claritin.zyrtec during day and benadryl at night.Patient to see MD if increased problems.

VAERS ID:359046 (history)  Vaccinated:2009-09-30
Age:43.0  Onset:2009-09-30, Days after vaccination: 0
Gender:Female  Submitted:2009-10-01, Days after onset: 1
Location:Missouri  Entered:2009-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra D
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960312P IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling cold, Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient recieved flu shot on 9/30/09 at approximately 1pm. Approximately 30 mintues after recieving the shot the patient reported to the nurse that her arm felt cold and numb (like it was asleep). The nurse inspected the arm and noted no redness, edema, ecchymosis or other abnormalities. Patient was asked if she would like to be seen by a physician and she declined. Patient was instructed to contact facility if symptoms worsened. Patient was contacted on 10/1/09 for follow-up on symptoms and reported that the feeling in her arm has returned to normal and she is just a little sore at the injection site.

VAERS ID:359507 (history)  Vaccinated:2009-10-02
Age:43.0  Onset:2009-10-05, Days after vaccination: 3
Gender:Female  Submitted:2009-10-05, Days after onset: 0
Location:California  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives on the front neck, itching.

VAERS ID:359608 (history)  Vaccinated:2009-10-06
Age:43.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 0
Location:Virginia  Entered:2009-10-06
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: Anemia, Hyperlipidemia, and Positional Vertigo
Diagnostic Lab Data: Orthostatic vital signs
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3172AA IMRA
Administered by: Military     Purchased by: Unknown
Symptoms: Headache, Vertigo
SMQs:, Vestibular disorders (narrow)
Write-up: Flu vaccine administered at 10:00 AM. Headache at 10:05 AM. Vertigo at 11:15 AM.

VAERS ID:359638 (history)  Vaccinated:2009-10-02
Age:43.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 4
Location:New York  Entered:2009-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: none
Diagnostic Lab Data: Employee not recovered yet.
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS96033 4P0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Laryngitis, Oropharyngeal pain, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: severe headache, rash, severe pruritis, laryngitis/sore throat

VAERS ID:359782 (history)  Vaccinated:2009-09-21
Age:43.0  Onset:2009-09-22, Days after vaccination: 1
Gender:Male  Submitted:2009-10-10, Days after onset: 18
Location:Texas  Entered:2009-10-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA4568A IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Blepharospasm, Eye disorder, Full blood count, Malaise, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Corneal disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (broad)
Write-up: Started with itching - generalized, no rash c/o not feeling well. 7 days later - c/o twitching to eyes - Referred to ER/Primary on 10/16 - with twitching/unable to close Lt eye.

VAERS ID:359753 (history)  Vaccinated:2009-09-17
Age:43.0  Onset:2009-09-17, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 20
Location:Florida  Entered:2009-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chest discomfort, Ocular hyperaemia, Upper respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: WHEEZING, CHEST TIGHTNESS, SEVERE CONGESION, BLOODSHOT EYES

VAERS ID:359894 (history)  Vaccinated:2009-10-04
Age:43.0  Onset:2009-10-05, Days after vaccination: 1
Gender:Male  Submitted:2009-10-07, Days after onset: 2
Location:Maryland  Entered:2009-10-07
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 at time of report
CDC Split Type:
Vaccination
Manufacturer
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2173SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Induration, Injection site pain, Myalgia, Pyrexia, Skin disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: S:self reported fever on 2nd night of 102 F and pain in LUE muscles, self administer tylenol for fever/pain O:8x17cm erythemic induration w/ small areas of mild skin breakdown,

VAERS ID:359898 (history)  Vaccinated:2009-09-28
Age:43.0  Onset:2009-09-28, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 9
Location:California  Entered:2009-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01449211A IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site induration, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Soreness at injection site 2 area''s of induration one 2cm by 2cm one 4cm by 4cm, pain with pressure, 2-3/10. Pain with arm use overhead. No warmth,no lymphadenopathy, no drainage.

VAERS ID:359991 (history)  Vaccinated:2009-10-02
Age:43.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 5
Location:Missouri  Entered:2009-10-08, 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: FLONASE; HCTZ
Current Illness:
Preexisting Conditions: Blood pressure; Allergy seasonal; CT contrast media; Thimerosal
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960351P IMLA
Administered by: Public     Purchased by: Private
Symptoms: Oropharyngeal pain, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Employee presented to employer seasonal flu vaccination clinic. Requested/inquired if vaccine was "preservative free" confirmed vaccine "preservative free". Received vaccination 10/02/09 at 0900, around 10:00 AM experienced sore throat - scratchy feeling - slight tightness. Took BENADRYL 50 mg P.O. with relief of symptom.

VAERS ID:360031 (history)  Vaccinated:2009-10-07
Age:43.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Female  Submitted:2009-10-08, Days after onset: 1
Location:Maryland  Entered:2009-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PENTASA; ALTACE; SYNTHROID
Current Illness: None
Preexisting Conditions: Crohns
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3192AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Cough, Dyspnoea, Eye pruritus, Ocular hyperaemia, Throat tightness, Urticaria, Vision blurred, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: Eyes itchy, blurry, completely red around 4 PM patient got into shower, throat started to tighten and had difficulty breathing, hives on front of legs, wheezing, coughing, patient went to ER and was given epinephrine, SOLU-MEDROL 60 mg, BENADRYL 50 mg.

VAERS ID:360567 (history)  Vaccinated:2009-09-22
Age:43.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-08, Days after onset: 16
Location:Michigan  Entered:2009-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: hypothyroid
Diagnostic Lab Data: EMG is pending
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3184AA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Electromyogram, Hypoaesthesia, Muscular weakness, Pain in extremity, Radiculitis brachial
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)
Write-up: Numbness, pain right arm and hand weakness. Began night after vaccine. increased symptoms. DX Acute Brachial Neuritis.

VAERS ID:360572 (history)  Vaccinated:2009-10-01
Age:43.0  Onset:2009-10-05, Days after vaccination: 4
Gender:Male  Submitted:0000-00-00
Location:Michigan  Entered:2009-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No 10/26/09 Hospital records received for dates 10/9/09 to 10/13/09 PMH: (+)TB test.
Diagnostic Lab Data: MRI 10/26/09 Hospital records received for dates 10/9/09 to 10/13/09 Diagnostics/Labs: MRI abnormal-T2 hyperintensities at several levels of thoracic spine. CXR(-), EKG(-), CSF WBC 120(H), CSF RBC 3400(H), CSF total protein $g600(H), CSF protein 81(H), CSF cx(-), CSF ACE(-), CSF HSV, varicella, west nile all (-), CSF myelin basic protein 477(H), BUN 24(H), HGB 12.9(L), HCT 37.6(L).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97839P20IMLA
Administered by: Other     Purchased by: Private
Symptoms: Blood urea increased, CSF culture negative, CSF myelin basic protein increased, CSF protein increased, CSF virus no organisms observed, CSF white blood cell count increased, Chest X-ray normal, Electrocardiogram normal, Haematocrit decreased, Haemoglobin decreased, Headache, Myelitis transverse, Nuclear magnetic resonance imaging abnormal, Paraesthesia, Red blood cells CSF positive, Urinary retention
SMQs:, Acute renal failure (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad)
Write-up: 10/1/09 pt states got flu shot for 1st time, 10/08/09 seen in Dr''s office, 10/09/09 admitted to hosp. 10/26/09 Hospital records received for dates 10/9/09 to 10/13/09. DC DX: postvaccinial transverse myelitis. Presenting SX: pt. seen in ER on 10/8 c/o 4 days after flu vax began sx. of tingling and paresthesias starting in feet and eventually all of lower extremities. Pt. c/o urinary retention, HA. Assessment: WNL, bladder scan WNL. Pt d/c and returned following day, sx. progressively getting worse. Pt. admitted, diagnostics performed pt. tx. And d/c improved stable condition.

VAERS ID:360661 (history)  Vaccinated:2009-09-30
Age:43.0  Onset:2009-10-05, Days after vaccination: 5
Gender:Female  Submitted:2009-10-13, Days after onset: 8
Location:Arizona  Entered:2009-10-13
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: Mitral Valve Prolapse Alergy to sulfa drugs 01/12/2010 PMH: Asthma, pneumothorax, cholecystectomy, hysterectomy, smoker, allergy to Sulfa (skin rash/hives).
Diagnostic Lab Data: None
CDC Split Type:
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Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA468CA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Cough, Eye irritation, Injection site pain, Limb discomfort, Movement disorder, Musculoskeletal disorder, Oropharyngeal pain, Pyrexia, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Corneal disorders (broad)
Write-up: Starting at 6 am 5 days after receiving the flu vaccine, employee experienced sor throat, low grade fever, chest congestion, coughing, chills, and burning eyes. The same day vaccine was administered she developed soreness in the right upper arm where her injection was given. These symptoms had improved but not resolved as of 10/12/2009.

VAERS ID:360965 (history)  Vaccinated:2009-10-13
Age:43.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 2
Location:Kansas  Entered:2009-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Seasonal, exercise induced asthma & allergies, Macrodantin allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Condition aggravated, Headache, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Had slight headache right after receiving nasal mist for h1n1. It lasted for about 3 hours. Had a asthma attack at 10:30 pm and used Maxair inhalar to stop episode.

VAERS ID:361147 (history)  Vaccinated:2009-10-09
Age:43.0  Onset:2009-10-09, Days after vaccination: 0
Gender:Male  Submitted:2009-10-09, Days after onset: 0
Location:Ohio  Entered:2009-10-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3207AA0IMUN
Administered by: Other     Purchased by: Private
Symptoms: Flushing, Pyrexia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: About 10 minutes after given influenza vaccine c/o itching throat, "fever", skin face, neck was flushed, given diphenhydramine 25mg IM right deltoid and 50 mg diphenhydramine PO, call 911 and EMS respond

VAERS ID:361155 (history)  Vaccinated:2009-09-05
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-07
Location:Illinois  Entered:2009-10-16, 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: RECLIPSEN; MECLIZINE.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P10IMLA
Administered by: Other     Purchased by: Private
Symptoms: Diplegia, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Numbness and paralysis in both arms, lasted several days.

VAERS ID:361245 (history)  Vaccinated:2009-10-05
Age:43.0  Onset:2009-10-06, Days after vaccination: 1
Gender:Female  Submitted:2009-10-16, Days after onset: 10
Location:Vermont  Entered:2009-10-16
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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TDAP: TDAP (ADACEL)SANOFI PASTEURC3249AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Pruritus, Reaction to preservatives, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Per doc @ hospital 10cm round, fading edged, induration, hard, hot redness. No sign secondary infection, no systemic sx. Dx: Alum reaction-very itchy. Tx: TRIAMCINELONE 0.5% and moist heat bid.

VAERS ID:361250 (history)  Vaccinated:2009-10-14
Age:43.0  Onset:2009-10-15, Days after vaccination: 1
Gender:Male  Submitted:2009-10-16, Days after onset: 1
Location:New Jersey  Entered:2009-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: seasonal allergies per patient;s wife
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR03213AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Body temperature increased, Chest X-ray normal, Chills, Feeling cold, Feeling of body temperature change, Laboratory test normal, Pain, Pruritus, Skin warm, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: 10/15/09 2am vomit one felt cold. 5am vomited once legs itchy felt cold. Went to work with chills and body aches. Continued with chills once home. Skin warmer than usual per wife. Went to bed early. 10/16/09 5 am chills and body aches 9 am temp 101.1-1st time recorded. c/o hot and cold TYLENOL taken this morning around 9 a.m. attempting to see PMD. Patient came to work and was sent home due to the fact that he claimed to have a temperature of 100.3 and 100.4 on 10/17/09 and 10/18/09. Also had vommited on 10/18/09 after dinner. Patient saw his PMD on 10/19/09 , had lab work, chest x-ray all results were normal per patient. Placed on Zpac. Returned to work on 10/23/09. Last fever per patient was on 10/21/09. He has been back to work since 10/23/09 and feels better now. Patient also mentioned that one of his children was ill with viral symptoms just around the time patient took the flu vaccine.

VAERS ID:361278 (history)  Vaccinated:2009-10-13
Age:43.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Male  Submitted:2009-10-16, Days after onset: 3
Location:Virginia  Entered:2009-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR 0IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Fatigue, Headache, Oropharyngeal pain, Productive cough, Respiratory tract congestion, Rhinorrhoea, Sinus congestion, Sinus headache
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Started with Runny Nose. By evening, I had a slight sore throat from drainage. Sinus pressure behind eyes that night (10-13-09) and next day. On 10-14-09, I had a headache similar to head cold and felt tired from blowing my nose all night long. Night of 10-14-09, drainage is trying to work its way in to my chest with slight coughing up of drainage. On 10-15-09, sinus drainage slowed up and almost stopped, but still have some chest congestion. Over the past days, I have taken Theraflu for symptoms.

VAERS ID:361344 (history)  Vaccinated:2009-10-15
Age:43.0  Onset:2009-10-15, Days after vaccination: 0
Gender:Male  Submitted:2009-10-18, Days after onset: 3
Location:Tennessee  Entered:2009-10-18
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 1IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Aches, Headache, slight fever on 10/15/2009. By 10/16/2009, all symptoms worse, fever 103.2, visited walk in clinic - diagnosis - more than likely - H1N1 as a result of the live virus vaccine. Said no treatment available except medicine to control fever, rest and lots of fluids.

VAERS ID:361588 (history)  Vaccinated:2009-10-16
Age:43.0  Onset:2009-10-17, Days after vaccination: 1
Gender:Female  Submitted:2009-10-19, Days after onset: 2
Location:Pennsylvania  Entered:2009-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oropharyngeal pain, Rash
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: rash and mild sore throat

VAERS ID:361847 (history)  Vaccinated:2009-09-15
Age:43.0  Onset:2009-09-21, Days after vaccination: 6
Gender:Male  Submitted:2009-10-20, Days after onset: 29
Location:New Jersey  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC allergy meds
Current Illness: none; FYI-had annual physical and bloodwork on 8/3/2009, with all normal results.
Preexisting Conditions: mild seasonal allergies
Diagnostic Lab Data: MRIs show myolitis (inflammation in the spinal cord from C2-C4) and white spots on brain. These issues suggest MS. Spinal tap (LP) done on 10/16/2009 support diagnosis of MS. Seeking second opinion.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3211AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypoaesthesia, Lumbar puncture abnormal, Multiple sclerosis, Myelitis, Nuclear magnetic resonance imaging abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Demyelination (narrow)
Write-up: Tingling in right hand fingers progressed over then next week to right side of body and worsening to numbness, especially in right hand. Eventually, referred to neurologist where MRIs show myolitis (inflammation in the spinal cord from C2-C4) and white spots on brain. These issues suggest MS. On 10/15/2009, started 3 days of intravenous steroids followed by oral Prednisone.

VAERS ID:362021 (history)  Vaccinated:2009-09-10
Age:43.0  Onset:2009-09-10, Days after vaccination: 0
Gender:Female  Submitted:2009-09-17, Days after onset: 7
Location:Georgia  Entered:2009-10-21, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: Patient state she takes allergy medication.
Diagnostic Lab Data:
CDC Split Type: GA09034
Vaccination
Manufacturer
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSHBVB583AACP1IMRA
Administered by: Public     Purchased by: Private
Symptoms: Nervousness, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient called 9-17-09 stating she was having itching and slight swelling two hours post getting shot, which went away and two days later she bean to itch again. She states she is leaving for California tomorrow 9/18/09 and is unsure if the reocurring itching is coming from the shot or her nerves. Patient also states she suffers from allergies. She suffers from allergies. Itching is releaved per medication. Encouraged to check with Dr. States she will just take some Benadryl if needed.

VAERS ID:362030 (history)  Vaccinated:2009-10-19
Age:43.0  Onset:2009-10-19, Days after vaccination: 0
Gender:Male  Submitted:2009-10-21, Days after onset: 2
Location:North Carolina  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: PAST HX. Client reports 02/06/2009 until 07/2009 illness. States specialist dx. unidentified virus after extensive testing. S/S began with "feeling hot inside (hot patches)like a sunburn that would move throughout different areas of the body." Also had various joint pain. Sores in mouth for several days and then bronchitis. S/S subsided sometime in July.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Feeling hot
SMQs:
Write-up: Client states feeling hot inside (hot patches) at various ares of body and face. Areas would move from spot to spot. Felt like sunburn. See past Hx. Felt worse during the night and early AM. States better now (10/20/2009 4:30 PM). States discussed with MD and was advised seek medical attention if cont. or worsens. States plans to see MD this week for seasonal flu vaccine as advised by MD. Client states he will call if any further px.

VAERS ID:362068 (history)  Vaccinated:2009-10-01
Age:43.0  Onset:2009-10-01, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 20
Location:Texas  Entered:2009-10-21
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
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3202AA  LA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Muscle spasms
SMQs:, Dystonia (broad)
Write-up: LEFT SIDE OF NECK GOT REAL SWOLLEN IN LYMPH NODES, LEG CRAMPS

VAERS ID:362129 (history)  Vaccinated:2009-10-21
Age:43.0  Onset:2009-10-21, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 0
Location:Ohio  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Wheezing.~Influenza (Seasonal) (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness: was tight waking yest
Preexisting Conditions: Asthma
Diagnostic Lab Data: aerosol; epinephrine 1/1000 .3 cc given Se
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98439P11IMRA
Administered by: Other     Purchased by: Other
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)
Write-up: 5 minutes after receiving Flu shot developed deep coughing.

VAERS ID:362141 (history)  Vaccinated:2009-09-28
Age:43.0  Onset:2009-09-28, Days after vaccination: 0
Gender:Female  Submitted:2009-10-21, Days after onset: 23
Location:Tennessee  Entered:2009-10-21
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: slight egg allergy, hypersomnia sleep disorder, low thyroid, period limb movement, exercise induced asthma, pms
Diagnostic Lab Data: spoke with nurse at employee health who prescribed Medrol dose pack. had skin and RAST testing which actually came back negative for egg allergy. May have been skewed by meds.
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Chest discomfort, Cough, Dysphonia, Oral pruritus, Oropharyngeal pain, Pharyngeal oedema, Pruritus, Radioallergosorbent test negative, Skin test negative
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: itching in inner ears, roof of mouth, hoarseness, tightness in chest, coughing (asthmatic), itching skin, very sore throat, some throat swelling.

VAERS ID:362189 (history)  Vaccinated:2009-10-20
Age:43.0  Onset:2009-10-21, Days after vaccination: 1
Gender:Female  Submitted:2009-10-22, Days after onset: 1
Location:Georgia  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA IMUN
Administered by: Private     Purchased by: Public
Symptoms: Headache
SMQs:
Write-up: Headache 1 hour after vaccine. Concerned because son got vaccine at the same time and also developed headache.

VAERS ID:362199 (history)  Vaccinated:2009-10-21
Age:43.0  Onset:2009-10-21, Days after vaccination: 0
Gender:Male  Submitted:2009-10-22, Days after onset: 1
Location:Connecticut  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Wears Contact Lenses
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500754P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Accidental exposure, Lacrimation increased
SMQs:, Lacrimal disorders (narrow)
Write-up: Nurse inadvertantly sprayed part of 2nd half dose of Monovalent Flu Mist onto the paitent''s right side of face. Nurse told patient to immediately wash face. Patient complied. Patient returned to work and changed his shirt. He also took out disposable contact lens, rinsed and replaced it. His eye then became teary. Patient reported it to his supervsior and then called us (the health department.) This morning about 10 AM, patient reports to having no problems. He reports conjuctiva is not reddened or weepy. Patient was told to contact his eye doctor or his regular physician if he had any further problems.

VAERS ID:362268 (history)  Vaccinated:2009-10-21
Age:43.0  Onset:2009-10-22, Days after vaccination: 1
Gender:Female  Submitted:2009-10-22, Days after onset: 0
Location:Arkansas  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3199AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Palpitations, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Had itching on back about 5 hours after injection. Continued itching and noticed hives on back around 22:00. Took over the counter antihistimine. Stated she still had hives on back, neck, stomach and was itching this morning when she called me at appr. 09:00. Reported no Shortness of breath at any time, but did have a few heart palptations around 17:00 (when she first starting noticeing the itching).

VAERS ID:362362 (history)  Vaccinated:2009-10-22
Age:43.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Unknown  Submitted:2009-10-22, Days after onset: 0
Location:Florida  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA IMUN
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chills, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 9:00am pt with vital signs (137/89), pt in complaining weakness, nausea, shivering. Keeping in observation. Pt denies any history of disease or current medication.

VAERS ID:362447 (history)  Vaccinated:2009-10-23
Age:43.0  Onset:2009-10-23, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 0
Location:South Carolina  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: None
Diagnostic Lab Data: Received Claritin 10 PO in Employee Health
CDC Split Type:
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500761P0IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash upper left chest and bilateral ears with itching.

VAERS ID:362476 (history)  Vaccinated:2009-10-16
Age:43.0  Onset:2009-10-18, Days after vaccination: 2
Gender:Male  Submitted:2009-10-19, Days after onset: 1
Location:Washington  Entered:2009-10-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98432P10UNLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site discharge, Injection site erythema, Injection site scab, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, swollen at site of injection. Red spot approximately 1 centimeter diameter with scab at center. Patient squeezed pus from injection site the day prior to today. No pain, no fever and not feeling sick.

VAERS ID:362593 (history)  Vaccinated:2009-10-19
Age:43.0  Onset:2009-10-19, Days after vaccination: 0
Gender:Female  Submitted:2009-10-19, Days after onset: 0
Location:Washington  Entered:2009-10-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Attached
Current Illness: None
Preexisting Conditions: Allergies (seasonal); Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP002AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Arthralgia, Chills, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Inj at 11am - Approx. 230p Pt started getting joint pains, cold chills, wheezing. Spoke with her daughter at her home next day (10/20) and patient had done fine and had gone to work on 10/20 as usual.

VAERS ID:362637 (history)  Vaccinated:2009-10-19
Age:43.0  Onset:2009-10-20, Days after vaccination: 1
Gender:Male  Submitted:2009-10-24, Days after onset: 4
Location:Maryland  Entered:2009-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache
SMQs:
Write-up: Headache on and off for 5 days located radiatingf from the back of the eyes to the base of the skull. Described as a naging dull ache.

VAERS ID:362683 (history)  Vaccinated:2009-10-22
Age:43.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-25, Days after onset: 3
Location:Ohio  Entered:2009-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: No
Diagnostic Lab Data: None. BP taken during event was 130/101
CDC Split Type:
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Dizziness, Dyspnoea, Feeling abnormal, Hyperhidrosis, Pallor, Palpitations, Tachycardia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Feeling of impending doom, pale, diaphoretic, shaky, lightheaded, red raised welts on face and right arm. Burning sensation on right arm, and shortness of breath. Also racing heart rate (tachycardic).

VAERS ID:362727 (history)  Vaccinated:2009-09-10
Age:43.0  Onset:2009-09-10, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 43
Location:Georgia  Entered:2009-10-26, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3176CA IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Chest discomfort, Dysphonia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Tightness in throat/chest, hoarse voice.

VAERS ID:362889 (history)  Vaccinated:2009-09-16
Age:43.0  Onset:2009-09-17, Days after vaccination: 1
Gender:Female  Submitted:2009-10-26, Days after onset: 39
Location:Kansas  Entered:2009-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: XYZAL; NORDETTE; DETROL LA
Current Illness: None
Preexisting Conditions: Allergies: pcn, sulfa, erythromycin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3253BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site joint pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: No pain @ time of insertion. Next day noticed pain with movement of (Rt) shoulder. Continues today (10/26/09) to have pain with any cross over type movement of Rt arm. Pain with dressing, baking, cleaning.

VAERS ID:362990 (history)  Vaccinated:2009-10-13
Age:43.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-10-13, Days after onset: 0
Location:Tennessee  Entered:2009-10-27, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yes~Hep B (no brand name)~2~22.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: ASA, Compazine, PCN, Iodine; Lidocaine, HX: Lupus; HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR500757P0IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Hypoaesthesia facial, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: 2-3 minutes after receiving H1N1 FLUMIST vaccine patient started feeling tingling in lips and tip of tongue. After about 7-10 minutes lips and tip of tongue became numb, no respiratory difficulty, throat was not numb. After 15 minutes patient reported numbness progressed to lower area around lips and nasal area, still no swelling of throat or nasal passages. Phone call to Dr. at clinic describing patient symptoms, phone order given to give BENADRYL 25mg capsule and observe for 1 hour, patient aware and capsule given po at 12:40PM. 12:50PM patient states, "The numbness is still present and has moved further down tongue but still not in throat, no problems breathing" 12:50Pm spoke with FNP about present symptoms and order given to administer BENADRYL 25mg. IM now, patient aware and regards positive; BENADRYL 25mg given in (RG) IM with inst. 1:00 patient states "It seems to be a little better, the numbness is letting up a little back of tongue. Still numb lips and around face and nose." No Sxs of respitory distress. 1:10 PM. Pt states "my tongue is getting a lot better, lips and surrounding face still numb." No Sxs of respiratory distress. LE 12:40 PM BP 120/70 AP 90b/min Respirations 14 1:30 Pm BP 120/70 AP 90 b/min Respirations 15 pt states "my tongue is still tingling just @ tip, the rest of tongue is okay now, lips and surrounding face area just tingling. I am very drowsy." 1:40 PM patient states, "just a little tingling in lips, I would like to go back to work now." Discussed not driving due to drowsiness. Discussed calling if any further problems arise. Discussed contacting PMD to report this side effect.

VAERS ID:362997 (history)  Vaccinated:2009-10-23
Age:43.0  Onset:2009-10-26, Days after vaccination: 3
Gender:Male  Submitted:2009-10-27, Days after onset: 1
Location:Connecticut  Entered:2009-10-27
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:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Chest discomfort, Dry mouth, Dyspnoea, Panic attack
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: reports awakening at 1 am with panic attack-sob, chest tightness, dry mouth. Symptoms resolved within one hour and he fell back asleep. Has never had panic attack in past.

VAERS ID:363047 (history)  Vaccinated:2009-10-16
Age:43.0  Onset:2009-10-18, Days after vaccination: 2
Gender:Male  Submitted:2009-10-20, Days after onset: 2
Location:Texas  Entered:2009-10-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma. 10/28/09: Medical records received for dates 10/20/09 to 10/22/09. PMH: Appendectomy. Abdominal surgery.
Diagnostic Lab Data: Sputum, blood cultures negative; Strep screen negative; Negative for Rapid Flu A; Positive for H1N1. 10/28/09: Medical records received for dates 10/20/09 to 10/22/09. Labs and diagnostics: WBC 12.98 (H). EKG: Sinus tachycardia. CT Head-no acute intercrainal abnormalities. CXR-No acute findings. 11/17/09 Hospital records received for dates 10/20/09 to 10/22/09. Diagnostics/Labs: CXR(-), Flu A&B(-), WBC 22.48(H), neutrophils 80.7(H), HCT 34(L), blood cult(-).
CDC Split Type:
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500759P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Blood culture negative, Chest X-ray normal, Chills, Cough, Electrocardiogram, Haematocrit decreased, Headache, Influenza serology negative, Influenza serology positive, Neutrophil count increased, Oropharyngeal pain, Pain, Pyrexia, Scan brain, Sputum culture, Streptococcus identification test negative, Viral infection, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad)
Write-up: Pt started 10/18/09 developing dry, nonproductive cough, fevers to 103, generalized body aches and joint pains. 10/28/09: Medical records received for dates 10/20/09 to 10/22/09. Final DX: Viral Syndrome with fever. Assessment: Scratchy throat progressed to dry, nonproductive cough, sore throat, fevers to 103 and generalized body aches and joint pains, specifically worse in the hips and knees. Also has some HA which gets worse with coughing. 11/17/09 Hospital records received for dates 10/20/09 to 10/22/09. DX: viral syndrome with fever. SX: fever, cough, chills, sore throat, body aches. ID consult DX viral syndrome. ICD9 codes: 780.6, 079.99, 462, V58.66

VAERS ID:363201 (history)  Vaccinated:2009-10-23
Age:43.0  Onset:2009-10-24, Days after vaccination: 1
Gender:Female  Submitted:2009-10-27, Days after onset: 3
Location:Michigan  Entered:2009-10-27
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: History of an allergy to Thimerisol
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3176CA1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest discomfort, Cough, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: dry non-productive cough clearing throat on a frequent basis sensation of chest tightness

VAERS ID:363500 (history)  Vaccinated:2009-09-23
Age:43.0  Onset:2009-09-23, Days after vaccination: 0
Gender:Female  Submitted:2009-10-28, Days after onset: 35
Location:Florida  Entered:2009-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: X-ray''s and MRI
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 15IJRA
Administered by: Private     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injected limb mobility decreased, Injection site inflammation, Injection site pain, Insomnia, Joint swelling, Nuclear magnetic resonance imaging abnormal, Pain, Swelling, X-ray
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Immediate soreness to site. Increasingly got worse... pain at upper arm/shoulder area. Difficulty lifting arm, rotating and sleeping. Went to Chiropractor who tried manipulating it, to no avail. Sent for MRI and images came back with incredible inflammation at injection site-- causing swelling to joints & tendons.

VAERS ID:363714 (history)  Vaccinated:2009-09-10
Age:43.0  Onset:2009-09-10, Days after vaccination: 0
Gender:Female  Submitted:2009-10-29, Days after onset: 49
Location:Michigan  Entered:2009-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3192AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Burning sensation, Pain
SMQs:, Peripheral neuropathy (broad)
Write-up: Within a few days of receiving vaccine up until present time, I have experienced intermittent, burning pain in left shoulder with movement away from body. It has been over a month, and finally improving somewhat.

VAERS ID:363922 (history)  Vaccinated:2009-10-25
Age:43.0  Onset:2009-10-26, Days after vaccination: 1
Gender:Female  Submitted:2009-10-30, Days after onset: 4
Location:Pennsylvania  Entered:2009-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: mild nasal congestion
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500754P0IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Pain, Weight bearing difficulty
SMQs:, Arthritis (broad)
Write-up: Significant right hip pain, aggrevated with extending sitting, caused limited weight bearing ability. Resolved in approximately 48 hours

VAERS ID:363924 (history)  Vaccinated:2009-10-29
Age:43.0  Onset:2009-10-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-30, Days after onset: 1
Location:Pennsylvania  Entered:2009-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pt is pregnant. PMH: chronic HTN.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP002AA0IMRA
Administered by: Public     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow)
Write-up: Pt called at 3:15 PM to report after being vaccined, she went home to take a nap and woke up to itchy rash on chest and neck. Pt called her primary obstitritian and they told her to take benedryl. After one dose of the benedryl, the rash subsided and there is no evidence of the rash today, 10/30/2009. 11/2/09 Medical records received for dates 10/30/09. Progress note. EDD 4/8/10 last visit 10/23/09 no problems.

VAERS ID:363956 (history)  Vaccinated:2009-10-29
Age:43.0  Onset:2009-10-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-30, Days after onset: 1
Location:Wisconsin  Entered:2009-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Asthma
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bronchospasm, Chest X-ray normal, Chest discomfort, Dizziness, Dyspnoea, Nausea, Reaction to previous exposure to any vaccine, Throat tightness, Tremor, Vaccination complication, Visual impairment, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Vommitting,shaking, SOB, and Pt reported trouble breathing and visual problems, and throat closing.

VAERS ID:364210 (history)  Vaccinated:2009-10-14
Age:43.0  Onset:2009-10-15, Days after vaccination: 1
Gender:Female  Submitted:2009-11-02, Days after onset: 18
Location:Massachusetts  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEUR 0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Cough, Hypoaesthesia, Influenza like illness, Listless, Pain, Pyrexia, Sneezing
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad)
Write-up: woke up sore, achy. dry cough. fever. sneezing. weak. next day, felt as though i had the flu. stayed in bed all day. very weak and achy. sneezing. this lasted about 7 days. over past three weeks since the initial week with sneezing and coughing, i have been incredibly achy and sore in particular areas of my body. forearms, shoulders, hips, butt, knees and occasionally my wrists. also, some numbness in my hands and left calf. as an fyi. i am very fit and active and never feel aches, pains or lethargy of any sort. this is an extremely unusual way for me to feel. listless and no energy and keep thinking it will go away, but now that it has been close to a month post the flu shot, i am becoming very concerned that there is a correlation between the shot and this pathology.

VAERS ID:364280 (history)  Vaccinated:2009-10-27
Age:43.0  Onset:2009-10-28, Days after vaccination: 1
Gender:Male  Submitted:2009-11-02, Days after onset: 5
Location:Virginia  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Short-fiber sensory neuropathy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Acoustic stimulation tests, Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: Sudden onset loud left tinnitus. Still present 5 days later. Hearing test scheduled tomorrow. Likely permanent according to ENT

VAERS ID:364297 (history)  Vaccinated:2009-10-29
Age:43.0  Onset:2009-10-31, Days after vaccination: 2
Gender:Male  Submitted:2009-10-31, Days after onset: 0
Location:Indiana  Entered:2009-11-02, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none 10/31/09
CDC Split Type:
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TTOX: TETANUS TOXOID (NO BRAND NAME)SANOFI PASTEURU2883BA0IMUN
Administered by: Other     Purchased by: Private
Symptoms: Induration, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Donor noticed multiple red raised areas on shoulder,arm and wrist area. Increased itching. Area are raised and hard to touch. Denies any other s/s. Dr @ med ops notified. Informed he can take BENADRYL for itching. If rash get worse see your HCP.

VAERS ID:364382 (history)  Vaccinated:2009-10-20
Age:43.0  Onset:2009-10-21, Days after vaccination: 1
Gender:Female  Submitted:2009-10-26, Days after onset: 5
Location:South Carolina  Entered:2009-11-02, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: Dr Office visit, ER visit
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0UNAR
Administered by: Public     Purchased by: Other
Symptoms: Cough, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Treatment TAMIFLU 75mg BID x 5 days onset cough. Fever 101.5, body ache, SOB.

VAERS ID:364561 (history)  Vaccinated:2009-10-24
Age:43.0  Onset:2009-11-02, Days after vaccination: 9
Gender:Male  Submitted:2009-11-02, Days after onset: 0
Location:Michigan  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.MIST500757P0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Pain
SMQs:
Write-up: Aches, pains, headache

VAERS ID:364774 (history)  Vaccinated:2009-10-27
Age:43.0  Onset:2009-10-28, Days after vaccination: 1
Gender:Female  Submitted:2009-11-03, Days after onset: 6
Location:Illinois  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Sinus problems
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPOO0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Myalgia, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Muscle soreness and tenderness to touch around collar area. Extends around neck to collar bone and down to scapula area.

VAERS ID:364787 (history)  Vaccinated:2009-10-10
Age:43.0  Onset:2009-10-11, Days after vaccination: 1
Gender:Male  Submitted:2009-11-03, Days after onset: 23
Location:New York  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Stated he had some cold symptoms with a sore throat. Denied fever
Preexisting Conditions: Unknown-admitted to having had flu shot in previous years
Diagnostic Lab Data: Client made appointment to see his primary care physician on Friday, Oct.16th at 10:20am. Client agreed to follow up with writer with MD recommendations and treatment. Writer tried calling client on Friday afternoon and left message. Also
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3199AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site haematoma, Rash vesicular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: Woke up with small blister like rash under both arms, between elbow and wrist, back, abdominal area, front left leg and buttocks area. No itching. Complained of some bruising at injection site. Called to report his symptoms on Monday, October 12th. Stated he was noting some improvement in symptoms. Medical Director made aware of event.

VAERS ID:365096 (history)  Vaccinated:2009-10-23
Age:43.0  Onset:2009-11-03, Days after vaccination: 11
Gender:Female  Submitted:2009-11-04, Days after onset: 1
Location:Maryland  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA278AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Cheilitis
SMQs:
Write-up: sores on lip

VAERS ID:365178 (history)  Vaccinated:2009-10-19
Age:43.0  Onset:2009-11-02, Days after vaccination: 14
Gender:Female  Submitted:2009-11-04, Days after onset: 2
Location:Wisconsin  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: No birth defects, no medical conditions @ time of vaccination. The only known drug reaction I have had was an allergic reaction to Floxin (for a UTI).
Diagnostic Lab Data: Did not go to the emergency room...I am in school, and had a test to take the next morning. I''m hoping these are just transient incidents.
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP002AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Burning sensation, Dysstasia, Fall, Hypoaesthesia, Sluggishness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Arthritis (broad)
Write-up: I was in bed sleeping, and heard our dog whine to go outside. I went to get out of bed, and fell right to the floor. I could not feel my legs, but they were not tingling like they were "asleep"...they just felt "dead". I could not stand up for about 5 minutes. I could move my legs, but could not really "feel" them. The closest thing I could equate it to was like having an epidural that numbed my legs from mid thigh and down. I tried several times to stand, and after a few minutes, I was able to crawl up the footboard and "get my legs under me". When I would try to walk, they would respond, but sluggishly. It took a few more minutes before I was able to walk fairly normally again. Two nights later, about 5:00 pm, I was sitting at the dining room table, and both knees felt like they were on fire, with intense aching. That lasted for about 1/2 hour, then went away. I''m not a sick person--I have an immune system that is like a tank. These two incidents were WEIRD. Not being able to walk was very startling.

VAERS ID:365288 (history)  Vaccinated:2009-10-22
Age:43.0  Onset:2009-10-22, Days after vaccination: 0
Gender:Female  Submitted:2009-10-30, Days after onset: 8
Location:Oregon  Entered:2009-11-05, 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: No
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500751P1IN 
Administered by: Private     Purchased by: Other
Symptoms: Chest discomfort, Dizziness, Hypoaesthesia, Muscular weakness, Nausea, Paraesthesia, Sensation of heaviness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Sudden, dizziness, nausea, tingling and numbness in arms and legs. Legs, felt weak and heavy. Chest felt tight. Persisted for 3 hours also then intermittently over next few days. Observed in the ER for 2 hours. No tx was given.

VAERS ID:365314 (history)  Vaccinated:2009-10-06
Age:43.0  Onset:2009-10-10, Days after vaccination: 4
Gender:Female  Submitted:2009-11-05, Days after onset: 26
Location:New Hampshire  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: Vertigo and nausea. Severe enough to stay in bed 24 hours, then abated over one week without specific therapy.

VAERS ID:365468 (history)  Vaccinated:2009-10-30
Age:43.0  Onset:2009-10-30, Days after vaccination: 0
Gender:Female  Submitted:2009-11-03, Days after onset: 4
Location:California  Entered:2009-11-05, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Flushing, Injection site erythema, Injection site pruritus, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: H1N1 vaccine left deltoid, received at 19:30 on 10/30/09. At 21:30 hrs removed band aid noticed redness about 70m x 70 mm. Rubbed area. Felt warm to touch. Complain of itching to area and face flushed, lasted x 2 days. No medication taken.

VAERS ID:365478 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2009-11-05, Days after onset: 2
Location:Colorado  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergy to sulfa drug
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP005AA0IMLA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500695P1IN 
Administered by: Public     Purchased by: Private
Symptoms: Chills, Dizziness, Headache, Immediate post-injection reaction, Local swelling, Lymphadenopathy, Nasal discomfort, Skin warm, Throat irritation
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 11/3/09 Within 45 sec-1 min-burning sensation in throat and nose, 5 min later-headache (whole head) dizziness. 7 hours later-swollen lymph nodes both sides of neck, general swelling back of neck. Dizziness resolving and headache. ADVIL (2) taken. Chills and skin warm to touch. 11/4/09 Woke up next AM with feeling that throat was constricted, difficult to swallow, swollen tongue. Lymph nodes in neck still swollen, small amt shortness of breath. Chills and cotinued skin warm to touch. ADVIL taken again feeling tired. 11/5/09 All symptoms above continue. Contacted MD- BENADRYL and TYLENOL ordered x1. Suggested pt recontact MD and ask how to continue taking BENADRYL. Pt. reports only had 1 inactivated flu shot last year. Allergic to Sulfa drugs.

VAERS ID:365579 (history)  Vaccinated:2009-10-30
Age:43.0  Onset:2009-10-31, Days after vaccination: 1
Gender:Female  Submitted:2009-11-02, Days after onset: 2
Location:Texas  Entered:2009-11-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0627Y UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Mobility decreased, Pain in extremity, Tenderness
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain, tenderness of affected L arm with decreased mobility x4 days.

VAERS ID:365654 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Male  Submitted:2009-11-06, Days after onset: 3
Location:Wyoming  Entered:2009-11-06
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: Br Asthma; Air chr; Migraine
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS10127604 IMUN
Administered by: Private     Purchased by: Public
Symptoms: Headache, Nausea, Tremor, Visual impairment
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Headache, tremor, nausea. "Falling star" in Rt eye. Recovered completely in 24 hrs.

VAERS ID:365798 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:2009-11-06, Days after vaccination: 3
Gender:Female  Submitted:2009-11-06, Days after onset: 0
Location:Kentucky  Entered:2009-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium, Ester c, Amphetamine Salts 10mg, Gabapentin 300mg, Budeprion XL 150mg namenda 10mg, Ortho Tri Cyclen Lo
Current Illness: none
Preexisting Conditions: allergic to copaxone, Generic Septra Ds Tablets, Keflex, Crab legs, Iodine. Medical Conditions,Multiple Sclerosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort, Dysphonia
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad)
Write-up: Symptoms, when I woke up heaviness in chest area and Hoarseness. Haven''t went to doctor yet but I did call, had to work. If not better by Monday will go to doctor.

VAERS ID:365836 (history)  Vaccinated:2009-10-18
Age:43.0  Onset:2009-10-31, Days after vaccination: 13
Gender:Male  Submitted:2009-11-07, Days after onset: 7
Location:New Mexico  Entered:2009-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
DTAP: DTAP (ACEL-IMUNE)PFIZER/WYETH    
Administered by: Unknown     Purchased by: Private
Symptoms: Abdominal pain, Back pain, Costovertebral angle tenderness
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pain in the right costovertebral angle area initially then similar pain on the left which has worsened and radiates around to the left side of abdomen. Skin over painful area is sensitive to touch and has a burning sensation. The distribution of the pain is dermatomal in nature.

VAERS ID:365853 (history)  Vaccinated:2009-10-27
Age:43.0  Onset:2009-10-29, Days after vaccination: 2
Gender:Female  Submitted:2009-11-07, Days after onset: 9
Location:Washington  Entered:2009-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma and Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS100739  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Flushing, Loss of consciousness, Pruritus generalised
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad)
Write-up: 20 minutes after the injection started haveing problems breathing, like I couldn''t catch my breath. I talked to my charge nurse and I took two puffs of my inhaler. That didn''t help and I was getting worse. My face was getting red. my BP was 168/90 and I was getting dizzy. At that point my charge nurse said I need to go the the emergency room. So her and a transporter brought me down in a wheelchair. While on the way down I kept trying not to lose consciousness. Arrived at the emergency room and they put me on oxygen and EKG my blood pressure was still high. The dr assessed me. After while they gave me two Benadryl because I had itching all over my body. I was given a albuterol to help with my breathing. Was given meds to go home with (steroid for my lungs- can''t remember what it was).

VAERS ID:366409 (history)  Vaccinated:2009-11-04
Age:43.0  Onset:2009-11-05, Days after vaccination: 1
Gender:Female  Submitted:2009-11-10, Days after onset: 5
Location:New York  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild cold symptoms
Preexisting Conditions: Allergic to Toradol, Biazin, and Cefzil - all cause severe vomiting/diarrhea requiring IV fluids and Potassium
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Chest pain, Cough, Disturbance in attention, Fatigue, Headache, Malaise, Myalgia, Neck pain, Neuralgia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe malaise, fatigue, poor concentration, head and neck ache, myalgia, rhinorrhea, deep cough, chest pain, progressively worsening over a course of a week with development of burning nerve root pain to right upper chest, axilla, and right scapular region consistent with onset of shingles.

VAERS ID:366443 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-11-03
Location:California  Entered:2009-11-10, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA UNLA
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: None

VAERS ID:366446 (history)  Vaccinated:2009-11-05
Age:43.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-05, Days after onset: 0
Location:Virginia  Entered:2009-11-10, 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: Reported history of panic attacks
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500780P0IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Blood pressure increased, Palpitations, Sensation of heaviness
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad)
Write-up: H1N1 mist administered. Pt c/o heart palpitations, arms feeling heavy, B/P 160/110, P 80. Pt to clinic for evaluation by MD.

VAERS ID:366501 (history)  Vaccinated:2009-10-28
Age:43.0  Onset:2009-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-11-10, Days after onset: 13
Location:Louisiana  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: excruciating pain in right arm within 4 hours of administration
Preexisting Conditions: none
Diagnostic Lab Data: PT RECEIVING MRI TODAY
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED08549111A1IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Nuclear magnetic resonance imaging, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: EXCRUICIATING PAIN IN RIGHT ARM

VAERS ID:366515 (history)  Vaccinated:2009-11-06
Age:43.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-10, Days after onset: 4
Location:Ohio  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to Kiwi, Bananas , Strawberries, Coconut,cats and dogs, pollen
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPO16AA0IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt. states a neighbor noticed she had raised red rash on arms and face at approximately 3:30PM on 11/06/2009. Denies any other symptoms. Pt took Benadryl 25mg capx1and put benadryl cream on rash. Rash subsided by 9:45 PM

VAERS ID:366563 (history)  Vaccinated:2009-11-07
Age:43.0  Onset:2009-11-09, Days after vaccination: 2
Gender:Female  Submitted:2009-11-10, Days after onset: 1
Location:Florida  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: SOB Hives Facial edema~Hep A + Hep B (no brand name)~~27.00~Patient
Other Medications: Avinza. Tylox, Skelaxin,Buspar, Rozerom, Fish Oil, Klonopin, Lisinopril, Micardis,Hydochlorothizide, clonidine, lyrica
Current Illness: none
Preexisting Conditions: Chronic Renal Disease Allergies: Zofran, Savella, Ultram, Methadone, Ceftin, Anaprox, Bactroban, Hepatitis Vaccine, Adhesive tape, Vanco IV, gent eye gel, PCN, Sulfa
Diagnostic Lab Data:
CDC Split Type: H1N1
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP004AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Face oedema, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: severe headache and very moderate amount of facial edema which required a referal to the emergency room via personal physician with treatment to include medro;-steroid dose pack, phenerga for nausea, lortab for severe headach and benadryl

VAERS ID:366572 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:2009-11-09, Days after vaccination: 6
Gender:Male  Submitted:2009-11-11, Days after onset: 2
Location:Nebraska  Entered:2009-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Some allergy problems. Mild asthma symptoms
Preexisting Conditions: asthma and allergies proven to be caused by two types of common molds
Diagnostic Lab Data: patient given 3 grams valtrex each day for 10 days. Too early to speculate on recovery.
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJRA
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: bad shingles outbreak. Never had shingles before. On right side of back and right side of stomach

VAERS ID:366809 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 9
Location:Georgia  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: 11-11-09, CT facial scan, no sinus infection 11/13/09 Labs and Diagnostic studies: BP 140/90 (H), CT scan of the face revealed no sinus infection.
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP018AA0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Angioedema, Blood pressure fluctuation, Computerised tomogram normal, Dizziness, Dyskinesia, Eyelid oedema, Facial palsy, Feeling jittery, Headache, Hypersensitivity, Hypoaesthesia, Hypoaesthesia facial, Hypoaesthesia oral, Malaise, Mouth cyst, Nervousness, Paraesthesia, Rash, Rhinorrhoea, Upper respiratory tract congestion, Visual impairment
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Oropharyngeal neoplasms (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: 11-3-09 Rash - 6-8 hr later. 11-4-09 headache, took BENADRYL - got OK - jerky legs, yellow spot in front of eyes. 11-6-09 knot in roof mouth, spot worse. Rt side face went numb, legs started jerking. To Dr''s office - "facial paralysis right side - hosp to monitor - increased BP then bottom out - on BENADRYL. 11-7-09 discharged stayed on BENADRYL. 11-11-09 CT scan allergic reaction Dr. feeling back in face. 11-12-09 Back at work - no numbness, no jerky legs still has headache relieved with meds. 11/13/09 History and Physical received for DOS 11/06/09. Final DX: Angioedema and possible reaction to the flu vaccine. LC Pt developed a yellow spot in R eye, upper respiratory congestion, rhinorrhea, and not feeling well. The next day Pt developed big white yellowish spot in R eye, swelling of upper R eyelid, numbness and tingling around the R side of lip and legs, headache, and felt nervous and jittery. After the review of HEENT Pt had headache, some dizziness, paresthesias around lip, and swelling above the R eye. Upon examination, both legs were notably jittery and nervous-feeling. The Pt was sent to the hospital for further observation and discharged on 11/07/09 in good condition with only some headache. The physician believes that the Pt''s swelling was possibly due to an allergic reaction to H1N1 vaccine. 11/25/09 Discharge summary recieved for DOS 11/06-11/07 Final DX: Angioedema w/some transient visual disturbance changes felt r/to allergic reaction Hospital course as stated above. D/C to home. Tingling almost resolved, angioedema resolved. No HA, moving well. Finish Tamiflu.

VAERS ID:366937 (history)  Vaccinated:2009-10-21
Age:43.0  Onset:2009-10-21, Days after vaccination: 0
Gender:Male  Submitted:2009-11-12, Days after onset: 22
Location:California  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 10mg, simvastatin 20mg,ibuprofen 800mg
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLLA282AA0IJRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache
SMQs:
Write-up: on going headache and pressure along forehead area,since receiving vaccine.

VAERS ID:367182 (history)  Vaccinated:2008-10-15
Age:43.0  Onset:2008-10-15, Days after vaccination: 0
Gender:Female  Submitted:2009-03-02, Days after onset: 138
Location:Unknown  Entered:2009-11-12, Days after submission: 255
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Diagnostic Lab Data: not reported
CDC Split Type: 200900693
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR6714940 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Chest discomfort, Cough, Disorientation, Eye discharge, Eye irritation, Eye swelling, Feeling abnormal, Ocular hyperaemia, Pain, Pain in extremity, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This non serious case was received on 24 February 2009 from VAERS (reference number 328982) via a search of the QSCAN database. A 43 year old female patient received FLUZONE SV 2008-2009 (lot number 6714940) intramuscularly on 15 October 2008 at 1:00 PM. The patient began feeling a little disoriented and her arm ached. At 5:00 PM she developed a heavy, wheezing feeling in her chest with a cough. Her body was aching, her eyes became red and irritated. At approximately 3:00 AM she woke up and her eyes were swollen and almost matted shut. She went to the doctor''s at 10:30 AM the following day. The doctor did not think the patient''s symptoms were related to FLUZONE. She thought the patient had a virus. The patient was instructed to take TYLENOL cold medicine, BENADRYL, and rest. The patient continued to complain of aching and a very weak feeling, but her low grade fever resolved. The patient''s recovery status was not reported. No further information was reported. List of Documents held by Sender: none.

VAERS ID:367517 (history)  Vaccinated:2006-11-02
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:2009-03-19
Location:Unknown  Entered:2009-11-12, Days after submission: 238
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200901067
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2717A IMUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Eye discharge, Ocular hyperaemia, Oral discomfort, Oropharyngeal pain, Pain, Stomatitis, Vomiting, Wheezing
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Ocular hyperemia, eye discharge, stomatitis, wheezing, face red, pharyngolaryngeal pain, vomiting, pain. This non serious case was received on 11 march 2009 from VAERS (reference number 265980) via a search of the QSCAN database. A 43 year old female patient received FLUZONE SV 2006-2007 (lot number U2717AA, which is invalid) intramuscularly on 02 November 2006. Approximately two hours after receiving flu vaccine the in side of the patient''s mouth began burning and stinging. Her throat hurt and felt "like something was in it". Her face became red, eyes became bloodshot with a mucousy discharge. She began wheezing, vomiting, and became achy. She went to the urgent care facility and was given an anti-histamine. The patient reported a similar reaction to a flu vaccine which happened the prior year (manufacturer not provided). The patient was reported as recovered.

VAERS ID:367554 (history)  Vaccinated:2005-12-13
Age:43.0  Onset:2005-12-13, Days after vaccination: 0
Gender:Female  Submitted:2009-03-17, Days after onset: 1189
Location:Unknown  Entered:2009-11-12, Days after submission: 240
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: 200901031
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR49281037615 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Cough, Eye pruritus, Eye swelling, Fatigue, Headache, Myalgia, Ocular hyperaemia, Oropharyngeal pain, Pyrexia, Upper respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This non serious case was received on 11 March 2009 from VAERS (reference number 249423) via a search of the QSCAN database. A 43 year old female patient received FLUZONE SV ''2005-''2006 USP (lot number reported as 49281037615) on 13 December 2005 at 10:40 AM. Thirty minutes later the patient developed fatigue. At approximately 3:30 PM the patient developed a fever, muscle aches, headache, cough, chest congestion and a sore throat. At 8 PM the patient''s left eye became very red, itchy, and swollen. The patient treated the fever with Tylenol and the eye symptoms with ELESTAT. The patient recovered. List of Documents held by sender: None.

VAERS ID:367975 (history)  Vaccinated:2008-10-08
Age:43.0  Onset:2008-10-08, Days after vaccination: 0
Gender:Female  Submitted:2009-01-06, Days after onset: 90
Location:Michigan  Entered:2009-11-12, Days after submission: 310
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOXYL; Omeprazole; Vitamin D; TYLENOL ARTHRITIS
Current Illness:
Preexisting Conditions: History of rheumatoid arthritis, hypothyroidism, gastroesophageal reflux. No illness at the time of vaccination. No other vaccines given in the four weeks prior. From follow-up information received 21 November 2008, the patient previously received FLUZONE on 01 December 2007 and had no problems associated that vaccination. The patient''s concomitant medications included LEVOXYL, Ome
Diagnostic Lab Data: None
CDC Split Type: 200803407
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2832A1IMAR
Administered by: Private     Purchased by: Public
Symptoms: Discomfort, Immediate post-injection reaction, Injected limb mobility decreased, Injection site pain, Joint range of motion decreased, Musculoskeletal pain, Pain, Rotator cuff syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (narrow)
Write-up: Rotator cuff tenditnitis - Injected limb mobility decreased. Shoulder pain. Initial report received on 31 October 2008 from a healthcare professional in the United States. A 43 year old female, with a history of rheumatoid arthritis and unknown concomitant medications, received on 08 October 2008 a left deltoid intramuscular injection of FLUZONE (lot number U2832AA). She had no illness at the time of vaccination and had received no other vaccines in the previous four weeks. At the time of vaccination, the patient complained of pain. She continued to have a dull aching pain and one week later she began having difficulty abducting the left arm. At the time of the report, the symptoms were persisting. Follow-up information received from a health care professional on 21 November 2008. The patient had experienced immediate discomfort after the FLUZONE vaccination. Site of pain was confirmed to be the left shoulder with no radiation of pain. The patient continued to have constant left shoulder ache, pain with movements and limited range of motion in forward flexion due to pain. diagnosis was left rotator cuff tendinitis. Treatment included FLECTOR PATCH and six visits to physical therapy. As of 14 November 2008, the patient''s condition showed improvement. Follow up information was received on 22 December 2008 from a health care professional in the USA. The patient had a history of hypothyroidism and gastroesophageal disease in addition to rheumatoid arthritis. The start date of the left rotator cuff tendonitis and pain were on 08 October 2008. The patient was medically evaluated on 04 November 2008. As of 15 December 2008 she was 90% improved. She completed six visits of physical therapy. She would occassionally use a LIDODERM PATCH and over the counter TYLENOL. No further physician visits were needed. Documents held by sender: None.

VAERS ID:367350 (history)  Vaccinated:2009-10-22
Age:43.0  Onset:2009-10-23, Days after vaccination: 1
Gender:Female  Submitted:2009-11-14, Days after onset: 22
Location:Tennessee  Entered:2009-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu vaccine made sick to stomach~Influenza (Seasonal) (no brand name)~1~36.50~Sibling
Other Medications: Toprol XL 50 mg per day Neurontin 300 mg at night
Current Illness: no
Preexisting Conditions: Atrial Fibrillation, Sulfa allergy, 9mo post s/x
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Oral herpes
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal infections (narrow), Hypersensitivity (broad)
Write-up: Mouth broke out in multiple (approx 6) fever blisters that night. By Saturday, 10/24/09 had approx 4 more blisters appears inside and outside of the mouth.

VAERS ID:367507 (history)  Vaccinated:2009-11-12
Age:43.0  Onset:2009-11-12, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 4
Location:Puerto Rico  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ALLERGIC TO IODINE
Diagnostic Lab Data: NONE
CDC Split Type: PR0923
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1009236P0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: NAUSEA AND VOMITING

VAERS ID:367528 (history)  Vaccinated:2009-11-06
Age:43.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Male  Submitted:2009-11-13, Days after onset: 7
Location:Texas  Entered:2009-11-16, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS10127609 UNRA
Administered by: Private     Purchased by: Other
Symptoms: Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Mild problems; muscle aches and soreness through entire body.

VAERS ID:367590 (history)  Vaccinated:2009-11-11
Age:43.0  Onset:2009-11-12, Days after vaccination: 1
Gender:Female  Submitted:2009-11-16, Days after onset: 4
Location:Pennsylvania  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Occasional migraines
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Migraine, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe migraine with nausea and vomitting lasting for 48 hours

VAERS ID:367626 (history)  Vaccinated:2009-10-26
Age:43.0  Onset:2009-10-29, Days after vaccination: 3
Gender:Female  Submitted:2009-11-09, Days after onset: 11
Location:Ohio  Entered:2009-11-16, 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: Depo Privera
Current Illness: No illness.
Preexisting Conditions: No known allergies.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA0IMLL
Administered by: Public     Purchased by: Public
Symptoms: Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Pain in left arm biceps 2 days after vaccine no outward sign of swelling or redness. Pain is on movement no loss of muscle strength.

VAERS ID:367683 (history)  Vaccinated:2009-11-16
Age:43.0  Onset:2009-11-16, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 0
Location:Colorado  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Asthma, saesonal allergies
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102123P1A0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Dysgeusia, Headache
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt stated that she had a metallic taste in her mouth and felt dizzy. She also stated that she had right sided headache.

VAERS ID:367898 (history)  Vaccinated:2009-10-20
Age:43.0  Onset:2009-10-21, Days after vaccination: 1
Gender:Female  Submitted:2009-11-16, Days after onset: 26
Location:Illinois  Entered:2009-11-16
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: HTN
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Injected limb mobility decreased, Injection site pain, Injection site swelling, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Flu shot given in left deltoid. Pain began on 10/21/09, the day after the injection and pain progressively worse to left deltoid with mild swelling. Rates pain 8-10.5 out of 10 weakness to left shoulder began around 11/11/09, worsen unable to lift arm. No prior injury.

VAERS ID:368173 (history)  Vaccinated:2009-10-28
Age:43.0  Onset:2009-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-11-15, Days after onset: 18
Location:Tennessee  Entered:2009-11-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data: None.
CDC Split Type: TN09034
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB761AA0IMRL
Administered by: Public     Purchased by: Unknown
Symptoms: Adverse reaction, Asthenia, Contusion, Feeling hot, Malaise, Skin disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow)
Write-up: Received shot around 10:20am on 10/28/2009. Left the room after receiving shot but still in building- c/o felling "hot" about 10-11 min is shot given-week all over-had to sit down and given water to drink.-Did not return to nurse or let nurse know she was feeling ill. Next morning noticed "ink blot" like bruise on arm. Phoned her physician who stated vessel may have been hit and nurse " should have aspirated" and that is why she had the reaction. Also stated she had not had much to eat that day. Still has a slight bruise on her arm but no other c/o.

VAERS ID:368224 (history)  Vaccinated:2009-11-03
Age:43.0  Onset:2009-11-07, Days after vaccination: 4
Gender:Female  Submitted:2009-11-17, Days after onset: 10
Location:Indiana  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 10 mg po daily Prozac 10 mg po daily
Current Illness: had a cough that was resolving
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow)
Write-up: Noticed small blister corner of left side of mouth, which turned in to large fever blister later that day. On 11/10/09, noticed a second smaller area right corner of mouth.

VAERS ID:368465 (history)  Vaccinated:2009-11-14
Age:43.0  Onset:2009-11-15, Days after vaccination: 1
Gender:Female  Submitted:2009-11-18, Days after onset: 3
Location:Missouri  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Influenza A and B nasal swab negative on 11/18/09
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IJLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fatigue, Influenza serology negative, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Myalgias, Malaise, fatigue.

VAERS ID:368472 (history)  Vaccinated:2009-11-06
Age:43.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-17, Days after onset: 11
Location:Tennessee  Entered:2009-11-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Inhalant, other allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102040P10IMRA
Administered by: Other     Purchased by: Other
Symptoms: Dysphonia
SMQs:, Parkinson-like events (broad)
Write-up: Voice change - antihistamine, visit to clinic, eventually Steroid dose pack.

VAERS ID:368623 (history)  Vaccinated:0000-00-00
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-11-18
Location:Montana  Entered:2009-11-18
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: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Military
Symptoms: Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Flu shot 2005-swelled up, hives, 0 breath, ER, Rxn lasted 2 days for full recovery. Unsure of treatment.

VAERS ID:369083 (history)  Vaccinated:2008-05-12
Age:43.0  Onset:2008-05-13, Days after vaccination: 1
Gender:Male  Submitted:2009-11-20, Days after onset: 556
Location:California  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE 12/22/09 Opioid dependence; history of polysubstance dependence with current marijuana abuse; nicotine dependence; rule out mood disorder; rule out anxiety disorder; resolved acute withdrawal syndrome
Diagnostic Lab Data: White count was elevated. 12/22/09 White count elevated
CDC Split Type:
Vaccination
Manufacturer
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1418U0 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Altered state of consciousness, Decreased appetite, Diarrhoea, Headache, Hyperhidrosis, Injection site swelling, Pain, Pyrexia, White blood cell count increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow)
Write-up: Severe headache and bodyache followed by fever of 102.3 the following day after the shot. Also swelling at the injection site. The night of the second and third day profuse sweating and diarrhea. The diarrhea could have been due to not being able to take fluids. One more thing loss of apitite and sense of surroundings set in on the second day. Theses symptoms lasted for approximately one week with the fever tapering of a little each day. 12/22/09 DC summary and medical records received for DOS 05/09/08-05/31/08.Pt. initially presented to chemical dependency unit, referred by employer. Received pneumococcal vaccination while detoxing and developed fever and slightly elevated white count for several days which resolved. Also c/o tenderness in right arm near vaccination site, which also resolved. Pt. left AMA insisting all problems were related to vaccine. Readmitted next day to complete detox program. Became disruptive and failed to comply with program and left AMA, without option of readmission. DC DX: Opioid dependence; history of polysubstance dependence with current marijuana abuse; nicotine dependence; rule out mood disorder; rule out anxiety disorder; resolved acute withdrawal syndrome; possible pneumococcal vaccination reaction, resolved.

VAERS ID:369282 (history)  Vaccinated:2009-11-05
Age:43.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-22, Days after onset: 17
Location:North Carolina  Entered:2009-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Metformin, Simvastatin, Aspirin, Aleve, Liprinopril, Aciphex. Then when ears clogged started: Pseudoephedrine and Suprax. Seasonal flu date is an estimate. Taken sometime in Oct. 2009
Current Illness: NO
Preexisting Conditions: Type 2 Diabetes. Hypothyroid, supplemented by Synthroid.
Diagnostic Lab Data: Went to urgent care for pain in ears. Look in ears, gave me antibiotics. No lab work done.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IJRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Aphonia, Deafness bilateral, Dysphonia, Ear discomfort, Ear infection, Increased upper airway secretion, Malaise, Otic examination, Throat irritation
SMQs:, Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hearing impairment (narrow)
Write-up: May have had a scratchy throat before 7 pm, but it was very noticeable by 7 pm. Hoarseness, couldn''t lay down without getting sick because so much mucus in my throat. Slept sitting up. Lost my voice for a day. Then, ears closed up and lost my hearing in one ear, then the second ear. Never had runny nose or fever. 2 weeks later still have closed ears and ear infection. Not recovered yet.

VAERS ID:369326 (history)  Vaccinated:2009-11-05
Age:43.0  Onset:2009-11-10, Days after vaccination: 5
Gender:Male  Submitted:2009-11-23, Days after onset: 13
Location:Georgia  Entered:2009-11-23
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: predisone Symbicort Atrovent albuterol sulfate
Current Illness: Sinus infection.
Preexisting Conditions: Asthma PMH: Sleep apnea and asthma Allergies: PCN and sulfa
Diagnostic Lab Data: Hospital er visit 11-21-2009. No labs noted Dx studies: CXR wnl
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bronchitis, Chest X-ray normal, Cough
SMQs:, Anaphylactic reaction (broad)
Write-up: Coughing with diagnosed bronchitis diagnosed, even with taking Levaquin antibiotics. Had to take Biaxin in addition to this antibiotic. 11/25/2009 ED record for 11/21/2009, Impression Acute bronchitis patient presents with c/o''s cough. CXR norm

VAERS ID:369443 (history)  Vaccinated:2009-11-19
Age:43.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 4
Location:Ohio  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no per pt
Preexisting Conditions: diabetes hypertension hyperlipidemia
Diagnostic Lab Data:
CDC Split Type:
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Headache dizziness weakness, persisted on office visit 11/23/2009 although better.

VAERS ID:369501 (history)  Vaccinated:2009-09-23
Age:43.0  Onset:2009-09-25, Days after vaccination: 2
Gender:Male  Submitted:2009-11-19, Days after onset: 55
Location:Illinois  Entered:2009-11-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported.
Diagnostic Lab Data: One patient experienced a CPK "in the 900 range".
CDC Split Type: 200904184
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3173AA IMAR
Administered by: Other     Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Chills, Differential white blood cell count normal, Full blood count normal, Granulocyte count decreased, Hyperhidrosis, Hypoaesthesia, Malaise, Metabolic function test, Myalgia, Pyrexia, Red blood cell sedimentation rate normal
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Initial case received from a health care professional on 05 October 2009. This case pertains to a cluster of four patients who experienced adverse reactions following receipt of FLUZONE 2009-2010. No individual identifiers were provided, and so all four patients are included in this case. Four patients experienced fever, malaise, sweating, and chills after receiving intramuscular injections of FLUZONE 2009-2010 (lot number U3173AA) individual dates not reported). All patients reported experiencing fever, general malaise, sweating, and chills the night of vaccination. One patient also had numbness in his arm which radiated to the back. Another patient reported muscular aches and pains two days post-vaccination, with an elevated CPK of approximately 900. Three of the four patients never had received influenza vaccines prior to this administration. Per the reporter, all of the events had resolved. Follow-up information was received from the health care professional on 09 November 2009, and provided identifying information for each of the four patients. This case now contains information for one patient; the other three cases are non-serious, and are captured in 2009-04795, 2009-04808, and 2009-04809. A 43-year-old male patient, with no reported medical history, received an intramuscular injection of FLUZONE 2009-2010 (lot number U3173AA) on 23 September 2009. In addition to fever, general malaise, sweating, and chills the night of vaccination, the patient also experienced muscular aches and pains on 25 September 2009. Laboratory testing performed on 29 September 2009 showed a CPK of 924 IU/L. Granulocytes were low at 39.6%. Additional testing, including a CBC with differential, sedimentation rate, and comprehensive metabolic panel, was normal. The patient recovered. Documents held by sender: None.

VAERS ID:369523 (history)  Vaccinated:2009-11-13
Age:43.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 10
Location:Michigan  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid; Seraquel; Aspirin; Effexor; Xanax; Trileptol
Current Illness:
Preexisting Conditions: BiPolar; Depression; Panic-Anxiety; Allergic to PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102045P10IMLA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Fatigue, Hot flush, Migraine, Myalgia, Pain, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Rash to chest, left shoulder, left side of neck; migraine for 3 days; body & muscles aches for 3 days, tired, chills, hot flashes

VAERS ID:369551 (history)  Vaccinated:2009-11-09
Age:43.0  Onset:2009-11-09, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 14
Location:New York  Entered:2009-11-23
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 PMH: None Allergies: NKDA
Diagnostic Lab Data: Benadryl, Zyrtec, Solumedrol Labs/Dx studies None
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP002AA0IMUN
Administered by: Public     Purchased by: Private
Symptoms: Hypersensitivity, Paraesthesia oral, Pruritus generalised, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Itching in arms and rest of body, felt like throat was tightening up, lips felt funny. 12/4/2009 ED records for 11/9/2009, patient with c/o''s itching, sore throat and throat closing, IVF, IV benadryl, solu-medrol, dc''d on prednisone and zyrtex. Dc Dx Allergic reaction

VAERS ID:369552 (history)  Vaccinated:2009-10-13
Age:43.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 34
Location:Massachusetts  Entered:2009-11-23, 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:
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP03AA IJLA
Administered by: Private     Purchased by: Unknown
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: At night time on the vaccination day, I felt a tingling sensation on my body.

VAERS ID:369675 (history)  Vaccinated:2009-11-21
Age:43.0  Onset:2009-11-21, Days after vaccination: 0
Gender:Male  Submitted:2009-11-24, Days after onset: 3
Location:Michigan  Entered:2009-11-24
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: allergies asthma PMH: allergies, asthma, hysterectomy
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1013262P1 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Aphonia, Chest discomfort, Dysphonia, Hypersensitivity, Laryngeal oedema, Pharyngeal oedema, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Throat swelled, acute loss of voice, spent night in hospital. 12/02/09 ED notes received DOS 11/21/09. DX: allergic reaction. Pt c/o allergic reaction, chest tightness, throat tightness, hoarse voice. On examination: laryngeal cord edema. tx: Albuterol, Zantac, Solu-Medrol, Benadryl. Pt improved and discharged home.

VAERS ID:370000 (history)  Vaccinated:2009-11-17
Age:43.0  Onset:2009-11-19, Days after vaccination: 2
Gender:Male  Submitted:2009-11-24, Days after onset: 5
Location:Washington  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seasonal allergies; Sulfa
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102041P10UNLA
Administered by: Other     Purchased by: Public
Symptoms: Immediate post-injection reaction, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash developed (pink, raised welps) post shot. Unsure of exact timeline.

VAERS ID:370124 (history)  Vaccinated:2009-11-23
Age:43.0  Onset:2009-11-24, Days after vaccination: 1
Gender:Female  Submitted:2009-11-25, Days after onset: 1
Location:California  Entered:2009-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Codeine
Diagnostic Lab Data:
CDC Split Type:
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YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUFS64AA1SCLA
Administered by: Military     Purchased by: Military
Symptoms: Cold compress therapy, Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: L arm 6.5cm x 7.0cm focal erythema at site of yellow fever injection with associated pruritus first noticed yesterday. Current tx: Naproxen, cold compresses, ZYRTEC and atarax as directed.

VAERS ID:370206 (history)  Vaccinated:2009-11-16
Age:43.0  Onset:2009-11-18, Days after vaccination: 2
Gender:Female  Submitted:2009-11-25, Days after onset: 7
Location:Massachusetts  Entered:2009-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: pregnant
Preexisting Conditions: pregnant
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1008132P0IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion spontaneous, Drug exposure during pregnancy, Rash pruritic, Thrombosis, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Hypersensitivity (narrow)
Write-up: I am uncertain of time vaccination was given, and time of onset of symptoms on 11/18/09. Symptoms include pruritic rash on chest per pt. Pt only informed me today 11/25/09. Pt then did go on to have a miscarriage 11/20/09. 11/30/09 MR received for vaccine administered on 11/16/09. 12/11/09 MR received for DOS 11/20/09, 11/24/09 and 12/01/09. DX: SAB. Pt started having bleeding and clotting. Pt miscarried and was seen in clinic. Pt had no pain, bleeding or cramping. OB exam was normal. Pt was to have follow up care after D&E with weekly blood tests.

VAERS ID:370254 (history)  Vaccinated:2009-10-06
Age:43.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 37
Location:North Carolina  Entered:2009-11-25, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pain med given 11-6-09 at Dr. visit
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
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RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS455011E2IMLA
Administered by: Public     Purchased by: Private
Symptoms: Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient states that her arm has been sore since receiving the injection on 10-06-2009. This was the third dose. She reports that the soreness has never gone away. States at times she has "pain shooting form the top of her arm to her hand". Reports her arm is painful when she lifts her arm up. The muscle feels sore" like after you work out". She went to see doctor on 11-06-2009. She was given a cortisone injection and pain medicine. (Diclofenac sodium) which has helped. Reports that she is able to use her arm more since receiving treatment. States that MD advised if pain was not better in two weeks to return for a visit at which time he will check for nerve damage.

VAERS ID:370418 (history)  Vaccinated:2009-11-18
Age:43.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-29, Days after onset: 11
Location:West Virginia  Entered:2009-11-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: diabetes,thyroid
Diagnostic Lab Data:
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Feeling hot, Rash macular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: I felt hot and broke out in HIVES on my arms back stomache was red and blotchy went to rainelle medical center in get a shot.

VAERS ID:370479 (history)  Vaccinated:2009-11-24
Age:43.0  Onset:2009-11-24, Days after vaccination: 0
Gender:Male  Submitted:2009-11-30, Days after onset: 6
Location:Massachusetts  Entered:2009-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: None
Preexisting Conditions: GERD
Diagnostic Lab Data: (R) vascular ultrasound, R/o DVT, no evidence DVT; Cephalic vein not identified
CDC Split Type:
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TDAP: TDAP (ADACEL)SANOFI PASTEURC33355AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Injection site pruritus, Injection site streaking, Tenderness, Ultrasound scan
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 11-25-09 burning/itching/pain in R deltoid with streaking from inferior aspect of deltoid in mid arm to anterior axillary fold: tenderness and R mid arm measured 29 cm, L mid arm 28 cm.

VAERS ID:370487 (history)  Vaccinated:2009-11-20
Age:43.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Female  Submitted:2009-11-20, Days after onset: 0
Location:Idaho  Entered:2009-11-30, 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: METFORMIN; LISINOPRIL
Current Illness: None
Preexisting Conditions: NKDA DM II; HTN
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00249611A   
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Hypoaesthesia facial
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Was feeling numbness in the face, chest stated hurting right after the shot was given.

VAERS ID:370503 (history)  Vaccinated:2009-11-12
Age:43.0  Onset:2009-11-20, Days after vaccination: 8
Gender:Female  Submitted:2009-11-30, Days after onset: 10
Location:Wisconsin  Entered:2009-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: 12/2/09 Medical records received for date 11/25/09 PMH: bipolar depression, hirsutism, erythromycin allergy, tick bite x2 months ago, Nissan fundoplication, galactorrhea.
Diagnostic Lab Data: 12/2/09 Medical records received for date 11/25/09 Diag/Labs: WBC 14.7(H), abs neutrophils 10,000(H), EKG(-)
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101278060IMLA
Administered by: Public     Purchased by: Other
Symptoms: Borrelia burgdorferi serology negative, Electrocardiogram normal, Eyelid ptosis, Facial palsy, Neck pain, Neutrophil count increased, Paraesthesia, White blood cell count increased
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Arthritis (broad)
Write-up: 11/20/09 Symptoms of L side Bells Palsy. Saw MD, Lymes titer negative. Treated with prednisone. 11/30/09 Symptoms getting better. 12/2/09 Medical records received for date 11/25/09. DX: Bell''s palsy. Consultation for new onset of bell''s palsy. Pt was seen by this consulting MD approx 48hrs ago. Pt c/o occurrence of bells palsy as a result of receiving H1N1 vax. Assessment: left sided facial droop, ptosis on left. Neuro consult 11/20/09 DX:paresthesia and pain rt.antierior neck. No significant neurological disorder found.

VAERS ID:370517 (history)  Vaccinated:2009-11-05
Age:43.0  Onset:2009-11-06, Days after vaccination: 1
Gender:Female  Submitted:2009-11-22, Days after onset: 16
Location:Virginia  Entered:2009-11-30, 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: None known
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102045P10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Genital lesion, Oral disorder, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: A day or two after receiving H1N1 injection, pt. noticed itchy red pimple - sized bumps on her face, arms, chest; now has 1 in her mouth and 2 "in my private area." C/o severe itching - referred to MD.

VAERS ID:370736 (history)  Vaccinated:2009-11-30
Age:43.0  Onset:2009-11-30, Days after vaccination: 0
Gender:Female  Submitted:2009-12-01, Days after onset: 1
Location:Kansas  Entered:2009-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Symptoms resulted in a 911 call and trip to the emergency room. Chest X-Ray, Blood work looking for clot and other stuff, and EKG. Patient is still running a fever and is in discomfort.
CDC Split Type: 49281064015
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP027AB0IJLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood test, Chest X-ray, Chest X-ray normal, Chest pain, Discomfort, Dyspnoea, Electrocardiogram, Full blood count normal, Pain, Pleurisy, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Difficulty breathing, chest pains, fever, pain and discomfort.

VAERS ID:370822 (history)  Vaccinated:2009-11-20
Age:43.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Male  Submitted:2009-11-20, Days after onset: 0
Location:Michigan  Entered:2009-12-01, Days after submission: 11
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: Recent severe motorcycle accident; Has COPD
Diagnostic Lab Data:
CDC Split Type:
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102044P10UNRA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Flushing, Hypersensitivity, Oxygen supplementation, Palpitations, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Respiratory failure (broad)
Write-up: He received .5mg H1N1 at 2:00pm. Within 5min of of returning to waiting room developed the following: heart racing, flushed face/neck with hives and felt like he was going to collapse-staff assisted him to exam table. Vitals taken, EMS called 02 44min nc administered and 25mg Benadryl IM given.

VAERS ID:370871 (history)  Vaccinated:2009-11-12
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-11-12
Location:California  Entered:2009-12-01, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:370936 (history)  Vaccinated:2009-11-18
Age:43.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 1
Location:Oklahoma  Entered:2009-12-01, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00349611A0UNRA
Administered by: Other     Purchased by: Private
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: C/o low back pain-on scale 0-10 #10- Took (3) Naproxen- started hurting 3 hrs after vaccine given-but pain #10 this am when woke up.

VAERS ID:370956 (history)  Vaccinated:2009-10-27
Age:43.0  Onset:2009-10-28, Days after vaccination: 1
Gender:Female  Submitted:2009-12-01, Days after onset: 34
Location:Michigan  Entered:2009-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P1 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)
Write-up: Pt returned a week or so later complaining of large bruise on arm. Advised to go to physician. Pt said had no insurance. I said should still go see.

VAERS ID:370971 (history)  Vaccinated:2009-11-02
Age:43.0  Onset:2009-11-03, Days after vaccination: 1
Gender:Female  Submitted:2009-11-23, Days after onset: 20
Location:Nebraska  Entered:2009-12-01, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 2nd Degree Burn on back
Preexisting Conditions: Darvocet: itching; Aspirin: Bloody noses
Diagnostic Lab Data: Recommended to consult allergist before receiving Tetanus again.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
DT: DT ADSORBED (DECAVAC)SANOFI PASTEURU2864CA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Dyspnoea, Injection site erythema, Injection site papule, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant 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), Tendinopathies and ligament disorders (broad)
Write-up: Patient called 11-5-2009 at 8:55 am reporting having elevated temp. on 11-3-09 and some difficulty breathing. Reports on 11-5-09 having a non-itching 3 inch raised, red, warm area at injection site. Patient appointment 11-5-2009 at 11:15AM. Patient presents with Lt. arm pain mild for three days with red swollen area at injection site. Treatment: Antibiotic and BENADRYL PRN.

VAERS ID:371010 (history)  Vaccinated:2009-11-12
Age:43.0  Onset:2009-12-01, Days after vaccination: 19
Gender:Female  Submitted:2009-12-01, Days after onset: 0
Location:Massachusetts  Entered:2009-12-01
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS100922 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion spontaneous, Drug exposure during pregnancy, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: First trimester miscarriage.

VAERS ID:371011 (history)  Vaccinated:2009-10-17
Age:43.0  Onset:2009-10-18, Days after vaccination: 1
Gender:Female  Submitted:2009-12-01, Days after onset: 44
Location:New Jersey  Entered:2009-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium, multivitamin, b12, adipex
Current Illness: none
Preexisting Conditions: anemia, polycystic ovarian syndrome, gastric bypass surgery
Diagnostic Lab Data: basic metabolic panel and cbc (results within normal limits)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP007AA0IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fluid replacement, Full blood count normal, Metabolic function test normal, Muscle spasms, Musculoskeletal chest pain
SMQs:, Dystonia (broad)
Write-up: 10/17 8am received vaccine; 10/18 430am awoken from sleep with excruciating pain in right rib area, cramping in nature, lasting approx 15 mins 430am-9pm sore but pain free 9pm same pain in same area, doubled over in pain, collapsed due to pain, emergency dept visit, received IV fluid and Toradol; 10/19 2am goes home 4pm same pain in same area 6pm same pain in same area 10/20 no pain, just sore.

VAERS ID:371058 (history)  Vaccinated:2009-11-16
Age:43.0  Onset:2009-11-18, Days after vaccination: 2
Gender:Female  Submitted:2009-12-02, Days after onset: 14
Location:Puerto Rico  Entered:2009-12-02
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: DIABETES (DM)
Diagnostic Lab Data: CBC AND SED RATE
CDC Split Type: PR0929
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101278030IMAR
Administered by: Unknown     Purchased by: Unknown
Symptoms: Full blood count, Red blood cell sedimentation rate, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: PATIENT REFERS THE DEVELOPMENT OF HIVES (ALLERGY-LIKE) IN TRUNK AND ARMS 48 HOURS AFTER VACCINATION. WAS TREATED WITH CLARINEX 5MG AND ORAL STEROIDS.

VAERS ID:371060 (history)  Vaccinated:2009-11-04
Age:43.0  Onset:2009-11-05, Days after vaccination: 1
Gender:Female  Submitted:2009-12-02, Days after onset: 27
Location:Illinois  Entered:2009-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101276060IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling of body temperature change
SMQs:
Write-up: Hot and Cold feeling for 10 hours post vaccination

VAERS ID:371095 (history)  Vaccinated:2008-11-01
Age:43.0  Onset:2008-11-20, Days after vaccination: 19
Gender:Female  Submitted:2009-03-19, Days after onset: 118
Location:Unknown  Entered:2009-12-02, Days after submission: 258
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: no illness at the time of vaccination.
Preexisting Conditions: No known medical history. No concomitant medications and; No other vaccinations within the four previous weeks.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA350BA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Skin test positive, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: A cluster of 4 adult patients who received TUBERSOL, lot number C2909AA, and developed reactions to the skin testing which the doctor believed was a reaction to the vaccine, but not a true positive reaction. Initial information received on 30 December 2008 from a health professional. This case is for a 44 year old female, with no known medical history, who received TUBERSOL (lot C2909AA) and FLUARIX (GSK, lot number AFLUA350BA) on either the 17 or 18 November 2008. At that time, the patient had no illnesses and had received no other vaccines in the four previous weeks. On 20 November 2008, the patient had an unspecified reaction to the skin testing which the doctor believed was a reaction to the vaccine, but not a true positive reaction. The patient recovered on an unspecified date. Follow up information received on 29 January 2009 from a health care professional. On 18 November 2008 at 15:26 the patient received the TUBERSOL and FLUARIX. The patient developed a 70 mm area of erythema (specific area not provided) on 20 November 2008 at 09:26. The patient recovered from the event. No further information was provided. Follow up information received on 18 February 2009 from a health care professional. The erythema was located on the patient''s left forearm. It was reported that the patient recovered in about one week on 15 December 2008. No treatment was necessary. No further information was provided. Follow up information received on 19 March 2009 from a health care professional. The TUBERSOL was administered intradermally in the left forearm and the FLUARIX was administered intramuscularly in the left deltoid. The erythema was located at the TUBERSOL injection site. It was reported that the patient recovered in about one week in November 2008. According to the reporter, no specific date was provided, but it was approximately 27 November 2008. Cases 2008-03694, 2008-04095, and 2008-04097, with the same reporter and the same TUBERSOL lot number, were created for the other three patients.

VAERS ID:371177 (history)  Vaccinated:2009-09-18
Age:43.0  Onset:2009-09-25, Days after vaccination: 7
Gender:Female  Submitted:2009-12-02, Days after onset: 68
Location:Rhode Island  Entered:2009-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No known
Preexisting Conditions: allergy:sulfa Pre-existing condition:GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960315P IMUN
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Fatigue
SMQs:, Arthritis (broad)
Write-up: Migratory polyarthralgia-hips,shoulders,wrists,ankles,feet,knees and fatique

VAERS ID:371188 (history)  Vaccinated:2009-11-12
Age:43.0  Onset:2009-11-13, Days after vaccination: 1
Gender:Female  Submitted:2009-11-20, Days after onset: 7
Location:Maryland  Entered:2009-12-02, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP025AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Formication, Muscular weakness, Skin exfoliation
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad)
Write-up: Onset 1 day after vaccination C/O peeling "like my skin is crawling" "antsy" "arms weak" - states symptoms are "from the waist up".

VAERS ID:371273 (history)  Vaccinated:2009-12-03
Age:43.0  Onset:2009-12-03, Days after vaccination: 0
Gender:Female  Submitted:2009-12-03, Days after onset: 0
Location:North Carolina  Entered:2009-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; HTN; Seasonal allergies; Allergies to Brazil nuts, chocolate, shellfish
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102125P10IMLA
Administered by: Private     Purchased by: Other
Symptoms: Dysphonia, Stomatitis, Throat irritation
SMQs:, Severe cutaneous adverse reactions (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: 0945-vaccine given. 1030- symptoms developed, scratchy throat, scratchy roof of mouth, change in voice tone. 1045- BENADRYL 25mg po, 1110-sent to urgent care given BENADRYL IM, KENALOG IM, and Rx for MEDROL dose pack.

VAERS ID:371928 (history)  Vaccinated:2009-11-19
Age:43.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-12-07, Days after onset: 18
Location:Wisconsin  Entered:2009-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP026AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure increased, Feeling hot, Injection site pain, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)
Write-up: Returned to vaccinator 10-15 after injection, c/o nausea, feeling hot with burning sensation at injection stite. BP 164/112, P 100 and P 120, T 97.8 R 22. c/o feeling shaky, moved to floor from chair. Paramedics called. BP by first responder 132/86 and P88. Transported by ambulance to ER.

VAERS ID:371985 (history)  Vaccinated:2009-11-10
Age:43.0  Onset:2009-11-18, Days after vaccination: 8
Gender:Male  Submitted:2009-12-07, Days after onset: 19
Location:California  Entered:2009-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: I had shingles rashes on my neck and back of head. I never had shingles before.

VAERS ID:372983 (history)  Vaccinated:2008-11-05
Age:43.0  Onset:2008-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-12-13, Days after onset: 403
Location:North Carolina  Entered:2009-12-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Dr. has all my informatiom
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA357BA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough decreased, Depression, Dizziness, Dysgeusia, Fatigue, Headache, Hypoaesthesia, Insomnia, Musculoskeletal pain, Nasopharyngitis, Nuclear magnetic resonance imaging normal, Pain in extremity, Skin irritation, Transient ischaemic attack
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: On November 5, 2008, I received a flu shot where I work at, and right away I started having symptoms from vaccine. From Nov, 5 2008 until July 1 2009 I had no treatment due to no Insurance, so I had to deal with the pain the best I could, So when I got Insurance I went to the DR and now under treatment. I am now taking Medicine for pain but not doing any good. I have to take sleep aide due to pain in arm cause I can''t sleep, and now Having to take Cymbalta due to depression cause of not being able to use arm like I use to. And I have to take 900MG of Gabapentin for pain. At times if I keep my arm immobile it goes numb on me. I also had a mini Stroke I believe due to all this going on. So any help would be very greatly to me. Will provide any other information if needed due to this...Thank you very much. DR says it''s damaged Nerve. So please help me.

VAERS ID:372985 (history)  Vaccinated:2009-12-10
Age:43.0  Onset:2009-12-11, Days after vaccination: 1
Gender:Male  Submitted:2009-12-13, Days after onset: 2
Location:Georgia  Entered:2009-12-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Balance disorder, Bedridden, Dehydration, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Throw up every 2 hours. Got very dehydrated. Very bad equilibrium. Could not stand for more than 5 minutes before getting very weak and had to lay down. Bed rest for 2 days.

VAERS ID:373067 (history)  Vaccinated:2009-10-08
Age:43.0  Onset:2009-11-02, Days after vaccination: 25
Gender:Female  Submitted:2009-12-07, Days after onset: 35
Location:Illinois  Entered:2009-12-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data: Us - Lt arm 11/4/09 - No evidence of cyst, hematoma or abscess
CDC Split Type:
Vaccination
Manufacturer
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0664X SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2965AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth, Ultrasound scan normal
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: MMR given 10-8-09 subcutaneously in Lt. post arm. Returned to clinic 11/2/09 with approx. 1 cm. "hard knot" at injection site; tender to touch. Sl warmth & redness.

VAERS ID:373438 (history)  Vaccinated:2009-12-12
Age:43.0  Onset:2009-12-12, Days after vaccination: 0
Gender:Male  Submitted:2009-12-15, Days after onset: 3
Location:Washington  Entered:2009-12-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dry skin, Headache, Nausea, Skin warm
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: At 14:32, client was referred over from post care station following H1N1 mist vaccination at 14:09. Client reported HA and nausea after mist administration. Assessment findings: Skin warm and dry to touch. No signs of rash on torso. Vitals WDL. At 14:46. patient reports no dizziness; c/o nausea. Client requested discharge home. Client''s husband states he will drive client home. Both client and husband verbalize understanding of symptoms to watch for. Client has no difficulty breathing or swallowing. Client discharged.

VAERS ID:373505 (history)  Vaccinated:2009-12-03
Age:43.0  Onset:2009-12-03, Days after vaccination: 0
Gender:Female  Submitted:2009-12-09, Days after onset: 6
Location:Arizona  Entered:2009-12-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: X~Influenza (H1N1) (Influenza (H1N1) (UNKNOWN MANUFACTURER))~1~43.00~Patient
Other Medications: None
Current Illness: No Illnesses
Preexisting Conditions: None
Diagnostic Lab Data: Could get medical treatment due to no financial support
CDC Split Type:
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500765P0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Aphonia, Body temperature increased, Headache, Impaired work ability, Myalgia, Nausea, Oropharyngeal pain, Pain, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: About 30 min after the spray was given, started to get nausea, then a severe in head ache, with a temperature of 100 degrees. Then started to vomit about a hour. After that my throat started hurting then I got very severe muscle and total body aches. I completely lost my voice. This all lasted about 5 days so far. I lost 5 days of work and I still haven''t fully recovered yet! I couldn''t go to the doctor or the hospital because I just can''t afford it.

VAERS ID:373960 (history)  Vaccinated:0000-00-00
Age:43.0  Onset:0000-00-00
Gender:Male  Submitted:2009-12-16
Location:Ohio  Entered:2009-12-17, 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: Vitamin; Hep B
Current Illness: Pt. Hep B +
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt. dizzy, sweating, felt lightfoot, 130/80, lungs clear.

VAERS ID:374074 (history)  Vaccinated:2009-12-14
Age:43.0  Onset:2009-12-15, Days after vaccination: 1
Gender:Male  Submitted:2009-12-18, Days after onset: 3
Location:Oklahoma  Entered:2009-12-18
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102131P10UNRA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Burning sensation, Diarrhoea, Eye irritation, Lung disorder, Oropharyngeal pain, Pain,