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Found 493323 cases in entire database

Case Details (Sorted by Age)

This is page 409 out of 494

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VAERS ID:78609 (history)  Vaccinated:1995-10-20
Age:52.6  Onset:1995-10-20, Days after vaccination: 0
Gender:Female  Submitted:1995-10-30, Days after onset: 10
Location:Montana  Entered:1995-11-02, 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: Premarin, Intal, Azmacort, Atrovent
Current Illness: NONE
Preexisting Conditions: asthma, allergic to PCN & sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site hypersensitivity, Injection site oedema, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: arm swoll up all around inj site; turned bright red w/a white ring around it;swelling lasted 3 days;site itched but burned when itched;On day 4 site changed from a red color to a rust color;itching cont for more days;had a bad h/a;

VAERS ID:78740 (history)  Vaccinated:1995-10-25
Age:52.7  Onset:1995-10-25, Days after vaccination: 0
Gender:Female  Submitted:1995-10-30, Days after onset: 5
Location:Texas  Entered:1995-11-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F611200IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site pain, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: lt deltoid sore almost immed p/vax localized reddness & tenderness w/whelps & rash developing w/in 24hrs;low grade fever;

VAERS ID:78745 (history)  Vaccinated:1995-10-11
Age:52.3  Onset:1995-10-11, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Arizona  Entered:1995-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Theodur, Pred, Aerobid, Serevent, Nasocort, Albuterol inhaler, Tilade
Current Illness: chornic stable asthma
Preexisting Conditions: severe asthma chronically
Diagnostic Lab Data: FEV, 2.53
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F610971IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES380957 SCLA
TTOX: TETANUS TOXOID (NO BRAND NAME)CONNAUGHT LABORATORIES5C71122 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Asthma, Condition aggravated, Dyspnoea, Injection site reaction, Malaise, Myalgia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 1/2hr p/vax had local itching @ site, then 6hrs later had large local rxn along w/entire body muscle aches, SOB & could not blow out to do a peak flow; pt has severe asthma chronically; felt very ill

VAERS ID:78952 (history)  Vaccinated:1995-10-17
Age:52.8  Onset:1995-10-18, Days after vaccination: 1
Gender:Female  Submitted:1995-11-09, Days after onset: 22
Location:Colorado  Entered:1995-11-14, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5J610070IMLA
Administered by: Public     Purchased by: Public
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt c/o sore arm when elevating arm above shoulder lever;no rash, swelling, discoloration, not hot to touch;

VAERS ID:78954 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:0000-00-00
Gender:Male  Submitted:1995-11-07
Location:New York  Entered:1995-11-14, 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: NONE
Diagnostic Lab Data:
CDC Split Type: NYS96044
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Headache, Insomnia, Pain
SMQs:
Write-up: 4 full days hardly any sleep, h/a''s, loose stomach-arm still hurt p/days;

VAERS ID:81563 (history)  Vaccinated:1994-08-16
Age:52.0  Onset:1994-08-31, Days after vaccination: 15
Gender:Female  Submitted:1994-09-29, Days after onset: 29
Location:Tennessee  Entered:1995-11-14, Days after submission: 411
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: HAV pos on 31aug94 & neg on 2sep94;
CDC Split Type: 940085201
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1374A40IMA
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: pt recvd vax;found to be anti HAV pos;confirmation test was neg;MD do not believe has HEP because pt has no signs or sx of any type of hep disease;Physicians consider the first anti HAV to be poss a false pos;

VAERS ID:79006 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:0000-00-00
Gender:Male  Submitted:1995-11-10
Location:Washington  Entered:1995-11-16, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Oedema, Pain, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: signif pain 1st 24 hrs followed by edema & erythema shoulder to mid fore arm-resolving by 4th day p/inj

VAERS ID:79103 (history)  Vaccinated:1995-10-16
Age:52.4  Onset:1995-10-20, Days after vaccination: 4
Gender:Female  Submitted:1995-10-20, Days after onset: 0
Location:Washington  Entered:1995-11-17, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Hormones
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WA951175
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49581392  
Administered by: Public     Purchased by: Unknown
Symptoms: Face oedema, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax 16OCT95 & woke 20OCT95 w/red rash rough on face, neck; no fever, illness sx;eyes puffy;no known new allergens;advised to see MD to determine cause; started clearing up 21OCT-did not to to MD

VAERS ID:79841 (history)  Vaccinated:1995-11-17
Age:52.2  Onset:1995-11-20, Days after vaccination: 3
Gender:Male  Submitted:1995-11-21, Days after onset: 1
Location:Washington  Entered:1995-12-04, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Cozoar
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS01595P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Skin nodule, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 68mm reddened area; inc heat noted induration present

VAERS ID:79869 (history)  Vaccinated:1995-10-28
Age:52.0  Onset:1995-11-07, Days after vaccination: 10
Gender:Male  Submitted:1995-11-14, Days after onset: 7
Location:California  Entered:1995-12-06, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azulfidine
Current Illness: unk
Preexisting Conditions: pt has regional enteritis treated w/azulfidine
Diagnostic Lab Data: culture neg; biopsy neg;
CDC Split Type: 895325006L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IMA
Administered by: Other     Purchased by: Other
Symptoms: Pneumonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: pt recvd vax & 7 to 10 days later pt was admitted to hosp w/temp of 105;underwent workup for pneumonis including culture & biopsy which are neg so far;condition has worsened & is in the ICU as of the date of this report;

VAERS ID:79926 (history)  Vaccinated:1995-12-01
Age:52.6  Onset:1995-12-01, Days after vaccination: 0
Gender:Female  Submitted:1995-12-04, Days after onset: 3
Location:New York  Entered:1995-12-12, 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: Menepausal sxs;
Preexisting Conditions: pt states eggs go right through pt but insisted on getting vax;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4958113 IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Vasodilatation
SMQs:, Guillain-Barre syndrome (broad)
Write-up: pt recvd vax & became weak instructed to sit in waiting room for 10-20 mins for observation;called later in day w/report of 2 1/2 diameter reddened area;no swelling;no SOB;if worse report to ER

VAERS ID:80093 (history)  Vaccinated:1995-10-18
Age:52.9  Onset:1995-10-28, Days after vaccination: 10
Gender:Female  Submitted:1995-12-04, Days after onset: 37
Location:Massachusetts  Entered:1995-12-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: blood work, EKG
CDC Split Type: MA9533
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F611341IMA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1559A0IMA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Headache, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)
Write-up: 48 hrs post vax c/o h/a; 10 days post vax c/o dizzy spells seen @ ER dx vertigo as a result of flu shot

VAERS ID:80125 (history)  Vaccinated:1995-10-27
Age:52.2  Onset:1995-10-28, Days after vaccination: 1
Gender:Female  Submitted:1995-11-08, Days after onset: 11
Location:California  Entered:1995-12-18, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt''s sibling exp allergic to eggs flu vax
Other Medications: Ventolin, Aeroid inhalers
Current Illness: NONE
Preexisting Conditions: chronic asthma, bronchitis, allergy to PCN, Sulfa, sensitive to ASA
Diagnostic Lab Data: CXR-clear
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER380960 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Anorexia, Asthma, Bronchitis, Condition aggravated, Dysphagia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: diff breathing, wheezing, poor appetite, choking started 28OCT;On 31OCT went to ER, nebulizer treatment;dx w/acute bronchitis & asthma (chronic also) Pred, Cephalexin;BP 100/80

VAERS ID:80136 (history)  Vaccinated:1995-10-27
Age:52.1  Onset:1995-11-04, Days after vaccination: 8
Gender:Female  Submitted:1995-12-06, Days after onset: 32
Location:South Carolina  Entered:1995-12-19, Days after submission: 13
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prinivil, Lopid, Glucotrol xl, Synthyroid
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: protein inc in CSF
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49580790 LA
Administered by: Public     Purchased by: Unknown
Symptoms: CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: acute Guillain-Barre Synd; hospitalized 5 days-recvd 5 rounds of immune globulin

VAERS ID:80233 (history)  Vaccinated:1995-11-16
Age:52.0  Onset:1995-11-16, Days after vaccination: 0
Gender:Female  Submitted:1995-12-26, Days after onset: 40
Location:New York  Entered:1995-12-26
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: apap; ear drops; topical ointment
Current Illness:
Preexisting Conditions: hx of neck/head injury;visually handicapped;lupus, mult chemical allergies, bronchitis
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Influenza, Malaise, Pain, Pharyngitis, Pyrexia, Stupor, Urticaria
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: pt recvd vax; had immed crushing pain in rt hand;w/in 15 min began to feel "really weird", felt woozy, strange odd;T 100-101, hives on face & neck; LOC fro 16 hrs;woke w/ fever, congestion; felt like the flu; still feels weird;

VAERS ID:80246 (history)  Vaccinated:1995-12-15
Age:52.4  Onset:1995-12-16, Days after vaccination: 1
Gender:Male  Submitted:1995-12-18, Days after onset: 2
Location:Tennessee  Entered:1995-12-26, 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: NA
Current Illness: finger laceration
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type: TN95131
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4293100IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pain, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recvd vax 15DEC95 later that next noc-red, swollen, & hard, sl pain dec arm (occ); Ibuprofen

VAERS ID:80368 (history)  Vaccinated:1995-12-18
Age:52.4  Onset:1995-12-18, Days after vaccination: 0
Gender:Female  Submitted:1995-12-20, Days after onset: 2
Location:Florida  Entered:1995-12-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s son exp fever/swelling w/infant w/DTP
Other Medications: PPD 5DEC95
Current Illness: NONE
Preexisting Conditions: allergies/hayfever
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1810A40 LA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Headache, Myalgia, Nausea, Pharyngitis, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: described via telephone from pt''s mom nausea/vomiting, abd cramping, aches & pains-chest pains, fever, h/a, sore throat

VAERS ID:80585 (history)  Vaccinated:1995-11-14
Age:52.3  Onset:1995-11-29, Days after vaccination: 15
Gender:Male  Submitted:1995-12-25, Days after onset: 26
Location:Oregon  Entered:1996-01-02, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4958041 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Neuritis, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)
Write-up: brachial neuritis; axillary numbness on opposite arm;no clear weakness; EMG neg;

VAERS ID:80934 (history)  Vaccinated:1995-10-02
Age:52.8  Onset:1995-10-03, Days after vaccination: 1
Gender:Female  Submitted:1995-10-05, Days after onset: 2
Location:Texas  Entered:1996-01-16, Days after submission: 103
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma & allergies to dust, mold & grass
Diagnostic Lab Data:
CDC Split Type: TXV96228
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F611191IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Chills, Diarrhoea, Laryngitis, Myalgia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: c/o laryngitis, frequent soft stool, body aches, joint pain & alternating between hot & cold sensation from 24hrs p/vax;

VAERS ID:80963 (history)  Vaccinated:1995-08-04
Age:52.5  Onset:1995-08-04, Days after vaccination: 0
Gender:Female  Submitted:1996-01-04, Days after onset: 153
Location:New Hampshire  Entered:1996-01-19, 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: Motrin, Thyroid, HCTZ, EStraderm, Interal, darvocet, Zolof, Indoc
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NH95034
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5A710201 LA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Myalgia, Nausea, Oedema peripheral, Vasodilatation, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: swelled elbow, very sore, hot, nausea, vomiting, chills;

VAERS ID:80967 (history)  Vaccinated:1993-11-18
Age:52.6  Onset:1993-11-27, Days after vaccination: 9
Gender:Male  Submitted:1995-12-21, Days after onset: 754
Location:Pennsylvania  Entered:1996-01-22, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 27 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC Split Type: 896004001L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)PFIZER/WYETH  IM 
Administered by: Private     Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia

VAERS ID:81085 (history)  Vaccinated:1996-01-08
Age:52.7  Onset:1996-01-09, Days after vaccination: 1
Gender:Female  Submitted:1996-01-15, Days after onset: 6
Location:Arizona  Entered:1996-01-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC
CDC Split Type: AZ9602
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5C711140IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Myalgia, Nausea, Oedema peripheral, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: redness, swelling, painful to move;fever, chills, nausea, gen body aches x 24hrs to 72hrs in length

VAERS ID:83889 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1996-02-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: antidepressants, nos;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95020987
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax; devel rash on chest, hands, arms; devel sore throat & T of 99;

VAERS ID:82335 (history)  Vaccinated:1995-09-15
Age:52.9  Onset:1995-09-16, Days after vaccination: 1
Gender:Female  Submitted:1995-09-20, Days after onset: 4
Location:Wisconsin  Entered:1996-02-12, Days after submission: 145
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WI95065
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4H611560 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Chills, Hyperhidrosis, Influenza, Injection site mass, Myalgia, Pruritus, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: started having chills,sweats approx 12-14 hrs p/vax;arm felt very hard c/o flu-like sx-body aches;red,itchy rash started 17SEP95 lt arm;

VAERS ID:84602 (history)  Vaccinated:1995-08-07
Age:52.0  Onset:1995-08-07, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Mississippi  Entered:1996-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: in pt, exp chills p/ 1st dose;
Other Medications: synthroid
Current Illness: none
Preexisting Conditions: thyroid disorder
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95080595
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1540W0IM 
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax;devel fever & large grapefruit size erythema on arm;f/u indicated devel redness,warmth and edema at inject site approx 3" in diam;

VAERS ID:83433 (history)  Vaccinated:1995-10-24
Age:52.6  Onset:1995-10-25, Days after vaccination: 1
Gender:Male  Submitted:1996-02-26, Days after onset: 124
Location:Illinois  Entered:1996-03-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: IL960019
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00975P IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5C71114 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Injection site oedema, Myalgia, Pyrexia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: pt c/o fever,aches,knot in arm;inj site was enlarged,hard,& warm to touch;went to MD & was prescribed Anaprox

VAERS ID:83589 (history)  Vaccinated:1995-10-31
Age:52.7  Onset:1995-10-31, Days after vaccination: 0
Gender:Male  Submitted:1996-02-27, Days after onset: 119
Location:New York  Entered:1996-03-11, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: na
CDC Split Type: BA96K004
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F610141IMLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pain
SMQs:
Write-up: pt recvd vax; pain in arm, severe HA''s for 4 days;

VAERS ID:83650 (history)  Vaccinated:1996-02-21
Age:52.1  Onset:1996-02-22, Days after vaccination: 1
Gender:Female  Submitted:1996-02-28, Days after onset: 6
Location:Illinois  Entered:1996-03-13, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: sulfa drugs?
Diagnostic Lab Data: NONE
CDC Split Type: IL960020
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1558A0 LA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Diarrhoea, Malaise, Myalgia, Oedema peripheral, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: arm slightly swollen & sore;felt bad the following day;thinks had fever;did not take temp;severe stomach pains following afternoon progressing to severe diarrhea by the 4th day;cont to be weak;diarrhea is almost resolved;

VAERS ID:85102 (history)  Vaccinated:1995-02-17
Age:52.4  Onset:1995-02-18, Days after vaccination: 1
Gender:Female  Submitted:1995-02-24, Days after onset: 6
Location:Massachusetts  Entered:1996-03-14, Days after submission: 384
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic diverticulitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 895067001S
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETH49481760SCLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax;devel large area of redness & tenderness at inject site;48 hrs later exp period of severe malaise;pt claims that immed following the inject,her diverticulitis improved but it has since gotten worse;

VAERS ID:85151 (history)  Vaccinated:1995-11-01
Age:52.8  Onset:1995-11-02, Days after vaccination: 1
Gender:Male  Submitted:1995-11-10, Days after onset: 8
Location:New Jersey  Entered:1996-03-14, Days after submission: 125
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 895331023L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)PFIZER/WYETH49580241IMLA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: pt recv vax 1NOV95 & devel localized cellulitis @ inj site,characterized by erythema & redness;pt was given oral ATB,Pred & Betamethasone;infectious disease specialist reportedly dx the cellulitis;it is unk if pt has recovered as of date

VAERS ID:85209 (history)  Vaccinated:1995-09-19
Age:52.0  Onset:1995-10-30, Days after vaccination: 41
Gender:Male  Submitted:1996-02-09, Days after onset: 102
Location:Illinois  Entered:1996-03-25, Days after submission: 45
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: HAV-6 = .662 30oct95 and .669 on 12jan96;
CDC Split Type: 960016551
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAMVHA440A60  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax;pt found to be a nonresponder;

VAERS ID:84643 (history)  Vaccinated:1996-03-07
Age:52.0  Onset:1996-03-10, Days after vaccination: 3
Gender:Male  Submitted:1996-04-04, Days after onset: 25
Location:Missouri  Entered:1996-04-08, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allerg to PCN
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.L07020SCRA
JEV: JAPANESE ENCEPHALITIS (J-VAX)CONNAUGHT LABORATORIESEJN120B0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Malaise, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: pt called MD office 15MAR96;reports rash & numbness from forehead to lips on the lt side of face,malaise,chills;instructed to take DPH;

VAERS ID:84644 (history)  Vaccinated:1996-03-14
Age:52.8  Onset:1996-03-15, Days after vaccination: 1
Gender:Male  Submitted:1996-04-04, Days after onset: 20
Location:Missouri  Entered:1996-04-08, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rash, chills, paresthesia, malaise w/dose 1 of Japanese Encephalitis
Other Medications: DPH;pt recvd Hep B vax by SKB lot# 2003A2 on 25MAR96
Current Illness: didn''t mention s/e from #1 until p/#2
Preexisting Conditions: allergic to PCN;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
JEV: JAPANESE ENCEPHALITIS (J-VAX)CONNAUGHT LABORATORIESEJN120A1SCLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Confusional state, Dizziness, Malaise, Paraesthesia, Rash, Similar reaction on previous exposure to drug, Thinking abnormal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: pt called ofc 15MAR96 reports rash & numbness from forehead to lips on the lt side of face, malaise, chills;instructed to take DPH;25MAR95 pt cont DPH & has some numbness in face;2APR96 diff focusing & thinking things through, foggy head

VAERS ID:84825 (history)  Vaccinated:1996-04-01
Age:52.4  Onset:1996-04-03, Days after vaccination: 2
Gender:Female  Submitted:1996-04-03, Days after onset: 0
Location:Massachusetts  Entered:1996-04-11, 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-annual exam
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4318740IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: rt upper extremities swell/redness ?cellulitis;

VAERS ID:85100 (history)  Vaccinated:1995-10-18
Age:52.3  Onset:1995-10-18, Days after vaccination: 0
Gender:Female  Submitted:1995-10-25, Days after onset: 7
Location:Hawaii  Entered:1996-04-23, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: HI9604
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F611620IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: devel tissue swelling,pain & hardness immed p/inj;site 6" diameter;sx stopped p/5 days

VAERS ID:85460 (history)  Vaccinated:1996-04-05
Age:52.9  Onset:1996-04-05, Days after vaccination: 0
Gender:Female  Submitted:1996-04-08, Days after onset: 2
Location:South Carolina  Entered:1996-05-01, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tagamet, ASA, zucor;5APR96 PPD by Connaught lot# 241111
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: SC96022
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES398904 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Malaise, Myalgia, Oedema peripheral, Pain, Pyrexia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: pt recv vax;soreness initially but by end of eve had pain from inject site to tips of fingers;T of 102 w/ chills;felt bad all eve;better in am;moderate swelling,pink;no obvious infect;

VAERS ID:85659 (history)  Vaccinated:1995-11-09
Age:52.5  Onset:1995-11-11, Days after vaccination: 2
Gender:Female  Submitted:1995-11-14, Days after onset: 3
Location:Tennessee  Entered:1996-05-08, Days after submission: 175
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: for high BP
Current Illness:
Preexisting Conditions: allergic to PCN, sulfa, erythromycin, molds, pollen, house dust
Diagnostic Lab Data:
CDC Split Type: TN96041
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F61126 IM 
Administered by: Public     Purchased by: Public
Symptoms: Conjunctivitis, Face oedema, Pruritus, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: couple of days p/vax began itching lt eye & rt hand, next day hives on bridge of nose, both hands, had whelps, both eyes became red & swollen, swollen lips, whelps on ankles-some areas improved others keep cropping up

VAERS ID:86167 (history)  Vaccinated:1995-12-04
Age:52.8  Onset:1995-12-06, Days after vaccination: 2
Gender:Female  Submitted:1996-02-08, Days after onset: 64
Location:California  Entered:1996-05-13, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: allergy to red wine & nail polish in early years
Diagnostic Lab Data: NONE reported
CDC Split Type: 0010150950303
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00195P0IM 
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Hypersensitivity, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 4DEC95 & 6DEC95 devel an itchy allerg rxn on both upper & lower arms on the inside of wrists there was a red rash;7DEC95 eyelids & lips were swollen, red & itchy as was face;rash changed to hives;

VAERS ID:86019 (history)  Vaccinated:1996-05-02
Age:52.9  Onset:1996-05-04, Days after vaccination: 2
Gender:Female  Submitted:1996-05-07, Days after onset: 3
Location:Pennsylvania  Entered:1996-05-14, 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: Zestril, Pravachol, Elavil, Insulin, Premarin, Provera, Calan, Zoloft, Keflex
Current Illness: NONE
Preexisting Conditions: Depression, CRF, inc chol, PUD, OA obesity, DM, HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6A81017 IMRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Rash pustular, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 2MAY96&pt devel swelling,redness&warmth;4MAY96 in ER 5MAY&cellulitis tx w/kelfex;7MAY95 19x17cm are of cellulitis w/pustules

VAERS ID:86378 (history)  Vaccinated:1995-10-01
Age:52.4  Onset:1995-10-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Nevada  Entered:1996-05-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen;Thyroid
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NV96011
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Hypertonia, Hypokinesia, Hypotonia, Migraine, Myalgia, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: in a few days-stroke like sx;both arms contracted against chest-fingers not aligned;no control over movement;pain in arms for a short time-unable to ambulate-drug self could not wipe self;worsened till 2 wk-w/pain able to move-paresthesia

VAERS ID:86811 (history)  Vaccinated:1996-05-24
Age:52.7  Onset:1996-05-25, Days after vaccination: 1
Gender:Female  Submitted:1996-05-28, Days after onset: 3
Location:North Carolina  Entered:1996-06-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Levothroid, Estrace
Current Illness: nONE
Preexisting Conditions: PCN, codeine
Diagnostic Lab Data: NONE
CDC Split Type: NC96056
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES51072 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Nausea, Oedema peripheral, Pyrexia, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: noticed fever & chills on 25MAy p/vax 24MAY96;did not take temp;rt arm swollen 25MAY, +redness from deltoid to elbow on 26MAY;still has knot +redness from deltoid down w/in 2" of elbow;also c/o nausea;knot about the size of a lemon

VAERS ID:87820 (history)  Vaccinated:1995-12-04
Age:52.8  Onset:1995-12-06, Days after vaccination: 2
Gender:Female  Submitted:1995-12-14, Days after onset: 8
Location:New Mexico  Entered:1996-06-18, Days after submission: 186
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt may have had a similar, though less severe, rxn to flu vax in pre yr;
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 895355014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES394903 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Injection site hypersensitivity, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 4DEC95 & 2 days later pt devel fever & fatigue;2 days p/vax pt devel inj site rxn, characterized by a taco shell shaped circular welt, redness, & poss rash;no other details were known as of reporting date;

VAERS ID:88716 (history)  Vaccinated:1996-06-12
Age:52.1  Onset:1996-06-13, Days after vaccination: 1
Gender:Female  Submitted:1996-06-20, Days after onset: 7
Location:Virginia  Entered:1996-08-06, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn w/smallpox vax
Other Medications: synthroid, ASA
Current Illness: NONE
Preexisting Conditions: hypothyroid, allergic to codeine & demerol
Diagnostic Lab Data:
CDC Split Type: VA96040
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5L71095 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Myalgia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 22JUN96 & mild soreness that noc;next day became hot & dec swollen w/aching pain hot relieved by APAP or compresses;raised fluid filled area around inj site;shoulder & arm firm & tender to touch;

VAERS ID:88977 (history)  Vaccinated:1996-05-14
Age:52.2  Onset:1996-05-15, Days after vaccination: 1
Gender:Female  Submitted:1996-07-09, Days after onset: 55
Location:Georgia  Entered:1996-08-14, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA96089
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1236W1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 14MAY96 & 6JUN96 c/o inj site being sore;recommended that pt put wet warm cloth on site several times daily;9JUL96 pt stated arm remains sore, red & swollen;MD felt had a flesh rxn;nurse noted lt arm sl discolored @ inj site;

VAERS ID:89009 (history)  Vaccinated:1996-07-30
Age:52.0  Onset:1996-07-30, Days after vaccination: 0
Gender:Female  Submitted:1996-08-05, Days after onset: 6
Location:Tennessee  Entered:1996-08-15, 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:
Current Illness: NONE
Preexisting Conditions: sulfa, loracet
Diagnostic Lab Data:
CDC Split Type: TN96067
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6A810075 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site oedema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: pt had accident resulting in injury to foot;requested tetanus several hr p/vax began to have site swelling spreading to underarm;saw MD 2 days later then to ER same day for worsening condition & swelling in neck;

VAERS ID:89475 (history)  Vaccinated:1995-08-21
Age:52.9  Onset:1995-08-21, Days after vaccination: 0
Gender:Female  Submitted:1996-06-19, Days after onset: 303
Location:Ohio  Entered:1996-08-23, Days after submission: 65
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: CO6093
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4H61118 IMA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Myalgia, Pruritus, Pyrexia
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)
Write-up: fever, body aches some local soreness w/itching;

VAERS ID:89387 (history)  Vaccinated:1995-11-21
Age:52.6  Onset:1995-11-23, Days after vaccination: 2
Gender:Male  Submitted:1996-07-02, Days after onset: 221
Location:D.C.  Entered:1996-08-29, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAMVHA466A60IMLA
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES5C711330SCRA
Administered by: Private     Purchased by: Private
Symptoms: Arthropathy, Hypokinesia, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: lt arm pain @ site of inj;next day or two devel rotator cuff injury in lt shoulder;eventually treated w/NSAID & physical therapy;8mo p/shot 90% mobility restored but still pain @ inj site on stretching the arm;

VAERS ID:89558 (history)  Vaccinated:1996-02-05
Age:52.5  Onset:1996-02-10, Days after vaccination: 5
Gender:Female  Submitted:1996-08-22, Days after onset: 193
Location:Pennsylvania  Entered:1996-09-03, 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: Premarin, Provera;Lorazepan;pt recvd hep B vax by SKB on 12FEB96;
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1319A0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Dizziness, Headache, Infection, Oedema, Osteoarthritis, Paraesthesia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (narrow)
Write-up: 5FEB96 pt recv vax & 6FEB96 c/o h/a, n,dizziness;BP 150/94;? virus vs stress vs rubella;26FEB96 c/o arthritic s/s, finger tips numb;saw MD 17FEB;10FEB96 arthritis s/s;17FEB aspiration fluid by MD;29FEB96 more edema;22AUG96 arthritic pain;

VAERS ID:89760 (history)  Vaccinated:1996-05-16
Age:52.1  Onset:1996-05-25, Days after vaccination: 9
Gender:Male  Submitted:1996-06-04, Days after onset: 10
Location:New York  Entered:1996-09-06, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NYS96038
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.K05113IMRA
Administered by: Private     Purchased by: Public
Symptoms: Arthropathy, Face oedema, Myasthenic syndrome, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Malignancy related conditions (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: 4:00 back itch, hives on back, then spread to stomach by 7PM, sides & upper arm by MN, then legs, top of feet, calves & eyes swelling by 7AM;also exp lameness in legs & weakness in knees;pt took antihistamine & noted some relief;

VAERS ID:89892 (history)  Vaccinated:1995-11-14
Age:52.6  Onset:1996-02-06, Days after vaccination: 84
Gender:Female  Submitted:1996-06-14, Days after onset: 128
Location:Michigan  Entered:1996-09-16, Days after submission: 94
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MI96113
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49581292IMLA
Administered by: Public     Purchased by: Public
Symptoms: Gait disturbance, Myalgia, Myasthenic syndrome, Neuritis, Neuropathy, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax & 2wk post vax exp aching in arms & legs;6FEB96 left work w/diff walking & holding onto thing w/hands got progressively worse;saw MD 7FEB96 adm x 2 days r/o stroke d/c saw shop MD dx rxn to flu shot;pvt MD dx polyneuritis

VAERS ID:89984 (history)  Vaccinated:1996-09-09
Age:52.1  Onset:1996-09-09, Days after vaccination: 0
Gender:Female  Submitted:1996-09-10, Days after onset: 1
Location:Oklahoma  Entered:1996-09-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mefoxin, tet tox, IM PCN, Mandol, bees/wasps, oranges;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM215A43 LA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Chest pain, Dizziness, Dysgeusia, Headache, Nausea, Neck pain, Vasodilatation
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: had extreme heat & pain lt arm, shoulder & neck, h/a, acid metallic taste in mouth;dizziness then tightness in chest 1hr later & nausea;

VAERS ID:90265 (history)  Vaccinated:1996-09-18
Age:52.0  Onset:1996-09-22, Days after vaccination: 4
Gender:Male  Submitted:1996-09-27, Days after onset: 5
Location:California  Entered:1996-09-30, Days after submission: 3
Life Threatening? No
Died? Yes
   Date died: 1996-09-22
   Days after onset: 0
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: CO6786
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER6F71223   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: death, flu-like sx 3 days p/shot;

VAERS ID:90601 (history)  Vaccinated:1996-09-09
Age:52.1  Onset:1996-09-10, Days after vaccination: 1
Gender:Female  Submitted:1996-09-19, Days after onset: 9
Location:Illinois  Entered:1996-10-08, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: SI joint pain
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6D81109  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: local rxn, red, tender, swollen;large 5inch bright red area on lt arm @ inj site;

VAERS ID:90760 (history)  Vaccinated:1996-10-01
Age:52.7  Onset:1996-10-02, Days after vaccination: 1
Gender:Male  Submitted:1996-10-16, Days after onset: 14
Location:Iowa  Entered:1996-10-21, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681810IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Dyspnoea, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: 2OCT96 temp up 100;3OCT96 coughing;4OCT96 coughing, temp, green phlegm;5OCT96 SOB seen in ER & adm to hosp w/dx pneumonia;

VAERS ID:91192 (history)  Vaccinated:1996-10-08
Age:52.8  Onset:1996-10-10, Days after vaccination: 2
Gender:Male  Submitted:1996-10-15, Days after onset: 5
Location:Iowa  Entered:1996-10-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nitro glycerin Blockers;cardiac meds- 6 or 7
Current Illness: NONE
Preexisting Conditions: coronary heart disease;angioplasty ballon 1995;stent insert SEP96;
Diagnostic Lab Data: BP 122/70;pulse 80;resp 18;
CDC Split Type: IA96036
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00586P IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Confusional state, Dyspnoea, Face oedema, Oedema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: edema, swelling of hands, rt foot, eyelids, back, buttocks, SOB, itching, mild chest pain, sl disorientation 10OCT96;Pred burst & DPH given 11OCT96;

VAERS ID:91246 (history)  Vaccinated:1996-10-12
Age:52.1  Onset:1996-10-12, Days after vaccination: 0
Gender:Female  Submitted:1996-10-12, Days after onset: 0
Location:Pennsylvania  Entered:1996-10-25, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681700IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Tachycardia, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax & w/in approx 1/2hr pt returned w/ c/o feeling SOB, dizziness, light-headedness;noted facial flushing;BP 133/88, P88, R16;cracked open an NH2 packet;pt stated did not feel better BP 108/70, P120, R24;epi given;pale, diaphoretic;

VAERS ID:91695 (history)  Vaccinated:1995-12-08
Age:52.7  Onset:1995-12-09, Days after vaccination: 1
Gender:Female  Submitted:1996-06-25, Days after onset: 198
Location:Washington  Entered:1996-10-30, Days after submission: 127
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: penicillin allergy, arthritis, chronic sinusitis, probable MS
Diagnostic Lab Data:
CDC Split Type: 896191009L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & exp urticaria & swelling of the lips & eyes;cont to exp urticaria as of the date of this report;

VAERS ID:93028 (history)  Vaccinated:1995-10-16
Age:52.5  Onset:1995-10-24, Days after vaccination: 8
Gender:Female  Submitted:1995-12-27, Days after onset: 64
Location:New Jersey  Entered:1996-10-30, Days after submission: 308
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: NKA
Diagnostic Lab Data: 24OCT95 LDH 286;SGOT 52;SGPT 65;PROT 6.2;ALBT 3.8;GLOB 2.4;6DEC95 SGOT 51;SGPT 71;ALBT 3.5;
CDC Split Type: 950116311
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1693A42IMA
Administered by: Private     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood lactate dehydrogenase increased, Hepatic function abnormal, Laboratory test abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow)
Write-up: pt recv vax & 8 days p/vax pt was found to have elevated liver enzymes;pt feels well, & has no sx;elevated lab values cont;

VAERS ID:93385 (history)  Vaccinated:1996-06-19
Age:52.0  Onset:1996-06-27, Days after vaccination: 8
Gender:Female  Submitted:1996-07-11, Days after onset: 14
Location:Pennsylvania  Entered:1996-10-30, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 960098311
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2036A24IMA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Back pain, Cough, Leukocytosis, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax & 8 days p/vax pt exp rt flank discomfort, nausea, exhaustion, fever, chills, cough & a lightly elevated WBC count;sx resolved w/o tx;

VAERS ID:93460 (history)  Vaccinated:1996-07-25
Age:52.0  Onset:1996-07-27, Days after vaccination: 2
Gender:Female  Submitted:1996-08-14, Days after onset: 18
Location:Missouri  Entered:1996-10-30, Days after submission: 77
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: NKA
Diagnostic Lab Data:
CDC Split Type: 960112411
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2008A43IMLA
Administered by: Public     Purchased by: Other
Symptoms: Asthma, Cough, Malaise, Pharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt recv 25JUL96 & w/in 48hr of vax pt exp sore throat, fever to 102.3, cough, bronchospasm, malaise;tx proventil inhaler & biaxin;sx cont;

VAERS ID:91560 (history)  Vaccinated:1996-10-19
Age:52.8  Onset:1996-10-20, Days after vaccination: 1
Gender:Female  Submitted:1996-10-29, Days after onset: 9
Location:Washington  Entered:1996-11-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WA971361
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Myalgia, Pharyngitis, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad)
Write-up: w/in 24hr sore throat, aches, runny nose;pt states poss it was a big coincidence?; pt states throat & runny nose, sore arm & aches were there in AM;

VAERS ID:91602 (history)  Vaccinated:1996-10-09
Age:52.6  Onset:1996-10-12, Days after vaccination: 3
Gender:Female  Submitted:1996-10-23, Days after onset: 11
Location:Minnesota  Entered:1996-11-04, 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: Insulin-Velosin,Humulin buffered
Current Illness: diabetes-chronic
Preexisting Conditions: diabetes-1962-present, allergies-amoxicillin (severe vomitting), Reglan
Diagnostic Lab Data: NONE
CDC Split Type: MN96040
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968167  LA
Administered by: Public     Purchased by: Other
Symptoms: Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: 30 days p/vax pt malaise;had tenderness in lt arm;tenderness remains unchanged;no palpable hematoma, no redness, no swelling;

VAERS ID:91646 (history)  Vaccinated:1996-09-05
Age:52.3  Onset:1996-09-05, Days after vaccination: 0
Gender:Male  Submitted:1996-10-24, Days after onset: 49
Location:Ohio  Entered:1996-11-05, 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: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 10OCT96 EMG-acute lt brachial neuopathy;
CDC Split Type:
Vaccination
Manufacturer
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Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6E81148 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Myasthenic syndrome, Neuropathy, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad)
Write-up: pt recv vax 5SEP96 & 2 days later pt devel intense pain in lt scapula, radiating down lt arm to elbow 4th & 5th digits of lt hand were numb & weak;

VAERS ID:91676 (history)  Vaccinated:1996-10-11
Age:52.5  Onset:1996-10-13, Days after vaccination: 2
Gender:Female  Submitted:1996-10-29, Days after onset: 16
Location:California  Entered:1996-11-05, 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: NA
Current Illness: NA
Preexisting Conditions: celiac sprue disease;
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER00786P1IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURERM230NA IM 
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER1626B SC 
Administered by: Private     Purchased by: Private
Symptoms: Chills, Influenza, Injection site hypersensitivity, Injection site oedema, Myalgia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: 2 days p/vax pt had flu-like sx, chills, myalgia, local swelling, erythema, warm;pt states knows sx are from pneumovax site;

VAERS ID:91723 (history)  Vaccinated:1996-10-11
Age:52.9  Onset:1996-10-14, Days after vaccination: 3
Gender:Female  Submitted:1996-10-15, Days after onset: 1
Location:Washington  Entered:1996-11-06, Days after submission: 22
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: WA961286
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968162 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Hypertonia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad)
Write-up: 14OCT woke up very stiff & sore;fever came on in PRN @ 2PM 101.7 lasted 12hr;today gen body soreness, fever gone, feels weak;states has had flu shot for post 6hr w/o any rxn;

VAERS ID:91964 (history)  Vaccinated:1996-10-25
Age:52.9  Onset:1996-10-25, Days after vaccination: 0
Gender:Male  Submitted:1996-11-06, Days after onset: 12
Location:Alaska  Entered:1996-11-13, 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:
Preexisting Conditions: sulfur
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash-sx;DPH tx sx lasted 12 days;

VAERS ID:91970 (history)  Vaccinated:1996-10-01
Age:52.4  Onset:1996-10-04, Days after vaccination: 3
Gender:Male  Submitted:1996-10-30, Days after onset: 26
Location:Missouri  Entered:1996-11-13, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Seldane, Beconase
Current Illness: NONE
Preexisting Conditions: allergy to molds & dust
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71247  LA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Oedema, Pain, Rash maculo-papular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: 4OCT96 or 5OCT96 noticed soreness & swelling in lt shoulder;7OCT96 noticed a localized red rash where vax had been given;10-15 sore on upper lt arm;no systemic complaints;11OCT96 to company MD for eval;30OCT96 raised pink areas on arm

VAERS ID:91934 (history)  Vaccinated:1996-11-04
Age:52.1  Onset:1996-11-04, Days after vaccination: 0
Gender:Female  Submitted:1996-11-05, Days after onset: 1
Location:Oklahoma  Entered:1996-11-14, 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: HBP med
Current Illness: NONE
Preexisting Conditions: High BP
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Pain, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: lt arm swelling, reddened, warm to touch & throbbing from 4PM to this AM 5NOV96 1130AM;took ASA last noc;encouraged no more ASA;took APAP or Ibuprofen;warm moist pack to site;

VAERS ID:92074 (history)  Vaccinated:1996-10-15
Age:52.3  Onset:1996-10-20, Days after vaccination: 5
Gender:Female  Submitted:1996-10-29, Days after onset: 9
Location:California  Entered:1996-11-15, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Tamoxifen, Ziac
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETHE30766D  LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0394D0 RA
Administered by: Private     Purchased by: Private
Symptoms: Conjunctivitis, Pruritus, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: pt broke out w/rash w/sl fever, itching 3 days;itch, red conjunctiva;

VAERS ID:92229 (history)  Vaccinated:1996-10-22
Age:52.0  Onset:1996-10-22, Days after vaccination: 0
Gender:Female  Submitted:1996-11-14, Days after onset: 23
Location:Washington  Entered:1996-11-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt had rxn to 1st allergy shot DEC94
Other Medications: Atenolal, Premarin, Triam/HCTZ
Current Illness: NONE
Preexisting Conditions: allergies weeds, grass, sage, trees, etc
Diagnostic Lab Data: 25OCT96 observation by pvt MD only;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES67713160IMA
Administered by: Other     Purchased by: Private
Symptoms: Oedema peripheral, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: arm swollen, red, welt approx 1"x3:;lasted about 1 1/2wk;

VAERS ID:92325 (history)  Vaccinated:1996-10-31
Age:52.9  Onset:1996-11-03, Days after vaccination: 3
Gender:Female  Submitted:1996-11-12, Days after onset: 9
Location:North Carolina  Entered:1996-11-25, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Firounal
Current Illness: did not indicate any
Preexisting Conditions: unk
Diagnostic Lab Data: NA
CDC Split Type: NC96134
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH68204 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Confusional state, Oedema, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: 3 days p/vax pt c/o redness, swollen arm, & rash down lt arm;reported on 12NOV96-stated no rash anywhere else;reported confusion along w/above sx;

VAERS ID:92350 (history)  Vaccinated:1996-08-19
Age:52.5  Onset:1996-08-19, Days after vaccination: 0
Gender:Male  Submitted:1996-08-20, Days after onset: 1
Location:Tennessee  Entered:1996-11-25, Days after submission: 97
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Novacaine day before
Current Illness: NONE
Preexisting Conditions: hx of prostate cancer
Diagnostic Lab Data:
CDC Split Type: TN86090
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2060BG0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: pt recv vax approx 115-120PM on19AUG96;@ approx 230-240PM pt was taken to ER for c/o chest pain & possible heart attack;

VAERS ID:92387 (history)  Vaccinated:1996-10-24
Age:52.8  Onset:1996-10-27, Days after vaccination: 3
Gender:Female  Submitted:1996-11-06, Days after onset: 10
Location:Georgia  Entered:1996-11-25, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp rxn 94-95 @ age 50/51 w/flu vax;
Other Medications: Vitamins Synthroid, Premarin, Coragid, Zoloft, RItalin
Current Illness: NONE
Preexisting Conditions: allergies seafood, environment allergies, allergic vodeine;asthma;MVP, back surgery, Epstein Barr virus, Firbomyalgia;
Diagnostic Lab Data: blood profile @ MD office
CDC Split Type: GA96153
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3036GA6IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Influenza, Myalgia, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad)
Write-up: 27OCT96 pt c/o body aches, cough, fever;2NOV96 c/o flu sx w/sore throat;4NOV96 MD saw pt stated had flu-?flu shot but would not say for sure that was rxn;6NOV96 pt states has allergy to chicken feathers;also has allergic asthma;

VAERS ID:92516 (history)  Vaccinated:1996-11-01
Age:52.2  Onset:1996-11-07, Days after vaccination: 6
Gender:Female  Submitted:1996-11-19, Days after onset: 12
Location:Nevada  Entered:1996-12-02, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: immitrex PRN h/a-migraine
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0318D0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Arthralgia, Asthenia, Headache, Lymphadenopathy, Malaise, Neck pain, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: on morning of day 6 p/vax felt feverish, tired, irritable, legs & hip pain, sore neck w/nodules, fever inc to 101 by day 12, h/a & raised red rash to face, chest, arms, back;

VAERS ID:93113 (history)  Vaccinated:1996-09-05
Age:52.0  Onset:1996-09-05, Days after vaccination: 0
Gender:Male  Submitted:1996-10-24, Days after onset: 49
Location:Ohio  Entered:1996-12-17, Days after submission: 54
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: 10OCT96 EMG acute lt brachial neuropathy;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6E81148 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Myasthenic syndrome, Neuropathy, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad)
Write-up: pt recv vax & 2 days later pt devel intense pain in lt scapula, radiating down lt arm to elbow;4th & 5th digits of lt hand were numb & weak;

VAERS ID:93240 (history)  Vaccinated:1996-11-02
Age:52.0  Onset:1996-11-02, Days after vaccination: 0
Gender:Female  Submitted:1996-12-02, Days after onset: 30
Location:Arkansas  Entered:1996-12-23, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: AR9687
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71307 IMLA
Administered by: Other     Purchased by: Public
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt states that left arm began hurting immediately after vax; it hurt all the way down pt arm. pt states that the nurse gave vax on top of shoulder; now one month later pt states she is unable to use arm. pt has not seen MD

VAERS ID:93517 (history)  Vaccinated:1996-10-28
Age:52.9  Onset:0000-00-00
Gender:Female  Submitted:1996-11-19
Location:Minnesota  Entered:1997-01-02, Days after submission: 44
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: sulfa, doxycycline; breast ca;
Diagnostic Lab Data:
CDC Split Type: MN96061
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968163 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypokinesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax; arm sore; lt arm started to ache; depends on position and movement of arm; lateral movements hurt the most; reports inc pain w/ immobility;

VAERS ID:94539 (history)  Vaccinated:1996-10-10
Age:52.2  Onset:1996-10-10, Days after vaccination: 0
Gender:Male  Submitted:1996-10-20, Days after onset: 10
Location:Maryland  Entered:1997-01-29, Days after submission: 101
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MD96042
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3086GG0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: lt deltoid red, warm to touch, swollen & itching;

VAERS ID:94542 (history)  Vaccinated:1995-10-25
Age:52.5  Onset:1995-12-07, Days after vaccination: 43
Gender:Female  Submitted:1996-08-12, Days after onset: 248
Location:Nevada  Entered:1997-01-29, Days after submission: 170
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen;Thyroid?
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00785P IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES1076B IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5F71086 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Amblyopia, Headache, Hypokinesia, Hyporeflexia, Myalgia, Paraesthesia, Skin hypertrophy, Tendon disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: both arms contracted against chest-fingers not aligned;no control over movement;unable to ambulate or perform personal hygiene tasks;paresthesia all extremities;muscle pain;h/a,myalgia,cephalgia,blurred vision;Heglund''s deformities;

VAERS ID:94581 (history)  Vaccinated:1996-05-01
Age:52.3  Onset:1996-05-03, Days after vaccination: 2
Gender:Female  Submitted:1996-10-08, Days after onset: 158
Location:Texas  Entered:1997-01-30, Days after submission: 114
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins, poss clariton
Current Illness: NONE
Preexisting Conditions: resp allergies & PCN
Diagnostic Lab Data:
CDC Split Type: TX96156
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD14036560PO 
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Oedema, Oedema peripheral, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: itching inside arms & neck & ankles & underside of legs;areas became swollen & hot;rash like tiny h20 blisters;sx lasted about 3wk, took DPH & hydrocortisone cream;

VAERS ID:94809 (history)  Vaccinated:1997-01-17
Age:52.3  Onset:1997-01-19, Days after vaccination: 2
Gender:Female  Submitted:1997-01-31, Days after onset: 12
Location:Louisiana  Entered:1997-02-04, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO7072
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6J81325   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 17JAN97 & it was reported that about 48hr later the inj site had become red (about 5 inches), warm & hard;

VAERS ID:94837 (history)  Vaccinated:1997-01-17
Age:52.7  Onset:1997-01-17, Days after vaccination: 0
Gender:Female  Submitted:1997-01-21, Days after onset: 4
Location:Georgia  Entered:1997-02-11, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: 4 tubes of blood according to pt
CDC Split Type: GA97002
Vaccination
Manufacturer
Lot
Dose
Route
Site
CHOL: CHOLERA (USP)PFIZER/WYETH49581862  
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0  
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6A810171  
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETH49680821  
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Dehydration, Diarrhoea, Headache, Neck pain, Pain, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: fever 105, dehydration, pain neck, shoulders, severe h/a (burning), back (kidney level[waist), legs arms, sore throat, diarrhea & vomiting;adm to hosp 19JAN97 given IVF pain meds;

VAERS ID:94992 (history)  Vaccinated:1997-01-15
Age:52.4  Onset:1997-01-22, Days after vaccination: 7
Gender:Female  Submitted:1997-02-06, Days after onset: 15
Location:New York  Entered:1997-02-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.0680D0SC 
Administered by: Other     Purchased by: Unknown
Symptoms: Malaise, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 22JAN started to have gen body, malaise;25JAN body malaise became worse w/fever;27JAN body malaise more severe, fever & devel red spots arms, thighs, back, chest & abd area;

VAERS ID:95472 (history)  Vaccinated:1996-07-17
Age:52.3  Onset:1996-07-17, Days after vaccination: 0
Gender:Male  Submitted:1997-02-26, Days after onset: 224
Location:Montana  Entered:1997-03-05, 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: UNK
Current Illness: UNK
Preexisting Conditions: drixoral
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0309D1 LA
Administered by: Public     Purchased by: Private
Symptoms: Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad)
Write-up: chronic muscle pain @ site of inj;

VAERS ID:95680 (history)  Vaccinated:1996-10-22
Age:52.8  Onset:1996-10-22, Days after vaccination: 0
Gender:Female  Submitted:1996-10-28, Days after onset: 6
Location:Michigan  Entered:1997-03-06, Days after submission: 129
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896312010L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968191 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chills, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: w/in 5min p/vax pt became cold, clammy, nauseous;recovered w/in 10 to 15min;this is 1 of 3 pt from this site to devel these sx p/vax;

VAERS ID:95698 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:0000-00-00
Gender:Female  Submitted:1996-10-31
Location:Maine  Entered:1997-03-06, 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: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896317006L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968173 IM 
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt exp itching @ inj site immed following vax;

VAERS ID:96457 (history)  Vaccinated:1997-03-06
Age:52.6  Onset:1997-03-13, Days after vaccination: 7
Gender:Female  Submitted:1997-03-14, Days after onset: 1
Location:North Carolina  Entered:1997-03-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NC97022
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6H81269 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt had redness, warmth & swelling @ site of inj of vax;(but problem occurred 1k p/vax;encouraged heating pad & to see PMD if not better;(redness & induration about 4in-x 2in;

VAERS ID:96520 (history)  Vaccinated:1996-04-20
Age:52.0  Onset:1996-04-27, Days after vaccination: 7
Gender:Female  Submitted:1997-03-25, Days after onset: 332
Location:New Jersey  Entered:1997-03-28, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clariten
Current Illness: fell-sprained both knees
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Hypokinesia, Injection site abscess, Injection site hypersensitivity, Oedema peripheral, Pain, Paraesthesia, Rhinitis, Tinnitus
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & devel abscess-red ring around inj site;tx in ER;swollen lt arm-problem lifting, moving arm w/o pain;given ATB & something for pain;ringing in ears;sinus problem, head numbness;

VAERS ID:96819 (history)  Vaccinated:1997-02-21
Age:52.4  Onset:1997-02-22, Days after vaccination: 1
Gender:Female  Submitted:1997-02-25, Days after onset: 3
Location:Texas  Entered:1997-04-08, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocor;Diltiazem;Climetadine;Humulin;Relafen;Nitro;Serzone, Fiflunt
Current Illness: puncture wound to foot
Preexisting Conditions: DM-HTN
Diagnostic Lab Data:
CDC Split Type: TX97025
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6F81189 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pain, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 5x6cm area of erythema, tenderness-warm to touch;

VAERS ID:98259 (history)  Vaccinated:1995-05-08
Age:52.9  Onset:1995-05-08, Days after vaccination: 0
Gender:Female  Submitted:1996-03-18, Days after onset: 315
Location:Louisiana  Entered:1997-04-16, Days after submission: 393
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was also immunized w/Typhoid & hepatitis vaccines @ some point p/vax;hives did not start until p/pt returned from a camping trip;one dermatologist thought pt was allerg to yellow dye in Premarin;pt switched to another estrogen product;
Diagnostic Lab Data: biopsy x2, 1 skin scrap, A&A, RA latex, CBC;HIV test, C-125 allergen patch test & CBc;
CDC Split Type: 896085006L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)PFIZER/WYETH  IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & approx 1wk p/vax pt devel hives, which started @ the inj site & progressed to trunk;the rxn persists as an ongoing dermatitis;pt has seen numerous dermatologists & undergone biopsies & other studies;rash & pruritus persist;

VAERS ID:97071 (history)  Vaccinated:1997-04-02
Age:52.3  Onset:1997-04-03, Days after vaccination: 1
Gender:Female  Submitted:1997-04-07, Days after onset: 3
Location:Florida  Entered:1997-04-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: IG by MDPH lot# IG125 given 2APR97;
Current Illness: NONE
Preexisting Conditions: codeine
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6L814120IMA
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD144771A0PO 
Administered by: Public     Purchased by: Private
Symptoms: Face oedema, Pain, Rhinitis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 2APR97 & bridge of nose swelled & got very tender (as if broken);3APR (eased off a little 4APR);

VAERS ID:97072 (history)  Vaccinated:1997-04-04
Age:52.3  Onset:1997-04-04, Days after vaccination: 0
Gender:Female  Submitted:1997-04-07, Days after onset: 2
Location:Florida  Entered:1997-04-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp nose swelling & tender w/dose 1 typhoid vax;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: codeine
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD144771A1PO 
Administered by: Public     Purchased by: Private
Symptoms: Face oedema, Pain, Rhinitis, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 4APR97 & nose swelled & was very tender;

VAERS ID:98774 (history)  Vaccinated:1995-10-17
Age:52.0  Onset:1995-10-20, Days after vaccination: 3
Gender:Male  Submitted:1997-02-06, Days after onset: 475
Location:Florida  Entered:1997-04-18, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO6333
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F61014   
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: red, swollen, tender area on inj site;

VAERS ID:98784 (history)  Vaccinated:1995-10-09
Age:52.0  Onset:1995-10-10, Days after vaccination: 1
Gender:Female  Submitted:1997-02-05, Days after onset: 484
Location:Texas  Entered:1997-04-18, Days after submission: 71
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: high BP pills
Current Illness:
Preexisting Conditions: high BP
Diagnostic Lab Data:
CDC Split Type: CO6214
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F61133   
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Malaise, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: face, lips & arm swollen w/in 10hr, feeling bad;tx w/Medrol dose pak;many flu vax in the past w/o incidents;

VAERS ID:98878 (history)  Vaccinated:1995-10-02
Age:52.0  Onset:1995-10-03, Days after vaccination: 1
Gender:Female  Submitted:1997-02-05, Days after onset: 491
Location:Texas  Entered:1997-04-18, Days after submission: 71
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: CO6159
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5F61119 IM 
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Chills, Diarrhoea, Laryngitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: began w/laryngitis, chills & fever, diarrhea until 5OCT95, joint pains;

VAERS ID:97255 (history)  Vaccinated:1997-04-07
Age:52.3  Onset:1997-04-12, Days after vaccination: 5
Gender:Female  Submitted:1997-04-17, Days after onset: 5
Location:Washington  Entered:1997-04-28, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Lotensin
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6D81109 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: large urticarial rxn (24cm) @ site of vax lt upper arm;

VAERS ID:97404 (history)  Vaccinated:1997-04-15
Age:52.4  Onset:1997-04-16, Days after vaccination: 1
Gender:Male  Submitted:1997-04-30, Days after onset: 14
Location:Arizona  Entered:1997-05-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: ASA pt using med for HTN, asthma
Current Illness: NONE
Preexisting Conditions: multiple allergies (cats, etc);astham, HTN
Diagnostic Lab Data: NONE
CDC Split Type: AZ9720
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES6J713510 LA
Administered by: Public     Purchased by: Public
Symptoms: Chills
SMQs:
Write-up: approx 28hr p/vax pronounced chills & shivering of hands last about two hours

VAERS ID:97452 (history)  Vaccinated:1997-04-24
Age:52.0  Onset:1997-04-25, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Wisconsin  Entered:1997-05-07
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: last time pt had heartburn was w/pregnancy 17 yrs ago;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD144771A PO 
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Diarrhoea, Dyspepsia
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 24APR97 & noted heartburn on 25APR97; Took 1st oral Typhoid 4/24/97, Noted heartburn on 4/25. Took 2nd oral Typhoid 4/26/97, with heartburn and later that day got diarrhea, worse on 4/27 & 4/28. Took ZANTAC x 2 (75 mg) - No relief. Took MAALOX liquid with some relief. 5/1/97: still taking ZANTAC PRN, queasy +/-. No heartburn or diarrhea but lingering GI Symptoms.

VAERS ID:98118 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:0000-00-00
Gender:Male  Submitted:1997-05-19
Location:Unknown  Entered:1997-05-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: pt devel tingling,myopathy,vasculitis, arthrosis, poor grip & mobility w/dose 1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Commont latex text for R$gA$g factor positive 1/40;
CDC Split Type: EML96679
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)MEDEVA PHARMA, LTD. 1  
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Infection, Laboratory test abnormal, Myasthenic syndrome, Pain
SMQs:, Malignancy related conditions (narrow), Guillain-Barre syndrome (broad)
Write-up: pt recv vax & devel pain in the top of arm & sensation of heaviness;rheumatoid arthritis rare form of a synd brought on by RS3PE virus;pt disabled for some months but recovered;

VAERS ID:98199 (history)  Vaccinated:1997-04-14
Age:52.4  Onset:1997-04-14, Days after vaccination: 0
Gender:Male  Submitted:1997-04-16, Days after onset: 2
Location:Washington  Entered:1997-05-21, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin-no taken
Current Illness: complete physical
Preexisting Conditions: sinusitis in FEB97;
Diagnostic Lab Data:
CDC Split Type: WA971349
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Coordination abnormal, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 14APR97 230PM & 430Pm t102, chills, loss of balance, generalized aches;went to MD 15APR97 w/cont sx;130/80, t101 orally;16APR97 leaves work because of fever again;

VAERS ID:98245 (history)  Vaccinated:1997-05-07
Age:52.6  Onset:1997-05-09, Days after vaccination: 2
Gender:Female  Submitted:1997-05-15, Days after onset: 6
Location:Maine  Entered:1997-05-22, 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: HCTZ;Provera;Premarin;Pepsid
Current Illness: fishook embedded;
Preexisting Conditions: unknown
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)PFIZER/WYETH49682841 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site mass, Oedema, Pain, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: red rimmed area-blanches easy to touch;14cm x 9cm little swelling;indurated (robin egg) area around inj site;itches, hurt 1-2 p/vax (days);

VAERS ID:98940 (history)  Vaccinated:1995-08-15
Age:52.5  Onset:1995-08-15, Days after vaccination: 0
Gender:Female  Submitted:1996-02-21, Days after onset: 190
Location:New York  Entered:1997-05-22, Days after submission: 455
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896138022L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49580131IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt devel an inj site rxn characterized by pain, redness, & swelling p/vax;

VAERS ID:99654 (history)  Vaccinated:1996-12-01
Age:52.5  Onset:1996-12-01, Days after vaccination: 0
Gender:Female  Submitted:1997-01-22, Days after onset: 52
Location:New Jersey  Entered:1997-05-24, Days after submission: 121
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: arteriovenous malformation
Diagnostic Lab Data: UNK
CDC Split Type: 010150970060000
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS01386P0IMA
Administered by: Public     Purchased by: Other
Symptoms: Conjunctivitis, Cough, Hypersensitivity, Pruritus, Rhinitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: pt recv vax DEC96 & since then has been exp an allergy rxn manifested by sneezing, watery eyes, itchy nose & mild cough to clear throat;pt has not yet recovered;

VAERS ID:99072 (history)  Vaccinated:1996-06-28
Age:52.1  Onset:1996-06-28, Days after vaccination: 0
Gender:Female  Submitted:1996-12-05, Days after onset: 160
Location:Illinois  Entered:1997-05-27, Days after submission: 172
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO6677
Vaccination
Manufacturer
Lot
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Route
Site
JEV: JAPANESE ENCEPHALITIS (J-VAX)CONNAUGHT LABORATORIESEJN120C1  
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Injection site hypersensitivity, Vasodilatation
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: arm felt burning gradually more inflammed 6x5cc local rxn, erythema, hot to touch, tiny blister on opposite wrist & knee;

VAERS ID:99397 (history)  Vaccinated:1996-10-11
Age:52.1  Onset:1996-10-11, Days after vaccination: 0
Gender:Female  Submitted:1996-10-14, Days after onset: 3
Location:Maryland  Entered:1997-05-29, Days after submission: 227
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: unk
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 010150960031000
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS  SCA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 11OCT96 & devel redness, swelling & pain @ inj site;pt has recovered;

VAERS ID:99642 (history)  Vaccinated:1996-10-01
Age:52.1  Onset:1996-10-01, Days after vaccination: 0
Gender:Male  Submitted:1997-01-09, Days after onset: 100
Location:Indiana  Entered:1997-05-29, Days after submission: 139
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 010150970046000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS 0IMA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 1OCT96 & arm started aching between elbow & shoulder the same day recv vax;pt reported arm feels like there is something still there because arm still aches four mo later;this case was reported by consumer;

VAERS ID:98664 (history)  Vaccinated:1997-05-01
Age:52.3  Onset:1997-05-02, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Washington  Entered:1997-06-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zestril for HTN & col-benemid for gout;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2146A42IM 
JEV: JAPANESE ENCEPHALITIS (J-VAX)CONNAUGHT LABORATORIESEJN*1208 SC 
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.L0040 SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pain, Skin nodule, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: devel gen rash erythematous maculopapular (not urticaria) p/vax;devel generalized rash next 24-48hr;

VAERS ID:98735 (history)  Vaccinated:1997-05-28
Age:52.3  Onset:1997-05-28, Days after vaccination: 0
Gender:Female  Submitted:1997-06-03, Days after onset: 6
Location:Minnesota  Entered:1997-06-09, 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: needed stitches no illness;
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES443187 IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)
Write-up: area of redness approx 1 1/2" in diameter @ site of inj;area warm to touch;no puss;large 2" in diameter;used ice to cool down;

VAERS ID:99711 (history)  Vaccinated:1997-02-10
Age:52.0  Onset:1997-02-17, Days after vaccination: 7
Gender:Female  Submitted:1997-03-19, Days after onset: 30
Location:Missouri  Entered:1997-06-24, Days after submission: 96
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: 970061061
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAMVHA503B60IMA
Administered by: Public     Purchased by: Private
Symptoms: Myalgia, Pharyngitis
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 10FEB97 & w/in 1 wk pt exp muscle aches & scratchy throat;sx resolved w/o any prescription meds;

VAERS ID:99325 (history)  Vaccinated:1997-06-04
Age:52.8  Onset:1997-06-16, Days after vaccination: 12
Gender:Female  Submitted:1997-06-20, Days after onset: 4
Location:Massachusetts  Entered:1997-06-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Glyubride
Current Illness: diabetes
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
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Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER0993D0SC 
Administered by: Public     Purchased by: Public
Symptoms: Drug ineffective, Infection, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 4JUN97 & devel a rash 16JUN97 & was dx as having a meeasles rxn by NP;the rash was behind pt ears & on upper body, DPH & APAP were prescribed;

VAERS ID:99508 (history)  Vaccinated:1997-05-08
Age:52.8  Onset:1997-05-09, Days after vaccination: 1
Gender:Female  Submitted:1997-05-12, Days after onset: 3
Location:Florida  Entered:1997-06-30, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN allergy
Diagnostic Lab Data: unk
CDC Split Type: FL97033
Vaccination
Manufacturer
Lot
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Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7B91518 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Dermatitis bullous, Injection site hypersensitivity, Injection site pain, Pain, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 8MAY97 & 9MAY pain started & pt had chills, fever & cont pain, w/blistering starting on 11MAY97;site now very red & painful w/large 13mm blister;TC to pt taken to ER 13MAY97 PM;c/o blisters arm, fever, T & arm red & painful;

VAERS ID:100389 (history)  Vaccinated:1997-06-25
Age:52.4  Onset:1997-06-30, Days after vaccination: 5
Gender:Female  Submitted:1997-07-02, Days after onset: 2
Location:Idaho  Entered:1997-07-21, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Prinivil
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data: NONE
CDC Split Type: ID97028
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6B81430 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 2JUL97 pt reports soreness, redness & swelling @ inj site approx 5 days p/vax;saw PMD who started IV ATB x 2 days;today reports has had 2nd course of IV ATB w/little response;states is to see MD for poss addtl ATB

VAERS ID:101498 (history)  Vaccinated:1995-12-04
Age:52.8  Onset:1996-02-04, Days after vaccination: 62
Gender:Female  Submitted:1996-03-18, Days after onset: 43
Location:New Mexico  Entered:1997-07-22, Days after submission: 490
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin;
Current Illness: NONE
Preexisting Conditions: Kanomycin allergy
Diagnostic Lab Data: NONE
CDC Split Type: 896200009L
Vaccination
Manufacturer
Lot
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Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES394903 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Dizziness, Headache, Influenza, Injection site oedema, Nausea, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: w/in 24hr of vax pt exp flu-like sx characterized by fatigue, dizziness, h/a, fever & nausea;pt also exp inj site swelling;2 days p/vax pt devel urticaria from shoulder to elbow;

VAERS ID:102042 (history)  Vaccinated:1995-01-01
Age:52.0  Onset:1995-01-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:California  Entered:1997-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 1995 ESR 125;inc platelets;
CDC Split Type: WAES97010508
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Anaemia, Arthralgia, Arthritis, Asthenia, Insomnia, Osteoarthritis, Synovitis, Thrombocythaemia
SMQs:, Haematopoietic erythropenia (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Arthritis (narrow)
Write-up: pt recv vax 1995 & approx 48 to 72hr p/vax pt exp noc sweats, fatigue, insomnia, chronic arthritis involving the rt & lt hip, rt shoulder, lt knee & 2nd & third metacarpal joints of rt hand;joints warm, red, swollen & tender;lab eval anemia

VAERS ID:102453 (history)  Vaccinated:1997-04-26
Age:52.6  Onset:1997-04-28, Days after vaccination: 2
Gender:Female  Submitted:1997-05-02, Days after onset: 4
Location:Tennessee  Entered:1997-09-10, Days after submission: 131
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: diabetes mellitus, type unk;allergic to contrast agents;obesity;dyslipidemia;
Diagnostic Lab Data:
CDC Split Type: 897139019L
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4412140IMA
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: 2 days p/vax pt devel a fever of 104 & painful retroauricular adenopathy; 4 days post vax pt began to improve;

VAERS ID:102680 (history)  Vaccinated:1996-11-26
Age:52.8  Onset:1996-11-26, Days after vaccination: 0
Gender:Female  Submitted:1997-09-09, Days after onset: 286
Location:New York  Entered:1997-09-22, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Bursitis, Calcium metabolism disorder, Chest pain, Gait disturbance, Gastric ulcer, Myalgia, Serum sickness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal ulceration (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: evening of vax muscle & joint pain, limping, affected sleep, serum sickness, allergic reaction;

VAERS ID:102754 (history)  Vaccinated:1997-01-25
Age:52.6  Onset:1997-01-26, Days after vaccination: 1
Gender:Female  Submitted:1997-08-01, Days after onset: 186
Location:Maryland  Entered:1997-09-24, Days after submission: 54
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: CO7077
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5H71002   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 25JAN97;the next day devel a local rxn consisting of site redness, swelling, hot to touch & about 4x5in in size;most of the upper arm was affected on the lateral side;last immun was over 10 yr ago;

VAERS ID:102725 (history)  Vaccinated:1996-12-16
Age:52.9  Onset:1996-12-16, Days after vaccination: 0
Gender:Female  Submitted:1996-12-20, Days after onset: 4
Location:Ohio  Entered:1997-09-26, Days after submission: 279
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4968093  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: swelling, erythema, blisters @ admin site;

VAERS ID:103046 (history)  Vaccinated:1997-09-22
Age:52.0  Onset:1997-09-28, Days after vaccination: 6
Gender:Female  Submitted:1997-10-06, Days after onset: 8
Location:Nebraska  Entered:1997-10-09, Days after submission: 3
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mastectomy;Splenectomy;Hodgkin''s disease;
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97092237
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Infection, Meningitis
SMQs:, Noninfectious meningitis (narrow)
Write-up: pt recv vax 22SEP97 & 28SEP97 pt devel poss bacterial meningitis, which was felt to be life-threatening;

VAERS ID:104003 (history)  Vaccinated:1997-10-22
Age:52.2  Onset:1997-10-22, Days after vaccination: 0
Gender:Female  Submitted:1997-10-22, Days after onset: 0
Location:Washington  Entered:1997-10-28, 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:
Current Illness: denied
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978143  LA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Injection site hypersensitivity, Oedema peripheral, Paraesthesia, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 11:55 c/o itching @ inj site-area sl red;12:00 c/o hand swelling-epi;pt states is fine-911 called given above site;12:05 DPH given c/o numbness, tingling face;9DEC c/o dizziness

VAERS ID:104051 (history)  Vaccinated:1997-10-23
Age:52.9  Onset:1997-10-23, Days after vaccination: 0
Gender:Female  Submitted:1997-10-27, Days after onset: 4
Location:Texas  Entered:1997-10-30, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Premarin & estrogen
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & 3hr later diff breathing then sat & sun hives on chest, upper arms, back & neck;called clinic took DPH-no more hives sl fever also;

VAERS ID:105521 (history)  Vaccinated:1996-11-21
Age:52.0  Onset:1996-11-23, Days after vaccination: 2
Gender:Female  Submitted:1997-05-22, Days after onset: 179
Location:Unknown  Entered:1997-10-30, Days after submission: 161
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid;
Current Illness: hypothyroid
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 970011691A
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2035A20IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lymphadenopathy, Pain
SMQs:
Write-up: pt recv vax & w/in 48hr pt exp pain in ax when applying deodorant;pain subsided pt discontinued using deodorant;

VAERS ID:104345 (history)  Vaccinated:1997-09-25
Age:52.1  Onset:1997-09-25, Days after vaccination: 0
Gender:Male  Submitted:1997-10-31, Days after onset: 36
Location:Florida  Entered:1997-11-03, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NOEN
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81817  RA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Dizziness, Influenza, Lacrimal disorder, Myalgia, Pharyngitis, Stomatitis
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Agranulocytosis (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (broad)
Write-up: 2hr p/vax devel a sore throat & flu sx (weakness, dizziness, aches ect) which lasted about 12hr;mouth, gums & inter nose devel a burning sensation which lasted for 1 day;eyes teared up for about 4 to 6 hr;

VAERS ID:104371 (history)  Vaccinated:1997-10-21
Age:52.2  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-10-24, Days after onset: 2
Location:Texas  Entered:1997-11-04, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Insulin AM & PM;capatril for HTN
Current Illness: NONE
Preexisting Conditions: diabetes, hypertension, back injury
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781394 RA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: had chills that noc p/vax woke up nauseated, vomited then vomited 4-5 times throughout the day;had major muscle aches that AM;called by MD phoned in prescription for phenergan suppository;cont to have muscle aches;cont w/muscles aches;

VAERS ID:104417 (history)  Vaccinated:1997-10-23
Age:52.0  Onset:1997-10-24, Days after vaccination: 1
Gender:Female  Submitted:1997-10-27, Days after onset: 3
Location:Minnesota  Entered:1997-11-05, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling & daughter devel rash & arm swelling @ 21 w/flu vax;
Other Medications: Synthroid;proverin-ogen;Maxide
Current Illness: NONE
Preexisting Conditions: codeine;HTN, hypothyroidism, hormonal changes;
Diagnostic Lab Data: nond done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817736IMRA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pruritus, Rash maculo-papular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: awoke @ 4AM 24OCT97 itching all over body;noticed swelling/rash on both legs below knees;rash did extend farther up leg on 25OCT & 26OCT but as of 27OCT AM rash & itching are resolving;used DPH for itching;rash was red, raised not hives;

VAERS ID:104424 (history)  Vaccinated:1997-10-13
Age:52.2  Onset:1997-10-23, Days after vaccination: 10
Gender:Female  Submitted:1997-10-24, Days after onset: 1
Location:Washington  Entered:1997-11-05, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp ache/pain w/last 3 flu shots;
Other Medications: Hormones
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH47744 LA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES432100 LA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Pain, Similar reaction on previous exposure to drug
SMQs:, Arthritis (broad)
Write-up: hip pain, joint pain, rxn in shoulder rt p/ then no rxn;now 10 days p/hip, shoulder pain, significant;

VAERS ID:104527 (history)  Vaccinated:1997-10-22
Age:52.1  Onset:1997-10-23, Days after vaccination: 1
Gender:Female  Submitted:1997-10-25, Days after onset: 2
Location:Missouri  Entered:1997-11-07, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MO97045
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH7F81816 IMA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Headache, Nausea, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: sever nausea, h/a, chills, fever, hives on stomach-back;tx took calritin-ASA;

VAERS ID:104599 (history)  Vaccinated:1997-10-01
Age:52.2  Onset:1997-10-03, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1997-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergy sulfa, ciporfloxacin, doxycycline, clinclamycin;hx chronic bronchitis, asthma;
Diagnostic Lab Data: CBC pending;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES431804 SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Injection site reaction, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 1OCT97 & 3OCT97 rt upper arm is now swollen, red, & warm to touch;current dx r/o cellulitis vs local tissue rxn;

VAERS ID:104638 (history)  Vaccinated:1997-10-27
Age:52.8  Onset:1997-10-29, Days after vaccination: 2
Gender:Female  Submitted:1997-11-07, Days after onset: 9
Location:Minnesota  Entered:1997-11-12, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp localized rxn in 1996 @ 51yr old w/flu vax;
Other Medications: iuethotrexate
Current Illness: rheumatoid arthritis (on methotrexate)
Preexisting Conditions: sertraline,tetracycline, macrolides,cephamycins, cephlasporins
Diagnostic Lab Data:
CDC Split Type: MN97046A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781681IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: rt deltoid lump @ inj site w/erythema & pruritus;

VAERS ID:104647 (history)  Vaccinated:1997-10-28
Age:52.2  Onset:1997-10-29, Days after vaccination: 1
Gender:Female  Submitted:1997-11-10, Days after onset: 12
Location:Minnesota  Entered:1997-11-12, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trifloridine eye drops
Current Illness: cold
Preexisting Conditions: NONE
Diagnostic Lab Data: cult-positive herpes simplex;anti-viral meds given;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Conjunctivitis, Face oedema, Herpes simplex, Myalgia, Pharyngitis
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow)
Write-up: scratchy throat, legs ached, lower back hurt, itchy puffy under lt eye;rx ATB sx of conjunctivitis poss herpes simplex;

VAERS ID:104736 (history)  Vaccinated:1997-10-30
Age:52.5  Onset:1997-10-30, Days after vaccination: 0
Gender:Female  Submitted:1997-11-03, Days after onset: 4
Location:South Carolina  Entered:1997-11-13, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt sibling devel severe swelling of arm @ 40+ w/tetanus
Other Medications: Ortho-EST
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: NONE
CDC Split Type: SC97077
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3287GH1IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91583 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Myalgia, Oedema peripheral, Pain, Pyrexia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: states began hurting in lt arm, lt shoulder & chest on evening p/vax;redness & swelling of lt arm began 48hr p/along w/fever of 100 until today 3NOV97 arm still ached from elbow to shoulder;swollen & red 3 1/2" x 3" T100;saw MD;

VAERS ID:104778 (history)  Vaccinated:1997-10-24
Age:52.0  Onset:1997-10-25, Days after vaccination: 1
Gender:Female  Submitted:1997-10-28, Days after onset: 3
Location:South Carolina  Entered:1997-11-14, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: colitis
Diagnostic Lab Data: NONE
CDC Split Type: SC97072
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3287GH0 RA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91583  LA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pain, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: lt arm became sore that noc;saturday morning lt arm was sore, red & swollen & pt was running a temp around 101 to 101.6;arm was still red & swollen;

VAERS ID:105066 (history)  Vaccinated:1997-11-05
Age:52.0  Onset:1997-11-05, Days after vaccination: 0
Gender:Female  Submitted:1997-11-06, Days after onset: 1
Location:Michigan  Entered:1997-11-24, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen patch
Current Illness:
Preexisting Conditions: fibromyalgia, severe osteoporosis, reynauds synd, Degenerative disc disease, tachycardia
Diagnostic Lab Data: blood checked for 02 lung scan WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781970IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4440670IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Apnoea, Arrhythmia, Asthenia, Dyspepsia, Hypoxia, Injection site mass, Nervousness, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow)
Write-up: w/in 1/hr nose was cold;felt weak & tired;5hr later exp inability to breath;taken to ER;blood 02 was very low;10NOV lt arm remains red, sore, hard & size of small apple;heart skipping beat;heartburn;nervous response;arrhythmia;

VAERS ID:105186 (history)  Vaccinated:1997-11-13
Age:52.9  Onset:1997-11-15, Days after vaccination: 2
Gender:Female  Submitted:1997-11-18, Days after onset: 3
Location:New York  Entered:1997-11-25, 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: Norvasc
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES  IMLA
Administered by: Public     Purchased by: Other
Symptoms: Hypertonia, Myasthenic syndrome, Pain, Tendon disorder
SMQs:, Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: bilat knee pain, stiffness & heaviness of lower legs all c/o -no fever, no edema, erythema or inc warmth;lt patella tendonitis noted on exam;

VAERS ID:105282 (history)  Vaccinated:1997-11-10
Age:52.4  Onset:1997-11-10, Days after vaccination: 0
Gender:Female  Submitted:1997-11-17, Days after onset: 7
Location:Virginia  Entered:1997-12-01, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hormone replacement therapy, niacin
Current Illness: none
Preexisting Conditions: mold and house dust allergy; hypertension
Diagnostic Lab Data:
CDC Split Type: VA97058
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781690IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Chills, Insomnia, Oedema, Osteoarthritis, Paraesthesia, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: pt recv vax 10NOV97 & exp gen itching;hands & feet became swollen, then all joints became swollen;tx w/DPH & the itching abated;14NOV joints were still swollen;

VAERS ID:105543 (history)  Vaccinated:1996-11-12
Age:52.1  Onset:1996-11-18, Days after vaccination: 6
Gender:Male  Submitted:1997-12-02, Days after onset: 379
Location:Indiana  Entered:1997-12-09, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 35 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ASA;Valium, Vicodin, Procan, Daypro
Current Illness:
Preexisting Conditions: SDMA coumpound, nalfon;degenerative disc disease lumars
Diagnostic Lab Data: blood test, spinal tap, MRI, NCV, EMG, EKG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F712770  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypotension, Hypoxia, Infection, Influenza, Neck pain, Paralysis, Pneumonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: flu like sx wk of 17NOV96 & again wk of 8DEC96;pain in neck & shoulders 23DEC96;weakness 24DEC96;collapsed in floor 26DEC96;hosp 27DEC97 transferred to rehab ctr 31JAN97;totally paralyzed staph pneumonia;T107.4;

VAERS ID:105612 (history)  Vaccinated:1997-10-21
Age:52.2  Onset:1997-10-21, Days after vaccination: 0
Gender:Male  Submitted:1997-12-10, Days after onset: 50
Location:Maryland  Entered:1997-12-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Diagnostic Lab Data: NONE
CDC Split Type: MPI971030
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.   RA
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;

VAERS ID:105788 (history)  Vaccinated:1997-10-01
Age:52.2  Onset:1997-10-03, Days after vaccination: 2
Gender:Female  Submitted:1997-10-03, Days after onset: 0
Location:Unknown  Entered:1997-12-18, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: sulfa, ciprofloxacin, doxycycline, clindamycin;PMhx chronic bronchitis, asthma;
Diagnostic Lab Data: CBC pending;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES431804 SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Injection site reaction, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 1OCT97 & presents 3OCT97 w/rt upper arm is now swollen, red, & warm to touch;current dx r/o cellulitis vs local tissue rxn;

VAERS ID:106254 (history)  Vaccinated:1997-02-03
Age:52.6  Onset:1997-02-04, Days after vaccination: 1
Gender:Female  Submitted:1998-01-08, Days after onset: 338
Location:Virginia  Entered:1998-01-09, Days after submission: 1
Life Threatening? Yes
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: various test, x-rays;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest pain, Headache, Injection site hypersensitivity, Malaise, Myalgia, Pain, Vasodilatation, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: 3FEB97 cut finger & recv vax 1 day later had pain in arm red, swelling, h/a, n/v;1 wk 10 days still felt bad-aching pains upper right quad of chest; muscles aches;joint pain;arm pain in lt arm @ site was a silver dollar;rash;jaw pain;h/a;

VAERS ID:107546 (history)  Vaccinated:1996-10-17
Age:52.6  Onset:1996-10-18, Days after vaccination: 1
Gender:Female  Submitted:1997-11-28, Days after onset: 406
Location:Unknown  Entered:1998-01-15, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Calan;Imitrex;
Current Illness:
Preexisting Conditions: early cancer of lt breast, resolved w/srugery 1992;hx of hormonal migraines, mild hypertension
Diagnostic Lab Data:
CDC Split Type: CO6975
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71293   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Arthritis, Gait disturbance, Hypokinesia
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow)
Write-up: pt recv vax 17OCT96 & the following day pt devel mild osteoarthritis;pt reportedly has a sacroiliac hx & had surgery a few wk prior to vax;pt exp rt SI joint (?pain severe rxn for 24hr);severe sx, unable to bear weight rt hip;tx w/daypro

VAERS ID:106433 (history)  Vaccinated:1997-12-11
Age:52.0  Onset:1997-12-12, Days after vaccination: 1
Gender:Male  Submitted:1998-01-11, Days after onset: 30
Location:Massachusetts  Entered:1998-01-16, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: pt recv flu vax by Wyeth lot# 4978167 given 8OCT97
Current Illness: NONE
Preexisting Conditions: allergies:animals, grass-PMHx: hemachromatosis;diabetics, depression
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4440700SCRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Influenza, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: sx started day p/vax h/a, fever 100, flu like sx;visit to MD office & on 2nd course of tx;

VAERS ID:107958 (history)  Vaccinated:1998-02-10
Age:52.8  Onset:1998-02-11, Days after vaccination: 1
Gender:Female  Submitted:1998-02-19, Days after onset: 8
Location:Wisconsin  Entered:1998-03-02, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 42yr old w/Td dose 1;
Other Medications: Prempro;Atenolol;Tricinolone cream;Timoptic
Current Illness: NONE
Preexisting Conditions: allergy to sulfa;
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4490681 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: redness around inj site size of softball a little raised, itched a little;took Ibuprofen per instruction;

VAERS ID:107990 (history)  Vaccinated:1998-02-17
Age:52.3  Onset:1998-02-17, Days after vaccination: 0
Gender:Male  Submitted:1998-02-19, Days after onset: 2
Location:Connecticut  Entered:1998-03-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv Hep A by SKB lot# VHA54986 given 27OCT97;also recv flu vax by Connaught lot# 7F81741 given 22OOCT97
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESL03000IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Headache, Hyperhidrosis, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)
Write-up: reported to have slurred speech, dizziness, h/a centered over lt eye, diaphoresis all sx occurred w/in 5min of shot;

VAERS ID:108402 (history)  Vaccinated:1997-03-14
Age:52.0  Onset:1997-03-14, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Tennessee  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES97060231
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 14MAR97 & w/in 4hr pt exp itchy palms, & hand were red;17MAR97 pt devel welts on neck;

VAERS ID:109469 (history)  Vaccinated:1997-03-10
Age:52.1  Onset:0000-00-00
Gender:Male  Submitted:1997-07-10
Location:Kentucky  Entered:1998-03-09, Days after submission: 242
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvasc
Current Illness: Unknown
Preexisting Conditions: Hypertension
Diagnostic Lab Data: EMG -unremarkable;Aldolase -normal; CPK -normal; PM1 antibody -negative
CDC Split Type: 897199017L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES    
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Gait disturbance, Infection, Myasthenic syndrome, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Pt recv vax 10Mar97. Approx 1 wk later pt exp weakness.Pt devel staggered gait & tingling in arms when held up. Becomes "very tired" after working 2 hr. Unable to work for 3 months.1 MD dx fatigue syndrome. 1 MD tx w/Prozac.SEE comments

VAERS ID:109108 (history)  Vaccinated:1997-12-09
Age:52.0  Onset:1997-12-10, Days after vaccination: 1
Gender:Male  Submitted:1998-03-18, Days after onset: 98
Location:North Carolina  Entered:1998-03-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BP meds;allergy shots;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: hepatitis A test positive for hep A antibody
CDC Split Type: 19980041411
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM550460IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abnormal faeces, Dermatitis exfoliative, Hepatic function abnormal, Hypersensitivity, Pruritus, Urine analysis abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad)
Write-up: pt recv vax 9DEC97 & 10DEC97 1 day p/vax pt devel elevated liver function tests, clay colored bowel movements & colored urine;dx allerg rxn to vax causing extensive itching & scaling over body;

VAERS ID:109210 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:0000-00-00
Gender:Female  Submitted:1997-10-21
Location:Idaho  Entered:1998-03-26, Days after submission: 156
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897314025L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978159 IM 
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site inflammation, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: w/in 24hr of vax pt devel an inj site rxn characterized by a 3cm by 3cm area of redness, inflammation & tenderness;pt recovered;this is 1 of 5 pt from this facility to have an adverse exp p/vax;

VAERS ID:109283 (history)  Vaccinated:1997-11-25
Age:52.5  Onset:1997-11-25, Days after vaccination: 0
Gender:Male  Submitted:1997-11-25, Days after onset: 0
Location:South Carolina  Entered:1998-03-26, Days after submission: 121
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: none
Preexisting Conditions: hypertension; hyperthyroidism; hyperlipidemia
Diagnostic Lab Data:
CDC Split Type: 897344014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Facial palsy, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: 25min p/vax pt exp facial paralysis & numbness & tingling in the arm;

VAERS ID:109300 (history)  Vaccinated:1997-12-05
Age:52.9  Onset:1997-12-05, Days after vaccination: 0
Gender:Female  Submitted:1997-12-05, Days after onset: 0
Location:New Hampshire  Entered:1998-03-26, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897344042L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978144   
Administered by: Public     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: pt inadvertently splashed flu vax in eye & exp a burning sensation;pt eye was flushed w/cool water & sx subsided;

VAERS ID:111441 (history)  Vaccinated:1997-03-07
Age:52.4  Onset:0000-00-00
Gender:Female  Submitted:1998-05-29
Location:Michigan  Entered:1998-06-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: calcium,Estrace,vitamin
Current Illness:
Preexisting Conditions: See comments
Diagnostic Lab Data: WBC 07/01/97 4,500. platelet count info from 1981& 1997 see scanned image; also serum hep B surf neg before 1982;positive 1982;serum TSH normal 1997
CDC Split Type: WAES97041862
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
Symptoms: Arthropathy, Constipation, Ecchymosis, Hepatitis, Infection, Leukopenia, Lymphadenopathy, Osteoarthritis, Splenomegaly, Thrombocytopenia, Weight increased
SMQs:, Hepatitis, non-infectious (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: W/in 1 wk of vax pt devel thrombocytopenia. Swelling & crepitus rt knee. 2cm ecchymosis rt arm.MD Dx thrombocytopenia to ITP onset 1981.MD suggests long-standing Hep B infect cause splenomegaly & hypersplenism.Constipated & weight gain See

VAERS ID:111427 (history)  Vaccinated:1995-01-18
Age:52.1  Onset:1995-01-19, Days after vaccination: 1
Gender:Female  Submitted:1998-05-27, Days after onset: 1223
Location:New York  Entered:1998-06-05, Days after submission: 9
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Public
Symptoms: Asthma, Bronchitis, Cough
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: day p/vax 18JAN95 began to cough;went to the MD & was treated for bronchitis;the cough cont even w/taking med prescribed by MD;further tests showed asthma;now taking med for asthma;

VAERS ID:111536 (history)  Vaccinated:1998-05-19
Age:52.2  Onset:1998-05-19, Days after vaccination: 0
Gender:Female  Submitted:1998-05-29, Days after onset: 10
Location:Indiana  Entered:1998-06-09, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Estradiol, Lipitor, Aygestin
Current Illness: NONE
Preexisting Conditions: pollen-tree, grass, rose;caddis fly
Diagnostic Lab Data:
CDC Split Type: IN98019
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2153A11IMLA
Administered by: Other     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash/itching x 2-3 days;

VAERS ID:111948 (history)  Vaccinated:1998-03-20
Age:52.9  Onset:1998-03-20, Days after vaccination: 0
Gender:Female  Submitted:1998-06-16, Days after onset: 87
Location:Arizona  Entered:1998-06-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp spasms, numbness, body ached, temp,weakness, pain w/DT in 1974;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NNE
Diagnostic Lab Data: NONE
CDC Split Type: AZ9827
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER   L
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Injection site pain, Insomnia, Muscle spasms, Myalgia, Pain, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad)
Write-up: spasms, numbness in hands, body aches, temp-weakness, muscles hurt-pain in arm @ inj site;pain in hands & fingers woke pt up;

VAERS ID:111999 (history)  Vaccinated:1998-03-20
Age:52.3  Onset:1998-03-20, Days after vaccination: 0
Gender:Female  Submitted:1998-03-20, Days after onset: 0
Location:Colorado  Entered:1998-06-19, Days after submission: 90
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Estorgen & Progesterone;TST (Mantoux)
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: CO98018
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0070E0IMA
Administered by: Public     Purchased by: Public
Symptoms: Dry mouth, Nervousness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 20MAR98 1130AM ate lunch 12noon;1PM back to work & began feeling panicky & nervousness;loud sudden noises caused excessive rxn;no trouble breathing or local rxn;130PM left work;145PM vomited & dry mouth;

VAERS ID:112209 (history)  Vaccinated:1998-05-26
Age:52.9  Onset:1998-05-28, Days after vaccination: 2
Gender:Male  Submitted:1998-06-05, Days after onset: 8
Location:Ohio  Entered:1998-06-26, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: DPH ointment
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OH98042
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1531E2 LA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 26MAY98 pt recv vax & reported fine body rash which started on 28MAY98 still has pruritus & rash on 5JUN98;has body rash;

VAERS ID:112275 (history)  Vaccinated:1998-06-18
Age:52.3  Onset:1998-06-23, Days after vaccination: 5
Gender:Male  Submitted:1998-06-23, Days after onset: 0
Location:Oklahoma  Entered:1998-07-01, 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: unk ATB
Current Illness: cold
Preexisting Conditions: unk
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0929590 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Insomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: pt reports persistent h/a, inability to sleep, felt feverish, since inj 18JUN98;

VAERS ID:112352 (history)  Vaccinated:1998-01-03
Age:52.1  Onset:0000-00-00
Gender:Female  Submitted:1998-06-27
Location:Illinois  Entered:1998-07-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: post traumatic lt lower leg wound
Preexisting Conditions: NKA
Diagnostic Lab Data: 2 independent neuro eval
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)PFIZER/WYETH4978061 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Injection site hypersensitivity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: erythema to inj site-resolved;subjective hypesthesia-lt upper arm;

VAERS ID:112545 (history)  Vaccinated:1997-10-20
Age:52.2  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1998-06-11, Days after onset: 233
Location:Georgia  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA;Vancenase;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: MPI97829C
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3277GA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest pain, Chills, Diarrhoea, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 20OCT97 & exp inc temp 100, n/v, diarrhea, chills, chest pain & severe h/a x 2 days;

VAERS ID:112624 (history)  Vaccinated:1998-05-28
Age:52.8  Onset:1998-06-03, Days after vaccination: 6
Gender:Female  Submitted:1998-06-20, Days after onset: 17
Location:California  Entered:1998-07-14, Days after submission: 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
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N03480 A
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES09228000 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: rash @ site;

VAERS ID:113107 (history)  Vaccinated:1997-12-29
Age:52.1  Onset:1997-12-30, Days after vaccination: 1
Gender:Female  Submitted:1998-07-30, Days after onset: 211
Location:Utah  Entered:1998-08-03, 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: unk
Current Illness:
Preexisting Conditions: codeine allergy;sulfa allergy
Diagnostic Lab Data:
CDC Split Type: WAES98010459
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pyrexia, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 29DEC97 & 30DEC97 pt to ER w/red, hot arm, swollen from shoulder to wrist;pt arm was about twice the nl size;T99.6;pt placed in a sling & instructed not to use arm;

VAERS ID:113313 (history)  Vaccinated:1997-11-03
Age:52.4  Onset:1997-12-01, Days after vaccination: 28
Gender:Female  Submitted:0000-00-00
Location:Montana  Entered:1998-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: recv allergy shots every two weeks
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 14JUN98 x-ray WNL
CDC Split Type: MT98020
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978146  LA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER4381360 RA
Administered by: Public     Purchased by: Private
Symptoms: Back pain, Injection site pain, Tendon disorder
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax 3NOV97 & 1DEC97 pt c/ lt upper arm pain;stated it had come on p/vax & had worsened since that time;@ that time pt felt to have a deltoid tendonitis;pt put on med;pt still having deltoid tendonitis & pain under acromion;

VAERS ID:113995 (history)  Vaccinated:1998-08-05
Age:52.1  Onset:1998-08-06, Days after vaccination: 1
Gender:Female  Submitted:1998-08-13, Days after onset: 7
Location:Texas  Entered:1998-09-08, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD by Connaught lot# 246811 given 5AUG98
Current Illness: NONE
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type: TX98131
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7K91938 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 5AUG98 & awoke next morning w/a red rash @ site, spreading down arm to elbow;pt c/o itching but denies any pain;

VAERS ID:114039 (history)  Vaccinated:1998-06-24
Age:52.3  Onset:1998-06-28, Days after vaccination: 4
Gender:Female  Submitted:1998-09-01, Days after onset: 65
Location:Texas  Entered:1998-09-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications:
Current Illness: finger slammed in door
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Hypertonia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad)
Write-up: fever to 5 days p/vax began exp extreme pain & stiffness in the rt shoulder & the surrounding area;presently exp pain;

VAERS ID:114175 (history)  Vaccinated:1998-08-19
Age:52.4  Onset:1998-08-28, Days after vaccination: 9
Gender:Female  Submitted:1998-09-09, Days after onset: 12
Location:Texas  Entered:1998-09-16, 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: Serzone, Synthroid, Estace, Provera, Vit
Current Illness: NONE
Preexisting Conditions: diabetic talwin, codeine, darvocet, toadel;valteric;
Diagnostic Lab Data: NA
CDC Split Type: SA98007
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM557860IMRA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 19AUG98 & noted bumps w/itching 28AUG98;spots were red w/scratching;from chin down lasting thru sept saw MD;hives w/itching;

VAERS ID:114296 (history)  Vaccinated:1998-09-15
Age:52.7  Onset:1998-09-16, Days after vaccination: 1
Gender:Female  Submitted:1998-09-21, Days after onset: 5
Location:Maryland  Entered:1998-09-23, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Plegine
Current Illness: NA
Preexisting Conditions: allergic rhinitis
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09739200IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: localized redness, swelling, itching, pain @ site of inj;apply cool pack to site;swelling 0.5cm, redness 5cm in width;claritin given;

VAERS ID:114878 (history)  Vaccinated:1997-10-01
Age:52.1  Onset:0000-00-00
Gender:Female  Submitted:1998-07-01
Location:Nevada  Entered:1998-10-13, Days after submission: 104
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp weakness, pin prick in finger tips & eyelid, sharp pain,vision blurred
Other Medications: Hormones;Fosamax;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NV98017B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 5  
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax & devel pain @ inj site x 1wk;no other problems;

VAERS ID:115003 (history)  Vaccinated:1998-10-04
Age:52.0  Onset:1998-10-04, Days after vaccination: 0
Gender:Female  Submitted:1998-10-07, Days after onset: 3
Location:Pennsylvania  Entered:1998-10-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt & mom exp local redness, swelling inj site, h/a, cough, aches, temp w/flu vax
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hayfever, asthma
Diagnostic Lab Data: NONe
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0967040   
Administered by: Other     Purchased by: Public
Symptoms: Cough, Headache, Injection site hypersensitivity, Injection site oedema, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: localized redness & swelling @ inj site, h/a, cough, body aches, sl temp;

VAERS ID:115382 (history)  Vaccinated:1998-10-14
Age:52.2  Onset:1998-10-15, Days after vaccination: 1
Gender:Female  Submitted:1998-10-16, Days after onset: 1
Location:Utah  Entered:1998-10-27, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: estrogen substitue;provera;prozac
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: UT982518
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER49882001IMLA
Administered by: Public     Purchased by: Public
Symptoms: Myalgia, Oedema, Pain, Paraesthesia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pain in the lt arm;ache-throbbing;numb feeling, red, swelling, hot;

VAERS ID:115467 (history)  Vaccinated:1998-10-16
Age:52.6  Onset:1998-10-16, Days after vaccination: 0
Gender:Female  Submitted:1998-10-22, Days after onset: 6
Location:California  Entered:1998-10-30, Days after submission: 8
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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: negative CT scan & ultrasound;
CDC Split Type: U199800686
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0971880   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysarthria, Hypokinesia
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 16OCT98 & reportedly w/in 3hr of vax pt exp dysarthria that lasted 45min;pt also exp diff controlling lt index finger & thumb;pt hosp over night for observation;

VAERS ID:115485 (history)  Vaccinated:1998-10-19
Age:52.9  Onset:1998-10-21, Days after vaccination: 2
Gender:Female  Submitted:1998-10-25, Days after onset: 4
Location:Georgia  Entered:1998-10-30, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: estrogen daily;altace daily
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data: NA
CDC Split Type: GA98092
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES452841 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 21OCT98 noticed soreness, minimal swelling, redness & inc warmth to area;sx began p/330PM;red area approx 5inches in length-5inch width;allergic rxn;

VAERS ID:115488 (history)  Vaccinated:1998-09-24
Age:52.9  Onset:1998-10-04, Days after vaccination: 10
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1998-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.0656E  RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Arthritis, Rash
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Arthritis (narrow)
Write-up: rash on face & arthritic pain

VAERS ID:115526 (history)  Vaccinated:1998-10-07
Age:52.0  Onset:1998-10-08, Days after vaccination: 1
Gender:Male  Submitted:1998-10-28, Days after onset: 20
Location:Georgia  Entered:1998-11-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: allergy;hemodialysis;skin graft;
Diagnostic Lab Data: 15OCT98 CXR rt upper lobe infiltrate;blood cult negative;WBC count 10,000;
CDC Split Type: WAES98101444
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0906E0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Endocarditis, Infection, Laboratory test abnormal, Lung disorder, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 7OCT98 & 13OCT98 pt to ER w/several day hx of T103;CXR revealed rt upper lobe infiltrate;adm to hosp;cough, myalgia, MD felt had bacterial endocarditis;

VAERS ID:115793 (history)  Vaccinated:1996-09-01
Age:52.0  Onset:1996-09-01, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 785
Location:Florida  Entered:1998-11-02, Days after submission: 7
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: Estrace, provera;Calcium;
Current Illness:
Preexisting Conditions: pt is allergic to mycins antibiotics;
Diagnostic Lab Data:
CDC Split Type: 19970301551
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 3IM 
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Gastrointestinal disorder, Pyrexia, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax SEP96 & approx 10 days later in SEP96 pt devel abd pain, fever, & diarrhea;lab test include colonoscopy & endoscopy showing positive results for erosion;pt was hosp in 1997 for 4 days;pt also exp weight loss;

VAERS ID:115912 (history)  Vaccinated:1998-10-28
Age:52.3  Onset:1998-10-28, Days after vaccination: 0
Gender:Female  Submitted:1998-10-30, Days after onset: 2
Location:Ohio  Entered:1998-11-06, Days after submission: 7
Life Threatening? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications:
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: FLU89161098
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02298P  RA
Administered by: Public     Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Chest pain
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: pt recv vax 28OCT98 4PM;taken to Er @ approx 6Pm w/sudden onset of chest discomfort;

VAERS ID:115933 (history)  Vaccinated:1998-10-15
Age:52.1  Onset:1998-10-16, Days after vaccination: 1
Gender:Female  Submitted:1998-10-19, Days after onset: 3
Location:Ohio  Entered:1998-11-06, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lotensor/BP, herbs
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OH98079
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0977170  LA
Administered by: Public     Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 15OCT98 & hives started on both arms 16OCT98 @ 4PM;hives on abd, between legs, back, breast on 17OCT98;call MD 17OCT;recommended DPH & cortisone cream;rash getting better;

VAERS ID:116088 (history)  Vaccinated:1998-10-09
Age:52.0  Onset:1998-10-09, Days after vaccination: 0
Gender:Female  Submitted:1998-10-15, Days after onset: 6
Location:Georgia  Entered:1998-11-09, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA98085
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0304H0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Injection site pain, Laboratory test abnormal, Leukocytosis, Lymphadenopathy, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 9OCT98 rt arm & area became painful w/redness & swelling noted;redness extended from elbow to underneath rt breast;pain cont until the next day;went to ER 10OCT98 in PM ER MD dx cellulitis reaction to needle to skin reaction;

VAERS ID:116318 (history)  Vaccinated:1998-10-19
Age:52.4  Onset:1998-10-19, Days after vaccination: 0
Gender:Female  Submitted:1998-10-22, Days after onset: 3
Location:Ohio  Entered:1998-11-09, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: FLU89031098
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02298P0IM 
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Dizziness, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: Pt recv vax on 10/19/98; on same day pt exp arm ache, fatigue, bone aches, dizzy; pt imp 30 hr

VAERS ID:116177 (history)  Vaccinated:1998-10-13
Age:52.2  Onset:1998-10-14, Days after vaccination: 1
Gender:Female  Submitted:1998-10-15, Days after onset: 1
Location:Washington  Entered:1998-11-10, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WA981499
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0975810 IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4549601IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Dyspepsia, Headache, Lymphadenopathy, Oedema, Oedema peripheral, Skin striae
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Gastrointestinal nonspecific dysfunction (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: rt arm swollen, breast swollen, red rings around rt arm almost down in armpit;had a h/a 14OCT98;sick to stomach;pt called clinic no one there;

VAERS ID:116365 (history)  Vaccinated:1998-11-09
Age:52.0  Onset:1998-11-09, Days after vaccination: 0
Gender:Female  Submitted:1998-11-09, Days after onset: 0
Location:Louisiana  Entered:1998-11-13, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergies to EES, tetracycline, no other med conditions
Diagnostic Lab Data: NONe
CDC Split Type: LA981105
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09805300IMLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4559350IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Dizziness, Dyspnoea, Hypertension, Hyperventilation, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: p/vax 1025AM pt went to car & then returned to pay for vaccine & became SOB & c/o tightness in chest;pt placed on back & requested head stay elevated to help w/breathing;BP 182/98, P140, c/o lightheadedness;02 began;P118, resp 24;

VAERS ID:116430 (history)  Vaccinated:1998-11-11
Age:52.0  Onset:1998-11-11, Days after vaccination: 0
Gender:Female  Submitted:1998-11-12, Days after onset: 1
Location:New Hampshire  Entered:1998-11-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882280 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Laryngospasm, Lymphadenopathy, Oedema, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/11/98; 30 min later pt exp bilateral swelling of throat glands, tight chest, hot vax site

VAERS ID:116431 (history)  Vaccinated:1998-10-30
Age:52.2  Onset:1998-10-30, Days after vaccination: 0
Gender:Female  Submitted:1998-11-09, Days after onset: 10
Location:Idaho  Entered:1998-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to Penicillin
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES 6IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/30/98; 30 min later pt exp 3x5 in red, hot, tender, hard area at vax site; tx=warm, moist packs & Ibuprofen x6 day

VAERS ID:116434 (history)  Vaccinated:1998-11-06
Age:52.1  Onset:1998-11-06, Days after vaccination: 0
Gender:Female  Submitted:1998-11-09, Days after onset: 3
Location:Georgia  Entered:1998-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09845308 LA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt recv vax on 11/6/98; on same day pt exp fever (102.4); tx=Advil

VAERS ID:116594 (history)  Vaccinated:1998-10-21
Age:52.4  Onset:1998-10-23, Days after vaccination: 2
Gender:Male  Submitted:1998-10-29, Days after onset: 6
Location:Massachusetts  Entered:1998-11-20, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Cancer tx of esophagus & stomach, Barret''s syndrome
Diagnostic Lab Data: NONE
CDC Split Type: MA9827
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09757901IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Pt recv vax on 10/21/98; on 10/23/98 pt exp headache, chills & shaking

VAERS ID:116792 (history)  Vaccinated:1998-11-17
Age:52.0  Onset:1998-11-18, Days after vaccination: 1
Gender:Female  Submitted:1998-11-18, Days after onset: 0
Location:Mississippi  Entered:1998-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt exp same rx post Flu vax at age 42
Other Medications: Univose
Current Illness: NONE
Preexisting Conditions: Hypertension, Allergic to Codeine, copper, Zinc & other metals
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09907801IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt recv vax on 11/17/98; on 11/18/98 pt exp redness, soreness, swelling & heat of vax site; joint pain, chills, fever x 2 day

VAERS ID:116828 (history)  Vaccinated:1998-11-28
Age:52.1  Onset:1998-11-28, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Maryland  Entered:1998-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergies-grass, some plants, some weeds;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Chills
SMQs:, Guillain-Barre syndrome (broad)
Write-up: same day chill in body, then fatigue & chill red day;saw MD next day put on amoxicillin, took 2 days side leave;

VAERS ID:117104 (history)  Vaccinated:1998-11-16
Age:52.2  Onset:1998-11-17, Days after vaccination: 1
Gender:Female  Submitted:1998-11-30, Days after onset: 13
Location:Wisconsin  Entered:1998-12-07, Days after submission: 7
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:
Current Illness: NONE
Preexisting Conditions: ASA, sulfa, PCN, flunase, macrodantin, codeine, theodur, tomatoes, peppers, spices, nuts;
Diagnostic Lab Data: allergy-egg negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Angioneurotic oedema, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: devel swelling of tongue;acute angioedema;tx epi & solumedrol, pred;

VAERS ID:117112 (history)  Vaccinated:1998-10-20
Age:52.0  Onset:1998-10-20, Days after vaccination: 0
Gender:Female  Submitted:1998-10-22, Days after onset: 2
Location:Colorado  Entered:1998-12-07, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NA
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO98054
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20188HA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1508E1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: swelling, redness, pain below inj site, temp of 100;pt reported when was hosp last DEC for resp problems they did give pt a pneumonia shot & pt had forgotten about it;

VAERS ID:117261 (history)  Vaccinated:0000-00-00
Age:52.0  Onset:1998-12-02
Gender:Female  Submitted:1998-12-04, Days after onset: 2
Location:Nevada  Entered:1998-12-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA;Synthroid;Zestril;Premarin
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data: unk
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Immune system disorder, Injection site oedema, Injection site pain, Rhinitis
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax 13NOV98 1030AM nurse gave the vaccine quickly & it burned badly as vaccine was entering arm;arm swelled & could not touch it for 2wk;still coughing, nose running & did not feel the immune system has strengthened;

VAERS ID:117404 (history)  Vaccinated:1998-06-26
Age:52.3  Onset:1998-07-06, Days after vaccination: 10
Gender:Female  Submitted:1998-12-06, Days after onset: 153
Location:California  Entered:1998-12-15, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA980135
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.1230E   
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Influenza, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 6/26/98;on 7/6/98 pt exp flu sx-achey &tired, headache

VAERS ID:117820 (history)  Vaccinated:1998-10-19
Age:52.2  Onset:1998-10-20, Days after vaccination: 1
Gender:Female  Submitted:1998-10-27, Days after onset: 7
Location:North Carolina  Entered:1998-12-30, Days after submission: 64
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: pt stated on 26OCT98 had reacted to flu shot in past 7 was allergic to egg whites, cigars, mold, mildew;
Diagnostic Lab Data:
CDC Split Type: NC98071
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0934600 IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site mass, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: pt recv vax 19OCT98 & states that arm became swollen about the size of a quarter @ inj site by next day it hurt somewhat;did not have any inc swelling or pain until 25OCT98;arm began itching & swelling more;induration close to site;

VAERS ID:117821 (history)  Vaccinated:1998-11-23
Age:52.7  Onset:1998-11-28, Days after vaccination: 5
Gender:Female  Submitted:1998-12-18, Days after onset: 20
Location:North Carolina  Entered:1998-12-30, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ
Current Illness: NONE
Preexisting Conditions: kidney stones
Diagnostic Lab Data: comprehension metabolic profile;UA;bx of lesion;CBC;PT/PTT;ANA;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES098592012IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 28NOV98 started itching on lower leg & then noted rash on both legs cont to get worst;3DEC98 seen by dermatologist sx on both lower legs & stomach;rash progressed up both legs;

VAERS ID:117898 (history)  Vaccinated:1998-11-02
Age:52.7  Onset:1998-11-08, Days after vaccination: 6
Gender:Female  Submitted:1998-11-10, Days after onset: 2
Location:New Hampshire  Entered:1999-01-04, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: NH9823
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4574631IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/2/98; on 11/8/98 pt exp vax site redness, tenderness & induration

VAERS ID:117910 (history)  Vaccinated:1998-11-12
Age:52.9  Onset:1998-11-24, Days after vaccination: 12
Gender:Female  Submitted:1998-12-30, Days after onset: 36
Location:Wisconsin  Entered:1999-01-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: Allergic to Penicillin, Hypothyroid
Diagnostic Lab Data: 12/14/98: CBC w/ diff, sed rate, WBC, CSR, ANA-all negative
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1045H0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Arthropathy, Breast pain, Conjunctivitis, Dry eye, Glossitis, Hypokinesia, Influenza, Insomnia, Lymphadenopathy, Malaise, Mouth ulceration, Nausea, Oedema peripheral, Osteoarthritis, Pain, Paraesthesia, Rash, Tongue oedema
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Lipodystrophy (broad), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt recv vax on 11/12/98; on 11/24/98 pt exp left &right knee stiff; conjunctivitis; pain in right fingers,shoulder &arm w/ swelling, tingling & numbness, left hand & foot pain; nausea, malaise, leg rash, lip &mouth lesions, headache cont...

VAERS ID:117971 (history)  Vaccinated:1998-10-26
Age:52.1  Onset:1998-10-27, Days after vaccination: 1
Gender:Female  Submitted:1998-11-17, Days after onset: 21
Location:Massachusetts  Entered:1999-01-07, Days after submission: 51
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49882210 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 3.0 x 5.7cm area of erythema, swelling pain warmth tender & painful induration;negative lymphadenopathy;sx greater than 1wk;

VAERS ID:118044 (history)  Vaccinated:1998-10-28
Age:52.9  Onset:1998-10-30, Days after vaccination: 2
Gender:Female  Submitted:1998-10-30, Days after onset: 0
Location:Minnesota  Entered:1999-01-12, Days after submission: 74
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES   LA
Administered by: Other     Purchased by: Private
Symptoms: Condition aggravated, Cough, Diarrhoea, Dizziness, Headache, Nausea, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv shot w/o incident @ 8PM;devel cough immed;woke up 4AM, dizzy, nauseated & feeling of diarrhea;did not have diarrhea or vomiting;ER visit h/a in ER;devel rash on chest 30OCT;

VAERS ID:118224 (history)  Vaccinated:1998-11-17
Age:52.4  Onset:1998-11-17, Days after vaccination: 0
Gender:Female  Submitted:1998-12-03, Days after onset: 16
Location:South Carolina  Entered:1999-01-21, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Arthrotec, Cinobac, Urised, Premarin, Halcion, Pepcid, Bentyl, Xanax
Current Illness: Cystitis, Arthritis
Preexisting Conditions: Multiple environmental allergies
Diagnostic Lab Data: NONE
CDC Split Type: SC98085
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES9786704IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES9705201IMRA
Administered by: Public     Purchased by: Public
Symptoms: Hypertension, Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain, Oedema peripheral, Pain, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 11/17/98; 12 hr post vax pt exp shoulder pain/ itching/ swelling to elbow x 2 wk, fever ; tx=Tylenol, ice pack & Allegra

VAERS ID:118310 (history)  Vaccinated:1999-01-09
Age:52.1  Onset:1999-01-10, Days after vaccination: 1
Gender:Female  Submitted:1999-01-21, Days after onset: 11
Location:New York  Entered:1999-01-25, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0754H1 LA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Hypertension, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad)
Write-up: severe h/a, hypertensive episode, palpitations 10 days rx beta blocker;

VAERS ID:118361 (history)  Vaccinated:1997-10-27
Age:52.0  Onset:1997-10-30, Days after vaccination: 3
Gender:Female  Submitted:1998-09-30, Days after onset: 334
Location:New Jersey  Entered:1999-01-26, Days after submission: 118
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: carpal tunnel
Diagnostic Lab Data:
CDC Split Type: 7753
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.LD5372 RA
Administered by: Private     Purchased by: Other
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax & some time p/vax pt exp a swollen thumb;reportedly this might have happened p/1st dose;

VAERS ID:118366 (history)  Vaccinated:1997-12-12
Age:52.0  Onset:0000-00-00
Gender:Male  Submitted:1998-10-09
Location:Maryland  Entered:1999-01-26, Days after submission: 109
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U199800018
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST. 2  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Arthralgia, Asthenia, Dermatitis bullous, Headache, Hyperhidrosis, Myalgia, Pruritus, Rash maculo-papular
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recv vax 12DEC97 & about 12hr p/vax pt exp itching other exp included muscle pain, vesiculation, joint pain, severe sweating, weakness, anorexia & h/a;pt had a measles-like rash w/little red bumps;severe itching;

VAERS ID:118369 (history)  Vaccinated:1998-03-05
Age:52.4  Onset:1998-03-05, Days after vaccination: 0
Gender:Male  Submitted:1998-10-09, Days after onset: 217
Location:Massachusetts  Entered:1999-01-26, Days after submission: 109
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: U199800049
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX ID)PASTEUR MERIEUX INST.MO475   
Administered by: Private     Purchased by: Private
Symptoms: Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 3/5/98; 15 min post vax pt exp swollen tongue x 20 min

VAERS ID:118447 (history)  Vaccinated:1998-10-30
Age:52.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Florida  Entered:1999-01-29
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: diabetic;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20248KA1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Influenza
SMQs:
Write-up: pt recv flu vax & MD realized this was last yr vax & pt given flu shot again w/in 4 days of the first one;pt states has been extremely ill w/flu type sx;MD called CDC for advice told to give 2nd shot this years flu vax would not effect last

VAERS ID:118493 (history)  Vaccinated:1998-07-14
Age:52.0  Onset:1998-07-20, Days after vaccination: 6
Gender:Male  Submitted:1998-07-22, Days after onset: 2
Location:Washington  Entered:1999-02-01, Days after submission: 194
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: U199800426
Vaccination
Manufacturer
Lot
Dose
Route
Site
JEV: JAPANESE ENCEPHALITIS (J-VAX)CONNAUGHT LABORATORIES 1UNUN
RAB: RABIES (IMOVAX)CONNAUGHT LTD. 1UNUN
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 7/14/98; on 7/20/98 pt exp rash on back, neck & arms x 48 hr; From follow-up of August 24, 1998 it was reported, "Duration of rash 48 hours, no treatment needed. Patient did not come in on July 22, 1998 for scheduled appointment." Reportedly the patient recovered from this experience.

VAERS ID:118526 (history)  Vaccinated:1998-05-22
Age:52.0  Onset:1998-06-05, Days after vaccination: 14
Gender:Female  Submitted:1999-02-01, Days after onset: 241
Location:California  Entered:1999-02-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: interstitial cystitus, psoriasis,underlying repetative strain injuries of forearms
Diagnostic Lab Data: all blood work to rule out anything else other than R;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1587D   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Blood test, Carpal tunnel syndrome, Fatigue, Fibromyalgia, Hypoaesthesia, Hypokinesia, Impaired work ability, Joint swelling, Paraesthesia, Surgery, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: swollen joints, numbness & tingling in rt hand unable to get up;blurred vision, fatigue now chronic carpal tunnel synd, chronic joint pain;seeing MD for complications;Annual follow-up dated 09/27/00 states the pt has fibromyalgia. Follow-up: 7/24/2000 Reporter calling in response to f/u letter she received from VAERS. I suggested she write in any updates and return it. She will also fax any pertinent medical records sometime in future. States the diagnosis of carpal tunnel syndrome was confirmed and she had surgery. Currently on Workmans Comp and unable to work. Otherwise the chronic joint pain has also persisted to present.

VAERS ID:118595 (history)  Vaccinated:1998-10-14
Age:52.6  Onset:1998-10-15, Days after vaccination: 1
Gender:Male  Submitted:1999-02-02, Days after onset: 110
Location:Florida  Entered:1999-02-08, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09771800 LA
Administered by: Other     Purchased by: Private
Symptoms: Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: c/o swelling of lt upper arm (lymph node);pt spoke w/MD & said it might be related;pt got better as the day went on;

VAERS ID:118662 (history)  Vaccinated:1996-10-04
Age:52.5  Onset:1996-10-04, Days after vaccination: 0
Gender:Female  Submitted:1999-02-03, Days after onset: 852
Location:Virginia  Entered:1999-02-09, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: blood test, several 3 MRI-mylogram;numerous x-rays;
CDC Split Type:
Vaccination
Manufacturer
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2072A21IMRA
Administered by: Private     Purchased by: Other
Symptoms: Gait disturbance, Hypokinesia, Myalgia, Myopathy, Pyrexia, Rheumatoid arthritis
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow)
Write-up: pt recv vax 4OCT96 & exp high fever & body aches x 3 days p/vax;walking became worse;JAN97 dx w/mult sclerosis; Many tests later that was ruled out;pt approved for disability but still do not have dx;pt is nurse but cannot walk w/o cane; Per follow-up dated 10/25/00, the pt states she now has arthritis in the right leg and thigh. She has to walk with a can. The doctor told her that she cannot work anymore as a nurse.

VAERS ID:118669 (history)  Vaccinated:1999-01-20
Age:52.0  Onset:1999-01-22, Days after vaccination: 2
Gender:Female  Submitted:1999-02-01, Days after onset: 10
Location:Maryland  Entered:1999-02-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: sulfa
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4578291 LA
Administered by: Unknown     Purchased by: Public
Symptoms: Chest pain, Injection site hypersensitivity, Injection site oedema, Lymphadenopathy, Neck pain, Oedema, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: swelling, heat, erythema lt upper arm & swelling, pain of supraclavicular & axillary nodes;swelling, tenderness to pectoral muscle;vaccine was given correctly into center of deltoid muscle;tx med;

VAERS ID:118805 (history)  Vaccinated:1998-10-27
Age:52.0  Onset:1998-10-28, Days after vaccination: 1
Gender:Female  Submitted:1999-01-20, Days after onset: 84
Location:California  Entered:1999-02-09, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: Loestrin
Current Illness: NONE
Preexisting Conditions: Hypertension
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES09846206 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/27/98; on 10/28/98 pt exp red, swollen, warm vax site w/ firmness; pt imp 11/3/98

VAERS ID:118929 (history)  Vaccinated:1998-11-23
Age:52.5  Onset:1998-11-24, Days after vaccination: 1
Gender:Female  Submitted:1999-01-27, Days after onset: 64
Location:Georgia  Entered:1999-02-12, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: Hytrim, Prinzide, PPD 11/23/98
Current Illness: NONE
Preexisting Conditions: Hypertension
Diagnostic Lab Data: UNK
CDC Split Type: GA99004
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0432H IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.0954H SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES0944780 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Adverse drug reaction, Arthralgia, Hypertonia, Myasthenic syndrome, Osteoarthritis
SMQs:, Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Pt recv vax on 11/23/98; 24 hr post vax pt exp tender & stiff knees, ankles, wrists &hands x 3 wk, weak hands

VAERS ID:119141 (history)  Vaccinated:1998-11-23
Age:52.6  Onset:1998-12-01, Days after vaccination: 8
Gender:Female  Submitted:1999-01-28, Days after onset: 58
Location:Iowa  Entered:1999-02-18, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1003H0 LA
Administered by: Private     Purchased by: Private
Symptoms: Arthritis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)
Write-up: arthritic sx for 2 wk;

VAERS ID:119278 (history)  Vaccinated:1999-01-28
Age:52.0  Onset:1999-01-28, Days after vaccination: 0
Gender:Female  Submitted:1999-02-01, Days after onset: 4
Location:Kentucky  Entered:1999-02-23, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dog bite
Preexisting Conditions: Alzheimers disease; high BP
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Anorexia, Arthralgia, Asthenia, Chills, Dysphagia, Influenza, Malaise
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Arthritis (broad)
Write-up: Severe pain in joints p/about 2hr of getting shot;felt like onset of bad flu;chills-no appetite for several days;very draggy & weak;some choking feeling;still having pain in joints. 12/2000. Non-Serious Case which did not require f/u now updated per telephone call from patient. She states that this reaction to TD injection has persisted in that pain in shoulders and back "never stopped". Has seen a specilaist who suggested pt may have carpal tunnel on L side. Patient would like this information place in VAERS record.

VAERS ID:119440 (history)  Vaccinated:1998-10-27
Age:52.9  Onset:1998-10-28, Days after vaccination: 1
Gender:Female  Submitted:1999-01-25, Days after onset: 89
Location:Texas  Entered:1999-02-26, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: Zestril, Voltaren, Flexaril, Premarin, Provera
Current Illness: NONE
Preexisting Conditions: Allergic to Penicillin, VE & respiratory polio(''51) residuals
Diagnostic Lab Data: NONE
CDC Split Type: 99TX12
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4485171 GM
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Asthenia, Hypertonia, Injection site pain, Myalgia, Nausea, Pyrexia, Speech disorder, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (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), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 10/27/98; on 10/28/98 pt exp fever (100-102.6), nausea, chills, trembling, unable to talk & stand, aches, dry heaves, weak, muscle pain at vax site; tx=Tylenol

VAERS ID:119527 (history)  Vaccinated:1997-10-01
Age:52.6  Onset:1997-10-01, Days after vaccination: 0
Gender:Male  Submitted:1998-10-29, Days after onset: 393
Location:New Hampshire  Entered:1999-02-26, Days after submission: 120
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Verapimal, Atenal, naproxen, Lopid, Neurontin, Glucotrol XL
Current Illness: NONE
Preexisting Conditions: diabetes;arteriosclerosis-heart disease;
Diagnostic Lab Data: NONE
CDC Split Type: 7537
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81854   
Administered by: Other     Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Myalgia, Nausea, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 1OCT97 & approx 4hr p/vax pt exp rhinitis, nausea, achiness & indigestion;

VAERS ID:119532 (history)  Vaccinated:1997-09-17
Age:52.0  Onset:1997-09-18, Days after vaccination: 1
Gender:Unknown  Submitted:1998-10-29, Days after onset: 406
Location:California  Entered:1999-02-26, Days after submission: 120
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: 7563
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81753   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 17SEP97 & the next day pt exp an inj site rxn consisting of a 3-4inch red welt, irritation & itching;

VAERS ID:119551 (history)  Vaccinated:1997-10-14
Age:52.5  Onset:1997-10-14, Days after vaccination: 0
Gender:Female  Submitted:1998-11-13, Days after onset: 395
Location:Washington  Entered:1999-02-26, Days after submission: 105
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: 7636
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81854   
Administered by: Other     Purchased by: Other
Symptoms: Visual field defect
SMQs:, Noninfectious encephalitis (broad), Optic nerve disorders (broad), Retinal disorders (broad)
Write-up: Pt recv vax on 10/14/97; 20 min post vax pt exp bright lights in the central & peripheral field of vision

VAERS ID:119561 (history)  Vaccinated:1997-10-14
Age:52.7  Onset:1997-10-16, Days after vaccination: 2
Gender:Female  Submitted:1998-11-17, Days after onset: 397
Location:California  Entered:1999-02-26, Days after submission: 101
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 7656
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81753 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/14/97; on 10/16/97 pt exp erythema/ red/ sore vax site

VAERS ID:119574 (history)  Vaccinated:1997-10-16
Age:52.7  Onset:1997-10-17, Days after vaccination: 1
Gender:Female  Submitted:1998-11-17, Days after onset: 396
Location:California  Entered:1999-02-26, Days after submission: 101
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: 7676
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81734   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 16OCT97 & approx 24hr p/vax pt exp a rash that resembled mosquito bites on elbows;subsequently this rash turned into hives;pt was seen in ER & treated w/atarax & steroids;

VAERS ID:119640 (history)  Vaccinated:1997-11-24
Age:52.7  Onset:1997-11-30, Days after vaccination: 6
Gender:Male  Submitted:1998-11-19, Days after onset: 354
Location:Colorado  Entered:1999-02-26, Days after submission: 99
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: U199800008
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Other     Purchased by: Other
Symptoms: Hepatitis, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Hepatitis, non-infectious (narrow), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 11/24/97; within 1 wk post vax pt exp myalgia, sweats & hepatitis

VAERS ID:119667 (history)  Vaccinated:1997-11-10
Age:52.4  Onset:1997-12-01, Days after vaccination: 21
Gender:Male  Submitted:1998-11-19, Days after onset: 353
Location:North Carolina  Entered:1999-02-26, Days after submission: 99
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: NONE
Preexisting Conditions: Hypertension
Diagnostic Lab Data:
CDC Split Type: U199800273
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81854   
Administered by: Other     Purchased by: Other
Symptoms: Cardiomyopathy
SMQs:, Cardiomyopathy (narrow)
Write-up: Pt recv vax on 11/10/97; in 12/97 pt exp cardiomyopathy

VAERS ID:119824 (history)  Vaccinated:1998-01-26
Age:52.8  Onset:1998-01-29, Days after vaccination: 3
Gender:Male  Submitted:1999-03-01, Days after onset: 396
Location:Pennsylvania  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES98020264
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0052E0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 26JAN98 & 29JAN98 pt devel urticaria & hives on arm & a red raised rash on the upper torso that seemed to follow a vein which was describe as a mild rxn;

VAERS ID:120044 (history)  Vaccinated:1998-09-18
Age:52.0  Onset:1998-09-18, Days after vaccination: 0
Gender:Male  Submitted:1999-03-01, Days after onset: 164
Location:Washington  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: sulfa allergy
Preexisting Conditions: hypersensitivity reaction
Diagnostic Lab Data: diagnostic lab test negative hepa b antibody test;
CDC Split Type: WAES98110348
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 6IM 
Administered by: Unknown     Purchased by: Private
Symptoms: Drug ineffective, Erythema, Hepatitis B antibody negative, Laboratory test,