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Case Details (Sorted by Age)

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VAERS ID:337849 (history)  Vaccinated:2009-01-05
Age:41.0  Onset:2009-01-14, Days after vaccination: 9
Gender:Female  Submitted:2009-01-16, Days after onset: 2
Location:New Jersey  Entered:2009-01-21, 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: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (ACAM2000)ACAMBIS, INC.VV04003XCA15 UN
Administered by: Other     Purchased by: Military
Symptoms: Axillary pain, Injection site rash, Lymphadenitis, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: T 98.0 degree rash on left arm surrounding smallpox vaccination site. Started 2 days ago 14 JAN 09, spread to axilla area, swelling in axilla area, tenderness to touch, no meds used ; states rash much improved. No fever, no chills, seen at 16 JAN 09. Sick call. Prescription for BENADRYL and IBUPROFEN.

VAERS ID:338109 (history)  Vaccinated:2009-01-22
Age:41.0  Onset:2009-01-22, Days after vaccination: 0
Gender:Male  Submitted:2009-01-23, Days after onset: 1
Location:New Jersey  Entered:2009-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF426AA0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: generalized rash noticed approximately 8 hours after receiving vaccine.lotion applied to rash at time noticed. called OMS on 1/23/09 to report rash and came in to OMS for treatment. Received Benedryl 25mg orally after being examined by staff physician and was told to take Benedryl 25mg orally three times a day and Clarinex 25mg orall daily.

VAERS ID:338710 (history)  Vaccinated:2009-01-27
Age:41.0  Onset:2009-01-28, Days after vaccination: 1
Gender:Female  Submitted:2009-01-30, Days after onset: 2
Location:Pennsylvania  Entered:2009-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: sinus infection
Preexisting Conditions: asthma, allergies (dust, dogs)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Burning sensation, Chills, Fatigue, Headache, Impaired work ability, Injected limb mobility decreased, Injection site pain, Lymphadenopathy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Fever 102.7 degrees, chills, body aches, swollen lymph glands, nausea, pain at injection, unable to lift/move arm, headache, backache, burning sensation in lungs, extreme fatigue. Has been 72 hours since vaccine and still not completely back to normal. Missed 2 1/2 days of work due to vaccine.

VAERS ID:338729 (history)  Vaccinated:2009-01-01
Age:41.0  Onset:2009-01-01, Days after vaccination: 0
Gender:Male  Submitted:2009-01-03, Days after onset: 2
Location:Unknown  Entered:2009-02-01, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV 1782SCLA
Administered by: Military     Purchased by: Military
Symptoms: Bed rest, Headache, Myalgia, Nausea, Pain, Photophobia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: LEFT SIDE UPPER BODY MUSCLE ACHES, HEADACHE, NAUSEA,PHOTOPHOBIA,PAIN 8/10. TX: TYLENOL, PHENERGAN, BEDREST X 48 HOURS. SX''S RESOLVED IN 4 DAYS. PATIENT MISSED 2 DAYS OF WORK.

VAERS ID:338772 (history)  Vaccinated:2008-12-01
Age:41.0  Onset:2009-01-17, Days after vaccination: 47
Gender:Female  Submitted:2009-01-28, Days after onset: 11
Location:Unknown  Entered:2009-02-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DECAVAC)SANOFI PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Erythema, Injection site swelling, Post procedural drainage, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 12/1/08 patient received tetanus/diptheria injection. Returned 1/19/09 with complaint of injection site swelling - left deltoid- Reported increased reddening over 3 weeks. On 1/17/09 area burst wit greenish drainage. Complained of pain at site, decreased swelling. Complained of chills and fever for 1-2 days. Treated conservatively: TYLENOL for pain, no antibiotics.

VAERS ID:338778 (history)  Vaccinated:2008-04-19
Age:41.0  Onset:2008-04-23, Days after vaccination: 4
Gender:Male  Submitted:2009-01-29, Days after onset: 281
Location:Indiana  Entered:2009-02-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SERTRALINE; XANAX
Current Illness:
Preexisting Conditions: The patient has no known allergies, and had no illnesses or use of other medications at the time of the vaccination. From new information received on 12 December 2008, at the time of the vaccination, the patient had history of chronic generalized anxiety and depression that continues. The patient never had a reaction to any prior tetanus vaccination in the past.
Diagnostic Lab Data: The patient''s neurological exam was normal, therefore no neurological tests were performed. The patient had an X ray of the left humerus on 06 October 2008 to assess for calcifications or other injury. The results were normal. 11-DEC-200
CDC Split Type: 200803085
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2767A0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Bursitis, Injection site pain, Neurological examination normal, Nuclear magnetic resonance imaging normal, Tendonitis, X-ray normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (narrow)
Write-up: Initial report received on 07 October 2008 from a physician. A 41-year-old male patient, with no concurrent illnesses, no known allergies, and no use of other medications, had received a first 0.5 mL intramuscular left deltoid injection of ADACEL (Lot # C2767AA) on 29 April 2008. The size of needle used for the administration of the ADACEL was unknown. Approximately four hours post-vaccination, the patient experienced soreness at the left deltoid injection site which persisted. The site appeared to be normal, but the soreness did not resolve. The patient subsequently required medical evaluation and an x-ray of the left arm was performed which was reported to be negative. At the time of this report, the patient had not recovered. Follow up information was received on 24 November 2008 from a health care professional. The patient was seen in the office on 03 October 2008. During the visit the doctor assessed the site as "normal in appearance". The patient''s neurological exam was normal, therefore no neurological tests were performed. The patient had an X ray of the left humerus on 06 October 2008 to assess for calcifications or other injury. The results were within normal limits. The patient was scheduled for a follow up appointment on 20 November 2008. No further information was provided. Follow-up information received on 12 December 2008 from a physician. At the time of the vaccination on 29 April 2008, the patient was taking Sertraline and Xanax for chronic generalized anxiety and depression which continues. The patient had not recovered at the time of the office visit on 03 October 2008. The patient was re-evaluated by neurology on 20 November 2008 and an Magnetic Resonance Imaging test of the left upper extremity was "ordered." The results of the MRI were still pending at the time of this report. The physician did not feel the events were related to any immunization issues. The reporter stated "see attached office visit notes", but there were no office visit notes provided. At the time of

VAERS ID:339271 (history)  Vaccinated:2009-02-06
Age:41.0  Onset:2009-02-06, Days after vaccination: 0
Gender:Male  Submitted:2009-02-09, Days after onset: 3
Location:Oklahoma  Entered:2009-02-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3032AA0IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Diarrhoea, Feeling hot, Limb discomfort, Musculoskeletal discomfort, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt reported dog bite in am and needed booster td was given tdap approx 10 am in rt delt im.pt states about noon his rt upper arm and rt shoulder started to ache. the next day he had fever-said felt hot and nausea vomiting and diarrhes started. today 2/9/9 he still has diarrhea. rt arm not red or swollen but has pain and complains of increased pain when raising arm. advised to sign up for same day appointment at our clinic to be evaluated by one of our providers.

VAERS ID:339427 (history)  Vaccinated:2009-02-05
Age:41.0  Onset:2009-02-09, Days after vaccination: 4
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2009-02-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bilat. Heel pain
Preexisting Conditions:
Diagnostic Lab Data: CBC with 14k wbc & neutrophila + Blood culture
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1124X0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3058AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood culture, Cellulitis, Erythema, Oedema peripheral, Pain in extremity, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: 2/9/09 = Red swollen left arm painful. 2/10/09 = Reddened area on arm, spreading painful. 2/11/09 = cellulitis. Pt has prior Hx staph infections.

VAERS ID:339512 (history)  Vaccinated:2009-01-26
Age:41.0  Onset:2009-01-27, Days after vaccination: 1
Gender:Female  Submitted:2009-02-12, Days after onset: 16
Location:California  Entered:2009-02-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, calcium, trazadone, aspirin, levothyroxin, niacin. I was on a low-carb diet at the time.
Current Illness: None
Preexisting Conditions: Low thyroid; PCN allergy.
Diagnostic Lab Data: All bloodwork normal; heart rhythm normal; echocardiogram normal; brain scan normal; urinalysis normal. Adrenal function normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Private     Purchased by: Private
Symptoms: Anxiety, Asthenia, Blood test normal, Brain scan normal, Cardiac flutter, Dehydration, Dizziness, Echocardiogram normal, Heart rate increased, Heart rate normal, Insomnia, Loss of consciousness, Nausea, Pallor, Palpitations, Presyncope, Syncope, Urine analysis normal, Viral infection
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: I received the TDAP vaccine on the morning of Jan. 26. That night, I was unable to sleep, felt very dry, and consumed a large amount of water. The next day, I felt faint, weak and nauseated, and heart fluttering. The following morning, I went by ambulance to the ER because I felt very close to fainting, and my heart was racing, and I felt that I was about to throw up. My heart rate was high, and the doctor noted that I was pale. I had a strong feeling of doom. The ER found nothing peculiar in my bloodwork, and nothing abnormal on a brain scan. They said I was dehydrated, gave me IV fluid, and sent me home. Two days later, despite having consumed large amounts of fluid, I went to an urgent care center for the same symptoms. I collapsed at the center while signing for the co-pay but did not lose consciousness. My blood pressure was not high, but my heart rate was. They said I was orthostatic, gave me IV fluids, and sent me home. The following day, Saturday, I went back to the ER with the same symptoms. They ran blood and urine tests - all normal - said I had a "virus," and provided no treatment. On Monday, one week after the vaccination, I went to see my regular physician, where I had received the vaccine. There I was orthostatic, except my blood pressure was not high; I was sent to urgent care and given IV fluids and sent home. This pattern continued until I had received four different IV fluid infusions. Urgent care referred me to cardiology, which did an echocardiogram (nothing), and which provided me with a 24-hour heart monitor, (also nothing.) With symptoms of racing heart, weakness, nausea and near-fainting continuing, I went to see my endocrinologist, who ran a test for adrenal gland insufficiency (nothing) and who ordered a 24-hour urine sample, to test for various other potential hormonal problems. Not all of these results are in yet, but no results received so far have identified a cause. I have been markedly better since about Feb. 8/9, but still experiencing some symptoms. My doctors have said they do

VAERS ID:339632 (history)  Vaccinated:2008-01-09
Age:41.0  Onset:2008-01-13, Days after vaccination: 4
Gender:Male  Submitted:2009-02-06, Days after onset: 390
Location:Washington  Entered:2009-02-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: denies
Current Illness: denies
Preexisting Conditions: Reitens disease
Diagnostic Lab Data: MRI pin pt
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB208AA0UNLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1992EA UNLA
TYP: TYPHOID LIVE ORAL TY21A (NO BRAND NAME)UNKNOWN MANUFACTURER  PO 
Administered by: Public     Purchased by: Private
Symptoms: Nuclear magnetic resonance imaging, Pain, Reiter's syndrome
SMQs:, Arthritis (narrow)
Write-up: Pt states reoccurrence of Reitens Disease after 3rd TYPHOID pill - c/o S-1 pain resolved post backs required steroid use Last episode of Reitens disease was 5 years prior- pain in wrist. Pt reported event today 2/6/09

VAERS ID:339721 (history)  Vaccinated:2007-09-05
Age:41.0  Onset:2007-10-07, Days after vaccination: 32
Gender:Male  Submitted:2009-02-17, Days after onset: 499
Location:Oregon  Entered:2009-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1100SCRA
Administered by: Military     Purchased by: Military
Symptoms: Disturbance in attention, Fatigue, Insomnia
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad)
Write-up: Chronic fatigue, difficulty concentrating & sleeping following vaccinations

VAERS ID:340151 (history)  Vaccinated:2005-10-01
Age:41.0  Onset:2005-10-01, Days after vaccination: 0
Gender:Female  Submitted:2008-10-28, Days after onset: 1123
Location:Unknown  Entered:2009-02-19, Days after submission: 114
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: TYAESON SUPERFICIAL PUNCTATE KERATITIS
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUN IMUN
Administered by: Other     Purchased by: Other
Symptoms: Eye infection, Eye pain, Eye pruritus, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad), Ocular infections (narrow)
Write-up: developed bilateral red eyes, itching, pain similar to 4/29/05 eye infection 2 hours after receiving both IM influenza 10/2005 and FLUMIST 10/2006. Problems resolved after nights sleep but was present for 12 hours. Ear pain, Red eyes, Itchy Eye lids.

VAERS ID:340177 (history)  Vaccinated:2009-02-16
Age:41.0  Onset:2009-02-16, Days after vaccination: 0
Gender:Female  Submitted:2009-02-16, Days after onset: 0
Location:North Carolina  Entered:2009-02-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: severe reaction~Yellow fever (no brand name)~1~41~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Glucose, finger stick, 102
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB252AA1IMRA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF426AA0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Blood glucose increased, Dizziness, Dysphagia, Dyspnoea, Erythema, Fatigue, Heart rate increased, Hypersensitivity, Hypertension, Hyperventilation, Hypoaesthesia oral, Muscular weakness, Paraesthesia oral, Rash macular, Sensation of heaviness, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 12:15 - Pt in today for yellow fever and Hep A vaccine for travel to Peru. Vaccine was given (yellow fever) SQ in left arm and Hep A IM in R deltoid at 11:45 am. Pt started c/o feeling tired, then mild SOB, just not being able to take a deep breath. Hives appeared on neck, bright red splotchie but non-puritic. B/P 163/96 P- 110, O2 SAT 99%, lips pink. Doctor notified immediately. 12:20 Epi .3 cc SQ given in L arm, pt. began feeling light headed and dizzy. Transport from immunization room to u/s room via WC. Assisted from chair to wheel chair and then from wheel chair to exam table. Upon transfer from wheel chair to exam table pt reported that her legs were weak feeling and very heavy. Doctor aware of legs feeling weak and very heavy. B/P 168/100 P- 98; O2 Sat 99% lying on exam table with head down and feet elevated. 12:25 Pt remains stable, no change in condition except lips starting to tingle slightly. SOB has subsided some. Spoke with Doctor about pt starting to have some tingling sensations in her lips. Orders received at this time 1 SOLUMEDROL 125 mg IM and 2 BENADRYL 50 mg po (stat). 12:30 BENADRYL 50mg po given and SOLUMEDROL 125 mg IM given in R hip. B/P 155/98 P- 96; O2 Sat 99%. Significant other notified of his need to come to health dept that his wife was having an allergic reaction to the Yellow Fever vaccine. 12:35 Significant other present. Pt reports that she is feeling "some"better. Pt was assisted to semi-fowlers position and was given some coca-cola to sip on. Pt awake, alert, orientated, talking coherently. Color is returning to lips. Hives are faded tremendously and hardly viable. Talking with significant other. 12:50 Pt was noted to take a very deep breath with a sigh and when asked she reported that the SOB, tiredness, and heaviness of her legs were returning. Pt asked to be laid back down in supine position. B/P 152/99 HR - 98. Doctor notified. 12:53 EMS called for a 1018 transport to medical center secondary to an allergic reaction to yellow fever vaccine. 12:55 Pt cont. to be the same, mil

VAERS ID:340718 (history)  Vaccinated:2009-02-24
Age:41.0  Onset:2009-02-25, Days after vaccination: 1
Gender:Female  Submitted:2009-02-25, Days after onset: 0
Location:Texas  Entered:2009-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID, 50mcg
Current Illness: None
Preexisting Conditions: Hypothyroidism NOS; Hyperlipidemia; elevated LDH
Diagnostic Lab Data: TSH= 0.01 on 2/18/09
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF471BA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood thyroid stimulating hormone decreased, Body temperature increased, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypothyroidism (broad), Hyperthyroidism (broad)
Write-up: Fever, nausea, vomiting; patient received shot of KETOROLAC 60 mg/2ml today, 2/25/09. Also, patient was prescribed PHENERGAN 25 mg tabs, 1 pill at bed time as needed. Temp 99.3, BP 118/76.

VAERS ID:341020 (history)  Vaccinated:2009-02-27
Age:41.0  Onset:2009-02-28, Days after vaccination: 1
Gender:Female  Submitted:2009-03-03, Days after onset: 3
Location:California  Entered:2009-03-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3031AA IMUN
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Musculoskeletal stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Severe local erythema, swelling, stiffness with fever up to 102 degrees F.

VAERS ID:341070 (history)  Vaccinated:2008-12-30
Age:41.0  Onset:2008-12-31, Days after vaccination: 1
Gender:Female  Submitted:2009-03-04, Days after onset: 63
Location:Illinois  Entered:2009-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2760AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: sore throat for 24 hours. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel box and vial not marked for pediatric use at time of administration. Error found when new Daptacel box received and new box was marked pediatric.

VAERS ID:341154 (history)  Vaccinated:2008-10-31
Age:41.0  Onset:2008-11-03, Days after vaccination: 3
Gender:Female  Submitted:2009-02-01, Days after onset: 90
Location:Ohio  Entered:2009-03-05, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500541P0IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Chest X-ray normal, Influenza like illness, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 3 days post immunization pt. c/o wheezing with exhalation. The Monday following 11/10 she came down with flu-like symptoms + fever 101 degrees. She saw her personal physician given Z Pack. 2 additional episodes in December + January treated with Z-Pack + OTC cold med CXR-negative in February.

VAERS ID:341558 (history)  Vaccinated:2009-03-02
Age:41.0  Onset:2009-03-03, Days after vaccination: 1
Gender:Female  Submitted:2009-03-11, Days after onset: 7
Location:Washington  Entered:2009-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: n/a
Preexisting Conditions: n/a
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1370X0SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3032AA3IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1751X0SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Induration, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: pain, swelling, redness, hotness, hardened area increasing over several days. started antibiotics on 3/6/09; symptoms resolved by 3/8/09

VAERS ID:343400 (history)  Vaccinated:2008-04-30
Age:41.0  Onset:2008-05-03, Days after vaccination: 3
Gender:Female  Submitted:2009-03-04, Days after onset: 305
Location:New Jersey  Entered:2009-03-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject had no medical history and was not taking any concurrent mediations at the time of vaccination with HAVRIX.
Diagnostic Lab Data: UNK
CDC Split Type: A0728382A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS 0UNUN
Administered by: Other     Purchased by: Private
Symptoms: Headache, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: This case was reported by a healthcare professional, via a sale representative, and described the occurrence of swollen gland in a 41-year-old female subject who was vaccinated with HAVRIX 1440 for prophylaxis. On 30 April 2008 the subject received 1st dose of HAVRIX 1440 (unknown). On 3 May 2008, three days after vaccination with HAVRIX 1440, the subject experienced swollen glands, headache, body pain and low grade fever. The subject was vaccinated at a travel clinic. The reporting travel clinic nurse recommended that the subject be seen at a physician''s office. At the time of reporting, the events were unresolved.

VAERS ID:342340 (history)  Vaccinated:2009-03-18
Age:41.0  Onset:2009-03-18, Days after vaccination: 0
Gender:Female  Submitted:2009-03-20, Days after onset: 2
Location:Oregon  Entered:2009-03-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL 3; BENADRYL
Current Illness: none
Preexisting Conditions: Sulfa; NSAIDS; food allergies
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3032AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Hyperhidrosis, Joint swelling, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Sensation of swelling in legs, knees, elbows and hands. Mild pain in quads, sweating, sensation of dyspnea. Treated 2 weeks prior for hives due to ibuprofen (took BENADRYL). Multiple sensitivities, told she had "hereditary angioedema type 2 protein", unconfirmed record. No rxn at injection site. Started on PREDNISONE 3/20. Unremarkable exam.

VAERS ID:343011 (history)  Vaccinated:0000-00-00
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-03-30
Location:Pennsylvania  Entered:2009-03-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Edema; Redness
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF457CA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Urticarial reaction at injection site 4 x 3 cm, + erythema + edema, TX BENADRYL, ice and CLARITAN.

VAERS ID:343316 (history)  Vaccinated:2009-02-09
Age:41.0  Onset:2009-02-09, Days after vaccination: 0
Gender:Male  Submitted:2009-02-09, Days after onset: 0
Location:Virginia  Entered:2009-04-02, Days after submission: 51
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt stated that he was sick after receiving shot.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS899960UNRA
Administered by: Public     Purchased by: Private
Symptoms: Eye rolling, Immediate post-injection reaction
SMQs:, Ocular motility disorders (narrow), Hypersensitivity (narrow)
Write-up: The moment needle was in right deltoid, pt started to waver w/eyes rolling back. Pt began to wobble to a fro. I helped him to his seat. Water was given. He stayed around for 15-20 minutes and he left stating that he was feeling okay.

VAERS ID:343741 (history)  Vaccinated:2008-10-24
Age:41.0  Onset:2008-10-25, Days after vaccination: 1
Gender:Male  Submitted:2009-04-08, Days after onset: 165
Location:Unknown  Entered:2009-04-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURERFAV1551IMLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Fatigue, Headache, Oedema peripheral, Pain, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Persitant redness, itching and swelling of the upper arm for a week followed by a general feeling of tiredness, headaches and general achiness lasting for several weeks

VAERS ID:344207 (history)  Vaccinated:2009-04-08
Age:41.0  Onset:2009-04-08, Days after vaccination: 0
Gender:Female  Submitted:2009-04-15, Days after onset: 7
Location:Nebraska  Entered:2009-04-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Edema, itching, erythemia~Influenza (no brand name)~1~40~In Patient
Other Medications: Levothyroxin, Advair, Ibprofen, Cloratab
Current Illness: None
Preexisting Conditions: Allergies: Percocet, Ultram, Augmentin; Asthma, Hypothyroid, Enviromental allergies.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1290X0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1389X0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: At 1800, noted dime size erythemia at SQ injection site of the Varicella vaccine on Left upper arm. On 04/09/09 at 1215, area measured 4 x 3 cm and was red, hard, warm, and itching. The largest size noted extended to 3 cm proximal to left elbow and 3 cm proximal to the left upper arm with warmth, erythemia, and itching. Patient took Xyzal 5 mg po x 1 day and applied topical hydrocortisone cream PRN for 4 days. By 09/12/2009, most symptoms had resolved. On 19/13/2009, all symptoms resolved.

VAERS ID:344249 (history)  Vaccinated:2009-03-16
Age:41.0  Onset:2009-03-17, Days after vaccination: 1
Gender:Female  Submitted:2009-03-18, Days after onset: 1
Location:California  Entered:2009-04-15, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Rash~Influenza (no brand name)~UN~0~Patient
Other Medications: Hydrochlorothiazide
Current Illness: None
Preexisting Conditions: Allergic to flu vaccine containing Thimerisol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3070AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Nausea, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Onset of mild - mod fever, nausea, severe pain at injection site evening of 3/16/09. Onset of itching + mild rash over body 3/17/2009.

VAERS ID:344354 (history)  Vaccinated:2009-04-13
Age:41.0  Onset:2009-04-15, Days after vaccination: 2
Gender:Female  Submitted:2009-04-17, Days after onset: 2
Location:Washington  Entered:2009-04-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR    
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site pain, Musculoskeletal pain, Nodule
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Received Tdap vaccination on 4/13/09 in upper left arm. Injection site is still painful on 4/17/09, but real issue is pain caused by two pea sized nodules that have formed since 4/15/09. The nodules are 3-5 inches from the injection site over my left shoulder blade. Skin is slightly red over the area, but pain is constant, and worsens if touched.

VAERS ID:344577 (history)  Vaccinated:2003-01-11
Age:41.0  Onset:2003-01-13, Days after vaccination: 2
Gender:Male  Submitted:2008-07-28, Days after onset: 2022
Location:Unknown  Entered:2009-04-21, Days after submission: 267
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Denied
Preexisting Conditions: Knee problems, elev triglyceride
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0700UNUN
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Depression, Fatigue, Memory impairment, Mental disorder, Rash, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: This is a follow-up to a previously submitted VAERS report this 47 year old patient received 4 BIOTHRAX prior to and during his deployment in 2003. His concerns centered on whether the BIOTHRAX contributed to mental (depression, memory, fatigue) and physical disorders (joint pain, skin discoloration, rash) that "began in 2003".

VAERS ID:344969 (history)  Vaccinated:2009-03-02
Age:41.0  Onset:2009-03-02, Days after vaccination: 0
Gender:Female  Submitted:2009-04-07, Days after onset: 35
Location:Colorado  Entered:2009-04-22, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine sodium
Current Illness: Pregnancy NOS (LMP=12/22/2008); Hypersensitivity
Preexisting Conditions: Hemorrhage in pregnancy
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0903USA00792
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy, Pregnancy test, Ultrasound abdomen, Wrong drug administered
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a 41 year old female patient with an allergy to "cloricidin" and a history of bleeding during pregnancy who on 2-MAR-2009 was accidentally vaccinated with a first dose of GARDASIL (lot number and route not reported) in the arm while she was 10 weeks pregnant. She was supposed to be receiving globulin, RHOGAM. Concomitant therapy included levothyroxine Na. Pregnancy test and ultrasound were performed on an unspecified date (no results reported). The patient saw the physician. It was reported that the patient was 10 1/2 weeks pregnant at the time of this report. Additional information has been requested.

VAERS ID:344923 (history)  Vaccinated:2009-04-18
Age:41.0  Onset:2009-04-19, Days after vaccination: 1
Gender:Male  Submitted:2009-04-27, Days after onset: 8
Location:New York  Entered:2009-04-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF457DA0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site pain, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt received TD vaccination 18 April 09. C/O increased pain over right deltoid muscle on 19 April. Pt states that pain has been stable for the past week. Denies any C/O radiation of pain, Paresthesia of right arm. States that pain disturbes sleep but does not interfere with work. Denies presence of any lump or bump over injection site.

VAERS ID:345060 (history)  Vaccinated:2009-04-22
Age:41.0  Onset:2009-04-25, Days after vaccination: 3
Gender:Female  Submitted:2009-04-28, Days after onset: 3
Location:Wyoming  Entered:2009-04-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~NULL~~In Patient
Other Medications: celexa, synthroid, singulair
Current Illness: Cat bite
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF 456AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt received Tdap on 4-22-2009, IM in left deltoid swelling stated 3 days later. Redness from top of deltoid to elbow and area is hard and warm to the touch. Treatment includes warm packs and watch for infection.

VAERS ID:345084 (history)  Vaccinated:2009-04-28
Age:41.0  Onset:0000-00-00
Gender:Male  Submitted:2009-04-28
Location:Texas  Entered:2009-04-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA389BA UNLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB302BA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:345091 (history)  Vaccinated:2009-04-09
Age:41.0  Onset:2009-04-09, Days after vaccination: 0
Gender:Female  Submitted:2009-04-13, Days after onset: 4
Location:North Carolina  Entered:2009-04-28, 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: None
Current Illness: None by report
Preexisting Conditions: Allergy to PCN / Dilaudid per client
Diagnostic Lab Data: None performed at County Dep. of Public Health
CDC Split Type: NC09015
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB096AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF457DA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Dysphagia, Dyspnoea, Musculoskeletal pain, Neck pain, Rash, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Client reports rash to inner arms approx. 10 minutes after receiving vaccines on 04/09/09. Clients states she began to experience pain in Rt shoulder area which up the Rt side of her neck with "extreme" tenderness and slight difficulty swallowing. Rash continues - widespread - Client experienced 4 episodes of chest pain and shortness of breath 04-11-09 - lasting Approx - 20 minutes CT. Has appt for MD follow up today.

VAERS ID:345818 (history)  Vaccinated:2004-06-28
Age:41.0  Onset:2004-06-28, Days after vaccination: 0
Gender:Male  Submitted:2009-05-01, Days after onset: 1768
Location:Unknown  Entered:2009-05-06, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Denied
Preexisting Conditions: Denied
Diagnostic Lab Data: not available 5/8/09 medical records recieved DOS 10/2003-2006. LABS and DIAGNOSTICS: Initial thyroid labs: T3=553, FT4=5.61, repeat values: T3=255, FT4=3.13 8/27/2004 T4=5, 9/4/2004 T4=3 2004: Removal of infected lymph node 3/2005 and 4/2005: decompression surgery eyes secondary to Grave''s disease.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0852UNUN
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURER4030013 IDUN
Administered by: Military     Purchased by: Unknown
Symptoms: Agitation, Anorexia, Appetite disorder, Arthralgia, Basedow's disease, Blindness, Chest pain, Chills, Deafness, Dyspnoea, Eating disorder symptom, Eye operation, Fatigue, Headache, Insomnia, Loss of consciousness, Lymphadenectomy, Lymphadenopathy, Myocardial infarction, Nausea, Nervousness, Palpitations, Photophobia, Pyrexia, Sinus disorder, Thyroxine increased, Tinnitus, Tremor, Tri-iodothyronine increased, Vomiting, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypothyroidism (broad), Hyperthyroidism (narrow), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad)
Write-up: See HPI: n/v fever, headaches 12-24 hours after every AVA vaccine, but had 2 episodes cp/sob after AVA #3/SMPX vac, wt loss, hungry, insomnia...dx graves disease Aug 2004 and septal MI. Symptoms: Tremors, Palpitations, Weight loss, unexpected, Chest Pain, Dyspnea (shortness of breath), Joint Pain, multiple joints, Fever, Headache, general, Fatigue. 5/8/09 medical records recieved DOS 10/2003-2006. FINAL DIAGNOSIS: Grave''s disease with exophthalmos, septal MI, PTSD Post vaccine dose #1: chills, vomiting, fever, headache behind eyes. Post vaccine dose #2: headache pain behind eyes, vomiting, eyes sensitive to light, unspecified sleep disturbance. Post vaccine dose 3#: no adverse events remembered, went to bed early. 2004 MI/septal infarct. Eye sight decreasing, hand tremors. Chest pain, shortness of breath. Heart fluttered. Constantly eating difficulty sleeping. Later episode consisting of grayed out vision with loss of consciousness. Weight loss. Septal MI confirmed. Graves disease confirmed. Multiple joint pains. Infected lymph node behind right ear. Nervous, agitated. 2005 sinus problems. Buzzing in ears, early hearing loss. Medical records have been requested. Follow-up: No known changes.

VAERS ID:346131 (history)  Vaccinated:2008-03-31
Age:41.0  Onset:2008-03-31, Days after vaccination: 0
Gender:Female  Submitted:2008-04-02, Days after onset: 2
Location:Maine  Entered:2009-05-06, Days after submission: 399
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No adverse effect~Rabies (no brand name)~1~0~Patient
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type: 200800942
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)SANOFI PASTEURA02592IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Epistaxis, Headache, Lymphadenopathy, Oropharyngeal pain, Rash generalised
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: This case was received from a health professional. A 41-year-old female patient, with a history of asthma, received an intramuscular left deltoid third dose of IMOVAX (lot number A0259-3) on 31 March 2008. The patient had received initial doses of IMOVAX, IMOGAM, and tetanus vaccine (lot number and manufacturer not provided) in the emergency room on 24 March 2008, after being exposed to raccoon saliva on a cat. She received an intramuscular left deltoid second dose of IMOVAX (lot number A0259-3) on 27 March 2008, and no adverse reactions were reported at that time. In the evening of 31 March 2008, following her third dose of IMOVAX, she experienced a generalized rash, headache, sore throat, swollen lymph nodes, and a bloody nose. Treatment included BENADRYL and TYLENOL, and at the time of the report the events had not yet recovered.

VAERS ID:346419 (history)  Vaccinated:2009-05-11
Age:41.0  Onset:2009-05-12, Days after vaccination: 1
Gender:Female  Submitted:2009-05-16, Days after onset: 4
Location:Kentucky  Entered:2009-05-16
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: Allergies, asthma, migraines
Diagnostic Lab Data: Bloodwork came back normal, BUN and Iron level a little on the low side. Also, had chest x-ray which came back normal, strep test came back normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blood iron decreased, Blood test normal, Blood urea decreased, Chest X-ray normal, Dyspnoea, Fatigue, Headache, Injection site swelling, Injection site warmth, Lymphadenopathy, Oropharyngeal pain, Pharyngeal erythema, Pyrexia, Streptococcus identification test negative, Tongue disorder, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: On the day of the shot, the injection site had minamal swelling; however the following starting occurring the day after the shot, Severe swelling of lymph node along the collar bone (egg size), hives on face, neck and hands, swelling from the injection site up to the face on left side of body, labored breathing, constant low grade fever, fatigue, thick tongue, havev felt very weak, also very sore throat (bloody red), headache, extremely hot swollen injection site. Visited a doctor on 5/15 due to continuous inlargement of lypmh node on collar bone, fever, etc. . . was told to continue on Benedryl & Motrin and to go to emergency room if fever started going up, lymph nodes continued to get bigger or if I continued to have breathing difficulties. Today, the 6th day after the shot I still have a fever (100.1) but the swelling has gone done some.

VAERS ID:346580 (history)  Vaccinated:2009-05-02
Age:41.0  Onset:2009-05-11, Days after vaccination: 9
Gender:Female  Submitted:2009-05-15, Days after onset: 4
Location:Missouri  Entered:2009-05-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200902146
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURERFAV1640UNRA
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04-003A0IDLA
Administered by: Military     Purchased by: Military
Symptoms: Abdominal discomfort, Cough, Headache, Injection site erythema, Injection site induration, Injection site streaking, Injection site swelling, Injection site warmth, Lymphadenopathy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case was received on 13 May 2009 from a consumer. A 41 year old female patient received ACAM2000 (lot number unknown) in her left arm and anthrax vaccine (manufacturer and lot number unknown) in her right arm on 02 May 2009. Nine days after vaccination the patient noticed increased redness and swelling around the ACAM2000 vaccination. The patient also experienced fever, an extremely bad headache, abdominal discomfort and mild cough. The redness progressively increased to approximately 3 inches in diameter with a 1 inch wide red streak radiating laterally around arm to under the armpit. The patient also reports mild lymphadenopathy. The patient was advised to see a local healthcare provider for evaluation of possible cellulitis. List of Documents held by Sender: None. 7/7/09 ED records received DOS 5/2/09. Assessment: Cellulitis, reaction to smallpox vaccination. Patient presented with loss of band-aid covering immunization site. Site demonstrated ''redness and erythema'', red streaking, warm and hard, headache. ICD-9 Codes: V5989, V5889

VAERS ID:346614 (history)  Vaccinated:2009-05-13
Age:41.0  Onset:2009-05-18, Days after vaccination: 5
Gender:Male  Submitted:2009-05-19, Days after onset: 1
Location:Mississippi  Entered:2009-05-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: hypertension. 6/2/09 ED and inpatient hospital records received DOS 5/19/09 to 5/21/09. Hypertension, childhood asthma, egg allergy.
Diagnostic Lab Data: 5/19 wbc count 12.6, BUN 10 Crea 1.04. LUE Venous ultrasound: slow flow at confluence of left IJ and left subclavian vein. 6/2/09 ED and inpatient hospital records received DOS 5/19/09 to 5/21/09. LABS and DIAGNOSTICS: Upper Extremity Vascular Doppler - Slow flow at confluence of left internal jugular and subclavian veins. Echocardiogram: mild mitral regurgitation. CBC - WBC 12.6 bil/L (H) Hgb 16.7 g/dL (H) Lymph 17.4% (L) Eos 5.7% (H) Eos Count 500 thou/L (H) Mono 0.7 K/uL (H) Gran 9.3 K/uL (H). CHEM: Prot 6.2 g/dL (H). Blood culture - no growth.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1640IMLA
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURVV04003A1IDRA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Blood creatinine normal, Blood culture negative, Blood urea normal, Echocardiogram abnormal, Eosinophil count increased, Eosinophil percentage increased, Erythema, Granulocyte count increased, Haemoglobin increased, Induration, Injection site discharge, Injection site inflammation, Injection site pustule, Joint effusion, Lymphocyte percentage decreased, Mitral valve incompetence, Monocyte count increased, Oedema peripheral, Pain in extremity, Protein total increased, Pruritus, Skin warm, Ultrasound scan abnormal, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 5 days after receiving vaccines, he had left upper extremity swelling, redness, and warmth. His left thumb base was itching. There was left thumb pain with motion. Today, he noted right 4th finger tip being hard. 6/2/09 ED and inpatient hospital records received DOS 5/19/09 to 5/21/09. FINAL DIAGNOSIS: Hypertension, hand cellulitis. Post vaccination presented with swelling in left arm, erythema. Itching and bruising of left thumb, painful on motion, pain at base of thumb. Erythema, swelling, and purplish discoloration of right middle finger. Pain and swelling of left knee. Purulent area, with erythema at site of smallpox vaccine on right biceps. Infectious disease consult notes whitish pustule on right arm. ICD-9 Codes: 682.4 Cellulitis/Abcess Hand Exc Finger/Thumb, 401.9 Hypertension NOS.

VAERS ID:346638 (history)  Vaccinated:2009-04-29
Age:41.0  Onset:2009-04-30, Days after vaccination: 1
Gender:Male  Submitted:2009-05-08, Days after onset: 8
Location:New Jersey  Entered:2009-05-19, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB275AA1IMUN
Administered by: Private     Purchased by: Other
Symptoms: Dry skin, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt. developed rash behind his leg, forearms and few spots on trunk. Describes as itchy, appears dry, Flat. Began approx. 24 hours post 2nd dose HEP A vaccine. Pt. had sunburned skin on same areas prior to vaccine and rash

VAERS ID:346731 (history)  Vaccinated:2008-03-11
Age:41.0  Onset:2008-03-14, Days after vaccination: 3
Gender:Female  Submitted:2009-05-20, Days after onset: 432
Location:Texas  Entered:2009-05-20
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Recovering from unknown immune deficiency symptoms.
Preexisting Conditions: Tested positive for Gluten & Wheat Allergy. 6/4/09-records received-PMH-gluten intolerance and gastritis.
Diagnostic Lab Data: 6/4/09-records received-Abnormal electrocardiogram prolonged QT interval and ST segment depression suggestive of ischemia with subsequent EKG normnal. Labs WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Chest pain, Dyspnoea, Electrocardiogram QT prolonged, Electrocardiogram abnormal, Fatigue, Gastritis, Heart rate increased, Heart rate irregular, Hypertension, Hypoacusis, Influenza like illness, Ischaemia, Laboratory test normal, Malaise, Oedema peripheral, Pruritus, Urticaria, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hearing impairment (narrow), Hypersensitivity (narrow)
Write-up: On March 11, 2009, I went in for a check-up, and referral for neurological evaluation and saw Dr. I had been previously ill since April 2005, and had begun to recover. Did describe to her my previous illnesses, and that seem to have a lot of issues with my immune system, and still tend to have reoccurring issues. She asked when my last tetanus shot was and I told her it had to been more than 15 years. And said it was time, and I told her that I was very sensitive to what seems to everything. She said given my immune system problem that is more reason to have one. Minutes later her nurse came in to give me the injection, and I still questioned it and had reservation, and she insisted on giving it to me because Dr. said so; I asked about giving half the dose, and replied could not. About three days later I started to experience my same old symptoms very fluish, and 3 days after that I broke out in unbearable itchy hives, starting from my feet all the way up my body ending at my neck, and then my feet blew up. Once this happened I called Dr''s office and explained this to them, and spoke to an On Call Doctor, and delivered a message to Dr''s office what had happened, and from thereafter received a returned call from nurse, this was not possible, and etc, and did nothing to help me. The hives were very hard to get rid of. I was rid of the hives in about 2 weeks, but was still feeling very ill once again, where I started to exhibit extreme fatigue, once again fluish symptoms, serious visual disturbances and hearing problems, my hearing felt like it was fading in and out; and the scariest part was heart symptoms, high blood pressure, abnormal ekg, & rapid heartbeat. Later on, did have an interruptions with my heart, I felt different and my heart started to beat. Went to immediate care, and wouldn''t treat me because my heart symptoms were too serious, sent me to the hospital. I immediately put in the Cardiac Wing over the weekend; I was given medicine for my heart; And they just didn''t understand my condition and wanted m

VAERS ID:347295 (history)  Vaccinated:2008-09-23
Age:41.0  Onset:2008-09-24, Days after vaccination: 1
Gender:Female  Submitted:2009-05-15, Days after onset: 233
Location:Florida  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0809USA04626
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB584AA4IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0737X0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site discomfort, Injection site erythema, Injection site induration, Injection site pruritus, Injection site reaction, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial and follow-up information has been received from a registered nurse concerning a 41 year old female with no pertinent medical history and no known drug reactions or allergies, who on 23-SEP-2008 was vaccinated with a first dose of VARIVAX (Merck) (lot # 661334/0737X) 0.5 mL, subcutaneously into her left triceps. Concomitant vaccination included a fifth dose of ENGERIX-B (lot # AHABVB584AA) into her left thigh. On 24-SEP-2008 the patient developed an injection site reaction following vaccination with VARIVAX (Merck). The patient had a large raised oval reddened area approximately 6" long to 2" wide, and a swollen area that was 6 inches long (shaped like a cucumber). The oval was mostly below the injection site, but just at the injection site the area was hardened and warm in addition to being swollen and red. Skin area was hot to touch. The patient did not have any fever. Reactions caused a significant discomfort. No fever reported. It was also reported that there was itching at site of injection (also reported as beginning on day 4 on 26-SEP-2008). There were no labs or diagnostic studies performed. The patient sought unspecified medical attention. The patient recovered from the large raised reddened area, significant discomfort, itching at site and area hot to touch on 29-SEP-2008 (previously reported as 28-SEP-2008). The patient also recovered from all the adverse events on 29-SEP-2008. There was no illness at time of vaccination. Additional information is not expected.

VAERS ID:347638 (history)  Vaccinated:1998-04-01
Age:41.0  Onset:2008-07-01, Days after vaccination: 3744
Gender:Female  Submitted:2009-05-15, Days after onset: 318
Location:Unknown  Entered:2009-05-21, 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: Graves disease; allergic reaction to antibiotics
Preexisting Conditions:
Diagnostic Lab Data: Serum varicella zoster, 07/??/08, negative
CDC Split Type: WAES0808USA01011
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Antibody test negative, Varicella virus test negative
SMQs:
Write-up: Information has been received from a 41 year old female with Graves disease and an allergy to cephalexin who in April 1998, was vaccinated with the second dose of VARIVAX (Oka/ Merck). In July 2008, the patient went to her primary care physician for a regular check up. Since the patient received VARIVAX (Oka/Merck) about 10 years ago, she asked the physician if she needed to be revaccinated or if she was protected for life. The physician stated that she could do a titer test to find out. The titer test demonstrated that the patient was not immune to varicella (chicken pox). No further information available.

VAERS ID:348930 (history)  Vaccinated:2009-02-23
Age:41.0  Onset:0000-00-00
Gender:Male  Submitted:2009-06-05
Location:Georgia  Entered:2009-06-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Other
Symptoms: Hypoaesthesia, Musculoskeletal pain, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: The shot was given to me months ago in my left arm. It was understood that it was result in some soreness for a while. But there is a numbness and soreness in my shoulder area when I lift my arm up. And sometimes tingling feeling when I wake up. Can''t lie on it or it will be sore.

VAERS ID:349494 (history)  Vaccinated:2009-06-15
Age:41.0  Onset:2009-06-17, Days after vaccination: 2
Gender:Female  Submitted:2009-06-18, Days after onset: 1
Location:Indiana  Entered:2009-06-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: following laparoscopic cholecystectomy
Preexisting Conditions: Codeine, aspirin. 7/2/09 Hospital records received DOS 6/18/09 to 6/20/09. Recent laparoscopic cholecystectomy.
Diagnostic Lab Data: CT scan ruled out post op infection as source of fever. 7/2/09 Hospital records received DOS 6/18/09 to 6/20/09. LABS and DIAGNOSTICS: CBC - WBC 15.6 X10*3 (H) RDW 10.8% (L) Eosinophil 0.9% (L) Abs Neutrophil 11.9 X19*3 (H). CHEM - BUN 6 mg/dL (L) Sodium 134 mmo/L (L) AST 41 U/L (H) Lipase 56 U/L (L).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2770A IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.9722106046540IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3058AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood sodium decreased, Blood urea decreased, Computerised tomogram normal, Eosinophil percentage decreased, Flatulence, Injection site erythema, Injection site swelling, Lipase decreased, Nausea, Neutrophil count increased, Pain, Pyrexia, Rash macular, Red cell distribution width decreased, Vomiting, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow)
Write-up: Fever 103, body aches, blotchy redness, and severe swelling to right upper arm especially near & surrounding PPSV injection site. 7/2/09 Hospital records received DOS 6/18/09 to 6/20/09. Assessment: Post-Operative Fever. Patient presented with fever nausea, vomiting, abdominal pain, passing gas. Right arm swelling at the site of vaccine injection. ICD-9 Codes: 780.63, 789.07, V45.79

VAERS ID:349583 (history)  Vaccinated:2009-06-04
Age:41.0  Onset:2009-06-04, Days after vaccination: 0
Gender:Male  Submitted:2009-06-19, Days after onset: 15
Location:North Carolina  Entered:2009-06-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV1481IMRA
Administered by: Military     Purchased by: Military
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Anthrax Vaccine exceeded the recommended temperature range. Shipping and Handling requirements were discussed. No harm done to patient.

VAERS ID:349648 (history)  Vaccinated:2009-06-12
Age:41.0  Onset:2009-06-14, Days after vaccination: 2
Gender:Male  Submitted:2009-06-15, Days after onset: 1
Location:South Carolina  Entered:2009-06-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF406BA9UNLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, redness at site one day after vaccine administered. Knot under (L) arm two days after.

VAERS ID:351965 (history)  Vaccinated:2008-09-16
Age:41.0  Onset:2008-09-22, Days after vaccination: 6
Gender:Female  Submitted:2008-09-30, Days after onset: 8
Location:California  Entered:2009-07-14, Days after submission: 287
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TUBERSOL 5 TU
Current Illness:
Preexisting Conditions: No medical history, no known allergies, no concomitant medications, and no illness at the time of vaccination.
Diagnostic Lab Data:
CDC Split Type: 200802997
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2995B0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: A cluster of 2 adult patients who received TUBERSOL, lot number C2910AA, and developed injection site redness and induration four days after the test had been read as negative. Initial report received on 26 September 2008 from a healthcare professional. A 41 year old female patient, with no medical history and no known allergies, received on 16 September 2008 a first left foramen intradermal injection of TUBERSOL (lot number C2910AA) and a first right deltoid intramuscular injection of ADACEL (lot number C2995BA). The tuberculin test was read as "0/0 negative" (0 redness and 0 induration) on 18 September 2008. On 22 September 2008, four days after the negative test result, the patient had redness and induration of unknown size at the TUBERSOL injection site on the left forearm. Corrective treatment was not reported. The patient had no illness at the time of testing, was taking no concomitant medications and had no other vaccines given in the previous four weeks. At the time of the report, 26 September 2008, the patient had recovered. Case 2008-02998 with the same reporter and same TUBERSOL lot number was created for the other patient.

VAERS ID:352422 (history)  Vaccinated:2005-10-13
Age:41.0  Onset:2005-10-20, Days after vaccination: 7
Gender:Male  Submitted:2009-07-27, Days after onset: 1376
Location:Unknown  Entered:2009-07-27
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 203 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Recovering from acute laryngotrachiitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood product transfusion, Extraskeletal ossification, Guillain-Barre syndrome, Mechanical ventilation
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Respiratory failure (broad)
Write-up: Guillain Barre Syndrome developed 8 days after receiving the vaccine, resulting in 2 months ventilation, 7 months hospitalisation, subsequent heterotopic ossification. Received immunoglobulin in early stages.

VAERS ID:352649 (history)  Vaccinated:2009-04-27
Age:41.0  Onset:2009-05-02, Days after vaccination: 5
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2009-07-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: reported recent sprained ankle: onset 21-April-2009.
Diagnostic Lab Data: Not Reported
CDC Split Type: 200901996
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEUR  IDUN
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Back pain, Nuclear magnetic resonance imaging, X-ray
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad)
Write-up: This case was received on 05 May 2009 from a consumer/patient. A 41 year old male patient received the following vaccinations on 27 April 2009: ACAM2000 (Sanofi Pasteur Biologics Co., lot number not reported) and ANTHRAX vaccine (trade name and manufacturer not reported). Five days following vaccination, the patient reported left-sided lower back pain, shoulder, wrist and left knee pain on bending. The patient''s medical history reported a recent sprained ankle on 21 April 2009. The patient was seen in a clinic and had an x-ray and was scheduled to have an MRI of his back. The results of these tests were not reported. The patient reported no flu-like symptoms and no fever. The patient reported that the shoulder and wrist pain were improving at the time of the report but his joint pain was continuing. The patient''s pain has not prevented him from working. List of documents hed by sender: None

VAERS ID:353360 (history)  Vaccinated:2009-01-30
Age:41.0  Onset:2009-01-30, Days after vaccination: 0
Gender:Female  Submitted:2009-07-30, Days after onset: 180
Location:Unknown  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Breast cancer; Drug hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0902USA01799
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNGM
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Drug administered at inappropriate site
SMQs:
Write-up: Information has been received from a pharmacist concerning a 41 year old female with breast cancer and morphine allergy who on 30-JAN-2009 was vaccinated with a dose of PNEUMOVAX 23 in the left gluteus, and then presented with cellulitis on 02-FEB-2009. The patient was hospitalized for the cellulitis. Follow up information received on 13-APR-2009 stated that there was no other information available. No further information is available.

VAERS ID:354247 (history)  Vaccinated:2008-12-23
Age:41.0  Onset:0000-00-00
Gender:Male  Submitted:2009-07-30
Location:Kentucky  Entered:2009-08-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0901USA01937
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0980X0SCUN
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Erythema, Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a licensed practical nurse (LPN) concerning a patient who in November 2008, was vaccinated with PNEUMOVAX. The patient had random lot number (lot number not provided). The patient developed severe cellulitis reactions immediately after or by the evening of the PNEUMOVAX administration. The patient had symptoms, which included swelling, redness, pain and heat at the injection site. The patient was treated for cellulitis and was put either on an (unspecified) antibiotic and/or (unspecified) steroid. The outcome of the patient''s adverse reaction was not reported. Follow-up information was received from an office manager who confirmed that several patients had injection site reactions. Follow-up information was received from the licensed practical nurse (LPN). It was reported that on 23-DEC-2008, at 14:00, a 41 year old male was vaccinated SQ with the first dose of PNEUMOVAX (lot #: 662663/0980X). Subsequently, the patient developed redness, fever, edema and was diagnosed with cellulitis at a clinic. The patient was treated with antibiotics with symptoms lasting for 7-10 days. At the time of this report, the patient was recovered. This is one of several reports received from the same source. The nurse requested a lot check. Additional information has been requested.

VAERS ID:355451 (history)  Vaccinated:2008-11-04
Age:41.0  Onset:2008-11-04, Days after vaccination: 0
Gender:Female  Submitted:2008-11-10, Days after onset: 6
Location:Colorado  Entered:2009-08-13, Days after submission: 275
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not reported
Current Illness:
Preexisting Conditions: History of hives of unknown etiology with trips to emergency room IV treatment
Diagnostic Lab Data:
CDC Split Type: MEDI0007457
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500540P IN 
Administered by: Public     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A non-serious, spontaneous report of hives all over her body was received from a nurse, a 41 year-old female subsequent to FluMist. The patient''s past medical history includes hives of unknown etiology and trips to the emergency room for IV treatment. Concomitant medications or therapies are unknown. The patient received FluMist , nasal on 04-Nov-2008 for flu vaccination. On the evening of 04-Nov-2009 the patient experienced hives all over her body. The patient went to the emergency room for treatment and received an unknown IV. The patient was not admitted. No additional reactions or descriptions of the reaction were reported of available. The patient recovered from the same night and did not consider the event a "big deal".

VAERS ID:355820 (history)  Vaccinated:2009-01-27
Age:41.0  Onset:2009-01-27, Days after vaccination: 0
Gender:Female  Submitted:2009-05-12, Days after onset: 104
Location:New Jersey  Entered:2009-08-13, Days after submission: 93
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0008135
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P OTUN
Administered by: Military     Purchased by: Military
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious spontaneous report of administration of expired FLUMIST was received from a nurse concerning a 41-year-old female. Neither medical history nor concomitant medications were reported. On 27-Jan-2009, the patient received expired FLUMIST vaccine. The vaccine had an expiration date of 11-Jan-2009. As of 18-Mar-2009, there was no adverse event associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause for the medication errors were caused by 1) customers not discarding product from previous season and 2) product expiring during the peak of flu season resulting in some medication errors that occurred shortly after the product expired. Follow-up information was received on 12-May-2009: Product Complaint Investigation results.

VAERS ID:355983 (history)  Vaccinated:2009-03-02
Age:41.0  Onset:2009-03-02, Days after vaccination: 0
Gender:Male  Submitted:2009-05-12, Days after onset: 70
Location:New Jersey  Entered:2009-08-13, Days after submission: 93
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0008194
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P IN 
Administered by: Military     Purchased by: Military
Symptoms: Expired drug administered
SMQs:
Write-up: Expired vaccine used. A non-serious spontaneous report of administration of expired FLUMIST was received from a nurse in the military concerning a 41-year-old male. Neither medical history nor concomitant medications were reported. On 02-Mar-2009, the patient received expired FLUMIST vaccine. The vaccine had an expiration date of 11-Jan-2009. As of 18-Mar-2009, there was no adverse events associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause for the medication errors were caused by 1) customers not discarding product from previous season and 2) product expiring during the peak of flu season resulting in some medication errors that occurred shortly after the product expired. Additional information was received on 12-May-2009: Product Complaint Investigation results.

VAERS ID:355987 (history)  Vaccinated:2009-01-12
Age:41.0  Onset:2009-01-12, Days after vaccination: 0
Gender:Male  Submitted:2009-05-12, Days after onset: 119
Location:New Jersey  Entered:2009-08-13, Days after submission: 93
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: MEDI0008200
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500568P IN 
Administered by: Military     Purchased by: Military
Symptoms: Expired drug administered
SMQs:
Write-up: A non-serious spontaneous report of administration of expired FLUMIST was received from a nurse concerning a 40-year-old male. Neither medical history nor concomitant medication were reported. On 12-Jan-2009, the patient received expired FLUMIST vaccine. The vaccine had an expiration date of 11-Jan-2009. There was no adverse events associated with this medication error; therefore, treatment and reporter/sponsor causality assessments are not applicable, and the event is considered resolved. Based on the results of the investigation, the root cause for the medication errors were caused by 1) customers not discarding product from previous season and 2) product expiring during the peak of flue season resulting in some medication errors that occurred shortly after the product expired. Additional information was received on 18-Mar-2009 that indicated no adverse events were reported through the medical clinic and included patient demographics. Additional information was received on 12-May-2009: product complaint investigation results.

VAERS ID:354280 (history)  Vaccinated:2009-06-30
Age:41.0  Onset:2009-06-30, Days after vaccination: 0
Gender:Female  Submitted:2009-08-14, Days after onset: 45
Location:Alabama  Entered:2009-08-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: AL0915
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460BA0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lip oedema, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Swelling of leftside of lower lip occured approx. 15 min. after receiving Tdap vaccine. Pt. had already left clinic took 25 mg. of Benadryl at home. Returned to clinic. 1:15 pm with edema left lower lip. Cold compress applied on 5 min. off 5 min. Instructed if swelling increases to see ER or MD imnediately.

VAERS ID:354370 (history)  Vaccinated:2009-06-03
Age:41.0  Onset:2009-06-12, Days after vaccination: 9
Gender:Female  Submitted:2009-08-12, Days after onset: 61
Location:North Carolina  Entered:2009-08-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Flu negative/ Strep negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1249X1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1012X0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Blister, Influenza serology negative, Oropharyngeal blistering, Pyrexia, Streptococcus identification test negative, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: 6/12 by history hives like rash, fever, watery blisters mostly above waist & watery blisters down throat. Seen in ER 6/12/09 flu & strep negative.

VAERS ID:354933 (history)  Vaccinated:2009-08-19
Age:41.0  Onset:2009-08-20, Days after vaccination: 1
Gender:Female  Submitted:2009-08-21, Days after onset: 1
Location:Nebraska  Entered:2009-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3098AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest pain, Erythema, Musculoskeletal pain, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain in chest and along shoulder blade on left side, red & warm to the touch.

VAERS ID:355211 (history)  Vaccinated:2009-07-30
Age:41.0  Onset:2009-07-31, Days after vaccination: 1
Gender:Female  Submitted:2009-08-25, Days after onset: 25
Location:Arkansas  Entered:2009-08-25
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: morbid obesity; connective tissue diseases; esophageal motility disorders; primary Raynaud''s phenomenon; fibromyalgia; anxiety disorder; GERD; major depression; HTN; personal history of exposure to Persion Gulf Region; Adjustment disorder unspecified; sexual abuse of adult(DSM-IV 995.83)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.125X IMLA
Administered by: Military     Purchased by: Military
Symptoms: Agitation, Body temperature increased, Injection site erythema, Injection site induration, Insomnia, Myalgia, Tachycardia, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Reaction started on July 31 - had some wheezing, tachycardia, temp 103.6, severe myalgia, difficulty sleeping due to agitation despite taking zolpidem (Ambien). This lasted throughout week. On 8/3/09 patient was seen by primary care provider who stated that there was hard red indurated area over left deltoid with some increase in redness of skin overall but noted that it did not look urticarial. Also stated that reacion is resolving and patient is afebrile and not in respiratory distress so close follow-up is best approach.

VAERS ID:355506 (history)  Vaccinated:2009-08-24
Age:41.0  Onset:2009-08-24, Days after vaccination: 0
Gender:Female  Submitted:2009-08-26, Days after onset: 2
Location:Minnesota  Entered:2009-08-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ciproflaxin
Current Illness: Puncture wound
Preexisting Conditions: Ampicillin allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN5IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Joint stiffness, Muscle spasms, Muscular weakness, Pain in extremity, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Deltoid muscle weakness. Pain in deltoid muscle 7/10=best. Swelling and joint stiffness in right hand, wrist, fingers. Muscle spasm in neck and shoulder. Severe headache.

VAERS ID:356362 (history)  Vaccinated:2009-08-31
Age:41.0  Onset:2009-08-31, Days after vaccination: 0
Gender:Female  Submitted:2009-09-01, Days after onset: 1
Location:Virginia  Entered:2009-09-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension, Hay Fever
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01849211A0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Asthenia, Chest discomfort, Cold sweat, Defaecation urgency, Hyperhidrosis, Malaise, Nausea, No reaction on previous exposure to drug, Syncope, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: Patient experienced wheezing and chest tightness 2 hours after receiving the flu vaccine 8/31/09. She has not felt well since this episode began and today, 9/1/09, she experienced nausea, stomach cramping and feeling like she needed to go to the bathroom. She fainted while in the bathroom. She woke up sweating, clammy and very weak. BP 104/60, BS 132 (1 1/2 hours after eating). She has a history of hypertension, history of hay fever but no other medical problems nor history of an adverse event to vaccine administration. No one in her family has history of an adverse event after vaccine administration. She has been taken to a doctor here in town for evaluation. She received FLU-CSL 0.5 ml IM left deltoid.

VAERS ID:356447 (history)  Vaccinated:2009-09-02
Age:41.0  Onset:2009-09-02, Days after vaccination: 0
Gender:Female  Submitted:2009-09-03, Days after onset: 1
Location:Arkansas  Entered:2009-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: N/aA~ ()~NULL~~In Patient
Other Medications: Ortho-Cyclen
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3253AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest discomfort, Cough, Hypertension, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Hypersensitivity (broad)
Write-up: Tightness in throat, radiating to chest, coughing, high blood pressure (173/109). Symptons began at 4:20pm and continued until steroid were administered in ER at 6:15 and 6:27pm.

VAERS ID:356472 (history)  Vaccinated:2009-09-01
Age:41.0  Onset:2009-09-02, Days after vaccination: 1
Gender:Female  Submitted:2009-09-03, Days after onset: 1
Location:Arizona  Entered:2009-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Adderall, Symbicort
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3189AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1086X0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: R Arm - site of injection swollen red and painful per patient. Swelling extends inot axilla,

VAERS ID:356849 (history)  Vaccinated:2009-08-31
Age:41.0  Onset:2009-08-31, Days after vaccination: 0
Gender:Female  Submitted:2009-09-02, Days after onset: 2
Location:Mississippi  Entered:2009-09-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 0900 am started tingling
Preexisting Conditions: Allergic to SULFA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB719AA2IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dysgeusia, Paraesthesia, Skin warm
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad)
Write-up: Tingling sensation heavily on tongue and face, also all over body. Body feels warm, with no sweating. Metal taste in mouth.

VAERS ID:357250 (history)  Vaccinated:2009-09-01
Age:41.0  Onset:2009-09-01, Days after vaccination: 0
Gender:Female  Submitted:2009-09-10, Days after onset: 9
Location:Iowa  Entered:2009-09-14, 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: Vicodin; Synthroid; Ambien
Current Illness: None
Preexisting Conditions: Allergy- Erythromycin hypothyroid
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED018449211A0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Movement disorder
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: "Right deltoid burned on injection and keep burning". It became hard to move by the next morning it was swollen and red. Treatment- watch applied heat. Gone by Sunday Sept 6 2009.

VAERS ID:357253 (history)  Vaccinated:2009-09-02
Age:41.0  Onset:2009-09-02, Days after vaccination: 0
Gender:Female  Submitted:2009-09-10, Days after onset: 8
Location:Iowa  Entered:2009-09-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: IMITREX; YAZ; CEIEXA.
Current Illness: None
Preexisting Conditions: Hay fever; Migraines.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01844211A0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Received the flu shot on 9/2/09 at 08AM. By 21:00 on 9/2/09 she noticed hives on left arm and bilateral thighs. The hives were red, raised, and white in center. She reported them on 9/3/09 when she went to campus clinic. Plan - CLARITIN X 1 month, and PREDNISONE x 11 days. Follow up 2 weeks.

VAERS ID:357360 (history)  Vaccinated:2009-08-24
Age:41.0  Onset:2009-08-29, Days after vaccination: 5
Gender:Female  Submitted:2009-09-15, Days after onset: 17
Location:Kentucky  Entered:2009-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: N/A~ ()~~0~Patient
Other Medications: Lipitor 20MG 1 daily for 2 years duration
Current Illness: N/A
Preexisting Conditions: Patient states that he has a history of compressed disk but is unsure of the location. Injury occurred approx 15 years prior. 9/24/09 PCP office note DOS 9/8/09. Hyperlipidemia, allergic rhinitis.
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF437AA0SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abasia, Back pain, Hypoaesthesia, Malaise, Myalgia, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient received yellow fever vaccine on Monday 8/24 just prior to departure on 8/25. He became ill with high fever (104.5) and myalgia, (more specific to back pain) on 8/29. The fever lasted approx 2 days but back pain persisted. During this time, the patient returned home. He was contacted by the nurse on Monday 8/31 and stated that the fever had improved and he was feeling somewhat better. He had returned to work. On 9/5 the patient started experiencing shooting pain down his leg. By 9/6, he was unable to walk due to numbness in the the limb. He did not report for work on Tuesday 9/8 and make an appointment with his family physician. At this time he has completed a five day course of steroid therapy and states that he has seen some improvement in the leg pain but it has not resolved completely. 9/24/09 PCP office note DOS 9/8/09. Assessment: lumbar disc displacement. Patient presents with low back pain of 2 weeks duration, radiates down right leg to foot.

VAERS ID:357575 (history)  Vaccinated:2009-09-15
Age:41.0  Onset:2009-09-17, Days after vaccination: 2
Gender:Male  Submitted:2009-09-17, Days after onset: 0
Location:Unknown  Entered:2009-09-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Maxide, lisinopril, sertraline
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Not able to reproduce the carpal spasms by inflating Blood pressure cuff for one minute on the right arm.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Muscle spasms
SMQs:, Dystonia (broad)
Write-up: 2 days after anthrax vaccination to the right deltoid, patient reported 2 episodes of right arm carpal spasms that lasted for several minutes. Denies any other associated symptoms such as shortness of breath, chest pain, rash, headache or dizziness. Patient was reassured and precautions given to return if further problems.

VAERS ID:357804 (history)  Vaccinated:0000-00-00
Age:41.0  Onset:2009-09-15
Gender:Unknown  Submitted:2009-09-21, Days after onset: 6
Location:California  Entered:2009-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Public     Purchased by: Unknown
Symptoms: Muscular weakness, Myalgia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: left arm muscle ache, muscle pain, runny nose, left arm weakness

VAERS ID:357815 (history)  Vaccinated:2009-09-19
Age:41.0  Onset:2009-09-20, Days after vaccination: 1
Gender:Female  Submitted:2009-09-21, Days after onset: 1
Location:Florida  Entered:2009-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: estrace, synthroid, ditropan
Current Illness: no
Preexisting Conditions: hypothyroid
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3204AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Influenza like illness, Oropharyngeal pain, Pain, Rhinorrhoea
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: flu-like sy''s: sore throat, achy, runny nose x 2 days

VAERS ID:358004 (history)  Vaccinated:2009-09-18
Age:41.0  Onset:2009-09-18, Days after vaccination: 0
Gender:Female  Submitted:2009-09-22, Days after onset: 4
Location:Oregon  Entered:2009-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Dose
Route
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA256AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash and some itching appeared on trunk and left arm (admin arm) on 9/18/09 around 3 hours after injection. Treatment antihistamine.

VAERS ID:358015 (history)  Vaccinated:2009-09-16
Age:41.0  Onset:2009-09-18, Days after vaccination: 2
Gender:Female  Submitted:2009-09-22, Days after onset: 4
Location:Oregon  Entered:2009-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97845P10IMRA
Administered by: Other     Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:
Write-up: Swollen node left side of neck.

VAERS ID:358180 (history)  Vaccinated:2009-05-12
Age:41.0  Onset:2009-05-21, Days after vaccination: 9
Gender:Male  Submitted:2009-08-15, Days after onset: 86
Location:Unknown  Entered:2009-09-23, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: PREDNISONE
Current Illness:
Preexisting Conditions: 10/22/09: Discharge Summary and Medical Records received for Dates of Service 5/29/09 to 6/1/09. PMH: T-cell ALL, diagnosed 12/04, 1/05 had TBI/VB/16HLA-identical bone marrow transplant for ALL. Also hx. of auto and allo antibody. Febrile with URI in 3/09. NKDA. PMH: high cholesterol
Diagnostic Lab Data: 10/22/09: Discharge Summary and Medical Records received for Dates of Service 5/29/09 to 6/1/09. Labs and Diagnostics: Sodium 134 (L), BUN 22 (H), Direct Bilirubin 7.6 (H), Total Bilirubin 7.9 (H), WBC 28.3 (H), RBC 1.61 (L), Hgb 4.7 (L), Hct 14 (L), MCV 138 (H), MCH 46 (H), RDW 23.6 (H), Hypochrom-Moderate, Polycro-Moderate, Microcyte-Slight, Macrocyte-Moderate, Spherocyte-Moderate. Segs (Man) 80 (H), Lymph (Man) 12 (L), Seg. Abs. 17550 (H), Monocyte Abs 1728 (H). Varicella zoster IgG <0.91
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaemia haemolytic autoimmune, Asthenia, Blood bilirubin increased, Blood product transfusion, Blood sodium decreased, Blood urea increased, Dyspnoea exertional, Haematocrit decreased, Haemoglobin decreased, Headache, Jaundice, Lymphocyte count decreased, Mean cell haemoglobin, Mean cell volume abnormal, Neutrophil percentage increased, Red blood cell count decreased, Red cell distribution width increased, Transfusion, Varicella zoster serology negative, White blood cell count increased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Haemolytic disorders (narrow), Acute pancreatitis (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad)
Write-up: 41 yoM w/hx of allo-BMT for t-cell ALL 2005. PTA on 5/29/09, pt noted new DOE, HAs, and jaundice. Pt had normal CBC in late April and rec''d VARIVAX vaccine on 5/12/09. Pt was initially presented w/hgb 7.9.. at onc(5/21) w/warm autoimmune hemolytic anemia with no clear etiology started on prednisone 80mg daily, increased to 100mg qd but w/little improvement. On 5/29, hgb was 4.9. Based on timing of VARIVAX adm and onset of hemolytic anemia, this ADE is probably 2/2 VARIVAX between 1995-1998, there are 2 cases of aplastic anemia in pts<18 yrs. However. No hemolytic anemia was reported in any age groups. On adm. pt rec''d methylprednisolone 100mg IV daily (5/30-6/1) and two doses of IVIG 1g/kg/day (5/30-6/1), & 2 units PRBC on 5/30. On on 6/1, Hgb was 6.4. 10/22/09: Discharge Summary and Medical Records received for Dates of Service 5/29/09 to 6/1/09. Dx: Hemolytic anemia of unclear etiology. Assessment: Presented with new onset of weakness, dyspnea on exertion, headache and jaundice. Had a normal CBC on 4/22/09. Started on pulse steroids and 2 doses of IVIG. Given a total of 3 units packed red blood cells. Hemoglobin and T. Bilirubin levels improved with treatment. On day of discharge patient was feeling well. Follow up blood work ordered x2 week of discharge to determine if need for further transfusions. 1/20/09 Medical records received for DOS 5/12/09. Hospital AE form. Notes hemolytic anemia probably related to Varivax vaccine based on timing. HGB at d/c increased to 6.4 from 4.9 @ admission. /dsb 11/24/09 Medical records received for DOS 42/2-5/12.. Well visit notes w/routine labs. No immunity to Varicella noted. ICD9 Codes: 204.10

VAERS ID:358245 (history)  Vaccinated:2009-09-22
Age:41.0  Onset:2009-09-24, Days after vaccination: 2
Gender:Female  Submitted:2009-09-24, Days after onset: 0
Location:New York  Entered:2009-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexium; Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS96031 1P0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Soreness, redness 4.5x7cm, warmth at injection site.

VAERS ID:358312 (history)  Vaccinated:2009-09-23
Age:41.0  Onset:2009-09-23, Days after vaccination: 0
Gender:Male  Submitted:2009-09-24, Days after onset: 1
Location:New Hampshire  Entered:2009-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: COZAAR; ACTOS; GLUCOTROL; Meals; JANUMET; PREDNISONE; NAPROXYN; Food; Wrist brace; One Touch Ultra Test Strips; Daily vitamin; Fish Oil; ASACOL; ASPIRIN
Current Illness: None
Preexisting Conditions: Diabetes; Ulcerative colitis; Elevated liver enzymes; Hypertension; Hepatitis B
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA454CA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1162X0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site oedema, Injection site pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Lt arm cellulitis - severity 7/10 edema + pain from shoulder to elbow. Immunizations given 9/23 5:45 PM. Swelling noted 9 PM - increasing in severity until seen by PCP 9/24 9 AM. Treated with AUGMENTIN 8.75-12.5 x 7 days.

VAERS ID:358396 (history)  Vaccinated:2009-09-25
Age:41.0  Onset:2009-09-25, Days after vaccination: 0
Gender:Female  Submitted:2009-09-25, Days after onset: 0
Location:California  Entered:2009-09-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pseudophedrine
Current Illness: no
Preexisting Conditions: ASTHMA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97838P11IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Chestpain

VAERS ID:358644 (history)  Vaccinated:2008-08-27
Age:41.0  Onset:2008-12-15, Days after vaccination: 110
Gender:Female  Submitted:2009-09-29, Days after onset: 287
Location:Texas  Entered:2009-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB178AB0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2581AA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURERA09230IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0529X0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Alopecia universalis, Asthma, Back pain, Blood creatine phosphokinase increased, Ear pain, Hearing impaired, Hyperbilirubinaemia, Hypothyroidism, Liver function test abnormal, Palpitations, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Hypersensitivity (broad)
Write-up: Diagnosis :Hypothyroidism, Abnormal Liver function screening (Hyperbilirubinemia), heart palpitations, alopecia universalis, asthma, elevated creatine. Additional: back aches, earache (partial loss of hearing in left ear), Vertigo.

VAERS ID:358700 (history)  Vaccinated:2009-09-25
Age:41.0  Onset:2009-09-27, Days after vaccination: 2
Gender:Female  Submitted:2009-09-29, Days after onset: 2
Location:New York  Entered:2009-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none 10/5/09 Hospital records and DC summary received for dates 9/26/09 to 9/27/09. PMH: Dyslipidemia, allergy to PCN, syncopal episode after having the flu in the past.
Diagnostic Lab Data: serum K=3.3, troponin <0.04, <0.04, 0.06, HCG neg., Lyme IGG neg, WBC 16.1 at 0322 9/26 then 8.2 on 9/27 at 0430, Urine culture neg. 10/5/09 Hospital records and DC summary received for dates 9/26/09 to 9/27/09. Diagnostics/Labs: Echo-Norm
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED08249111A0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Atrial fibrillation, Blood potassium decreased, Blood thyroid stimulating hormone normal, Blood triglycerides increased, Borrelia burgdorferi serology negative, Chest X-ray normal, Computerised tomogram normal, Culture urine negative, Dizziness, Echocardiogram normal, Flushing, High density lipoprotein decreased, Lymphocyte count decreased, Lymphocyte percentage decreased, Nausea, Neutrophil percentage increased, Pregnancy test negative, Scan brain, Skin warm, Syncope, Troponin, Very low density lipoprotein increased, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: influenza vaccine administered approximately 8 pm on 9/25. At approx. 1 AM on 9/26 Ivette felt warm and dizzy she had frank syncope and also vomited. In the emergency room she was found to be in rapid atrial fibrillation (150/min.)treated with fluids and a cardiazen drip. She converted to sinus rhythm. 10/5/09 Hospital records and DC summary received for dates 9/26/09 to 9/27/09. DC Diagnosis: Syncopal episode, Atrial Fibrilation with rapid ventricular response. Presenting symptoms: Pt received flu vaccine. Several hrs later pt. felt flushed, dizzy, and had a syncopal episode lasting several minutes. Pt vomited x1, then felt nausea. In ER pt. found to be in A-fib. Pt tx in ICU. Pt improved and DC the following day. ICD9 codes: 427.31, 276.8, 780.2, 288.60, 272.4

VAERS ID:358844 (history)  Vaccinated:2009-09-21
Age:41.0  Onset:2009-09-22, Days after vaccination: 1
Gender:Female  Submitted:2009-09-23, Days after onset: 1
Location:California  Entered:2009-09-29, 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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3194AA2UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Eye discharge, Eyelid oedema, Pain, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: Wheezing, swollen eyelids with discharge, chills, body aches.

VAERS ID:358856 (history)  Vaccinated:2009-09-23
Age:41.0  Onset:2009-09-23, Days after vaccination: 0
Gender:Female  Submitted:2009-09-25, Days after onset: 2
Location:Texas  Entered:2009-09-29, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: A couple hours after taking flu shot she states her eyes suddenly turned red and matted up and started feeling a tightness in chest. Waited until 3:30 pm to go to clinic to see dr.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3702AAA IMRA
Administered by: Other     Purchased by: Public
Symptoms: Chest discomfort, Eye discharge, Ocular hyperaemia
SMQs:, Anaphylactic reaction (narrow), Glaucoma (broad)
Write-up: A couple hours after taking flu shot she states her eyes suddenly turned red and matted up and started feeling a tightness in chest. Waited until 3:30 pm to go to clinic to see dr.

VAERS ID:358950 (history)  Vaccinated:2009-09-28
Age:41.0  Onset:2009-09-29, Days after vaccination: 1
Gender:Female  Submitted:2009-09-30, Days after onset: 1
Location:D.C.  Entered:2009-09-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; Seafood allergy.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3172BA UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Fatigue, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Left clavicular (supra) lymphadenopathy, fatigue myalgias.

VAERS ID:359129 (history)  Vaccinated:2009-10-01
Age:41.0  Onset:2009-10-01, Days after vaccination: 0
Gender:Female  Submitted:2009-10-01, Days after onset: 0
Location:Virginia  Entered:2009-10-02, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INDERAL 120mg daily
Current Illness: None
Preexisting Conditions: Latex; Allergy to pollen, grasses, high fat dairy; migraines; Insulinemia
Diagnostic Lab Data: She has rec''d 3 prior latex free flu vaccine without probs in prior years.
CDC Split Type:
Vaccination
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Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3253DA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Eye swelling, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Pt dev sl. L periorbital swelling, dizziness and some tightness in throat, about 20 mins after she read the latex free preservative free Influenza (seasonal) vaccine. her symptoms were resolved after she took BENADRYL 25mg and later CETRIZINE 10mg. She was observed for one hour with meds without event. She declined BENADRYL 50mg. But will take 25mg 48 hrs.

VAERS ID:359302 (history)  Vaccinated:2009-09-24
Age:41.0  Onset:2009-09-24, Days after vaccination: 0
Gender:Female  Submitted:2009-09-25, Days after onset: 1
Location:California  Entered:2009-10-02, 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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED0724911A0UNLA
Administered by: Military     Purchased by: Military
Symptoms: Back pain, Musculoskeletal pain, Ocular hyperaemia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Glaucoma (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt c/o R lower back pain radiating on R buttock 10 min after pt received the pt received the influenza vaccine. Pt also c/o both eyes red when she got home. No pain, no itching.

VAERS ID:359357 (history)  Vaccinated:2009-10-01
Age:41.0  Onset:2009-10-02, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 3
Location:Georgia  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies
Preexisting Conditions: Asthma; Diet controlled diabetes; Thyroid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3199AA IMRA
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0472Y IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, warmth to left deltoid after receiving TDAP and PNEUMOVAX 10/1/09- Reaction did not occur until approx 24 hours later- ran fever 102 24 hours later took analgesics and resolved - area approximately 9" XS" left upper arm remains warm.

VAERS ID:359453 (history)  Vaccinated:2009-09-30
Age:41.0  Onset:2009-09-30, Days after vaccination: 0
Gender:Female  Submitted:2009-10-05, Days after onset: 5
Location:Idaho  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to several things Pt. did not specify
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3198AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives evening of 09/30/09 and 10/01/09 took BEANDRYL and only had problems occur in the evening.

VAERS ID:359522 (history)  Vaccinated:2009-08-27
Age:41.0  Onset:2009-08-29, Days after vaccination: 2
Gender:Female  Submitted:2009-09-25, Days after onset: 27
Location:New York  Entered:2009-10-06, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral birth control pills.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD58337000301 PO 
Administered by: Public     Purchased by: Private
Symptoms: Rash generalised, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Skin rash appeared 1 day after 1st dose and spread further and to more parts of body over the 8 days of treatment. Very itchy. Did not go away with prescription CORTICOSTEROID cream. Suddenly went away 1 day after last dose.

VAERS ID:359723 (history)  Vaccinated:2009-09-30
Age:41.0  Onset:2009-10-04, Days after vaccination: 4
Gender:Female  Submitted:2009-10-06, Days after onset: 2
Location:Minnesota  Entered:2009-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3246BA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash, Rash macular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Rash developed from top of shoulder to to top to elbow, raise, blotchy and itchy. Pt reported this AM it is the size of two 50 cents pieces now

VAERS ID:359784 (history)  Vaccinated:2009-09-30
Age:41.0  Onset:2009-09-30, Days after vaccination: 0
Gender:Female  Submitted:2009-10-05, Days after onset: 5
Location:Georgia  Entered:2009-10-07, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: BP 139/92 after 30 minutes 119/84 symptoms resolved
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA255BA0IMUN
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Dizziness and headache started 20 mins after administration of vaccine.

VAERS ID:359835 (history)  Vaccinated:2009-10-02
Age:41.0  Onset:2009-10-03, Days after vaccination: 1
Gender:Female  Submitted:2009-10-07, Days after onset: 4
Location:North Carolina  Entered:2009-10-07
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: denies
Preexisting Conditions: HTN, fibrillary glomerulonephropathy, chronic pain issues PMH: Chronic LBP, HTN, Fibrillary glomerulonephropathy Allergies: Ibuprofen, Toradol and Lyrica
Diagnostic Lab Data: still working this up. still in the hospital, ICU. Lab: CBC: wbc 17.0 high, Glucose 162 high, Lipase 2436, abnormal differential with left shift, neutrophils elevated at 14,000. Xrays: Abdominal US neg for gallstones, CT Abd/Pelvis noted acute pancreatitis involving whole pancreas. Xrays of abdomen revealed cardiomegaly.
CDC Split Type:
Vaccination
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98437P1A IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Blood glucose increased, Chills, Computerised tomogram abnormal, Full blood count, Intensive care, Lipase increased, Nausea, Neutrophil count increased, Pancreatitis, Ultrasound abdomen normal, White blood cell count increased, X-ray abnormal
SMQs:, Acute pancreatitis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Diagnosed with pancreatitis 10/6/09 here at Emergency Room. No obvious other cause of the pancreatitis. 10/13/2009 received hospital records for 10/6-10/10/2009. DC DX Acute Pancreatitis. Patient presented with c/o''s epigastric pain, chills, and nausea. Received vaccine 10/2/2009. Admitted to ICU for monitoring,

VAERS ID:359863 (history)  Vaccinated:2009-09-24
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-05
Location:Arkansas  Entered:2009-10-07, 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: TOPAMAX
Current Illness:
Preexisting Conditions: The patient had no known allergies and no pre-existing medical conditions. The patient had been taking TOPAMAX concomitantly at the time of vaccination.
Diagnostic Lab Data: Not reported
CDC Split Type: 200904109
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3205C UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Dizziness, Dyspnoea, Eye discharge, Feeling hot, Myalgia, Nausea, Ocular hyperaemia, Oral pruritus, Paraesthesia, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: Initial report was received from a consumer on 25 September 2009, who is also the patient. A 41-year-old female patient with no concurrent illness or past medical history who had been taking TOPAMAX concomitantly, had received an injection (route not reported) of FLUZONE SV 2009-2010, lot number U3205CA on 24 September 2009, and 4 hours later, she complained of difficulty breathing, itchy throat, mouth and tongue, lips burning, mucous discharge from both eyes, eyes reddened, muscle aches/ pain, dizziness, nausea and feeling feverish. The patient self medicated with ADVIL and 2-3 doses of BENADRYL until she went to bed. The next day, all symptoms were resolved except for a "feeling of tingling skin all over". The patient had not been evaluated by their health care provider and at the time of the report, they had not recovered. Documents held by sender: None.

VAERS ID:359887 (history)  Vaccinated:2009-09-29
Age:41.0  Onset:2009-09-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 8
Location:Illinois  Entered:2009-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED0794911A IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Itching face, arms and head; generalized hives

VAERS ID:359927 (history)  Vaccinated:2009-10-06
Age:41.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-10-07, Days after onset: 1
Location:Virginia  Entered:2009-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Tinea Corpis
Preexisting Conditions: Sarcoidosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3207AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1287X IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, pain at injection site. Patient advised to take ALEVE and use cold compresses for comfort, right arm.

VAERS ID:360285 (history)  Vaccinated:2009-10-06
Age:41.0  Onset:2009-10-07, Days after vaccination: 1
Gender:Female  Submitted:2009-10-09, Days after onset: 2
Location:Wisconsin  Entered:2009-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: None
Diagnostic Lab Data: Reaction from flu shot per physician
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU31930 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Breast pain, Immunisation reaction, Lymph node pain, Pain
SMQs:, Lipodystrophy (broad)
Write-up: severe pain under arm pit, lymph nodes extending into breast

VAERS ID:360413 (history)  Vaccinated:2009-09-30
Age:41.0  Onset:2009-09-30, Days after vaccination: 0
Gender:Female  Submitted:2009-09-30, Days after onset: 0
Location:California  Entered:2009-10-12, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 10/01/2008~Pneumo (no brand name)~1~40.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions: Asthmatic
Diagnostic Lab Data: Pulse $g 120 bpm
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3185AA0IMUN
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Dyspnoea, Heart rate increased, Palpitations, Sensation of heaviness
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)
Write-up: Pt complained of faintness, sob, heaviness and heart racing. Injected 0.3 epinephrine and called 911. Paramedics arrived and checked vitals. Pt was not transported and allowed to leave at 11:25.

VAERS ID:360426 (history)  Vaccinated:2009-10-01
Age:41.0  Onset:2009-10-02, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 3
Location:Indiana  Entered:2009-10-12, 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: METFORMIN HCI; VESICARE; VERAPAMIL HCI CR; LANOXIN; ALLEGRA; KARIVA; omeprazole; FLONASE; guaifenesin; HYDROCHLOROTHIAZIDE; ACYCLOVIR; multiple vitamins; fish oil
Current Illness: None
Preexisting Conditions: Mixed incontinence urge and stress; allergic rhinitis; palpitation; DM w/o complication Type II; compartment syndrome; plantar fasciitis; gestational diabetes mellitus; varicose vein; pain in joint, pelvic region and thigh; abdominal pain; obese; melasma; neuralgia
Diagnostic Lab Data: CBC, UA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3203AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Full blood count, Mass, Musculoskeletal stiffness, Rash generalised, Urine analysis
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: "Knots on back of my head." 10/2/2009. Rash all over body 10/3/09. Today unable to move neck.

VAERS ID:360603 (history)  Vaccinated:2008-11-20
Age:41.0  Onset:2008-11-21, Days after vaccination: 1
Gender:Male  Submitted:2009-10-07, Days after onset: 319
Location:Unknown  Entered:2009-10-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKDA
Diagnostic Lab Data: ANA; HIV; RPR; RF; Hepatitis panel
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS  IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Antinuclear antibody, Aspartate aminotransferase increased, Blister, Blood albumin decreased, Blood alkaline phosphatase, Blood calcium decreased, Blood glucose increased, Blood potassium decreased, HIV test, Haematocrit decreased, Haemoglobin decreased, Hepatitis viral test, Petechiae, Purpura, Red cell distribution width increased, Rheumatoid factor, Syphilis test
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad)
Write-up: Patient developed a purpuric rash and vesicles on his abdominal wall after receiving the Hepatitis B vaccine.

VAERS ID:360988 (history)  Vaccinated:2009-10-13
Age:41.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-10-14, Days after onset: 1
Location:Indiana  Entered:2009-10-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: S/P splenectomy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1124X0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3249AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 20 x 20cm edematous, painful area to R arm from shoulder to below deltoid limited ROM to arm

VAERS ID:361106 (history)  Vaccinated:2009-09-28
Age:41.0  Onset:2009-09-28, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 17
Location:North Carolina  Entered:2009-10-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: TB-Skin test 20mm Localized reaction 5 min p injection
Diagnostic Lab Data: He also advised against H1N1.
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3176PA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Adverse reaction, Facial palsy, Hypoaesthesia, Hypoaesthesia facial, Hypoaesthesia oral, Injection site erythema, Injection site swelling, Injection site vesicles, Local reaction, Musculoskeletal pain, Neck pain, Paraesthesia, Swelling face
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 9/28/2009 5 minutes after injection localized reaction with redness, swelling & blister on injection site. 9/29/2009 Tuesday morning woke up with Lt facial swelling numbness & tingling around L orbital area radiating down side of face to midline of chin. 9/30/09 woke up with more pronounced facial swelling & numbness shoulder & neck pain. 10-1-09 Thursday woke up & facial area & Lt side & tongue numb. Evaluated by Employee Health PAC sent to local MD. He prescribed Prednisone & documented adverse reaction Bell''s Palsy.

VAERS ID:361109 (history)  Vaccinated:2009-10-13
Age:41.0  Onset:2009-10-13, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 2
Location:New Jersey  Entered:2009-10-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3211AA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Cough, Eyelid oedema, Oculorespiratory syndrome, Oropharyngeal pain, Scleral hyperaemia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Periorbital and eyelid disorders (narrow), Scleral disorders (narrow), Hypersensitivity (narrow)
Write-up: Occulo-respiratory-eyes-sclera very infected sore throat, chills, cough - eyelids with edema- onset 3-4 hours s/p FLUZONE inj.

VAERS ID:361194 (history)  Vaccinated:2009-10-08
Age:41.0  Onset:2009-10-08, Days after vaccination: 0
Gender:Female  Submitted:2009-10-16, Days after onset: 8
Location:North Carolina  Entered:2009-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam; LEXAPRO; LORCET; Simvastatin; Montelukast sodium; Omeprazole; SYMBICORT; Unknown
Current Illness: Unknown
Preexisting Conditions: Allergy to Mosquito Bite; Allergy to Wasp; Bee Sting Allergy; The subject had not previously received influenza vaccinations. No adverse events were reported following receipt of prior immunizations.
Diagnostic Lab Data: Unk
CDC Split Type: A0811685A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJRA
Administered by: Public     Purchased by: Other
Symptoms: Influenza, Injection site erythema, Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: This case was reported by a consumer and described the occurrence of influenza in a 41-year-old female subject who was vaccinated with Flu vaccine (manufacturer unspecified). A physician or other health care professional has not verified this report. The subject''s medical history included mosquito allergy, allergy to wasp and bee sting allergy. Concurrent medications included XANAX, LEXAPRO, LORCET, SIMVASTATIN, SINGULAIR, OMEPRAZOLE, SYMBICORT and Unknown injection (unknown if it was a vaccine or a vitamin B-12 shot). On 8 October 2009 at 10:00 the subject received 1st dose of Flu vaccine (unknown, right arm). On 8 October 2009, the same day after vaccination with Flu vaccine, the subject experienced a red, hot welt at the injection site. On 12 October 2009 (at mid-day), four days after vaccination with Flu vaccine, the subject experienced influenza. This case was assessed as medically serious by GSK. At the time of reporting the outcome of the red, hot welt at the injection site was unknown and the symptoms of the influenza were unresolved. The consumer consulted a health care professional regarding the event(s). On 13 October 2009, the consumer reported that she was given an unknown manufacturer''s flu shot. The injection was given on 08 October 2009. The subject reports that a red, hot welt appeared at the injection site on the day of the injection. The subject also reports that she developed the flu. Her flu symptoms began on 12 October 2009. At time of report, symptoms of the flu were unresolved. The subject said that she was given an injection in the gluteal area. She does not know if this was a vaccine or a vitamin B-12 shot.

VAERS ID:361342 (history)  Vaccinated:2009-10-12
Age:41.0  Onset:2009-10-14, Days after vaccination: 2
Gender:Female  Submitted:2009-10-18, Days after onset: 4
Location:Florida  Entered:2009-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Diagnostic Lab Data: referred to PCP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS9721504 IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0823Y1UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: red and swollen around the injection site and extending in a large area on her upper arm. Warm to touch

VAERS ID:361575 (history)  Vaccinated:2009-09-25
Age:41.0  Onset:2009-09-25, Days after vaccination: 0
Gender:Female  Submitted:2009-10-19, Days after onset: 24
Location:Washington  Entered:2009-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: have not taken any tests or anything.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURAFLUA448BA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Axillary pain, Injected limb mobility decreased, Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: My left arm received the shot. It has been sore since I received it. Now the soreness is in the back of my underarm and at the top of my shoulder blade. I can lift my arm up not even half way since I took the shot. If I try to lift my arm up any further it hurts really bad.

VAERS ID:361644 (history)  Vaccinated:2009-10-05
Age:41.0  Onset:2009-10-05, Days after vaccination: 0
Gender:Female  Submitted:2009-10-20, Days after onset: 15
Location:New York  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR43253CA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Fatigue, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Immediately after receiving shot, c/o feeling "woozy" passed after 20 mins. That evening pt c/o feeling exhausted, dizzy, weak - continued next morning. Patient went to ED & received IV fluids.

VAERS ID:361848 (history)  Vaccinated:2009-10-19
Age:41.0  Onset:2009-10-20, Days after vaccination: 1
Gender:Male  Submitted:2009-10-20, Days after onset: 0
Location:Ohio  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: unknown has not gotten medical attention at this time.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500779P1IN 
Administered by: Public     Purchased by: Unknown
Symptoms: Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Awoke with numbness of upper lip states"like when you have dental work"

VAERS ID:361897 (history)  Vaccinated:2009-10-02
Age:41.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-20, Days after onset: 18
Location:New York  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: hx of mood disorder, HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA482AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Pruritus, Rash generalised, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt states skin rash on body , itching since yesterday after FLU vaccine. ash for 1 day, after flu vaccion. + macular rash scattered to entire body. no erythem, no swelling, + itchy. no cp, no sob, no n/v

VAERS ID:361923 (history)  Vaccinated:2009-10-02
Age:41.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-20, Days after onset: 18
Location:Michigan  Entered:2009-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED594541A UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injected limb mobility decreased
SMQs:
Write-up: Patient could not move arm soon after vaccination. Saw MD who told her to ice her shoulder and try to move arm. Patient will keep us updated on condition. Was advised to see MD again for further treatment.

VAERS ID:362876 (history)  Vaccinated:2009-10-14
Age:41.0  Onset:2009-10-14, Days after vaccination: 0
Gender:Female  Submitted:2009-10-14, Days after onset: 0
Location:Hawaii  Entered:2009-10-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 11/17/08~Influenza (Seasonal) (no brand name)~UN~40.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: No known allergies or chronic condition.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3204AA IMRA
Administered by: Other     Purchased by: Public
Symptoms: Hypoaesthesia, Injection site pain, Injection site swelling, Injection site warmth, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, warmth at Rt deltoid injection site 5 min after vaccine administration. Then c/o numbness, tingling in rt wrist area 45 min after mild pain @ injection site. Ice pack given.

VAERS ID:362091 (history)  Vaccinated:2009-10-19
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-21
Location:Colorado  Entered:2009-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: NIDDM
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500764P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: No adverse event
SMQs:
Write-up: None

VAERS ID:362380 (history)  Vaccinated:2009-09-24
Age:41.0  Onset:2009-09-24, Days after vaccination: 0
Gender:Female  Submitted:2009-10-15, Days after onset: 21
Location:California  Entered:2009-10-22, 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR3193AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injected limb mobility decreased, Musculoskeletal pain, Nerve injury, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Shot given in L arm/shoulder very sore 3 wks later possible nerve damage can''t lift arm, fingers & circulation poor.

VAERS ID:362385 (history)  Vaccinated:2009-10-18
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-22
Location:Michigan  Entered:2009-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED08549111A IMLA
Administered by: Other     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Pt stated arm swelled and became painful. The swelling was under the arm.

VAERS ID:362459 (history)  Vaccinated:2009-10-16
Age:41.0  Onset:2009-10-16, Days after vaccination: 0
Gender:Female  Submitted:2009-10-23, Days after onset: 7
Location:Pennsylvania  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Eye haemorrhage, Eye irritation, Eye pain, Ocular hyperaemia, Pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Eyes began stinging Fri evening 10/16/09. All weekend burning progressed Monday morning 10/18/09 left eye bloody in corner like blood vessel broke. Very sore to touch eyes felt bruised. Continued Tues, Wed. by Thursday redness a bit better but still sore. Now Friday (10/23) redness/soreness continues.

VAERS ID:362545 (history)  Vaccinated:2009-10-20
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-23
Location:West Virginia  Entered:2009-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPO10AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: EMPLOYEE CAME IN FOR THE H1N1 NASAL LIVE VACCINE ON 10/8/09, SHE CAME BACK ON 10/20 AND RECEIVED THE INJECTABLE H1N1. DID NOT UNDERSTAND THAT SHE WAS NOT TO GET THE SECOND VACCINE. NO ADVERSE REACTION REPORTED.

VAERS ID:362641 (history)  Vaccinated:2009-10-20
Age:41.0  Onset:2009-10-21, Days after vaccination: 1
Gender:Female  Submitted:2009-10-24, Days after onset: 3
Location:North Carolina  Entered:2009-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IJLA
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Cough, Diarrhoea, Feeling cold, Headache, Malaise, Pyrexia, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Started with unproductive coughing, was awake for about 2 hours that night from coughing, the same the following night but worse. Friday morning, I still went to work although I felt misserable. I also had diarrhea. By 9:15, I had to ask my superior to get me a substitute because I had to leave. I was chilly and I did not have any energy. I went home and slet all day. I woke up to a terrible headache and fever. All Friday night, I kept waking up because of headache and coughing. Today is Saturday and I still have fever, coughing and headache. Had I known that this is what I will get after a flu shot, I would never have gotten it in the first place.

VAERS ID:362665 (history)  Vaccinated:2009-10-24
Age:41.0  Onset:2009-10-24, Days after vaccination: 0
Gender:Female  Submitted:2009-10-25, Days after onset: 1
Location:New Jersey  Entered:2009-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: synthroid
Current Illness: none
Preexisting Conditions: congenital heart valve defect
Diagnostic Lab Data: ct scan - initially clear, all other labs normal withthe exception of thyroid which is pre-existing
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 4IJRA
Administered by: Public     Purchased by: Unknown
Symptoms: Cerebrovascular accident, Computerised tomogram normal, Hemiparesis, Hypoaesthesia, Laboratory test normal, Thyroid function test abnormal
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Write-up: stroke like symptoms, right sided weakness, numbness

VAERS ID:362704 (history)  Vaccinated:2009-10-09
Age:41.0  Onset:2009-10-10, Days after vaccination: 1
Gender:Male  Submitted:2009-10-25, Days after onset: 15
Location:Unknown  Entered:2009-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: Full blood test panel: negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS66521-0112-105IDLA
Administered by: Unknown     Purchased by: Private
Symptoms: Blood test normal, Fatigue, Injection site erythema, Injection site pain, Mass, Neck pain, Pain in extremity, Paraesthesia, Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain and redness injection site. Tired. 2 days later developped tingling/itchy and pain feet/hands, tingling lips and throat, severe neck pain, lumps inner thighs and wrists. Treatment: benadril, ibuprofen, zyrtec

VAERS ID:362872 (history)  Vaccinated:2009-10-06
Age:41.0  Onset:2009-10-07, Days after vaccination: 1
Gender:Male  Submitted:2009-10-13, Days after onset: 6
Location:Vermont  Entered:2009-10-26, 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: No
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA456AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: General body aches.

VAERS ID:362893 (history)  Vaccinated:2009-10-21
Age:41.0  Onset:2009-10-22, Days after vaccination: 1
Gender:Male  Submitted:2009-10-26, Days after onset: 4
Location:Washington  Entered:2009-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98441P10IMUN
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500764P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Lymphadenopathy
SMQs:
Write-up: Pt is experiencing swollen, hard glands under the armpits. Pt says his lymph nodes are going "nuts."

VAERS ID:362998 (history)  Vaccinated:2008-10-16
Age:41.0  Onset:2008-10-16, Days after vaccination: 0
Gender:Male  Submitted:2009-10-27, Days after onset: 376
Location:Illinois  Entered:2009-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Never really seen by doctor. Called and was told to stay home from work.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500563P3IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Impaired work ability, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Felt lightheaded and dizzy in the bathroom before passing out.

VAERS ID:363245 (history)  Vaccinated:2009-10-26
Age:41.0  Onset:2009-10-27, Days after vaccination: 1
Gender:Male  Submitted:2009-10-27, Days after onset: 0
Location:Michigan  Entered:2009-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Date of seasonal influenza immunization approximate; some time in September
Current Illness: Getting over a cold but mainly resolved; no fever at any time
Preexisting Conditions: HTN, hypercholesterolemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site pain, Injection site reaction, Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Twitching of injection site with mild dull pain. Upper arm could be visibly seen convulsing for several minutes. I''ve had many shots and NEVER had any similar side-effects. Recurred throughout day.

VAERS ID:363277 (history)  Vaccinated:2009-10-27
Age:41.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-10-27, Days after onset: 0
Location:Virginia  Entered:2009-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA285AA UNLA
Administered by: Other     Purchased by: Private
Symptoms: Blood pressure normal, Immediate post-injection reaction, Injection site erythema, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Immediate swelling and redness and warm are (injection site) became itchy - Pt blood pressure normal at 116/82, called pt''s immediately.

VAERS ID:363340 (history)  Vaccinated:2009-10-27
Age:41.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-10-28, Days after onset: 1
Location:Missouri  Entered:2009-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP010AA0UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Feeling abnormal, Hypoaesthesia, Paraesthesia, Pharyngeal oedema, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: H1N1 vaccine given in R dlt at 9 A. Was feeling "weird" at 9:30 A tingly, numb, throat swelling up, wheezing, etc-met ambulance went to hospital given BENADRYL and EPI-sent home-returned last night about 7 PM-same symptoms.

VAERS ID:363421 (history)  Vaccinated:2009-10-19
Age:41.0  Onset:2009-10-19, Days after vaccination: 0
Gender:Female  Submitted:2009-10-28, Days after onset: 9
Location:Tennessee  Entered:2009-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Headache, Injection site swelling, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: swelling of arm at injection site, fever (102 degrees), body aches, fatigue, headache. Took Motrin for 5 days. 8 days later, arm is still sore.

VAERS ID:363527 (history)  Vaccinated:2009-10-09
Age:41.0  Onset:2009-10-10, Days after vaccination: 1
Gender:Female  Submitted:2009-10-28, Days after onset: 18
Location:Virginia  Entered:2009-10-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC-ESTROVEN; ZYRTEC; YAZ
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97845P20IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site haematoma, Injection site pain, Muscle injury
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Noticed severe bruising on arm morning after injection. Appx. 4-5 days after noticed muscle deterioration at injection site. Appx. 1 week after began having pain that has progressively gotten worse.

VAERS ID:363744 (history)  Vaccinated:2009-10-22
Age:41.0  Onset:2009-10-26, Days after vaccination: 4
Gender:Male  Submitted:2009-10-29, Days after onset: 3
Location:Pennsylvania  Entered:2009-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Unknown PMH: none/denies Allergies: NKDA
Diagnostic Lab Data: LABS & DIAGS: GLUCOSE 131 (H) ESR 29 (H), BUN 6 (L), CREAT 0.8 (L), CXR NEG, BRAIN CT WNL, EKG WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3209AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood creatinine decreased, Blood glucose increased, Blood urea decreased, Chest X-ray normal, Computerised tomogram normal, Electrocardiogram normal, Eye disorder, Eyelid ptosis, Facial palsy, Headache, Hypertension, Hypoaesthesia facial, Red blood cell sedimentation rate increased, Tachycardia, Tongue disorder
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypertension (narrow), Corneal disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)
Write-up: Right side of his face felt like it was drooping/paralyzed; hard to blink/close his eyes and really bad headaches behind the right ear. 11/30/09 Medical records and discharge summary received for DOS 10/26. Final DX: Bell''s Palsy C/O R side facial and tongue numbness x3days.Facial droop. Eye won''t close. Ptosis. Began 1 day s/p vaccine. Tachycardic, hypertensive. D/C to home stable.

VAERS ID:363790 (history)  Vaccinated:2009-10-07
Age:41.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Female  Submitted:2009-10-29, Days after onset: 22
Location:Wisconsin  Entered:2009-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJRA
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness, Eye swelling, Fatigue, Migraine, Ocular hyperaemia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: migraine, dizziness, blurry vision, exhaustion, red swollen eyes

VAERS ID:364023 (history)  Vaccinated:2009-09-14
Age:41.0  Onset:2009-09-15, Days after vaccination: 1
Gender:Male  Submitted:2009-10-30, Days after onset: 45
Location:Texas  Entered:2009-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX090030PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU3202AA  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: SWELLING OF UPPER ARM AROUND INJECTION SITE. PAIN RADIATING TO SHOULDER FROM INJECTION SITE.

VAERS ID:364221 (history)  Vaccinated:0000-00-00
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-27
Location:California  Entered:2009-10-30, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Arm pain for 3 days.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.04644 IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Pain
SMQs:
Write-up: Severe pain for 3 days on arm.

VAERS ID:364198 (history)  Vaccinated:2009-10-28
Age:41.0  Onset:2009-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-11-01, Days after onset: 4
Location:Louisiana  Entered:2009-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Keflex, seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP001AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Headache, Nasal congestion, Sinus congestion, Sneezing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: sneezing, headache, dizziness, nasal and sinus congestion

VAERS ID:364322 (history)  Vaccinated:2009-09-26
Age:41.0  Onset:2009-09-28, Days after vaccination: 2
Gender:Female  Submitted:2009-09-30, Days after onset: 2
Location:Missouri  Entered:2009-11-02, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~DTP (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97848P1C0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Vaccine administered 9/26/09. Patient returned to pharmacy with hives over most of her body.

VAERS ID:364458 (history)  Vaccinated:2009-10-22
Age:41.0  Onset:2009-10-23, Days after vaccination: 1
Gender:Male  Submitted:2009-11-02, Days after onset: 10
Location:New York  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU3176CA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)
Write-up: heart palpatations for 8 days

VAERS ID:364499 (history)  Vaccinated:2009-10-28
Age:41.0  Onset:2009-10-30, Days after vaccination: 2
Gender:Male  Submitted:2009-11-02, Days after onset: 3
Location:Pennsylvania  Entered:2009-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO, NONE REPORTED.
Preexisting Conditions: NONE KNOWN OR REPORTED.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500756P1IN 
Administered by: Public     Purchased by: Public
Symptoms: Heart rate increased, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow)
Write-up: BROKE OUT IN HIVES ON HAIRLINE, EARS, FACE & ARMS. COMPLAINED OF ITCHING. NO SOB. FELT HIS HEART WAS GOING FAST. TREATED WITH ALLEGRA AND BENEDRYL WITH RELIEF. NO KNOWN ALLERGIES TO VACCINE COMPONENTS.

VAERS ID:364619 (history)  Vaccinated:2009-09-21
Age:41.0  Onset:2009-10-01, Days after vaccination: 10
Gender:Female  Submitted:2009-10-29, Days after onset: 28
Location:Tennessee  Entered:2009-11-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mango Allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB711AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0620Y1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0858Y0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: 10 days after shot with ~30 blisters. Fever of 101-102 F the day before breakout. No health, did not go to the doctor, went away in about 3-4 days. C/O itching.

VAERS ID:364691 (history)  Vaccinated:2008-09-04
Age:41.0  Onset:2008-09-06, Days after vaccination: 2
Gender:Female  Submitted:2009-11-03, Days after onset: 423
Location:Texas  Entered:2009-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE STATED BY PATIENT
Preexisting Conditions: LUPUS
Diagnostic Lab Data: NONE
CDC Split Type: TX090057PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
DPP: DIPHTHERIA TOXOID + PERTUSSIS + IPV (NO BRAND NAME)UNKNOWN MANUFACTURERC2814AB0UNLA
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER0723F1UNLA
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER0667X1UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0171X0UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Systemic lupus erythematosus
SMQs:, Systemic lupus erythematosus (narrow)
Write-up: CLIENT GIVEN VARICELLA VACCINE 9/4/08. DID NOT DISCLOSE TO NURSE DURING SCREENING QUESTION ON HEALTH HISTORY OF LUPUS. CLIENT CALLED TO REPORT HAVING CHICKEN POX OUTBREAK 9/6/08.

VAERS ID:364891 (history)  Vaccinated:2009-10-29
Age:41.0  Onset:2009-10-30, Days after vaccination: 1
Gender:Male  Submitted:2009-11-04, Days after onset: 5
Location:Pennsylvania  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3227AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Patient complained of diffuse itching, without rash and described it as an ''internal'' itch which lasted several hours. Patient took Benadryl with positive results.

VAERS ID:364923 (history)  Vaccinated:2009-10-08
Age:41.0  Onset:2009-10-08, Days after vaccination: 0
Gender:Female  Submitted:2009-10-28, Days after onset: 20
Location:New York  Entered:2009-11-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98433P10IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0823Y0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Throat tightness, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad)
Write-up: Had flu shot, 30 seconds after pneumonia shot could feel throat closing, things went hazy. EMTs called, Epi given, transported to hospital. At hospital from 2:00pm to 12:00 midnight.

VAERS ID:364929 (history)  Vaccinated:2009-10-19
Age:41.0  Onset:2009-10-28, Days after vaccination: 9
Gender:Female  Submitted:2009-10-29, Days after onset: 1
Location:Missouri  Entered:2009-11-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None at present
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500756P0IN 
Administered by: Public     Purchased by: Other
Symptoms: Corneal reflex decreased, Facial palsy, Hypoaesthesia facial, Mastication disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (narrow)
Write-up: 10/28/09 Rt side face felt numb-some trouble chewing. 10/29/09 Rt side face not working-rt eye slow to blink-rt side mouth droops when smiles-probable Bell''s palsy.

VAERS ID:364967 (history)  Vaccinated:2009-10-08
Age:41.0  Onset:2009-10-11, Days after vaccination: 3
Gender:Female  Submitted:2009-11-01, Days after onset: 21
Location:Oregon  Entered:2009-11-04, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500759P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Cough, Decreased appetite, Exposure to communicable disease, Headache, Pyrexia, Rhinorrhoea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Vaccinated with live attenuated intranasal H1N1 vaccine on 10/08/09. On 10/11/09 I developed runny nose, headache, and scratchy throat. Cough developed over next few days. On 10/16/09 I had subjective fever and anorexia. A close contact became ill on 10/19/09 (exposed 10/15-17/09). Cough persisted until 10/24/09. My concern is that I am a healthcare professional who transmitted infection after the vaccination.

VAERS ID:365144 (history)  Vaccinated:2009-10-20
Age:41.0  Onset:2009-10-22, Days after vaccination: 2
Gender:Female  Submitted:2009-11-04, Days after onset: 13
Location:Tennessee  Entered:2009-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I Don''t know the lot number because it was given by Health Department
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: CBC, THYROID, PROLACTIN, ESTROGEN, PROGESTERONE
CDC Split Type:
Vaccination
Manufacturer
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  IJ 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood oestrogen, Blood prolactin, Breast pain, Breast swelling, Chest X-ray, Full blood count, Inflammation, Lymphadenopathy, Nuclear magnetic resonance imaging abnormal, Paraesthesia, Progesterone, Thyroid function test, Ultrasound breast
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Lipodystrophy (broad)
Write-up: I had the H1N1 vaccination. I started getting a tingling sensation in my chest area and my breast. My breast started swelling 2X as large, with excrutiating pain. Since then I have been to my Gynecologist. We have done all kinds of labs (CBC, Prolactin, Thyroid, Estrogen, etc.), these have all came back normal. We have had a breast ultrasound. Then we had a MRI of the breast. Where they found all the nodes were dilated. The breasts specialists was contacted where she thought also that this could have been a reaction to the shot and everything was inflamed. A chest x-ray was done last night.

VAERS ID:365281 (history)  Vaccinated:2009-10-27
Age:41.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Male  Submitted:2009-10-28, Days after onset: 1
Location:California  Entered:2009-11-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURU008AA IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Flushing, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: 15 minutes after shot, started to feel dizzy, nausea and flush.

VAERS ID:365422 (history)  Vaccinated:2009-11-03
Age:41.0  Onset:2009-11-04, Days after vaccination: 1
Gender:Female  Submitted:2009-11-05, Days after onset: 1
Location:Oklahoma  Entered:2009-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1142 Y0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Body temperature increased, Injection site pain, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 101 temp, redness, rash and pain at injection site.

VAERS ID:365569 (history)  Vaccinated:2009-10-16
Age:41.0  Onset:2009-10-18, Days after vaccination: 2
Gender:Female  Submitted:2009-10-26, Days after onset: 8
Location:Ohio  Entered:2009-11-06, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3200AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash papular
SMQs:
Write-up: Patient had Flu vaccine. Broke out in rash 2 days after vaccine. Observed to have fine pinpoint papular rash to chest, back, upper thighs.

VAERS ID:365610 (history)  Vaccinated:2009-10-27
Age:41.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Female  Submitted:2009-11-02, Days after onset: 6
Location:North Carolina  Entered:2009-11-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CoQ; omega 3, vit B; glucosamine; lecithin
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA UNLA
Administered by: Private     Purchased by: Other
Symptoms: Chest discomfort, Chills, Headache, Hyperhidrosis, Pain, Pyrexia, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever, chills, headache, sweating, pressure in chest, body aches, skin burning.

VAERS ID:365698 (history)  Vaccinated:2009-11-02
Age:41.0  Onset:2009-11-02, Days after vaccination: 0
Gender:Male  Submitted:2009-11-06, Days after onset: 4
Location:New Mexico  Entered:2009-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: CXR, EKG
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP012AA0UNRA
Administered by: Private     Purchased by: Other
Symptoms: Chest X-ray, Chest discomfort, Cough, Electrocardiogram
SMQs:, Anaphylactic reaction (broad)
Write-up: was given the H1N1 vaccine, approx 20 min after given, my left side lung felt heavy and a cough. Was taken to our emergency room and was treated. Symptoms were gone w/in about an hour.

VAERS ID:365700 (history)  Vaccinated:2009-11-05
Age:41.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-06, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt currently not on meds
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUP007AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pruritus generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt developed hives bilateral arms/chest/abd and itching over whole body 4 hours after recurring Influenza A (H1N1). Pt present to office 11/06/09 hives and itching still present.

VAERS ID:365825 (history)  Vaccinated:2009-11-03
Age:41.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2009-11-07, Days after onset: 4
Location:Texas  Entered:2009-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid, topamax, cymbalta
Current Illness: No
Preexisting Conditions: depression, anxiety
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Breath sounds abnormal, Dyspnoea, Oropharyngeal pain, Productive cough, Pyrexia, Respiratory tract infection, Sinusitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (narrow)
Write-up: Sore throat that progressed to a respiratory infection, coughing up stuff, difficulty breathing, fever after day 3, sinus infection after day 3. Rattling of lungs when breathing. Doctor prescribed antibiotic. Have had to breathe in steam to help breathing but may yet have to visit emergency room.

VAERS ID:365868 (history)  Vaccinated:2009-11-07
Age:41.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Female  Submitted:2009-11-08, Days after onset: 1
Location:Washington  Entered:2009-11-08
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: thyroid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500741P2IN 
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Feeling abnormal, Feeling hot, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Sitting, felt a big rush of heat come across, dizziness and feeling of wanting to vomit. One hour after these symptoms, terrible headache onset.

VAERS ID:365957 (history)  Vaccinated:2009-11-07
Age:41.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Female  Submitted:2009-11-09, Days after onset: 2
Location:Florida  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: A fib controlled by medication Sleep Apnea
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Atrial fibrillation, Condition aggravated, Dizziness, Fatigue, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Fatigue, nausea, dizziness, heart palpatations, afib. Went to bed: took baby aspirin and heart medicine.

VAERS ID:366137 (history)  Vaccinated:2009-09-28
Age:41.0  Onset:2009-10-05, Days after vaccination: 7
Gender:Male  Submitted:2009-10-15, Days after onset: 10
Location:Washington  Entered:2009-11-09, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. 11/9/09: Hospital records received for dates of service 10/8/09 to 10/10/09. PMH: None.
Diagnostic Lab Data: Elevated CK. 11/9/09: Hospital records received for dates of service 10/8/09 to 10/10/09. Labs and diagnostics: CRP 1.4 (H), CK-MB 9.8 (H), ESR-Neg., CK 1116 (H), CMP WNL, CBC WNL. Troponin-neg. Aspartate aminotransferase 57 (H), Chloride 110 (H), Platelets 145 (L), Absolute neutrophil ct. 1.5 (L), Absolute lymph. ct. 0.80 (L). CSF: WBC 4 (H), RBC 23 (H). Neutrophil % 74 (H), Monocyte % 13 (H). CSF Culture-no growth. MRI C-Spine WNL
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA474BA UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Acute polyneuropathy, Aspartate aminotransferase increased, Blood chloride increased, Blood creatine phosphokinase MB, Blood creatine phosphokinase increased, C-reactive protein increased, CSF culture negative, CSF white blood cell count increased, Full blood count normal, Lethargy, Lymphocyte count decreased, Metabolic function test, Monocyte count increased, Muscular weakness, Myalgia, Myositis, Neutrophil count decreased, Neutrophil count increased, Nuclear magnetic resonance imaging normal, Paraesthesia, Platelet count decreased, Pyrexia, Red blood cell sedimentation rate normal, Red blood cells CSF positive, Reflex test abnormal, Rhabdomyolysis, Troponin
SMQs:, Rhabdomyolysis/myopathy (narrow), Liver related investigations, signs and symptoms (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad)
Write-up: See attached hospital records myositis; received flu shot (seasonal) 10 days prior to symptoms. 11/9/09: Hospital records received for dates of service 10/8/09 to 10/10/09. Dx:Upper extremity weakness, improving, most likely secondary to myositis. Mild rhabdolysis secondary to viral myositis. Assessment: Developed fever, myalgia, lethargy, persistent muscle pain in both upper and lower extremities with persistent weakness of the upper extremities. UE strength 2/5, decreased DTR''s in UE''s. Forearm soreness on grip exercises. Slight paresthesias of the tips of the fingers. Improved UE weakness on DC.

VAERS ID:366168 (history)  Vaccinated:2009-11-05
Age:41.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-09, Days after onset: 4
Location:Michigan  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; allergic to Penicillin and Sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Tingling, then tightness in throat. Lungs clear. Evaluated by EMS on site then sent to ED.

VAERS ID:366217 (history)  Vaccinated:2009-11-06
Age:41.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Male  Submitted:2009-11-09, Days after onset: 3
Location:Florida  Entered:2009-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP009AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dry mouth, Fatigue, Hyperhidrosis, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Fatigue, dry mouth, possible mild tongue swelling, sweating

VAERS ID:366400 (history)  Vaccinated:2009-11-07
Age:41.0  Onset:2009-11-08, Days after vaccination: 1
Gender:Male  Submitted:2009-11-10, Days after onset: 2
Location:Idaho  Entered:2009-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMBIEN; CRESTOR
Current Illness: None
Preexisting Conditions: Sulfa sensitivity
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP010AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Asthenia, Flushing, Hypophagia, Injection site swelling, Myalgia, Nausea, Rash, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Nausea day of injection. Face flushing, mid trunk with rash, raised injection site. Episodes of nausea day after. Severe nausea and emesis, muscle aches and weakness 2 days after. Unable to tolerate intake until 21:00 that noc.

VAERS ID:366669 (history)  Vaccinated:2009-09-25
Age:41.0  Onset:2009-09-28, Days after vaccination: 3
Gender:Unknown  Submitted:2009-11-04, Days after onset: 37
Location:Kansas  Entered:2009-11-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3186AA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:366685 (history)  Vaccinated:2009-10-12
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-11-03
Location:Kansas  Entered:2009-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: After vaccine adm pt remembered she had scarred lung tissue from pertussis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500763P IN 
Administered by: Public     Purchased by: Public
Symptoms: Cough, Oropharyngeal pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Patient complained of cough, runny nose, fever, sore throat.

VAERS ID:366720 (history)  Vaccinated:2009-11-10
Age:41.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-11, Days after onset: 1
Location:Florida  Entered:2009-11-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP008AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Balance disorder, Diarrhoea, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: Headache, dizziness, lost balance, diarrhea

VAERS ID:366612 (history)  Vaccinated:2009-11-09
Age:41.0  Onset:2009-11-11, Days after vaccination: 2
Gender:Female  Submitted:2009-11-11, Days after onset: 0
Location:Indiana  Entered:2009-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP007AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Skin exfoliation, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Itching, hives, peeling facial skin.

VAERS ID:366618 (history)  Vaccinated:2009-10-23
Age:41.0  Onset:2009-10-23, Days after vaccination: 0
Gender:Male  Submitted:2009-11-11, Days after onset: 19
Location:Virginia  Entered:2009-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid, Depakote, Propecia, Maxalt
Current Illness: No
Preexisting Conditions: Over-active nervous system, acid reflux, some hearing loss, migraines
Diagnostic Lab Data: Hearing test.
CDC Split Type:
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acoustic stimulation tests, Hypoacusis, Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: Severe tinnitus, decreased hearing. Symptoms still on-going.

VAERS ID:366641 (history)  Vaccinated:2009-10-11
Age:41.0  Onset:2009-10-11, Days after vaccination: 0
Gender:Male  Submitted:2009-11-11, Days after onset: 31
Location:Michigan  Entered:2009-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Breathing problem~Influenza (Seasonal) (no brand name)~UN~40.67~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension Pollen, Ragweed, cat, dustmite allergy
Diagnostic Lab Data: Pulmonary administered breathing nebulizer, given Prednisone, prescription for Epi pen.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Public     Purchased by: Private
Symptoms: Dyspnoea, Paraesthesia oral, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Shortness of breath, wheezing, congestion, tingling lips and tongue

VAERS ID:366895 (history)  Vaccinated:2009-11-09
Age:41.0  Onset:2009-11-09, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 3
Location:New York  Entered:2009-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Arrythmia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEUR4P019AA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Feeling abnormal, Feeling cold, Hypoaesthesia, Injection site reaction, Muscle twitching, Palpitations, Paraesthesia, Speech disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Numbness, tingling, cold on left side of body and face ( inj. site) twitching, sob, racing heart beat, dizziness, disconnection with self felt, problems with speech. Started 15 min. after inj. still have these symptoms 3 days later have some inprovement. Went to ER given antihistamines only.

VAERS ID:367149 (history)  Vaccinated:2009-11-03
Age:41.0  Onset:2009-11-03, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 10
Location:California  Entered:2009-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUPO19AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Local swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Itching, swelling to neck, wheals starting within 5 minutes. Benadryl IM given.

VAERS ID:367374 (history)  Vaccinated:2009-11-13
Age:41.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Male  Submitted:2009-11-14, Days after onset: 1
Location:Florida  Entered:2009-11-14
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: lactose intolerance
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Dry throat, Dysphonia, Hyperhidrosis, Oropharyngeal pain, Pain, Throat tightness, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: HOARSENESS HIVES WEAKNESS AND SHAKINESS (SEVERE ON LEGS) ''FELT LIKE THROAT WERE DRY AND CLOSED WITH SUDDEN HOARSENESS BUT NO SHORT OF BREATH'' ''FELT LIKE FALLING DOWN WITH SHAKINEE'' *RECEIVED BENADRYL 50MG PO AT 10PM AFTER CONTACTED NURSING PRACTITIONER *REST WITH PLENTY OF FLUID PER RECOMMANDATION *MONITOR FOR FURTHER SYMPTOMS AND DIRECTED TO GO TO ER IF SX NOT BETTER, BUT SX GETS BETTER AM NEXT DAY ''STILL FEELS WEAK AND HAS MILD FLU SX SUCH AS ACHES, SORE THROAT, MILD SWEAT BUT NO FEVER

VAERS ID:367419 (history)  Vaccinated:2009-11-13
Age:41.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-15, Days after onset: 2
Location:Texas  Entered:2009-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Cold sweat, Dizziness, Heart rate increased, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Paleness, Weakness, Dizziness, a fast heart beat, cold sweat, almost faint, last 10 minutes. Next day 11/14 evening and 11/15 2:40 PM same symptoms happened again.

VAERS ID:367487 (history)  Vaccinated:2009-11-13
Age:41.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 0
Location:Tennessee  Entered:2009-11-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP025AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Dysgeusia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Within 2-5 mins after shot, pt c/o tasting medicine-like taste in mouth, tingling sensation that spread from R elbow up R shoulder across head and left neck to left shoulder and lasted less than 1 min. R hand to elbow soreness.

VAERS ID:367493 (history)  Vaccinated:2009-11-10
Age:41.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 6
Location:Ohio  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: "Water Pill", "BP pill"; and Estrace
Current Illness: None
Preexisting Conditions: Treated Hypertension
Diagnostic Lab Data: Referred to PCP
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Episodic Heart Racing with mild shortness of breath.

VAERS ID:367605 (history)  Vaccinated:2009-11-04
Age:41.0  Onset:2009-11-04, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 12
Location:Georgia  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID
Current Illness: DENIES CURRENT ACUTE ILLNESS.
Preexisting Conditions: HYPOTHYROIDISM
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: "Throat felt tight, like it was closing". Benadryl 25 mg by mouth repeated X 1 30 minutes later.

VAERS ID:367774 (history)  Vaccinated:2009-11-10
Age:41.0  Onset:2009-11-11, Days after vaccination: 1
Gender:Female  Submitted:2009-11-16, Days after onset: 5
Location:Pennsylvania  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Allergies Penicillin
Diagnostic Lab Data: BP 172/110 initially in the ER, Head Cat Scan Negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Brain scan normal, Feeling hot, Headache, Heart rate increased, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: On 11/11/09 at approx. 7:30, I experienced pain in the back of my head, rated a 10 on a scales of 1-10, it pulsating, I became hot, rapid heart beat, and nausea, I vomited within ten minutes, and the pain lasted until 4:00 am, and I continued vomiting, twice an hour until that time also. The pain was immediate, one minute I was fine, the next I was not. The very same thing happened two days later, Nov. 13, at 8:30 AM. I have not had Migraines before, This second episode I went to the Emergency room, Cat scan was negative. They gave me IV pain meds and something for the nausea. I spent 6 hours in the ER.

VAERS ID:367909 (history)  Vaccinated:2009-11-13
Age:41.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-16, Days after onset: 3
Location:New Hampshire  Entered:2009-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL ALLERGY; SYMBICORT; VENTOLIN; NAPROSYN; PAXIL; CONSTULOSE; CLARINEX; ATIVAN
Current Illness: cough, pneumonia resolving
Preexisting Conditions: COPD; asthma, anxiety, migraines
Diagnostic Lab Data: rash - pt report only no s & s documented.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3227AA0IJLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: dizziness 11/13/09 2 hours after injection 1 hr resolved. Rash-widespread 11/14/09 - itchiness resolved with BENADRYL on 11/15/09.

VAERS ID:368021 (history)  Vaccinated:2009-11-07
Age:41.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 6
Location:Ohio  Entered:2009-11-17, 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: TIA 15 years ago; Migraine headaches.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500797P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Dysgeusia, Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Within 5 minutes, first symptom was R hand numbness and tingling, then traveled up arm to 4" above wrist. No change in hand color or temperature. No difficulty with movement. 5 minutes later right side of mouth with numbness and tingling. No trouble speaking. No difficulty breathing. No facial asymmetry. Mouth only tasted about 5-10 minutes. Hand started feeling better within 30 minutes, completely gone in an hour.

VAERS ID:368040 (history)  Vaccinated:2009-11-06
Age:41.0  Onset:2009-11-09, Days after vaccination: 3
Gender:Male  Submitted:2009-11-10, Days after onset: 1
Location:Indiana  Entered:2009-11-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seasonal allergies and Penicillin.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500758P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash erythematous, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Started with itching of feet and ankles. 7:30 when undressed, red, pink, splotches. Medrol Pack ; Pepcid AC, Allegra.

VAERS ID:368091 (history)  Vaccinated:2009-10-16
Age:41.0  Onset:2009-10-16, Days after vaccination: 0
Gender:Female  Submitted:2009-10-22, Days after onset: 6
Location:California  Entered:2009-11-17, 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: N/A
Preexisting Conditions: Asthma; COPD
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500760P0IN 
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Eye pruritus, Nasal congestion, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Stuffy nose, scratchy throat - hives, abdominal cramps - itchy eyes.

VAERS ID:368143 (history)  Vaccinated:2009-11-17
Age:41.0  Onset:2009-11-17, Days after vaccination: 0
Gender:Female  Submitted:2009-11-17, Days after onset: 0
Location:South Carolina  Entered:2009-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYMBICORT 160/4.5; ALVESCO 160; XOLAIR
Current Illness: None
Preexisting Conditions: Allergic rhinitis; moderately severe asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101278010SCRA
Administered by: Private     Purchased by: Public
Symptoms: Rash maculo-papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt received H1N1 shot at 08:30, Nov 17, 2009. At 10:00, developed fine maculopapular rash on both arms; slightly pruritic. No throat fullness, wheezing, SOB.

VAERS ID:368321 (history)  Vaccinated:2009-10-05
Age:41.0  Onset:2009-10-05, Days after vaccination: 0
Gender:Male  Submitted:2009-11-18, Days after onset: 44
Location:Michigan  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit C 500mg daily, B complex (B-100), calcium 500mg , chromium picolinate 200mcg daily, Vitamin D2 400 IU daily, Hydrochlorothiazide 12.5mg daily for fliud retension, Melatonin 2mg q hs
Current Illness: Felt warm like may have had fever for 5 days prior but no fever on day of shot.
Preexisting Conditions:
Diagnostic Lab Data: L supraspinatous tendonosis by exam. No lab tests.
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3213AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Axillary pain, Injection site erythema, Injection site pain, Injection site swelling, Musculoskeletal pain, Rotator cuff syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (narrow)
Write-up: Aching in L shoulderx 3 weeks. Swelling which was red and tender in axilla on L where seasonal influenza injection was given in deltoid x 1 week.

VAERS ID:368511 (history)  Vaccinated:2009-11-14
Age:41.0  Onset:2009-11-14, Days after vaccination: 0
Gender:Male  Submitted:2009-11-18, Days after onset: 4
Location:New York  Entered:2009-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Constant mild dizziness
Preexisting Conditions: Sinusitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED0064996HA SCUN
Administered by: Public     Purchased by: Other
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Dizziness. Dizziness started after the shot. At the beginning it was less. Since November 17 it worse. See attached.

VAERS ID:368870 (history)  Vaccinated:2009-11-17
Age:41.0  Onset:2009-11-19, Days after vaccination: 2
Gender:Female  Submitted:2009-11-20, Days after onset: 1
Location:Pennsylvania  Entered:2009-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz Zoloft
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: I woke up with shingles in a line extending from my left breast to my left underarm. I received the vaccination in my left arm. I am taking anti-viral medication.

VAERS ID:368956 (history)  Vaccinated:2009-11-16
Age:41.0  Onset:2009-11-16, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 3
Location:Iowa  Entered:2009-11-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Many
Current Illness: No
Preexisting Conditions: Pregnant; Chronic Bronchitis; Immune comprised PMH: Asthma, HTN, Hepatitis C Allergies: NKDA
Diagnostic Lab Data: None Labs: sputum for culture, patient declined CXR
CDC Split Type: IA090026
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (CSL)CSL LIMITED00849611A0UNRA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Cough, Drug exposure during pregnancy, Dyspnoea, Fatigue, Respiratory tract congestion, Sputum culture
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: While waiting for bus one hour & 45 minutes after shot- chills, fatigue- went home took Tylenol, slept 2 hours- felt better, that evening (Mon) congestion, cough. 11/19/09 shortness of breath, cough. Told to call doctor clinic. 12/8-12/9/2009 OB records ov''s 11/2009, patient with c/o''s productive cough, SOB post vaccine, started on Tamiflu with no improvement, seen 11/24/2009 and started on ABX.

VAERS ID:368969 (history)  Vaccinated:2009-11-06
Age:41.0  Onset:2009-11-08, Days after vaccination: 2
Gender:Female  Submitted:2009-11-11, Days after onset: 3
Location:New York  Entered:2009-11-20, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Environmental Allergies; with 2008 seasonal Fluvax IM- ; Itchy tongue resolved with Benadryl.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500756P0IN 
Administered by: Private     Purchased by: Public
Symptoms: Aphonia, Impaired work ability, Laryngitis, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Laryngitis - lost voice. Tight feeling. Sore throat (burning). Missed 2 days of work (RN). No fever, no shortness of breath, no wheezing, no cough.

VAERS ID:369065 (history)  Vaccinated:2009-09-16
Age:41.0  Onset:2009-09-16, Days after vaccination: 0
Gender:Female  Submitted:2009-09-16, Days after onset: 0
Location:Georgia  Entered:2009-11-20, Days after submission: 65
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)SANOFI PASTEURU3192AA UNRA
Administered by: Public     Purchased by: Private
Symptoms: Anxiety, Lip swelling, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Client reported to pharmacy with complaints of reaction to flu shot. Pharmacist states client had red skin rash upper chest and swollen lips and appeared anxious. Benadryl issued per pharmacy and instructed client to have husband drive her to the emergency room.

VAERS ID:369319 (history)  Vaccinated:2009-11-13
Age:41.0  Onset:2009-11-15, Days after vaccination: 2
Gender:Female  Submitted:2009-11-23, Days after onset: 8
Location:Tennessee  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: ASA allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP003AA0IJLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site haematoma, Injection site pain, Injection site warmth, Sleep disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Injection site became painful, bruised and warm to touch on 11-15-09. So painful that it prevented sleep. Painfulness at site lasted approximately 24 hours. Patient treated with ADVIL and hot/cold compresses.

VAERS ID:369550 (history)  Vaccinated:2009-11-16
Age:41.0  Onset:2009-11-16, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 7
Location:Florida  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 12/7/09 ER records received for date 11/17/09 PMH: genital herpes.
Diagnostic Lab Data: 12/7/09 ER records received for date 11/17/09 Diag/Labs: EKG(-)
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.102041P10IMLL
Administered by: Private     Purchased by: Public
Symptoms: Anxiety, Dyspnoea, Electrocardiogram normal, Hypersensitivity, Injection site reaction, Paraesthesia, Rash, Sensation of heaviness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Received H1N1 vaccine 11/16/09 at 11pm left arm where received vaccine felt heavy. Then tingling of muscles and arms, hives, difficulty breathing. Went to ED at hospital. 12/7/09 ER records received for date 11/17/09. DX: hives, allergic reaction, anxiety. Chief c/o skin rash, intermittent leg tingling. Pt states received H1N1 vax x1day ago. Assessment: mild erythematous, blanching skin rash located on chest.

VAERS ID:369639 (history)  Vaccinated:2009-11-20
Age:41.0  Onset:2009-11-21, Days after vaccination: 1
Gender:Male  Submitted:2009-11-23, Days after onset: 2
Location:California  Entered:2009-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: TBA - Visiting
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling hot, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: Arm extremely sore, tingling in fingers, feeling of heat rushing down to my hand. Today is 11/23/09 and there has been no relief in the pain. I am visiting my physician today for the pain.

VAERS ID:369668 (history)  Vaccinated:2009-11-23
Age:41.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Female  Submitted:2009-11-23, Days after onset: 0
Location:Illinois  Entered:2009-11-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Guillain-Barre~Measles + Mumps + Rubella (no brand name)~UN~28.00~Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: Animal dander; pollen; TORADOL; DEMEROL
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1008130IMRA
Administered by: Private     Purchased by: Public
Symptoms: Headache, Hyperhidrosis, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow)
Write-up: Itching, diaphoretic, rash, headache.

VAERS ID:369734 (history)  Vaccinated:2009-11-23
Age:41.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Female  Submitted:2009-11-24, Days after onset: 1
Location:New York  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA0IMUN
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Chills, Fatigue, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt received H1N1 vaccine yesterday. C/O tenderness to site, weakness, fatigue, body aches, fever and chills 4 hours post vaccine. PS she''s taking ADVIL and feels better.

VAERS ID:369758 (history)  Vaccinated:2009-11-05
Age:41.0  Onset:2009-11-15, Days after vaccination: 10
Gender:Female  Submitted:2009-11-24, Days after onset: 9
Location:D.C.  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: 15 weeks pregnant. 12/4/09 OB/GYN consultant records received. Service date 7/9/09 to 12/3/09. Simple myomectomy 6 yrs prev.
Diagnostic Lab Data: None needed
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS101276060UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Drug exposure during pregnancy, Herpes zoster, Paraesthesia, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow)
Write-up: Shingles (confirmed by Hospital on 11/18/09). 12/4/09 OB/GYN consultant records received. Service date 7/9/09 to 12/3/09. OB visits. 12/1/09 ED records received, service dates 11/18/09. Assessment: Shingles. Patient presents with rash around (R) breast going around to back, abdomen. Tingling feeling. Itching. Feels like back is on fire. Zoster rash.

VAERS ID:369963 (history)  Vaccinated:2009-11-18
Age:41.0  Onset:2009-11-18, Days after vaccination: 0
Gender:Female  Submitted:2009-11-24, Days after onset: 6
Location:Ohio  Entered:2009-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  IJ 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Injection site pain, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Soreness at injection site. Progressing to pain up to neck and down to elbow. Pain present for 1 week at this point.

VAERS ID:370018 (history)  Vaccinated:2009-10-28
Age:41.0  Onset:2009-10-30, Days after vaccination: 2
Gender:Female  Submitted:2009-11-24, Days after onset: 25
Location:California  Entered:2009-11-24
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: Past history of Multiple Sclerosis. Diagnosed in 2000, in remission for "years".
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500796P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fatigue, Gait disturbance, Hypoaesthesia, Muscular weakness, Neurological examination abnormal, Nuclear magnetic resonance imaging normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Extreme weakness and fatigue in lower extremeties.

VAERS ID:370085 (history)  Vaccinated:2009-11-13
Age:41.0  Onset:2009-11-15, Days after vaccination: 2
Gender:Female  Submitted:2009-11-25, Days after onset: 10
Location:Florida  Entered:2009-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sore arm at site of shot
Preexisting Conditions: Hypothyroidism; fibromyalgia; arthritis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chills, Dizziness, Dysstasia, Eye disorder, Fatigue, Feeling abnormal, Feeling cold, Impaired work ability, Nausea, Night sweats, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: Developed chills as if getting a fever. Felt tired and cold from the afternoon throughout the following night. In the am, when I got up I became distinctly nauseous and dizzy and could not stand for long. Went immediately to lie down. Slept most of the day; keeping my eyes open hurt my head. The next night was better although I went through cycles of sweating during the night. That morning I felt better but after showering became too tired to go to work. Rested all day. 3rd night ok, am at work now with a fuzzy head and I feel weak, but I should be able to function.

VAERS ID:370280 (history)  Vaccinated:2009-11-25
Age:41.0  Onset:2009-11-25, Days after vaccination: 0
Gender:Male  Submitted:2009-11-26, Days after onset: 1
Location:Florida  Entered:2009-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: na~ ()~~0.00~Patient
Other Medications:
Current Illness: No, symptoms started approximately 2 hours later.
Preexisting Conditions: NO
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURERNA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Chills, Headache, Musculoskeletal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Cold Chills, mild fever, extreme headache, severe joint and muscle aches.

VAERS ID:370284 (history)  Vaccinated:2009-11-20
Age:41.0  Onset:2009-11-25, Days after vaccination: 5
Gender:Male  Submitted:2009-11-26, Days after onset: 1
Location:Colorado  Entered:2009-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chills, Cough, Fatigue, Headache, Nasal congestion, Pyrexia, Rhinorrhoea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Runny nose, nasal congestion, scratchy throat, cough, chills, tiredness/weakness, headache, slight fever [all of these symptoms were finally present as of report date, but it took several days for them to accumulate] feels like a typical progression of a cold/flu.

VAERS ID:370313 (history)  Vaccinated:2009-11-20
Age:41.0  Onset:2009-11-24, Days after vaccination: 4
Gender:Female  Submitted:2009-11-27, Days after onset: 3
Location:Texas  Entered:2009-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: 112009
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (GSK)GLAXOSMITHKLINE BIOLOGICALS 0 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives on chest and back. Progressing to my back.

VAERS ID:370497 (history)  Vaccinated:2009-10-22
Age:41.0  Onset:2009-11-23, Days after vaccination: 32
Gender:Male  Submitted:2009-11-30, Days after onset: 7
Location:New Jersey  Entered:2009-11-30
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: HIV positive. Pmh: HIV+, DM, Hepatosplenomegaly Allergies: NKDA
Diagnostic Lab Data: AST 480; ALT 380; GGTP 222 TBil 26.4; AlkP. Labs from 11/23/2009, CBC abnormal, LFT''s elevated, Hep C+, UA abnormal elevated protein and glucose Dx studies from 11/19/2009 MRI Abdomen abnormal noting acute hepatitis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500764P IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase, Blood bilirubin increased, Diarrhoea, Fatigue, Full blood count abnormal, Gamma-glutamyltransferase increased, Hepatic failure, Hepatitis C antibody positive, Nuclear magnetic resonance imaging abnormal, Urine analysis abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver infections (narrow), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt has begun an unexplained Liver Failure.12/17/2009 Admission note and orders for 11/30/2009, increased bilirubin, LFT''s 2-3x normal, c/o''s extreme fatigue and diarrhea, MRI + for Hepatosplenomegaly, PE + for hepatomegaly. Will order GI consult, Morphine for pain.

VAERS ID:370695 (history)  Vaccinated:2009-11-18
Age:41.0  Onset:2009-11-19, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2009-11-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Poly neuropathy
Preexisting Conditions: None
Diagnostic Lab Data: Blood work e+
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP044AA0 LA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Blood potassium increased, Blood sodium increased, Blood test
SMQs:, Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (broad)
Write-up: Nov 19 in evening. Pain in back of knees. Went to Urgent Care on Nov 20 tx: PREDNISONE. K + was increased na + was decreased.

VAERS ID:370745 (history)  Vaccinated:2009-11-07
Age:41.0  Onset:2009-11-07, Days after vaccination: 0
Gender:Male  Submitted:2009-12-01, Days after onset: 24
Location:Unknown  Entered:2009-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None known
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS00549611A0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Ageusia, Facial palsy, Headache, Neck pain, Rash
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Started with neck pain and headaches on the right side. These continued through the next few days. Two days later I had lost my sense of taste. The next day the right side of my face became paralyzed, affecting my mouth, eye lids, and cheeks. This continued for about two weeks until gradually beginning to subside after being put under a doctors care. I later broke out in a rash but they believe this was due to a reaction I had to medication prescribed for this condition.

VAERS ID:370818 (history)  Vaccinated:2009-11-02
Age:41.0  Onset:2009-11-02, Days after vaccination: 0
Gender:Female  Submitted:2009-11-19, Days after onset: 17
Location:Louisiana  Entered:2009-12-01, 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:
Current Illness:
Preexisting Conditions: Allergic to Morphine and Codeine
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP001AA0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Adverse reaction, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: On Monday Nov 2, 2009 received H1N1 vaccine IM. On Nov 2 at 5pm began with adverse reaction. Took Benadryl that evening. Next day rash became worse and did seek Tx in ER. Had rash and hives to chest, arms and back. Treated with Decadron 8 mg IM in ER and was given prescription for Medrol Dose Pack.

VAERS ID:370849 (history)  Vaccinated:2009-10-08
Age:41.0  Onset:2009-10-12, Days after vaccination: 4
Gender:Female  Submitted:2009-11-20, Days after onset: 39
Location:Kansas  Entered:2009-12-01, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Psoriasis; Hyst.
Diagnostic Lab Data: MRI showed 4 plaques, routine labs normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500763P10IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Balance disorder, Headache, Laboratory test normal, Muscle spasms, Nuclear magnetic resonance imaging abnormal, Pupils unequal, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: Increasing headaches. Vision altered L eye not tracking 2 right eye. Balance off L pupil larger than right multiple muscle cramps.

VAERS ID:370891 (history)  Vaccinated:2009-11-23
Age:41.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Female  Submitted:2009-11-24, Days after onset: 1
Location:Pennsylvania  Entered:2009-12-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seizure disorder; dialysis patient; HTN; renal failure; asthma 12/7/09 ER records received for dates 11/23/09. PMH: PCN allergy, CVA, ESRD, asthma, anemia.
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102045P10UNLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB761AA4IMRA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Chest pain, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Nausea and felt weak with chest pains and vomiting 5 min after vaccine given. 12/7/09 ER records received for dates 11/23/09. DX: vomiting. Chief c/o weakness, vomiting 2min after H1N1 vax. Pt states received Hep B dose 3 same day. Pt appeared in no distress. Pt states presently feeling fine. 12/14/09 ER records duplicate of 12/7/09 records received.

VAERS ID:371031 (history)  Vaccinated:2009-11-15
Age:41.0  Onset:2009-11-15, Days after vaccination: 0
Gender:Male  Submitted:2009-12-01, Days after onset: 16
Location:Arizona  Entered:2009-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: None done yet.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Muscle contractions involuntary
SMQs:, Dystonia (broad)
Write-up: Fasciculations of muscles - started first in deltoid where injected, since spread to face, abdominal muscles.

VAERS ID:371143 (history)  Vaccinated:2009-11-11
Age:41.0  Onset:2009-11-12, Days after vaccination: 1
Gender:Female  Submitted:2009-12-02, Days after onset: 20
Location:California  Entered:2009-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1009236P0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Influenza like illness, Injection site discomfort, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Achiness at the injection site day after. Flu like symptoms for th following 3 weeks. Nausea for 2 days.

VAERS ID:371157 (history)  Vaccinated:2009-11-19
Age:41.0  Onset:2009-11-19, Days after vaccination: 0
Gender:Female  Submitted:2009-12-02, Days after onset: 13
Location:Missouri  Entered:2009-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Headache
SMQs:
Write-up: H/A started late afternoon on day of injection (11/19/2009). Lasted x4 days-pain level 8 (1-10 scale).

VAERS ID:371245 (history)  Vaccinated:2009-11-23
Age:41.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Male  Submitted:2009-11-23, Days after onset: 0
Location:North Carolina  Entered:2009-12-03, 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: Blood pressure
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS9721506 IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Chest discomfort, Injection site swelling, Muscle tightness, Wrong technique in drug usage process
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Gave seasonal flu vaccine in patients left deltoid muscle, vaccination was not attached well to needle, patient only received part of the dose, when I returned to revaccinate patient had a huge knot where injection had occurred and started feeling tightness in chest and extremities. Gave EPI PEN, called EMS within minutes.

VAERS ID:371253 (history)  Vaccinated:2009-10-21
A